Sat, Jul 10, 2004 - Page 9 News List

Asia is the new hotbed for AIDS

With five million people infected, India is poised to overtake South Africa as the nation with the most AIDS patients, and the news from China, Indonesia and Vietnam -- nations with 50 percent of Asia's population -- is no better

By Lawrence Altman  /  NY TIMES NEWS SERVICE , Bangkok


The proportion of the world's new HIV infections occurring in Asia has risen sharply in the past two years as the epidemic outstrips efforts to stop it, the UN said in a report released on Tuesday.

The size of the increase surprised UN health officials, who said that one in four -- or nearly 1.2 million of the estimated 4.8 million new infections last year -- occurred in Asia. That figure rose from one in five, or about 910,000 of the 4.4 million new infections in 2001.

Worldwide, the rate of new infections of HIV, the virus that causes AIDS, was the highest last year of any year since the epidemic was recognized more than two decades ago, the report said. Since 1981, more than 20 million people have died of AIDS, 2.6 million of them last year.

Kathleen Cravero, the deputy executive director of the UN AIDS program, said a small window of opportunity existed to stop the HIV epidemic in Asia and elsewhere.

"If we miss it, it will slam shut forever," and "we will see an epidemic the likes of which we never imagined, despite what has happened in Africa," Cravero said at a news conference in Bangkok on Tuesday.

Eastern Europe also has a fast growing epidemic, the UN said.

The UN updates the state of AIDS in the world every two years in advance of the International AIDS Conference. The 15th conference opens in Bangkok tomorrow. Many health officials have warned that Asia faces an HIV epidemic that could rival Africa's.

The epidemic is expanding rapidly in Asian countries, particularly in China, Indonesia and Vietnam, nations that account for 50 percent of Asia's population. So even small percentage increases can represent large numbers of people.

For example, about 5.1 million people in India are living with HIV, leaving India poised to overtake South Africa, with 5.3 million, as the country with the most infected people.

In a separate news conference conducted by telephone from London on Tuesday evening, Cravero's superior, UN AIDS program director Peter Piot, speculated that some Asian countries might reach the level of 20 percent or higher already reported in some African countries. But Piot said he doubted that Asia would experience as devastating an epidemic as Africa.

Many epidemiologists say that when more than 1 percent of a country's population is living with HIV, the country is in a general epidemic that is much harder to stop than if the prevalence is less than 1 percent, Cravero said.

In Asia, she said, "many countries have prevalence rates less than 1 percent, and some are hovering around 1 percent."

"So that is where the window of opportunity comes," she added. "You either drive it down now through maximum scaling up of prevention or you spend exponentially more money and energy trying to drive it down."

She said the HIV epidemics in Asian countries began largely among drug users who inject themselves, prostitutes and gay men, but now "are fast moving into the general population."

To stop the rise, countries need to vastly increase their efforts for prevention and treatment, she said. But in Asia, current prevention strategies largely miss women and girls, who lack the option of abstaining from sex and have little control over whether their husbands use condoms or have extramarital sexual contacts, she said.

Health workers have less than half of the US$12 billion that is needed for treatment and prevention by the end of next year, if the course of the epidemic is to be reversed, Cravero said. More than 22 percent of the US$12 billion is needed for Asia alone.

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