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> TRACKING ASIA'S HIV/AIDS EPIDEMIC
>
> ***The information below was presented at the International AIDS
> Conference in Bangkok this week by Tim Brown, a senior research fellow at
> the East-West Center in Honolulu and a leading specialist on HIV/AIDS in
> Asia.
>
>
> ASIA IS NOT AFRICA, BUT HIV IS NO LESS SERIOUS
> By Tim Brown, East-West Center
>
> HIV epidemics in Asia follow a similar pattern, but vary in timing and
> severity. Most people are already familiar with this pattern. HIV
> epidemics in Asia begin in drug users who share needles and in homosexual
> and bisexual men. Then HIV starts to rise among sex workers and the men
> attending sexually transmitted disease clinics, who are largely the
> clients of sex workers. These men then transmit to their wives, who in
> turn pass HIV on to their children.
>
> But we see variations in how quickly the epidemics grow and how serious
> they become around the region:
>
> -- A few countries like Thailand, Cambodia, Myanmar and parts of India saw
> HIV epidemics take off rapidly in the late 1980s and very early 1990s.
> They have seen 1 to 3 percent of adults infected with HIV.
>
> -- Other countries, e.g., China, Indonesia and Vietnam, have seen the
> epidemics start growing more gradually, but steadily, in the late 1990s.
> Most are at a few tenths to half a percent now.
>
> -- A few countries, e.g., Bangladesh, Japan, Laos and the Philippines,
> have yet to see extensive HIV spread. Prevalence is below a tenth of a
> percent.
>
> The East-West Center and its collaborators have developed a model based on
> this pattern that allows us to explore the factors controlling the speed
> and seriousness of HIV epidemics in Asia. We call this the "Asian Epidemic
> Model." The model allows us to vary the levels of risk behavior to fit
> specific countries and see the impact this has on the epidemic.
>
> What the Asian Epidemic Model tells us:
>
> -- Because many injecting drug users are clients of sex workers, HIV
> epidemics among them speed up the start of the epidemic between clients
> and sex workers. This means that delaying or preventing epidemics among
> injecting drug users can buy us valuable time to increase condom use
> between clients and sex workers.
>
> -- The primary factor controlling the rate of growth and ultimate extent
> of HIV infection in a country is the size of the population of clients. In
> countries where 20 percent of adult men are clients of sex workers, e.g.
> Thailand and Cambodia, the epidemic grows rapidly and can reach high
> levels unless prevention programs achieve good coverage. In countries
> where only 5 percent of men are clients, the epidemics grow much more
> gradually, but they do eventually grow.
>
> -- Most Asian epidemics developing now will grow gradually and steadily to
> reach levels of a few percent unless prevention programs are expanded. The
> recent epidemics in China, Indonesia and Vietnam, will most likely undergo
> steady growth until they reach several percent of the adult population.
> These are particularly dangerous, because the slow, steady growth is
> unlikely to raise alarm bells with policymakers.
>
> -- Asian epidemics are and will stay focused in at-risk populations and
> their partners, making focused prevention extremely effective. The common
> picture that epidemics "break out" of at-risk populations and begin
> spreading widely in the general population is wrong. Women primarily have
> sex within marriage in Asia, and the levels of premarital and extramarital
> risk are low enough that less than 5 percent of new infections will occur
> this way. Most infections, even at advanced stages of the epidemics, will
> occur among clients and sex workers, injectors, males engaging in sex with
> other males and, a few years later, their wives. This means that focused
> prevention programs in Asia that concentrate prevention efforts on these
> populations can be extremely effective.
>
> But that doesn't mean they'll remain small epidemics -- current responses
> are anemic and will allow continued epidemic growth. The clients of sex
> workers alone make up from 5 to 20 percent of adult males in most Asian
> countries. Their current or future wives add another 5 to 20 percent of
> the female population to those at higher risk of HIV. In countries where
> 10 percent of men are clients, the HIV infection level will probably
> stabilize somewhere around 3 to 5 percent without more effective
> prevention programs. They will never reach the levels of HIV infection
> seen in sub-Saharan Africa, but with Asia's large populations, each
> percentage point means large contributions to the global epidemic. And at
> present, the prevention coverage of the at-risk populations in most Asian
> countries is very poor, allowing HIV to continue spreading.
>
> Tim Brown can be reached at tim@hawaii.edu
