According to the official records of Taiwan's Center for Disease Control (CDC), there is one recorded HIV carrier per 5,773 adults, or people aged 15 or older in Taiwan. Compared to the rest of the world, this accounts for an extremely low 0.017 percent of the adult population. According to the same agency's estimates, the rate of recorded and unconfirmed HIV carriers in Taiwan is one per 1,200 to 2,000 adults in Taiwan. This much higher range would nonetheless also make for a remarkably low 0.051 percent to 0.075 percent of the adult population.
Looking at the statistics another way, there are 3,044 officially recorded cases of HIV and AIDS in Taiwan, though it is estimated that there are actually between 9,000 and 15,000 cases.
"We used to think [the real number of cases] was five to 10 times the number of reported cases, but now we think it's only three to five times," said Lin Sheue-rong (
PHOTO: CHIANG YING-YING, TAIPEI TIMES
When it comes to AIDS, then, Taiwan is clearly not in the same company with South Africa, which has an estimated 4.2 million infected, or 19 percent of the country's adults, or Thailand, where an estimated 750,000 people are infected, or 2.1 percent of adults, or the US, which has an estimated 850,000 infected, or 0.61 percent of adults. But it would also be wrong to believe, as many people do, that Taiwan is removed from this growing pandemic.
As the world marked the 20th anniversary of the identification of the AIDS virus last month, one US researcher who was looking at the global picture reportedly remarked, "This is not the beginning of the end, this is only the end of the beginning."
Taiwan is not an exception
PHOTO: CHANG YING-YING, TAIPEI TIMES
In Taiwan, "most people think it's not a problem, and that's the big problem," said Troy Lee (
Generally speaking, the CDC agrees. Though the agency currently sees AIDS levels as manageable, the disease is growing in Taiwan, this year at a rate of about 100 new cases every two months, compared to a rate of 100 new cases every three months last year.
"We think it will continue to grow for a few more years, and then plateau at a stable level," said Wu Hsiow-ing (
Stuck on the issues
While statistics are easy to talk about, issues are not. And at present, the AIDS issue is so suppressed that one needs to practically go underground to get a closer look at the disease's victims and the organizations that work with them. To get into the Garden of Mercy, an AIDS hospice, I had to first convince May Chyou (
"Upset", barely reflects the deep trauma most PWA/Hs face upon exposure. The Sister followed up her remarks with several examples of extreme discrimination. One woman was driven out of her home by her own family, a case she called "not uncommon." Another man was forced out of his job through the machinations of his employer, who transferred him daily to offices in different parts of Taiwan until he resigned. And a great number, she said, have been unable to obtain either dental or non-AIDS related medical care.
Workers at the Garden of Mercy Foundation expressed similar reservations. The foundation is a Protestant-run non-profit organization that provides counseling and hospice care for AIDS sufferers, some of whom are terminally ill. When I asked Chyou to show me the facility, she asked me to sign a form saying that I would not disclose the location of the hospice any more specifically than saying it was in Taipei County. "We're scared that if the neighbors find out, they'll stage a protest and try to drive us out," she said.
In the end, I was taken to the 11-bed hospice. The light-filled two-story apartment included four bedrooms for patient care, a sun room and a small garden that was filled with dragonflies. On one wall hung a commemorative plaque for Happy, a woman who resided at the hospice until she died this May at the age of 43. According to Chyou, she had one son and one daughter, but had become a drifter after her divorce. "She never received any visitors while she was here," she said. "When we have some time, we want to make a quilt in her memory."
Another patient, also a woman, had been taken to the hospital earlier that morning with a high fever. The only inpatient left that day was a man, 60, whom Chyou only referred to as "the older gentleman upstairs." He too had been basically abandoned by his family, though Chyou said that family members had so far been complying with the hospice's request that they visit once a week.
When we went upstairs, the older gentleman was sitting on his bed wearing only a T-shirt and an adult diaper. He turned his head as we came in, though Chyou explained that he probably couldn't see us well due to cytomegalovirus, a virus that frequently besets HIV-damaged immune systems. In his case, it was causing lesions on his retinas, impairing his vision. Still feisty, the man pumped at a hand exercise device that Chyou said would keep strength in his arms and restore veins that had been depleted by intravenous drips. After a while, he looked over at me and mumbled, "Who's that?" "Just a volunteer," replied Chyou. He went on squeezing his device.
That same visit, I also met Huang Chuen-ying (
The first reported case of AIDS in Taiwan was that of a US citizen who was hospitalized in 1984. The first case of a Taiwanese citizen contracting HIV, a man the newspapers called simply Mr A, came to light in February, 1986.
In those days, Huang recalls, "a lot of the early AIDS carriers were not poor or lower class, they were students who'd studied abroad -- in Spain, England, the US and some other places."
As in the US and Europe, the AIDS virus attacked Taiwan's homosexual community first, before spreading to other sectors of the population. So far, AIDS has officially killed 675 in Taiwan.
Out of sight, out of mind
The most frightening thing about AIDS in Taiwan may be its virtual invisibility, a condition brought on by a combination of concealment and ignorance. Occasionally, the disease flashes across the pages of newspapers or its footsteps echo in the halls of seemingly empty clinics, but the public is hardly ever allowed to look at it full in the face.
Primarily due to social pressures and secondarily due to the side effects of their twice-a-day medication routines, identified HIV carriers often simply drop out of sight. In many cases, they have been forced out of their jobs or schools and sometimes even their families. Some have gone into seclusion. A few have committed suicide. Others have managed to take their drugs every day and hide it. If they are foreign, they have probably been deported.
And even though PWA/Hs are living longer and more comfortably now since the advent of drug cocktail therapy in the early 1990s, they still fear routine medical treatment and trips to the dentist, situations in which they will probably be refused service unless they lie about their condition. And finally, according to Chyou, when some of them inevitably die, they are usually rushed to cremation within 24 hours.
Among those who deal with PWA/Hs on a daily basis -- at the Lourdes Home, the Garden of Mercy and the Persons with HIV/AIDS Rights Advocacy Association of Taiwan (
"The most important service we offer is psychological counseling, which is something the hospitals don't offer," said Sister Theresa.
The same could be said for the other two groups as well. Between them, they provide numerous examples of trauma and discrimination. There was a man, 21, who found himself ostracized by his friends after a pre-conscription blood screening showed him to be HIV-positive; he eventually hanged himself.
Another man became known as HIV-positive to his graduate school classmates, who subsequently spread the news through the university over the Internet and told his professors. The school cafeteria changed metal food trays to Styrofoam plates, and school administrators called his friends and asked him to leave the school. In 1997, he suspended his studies and has not resumed them since.
In January, two Taipei police officers were found HIV-positive in the routine annual screening required of all Taipei city employees. The case sparked controversy as the test results were returned directly to the officers' superiors, rather than the officers themselves. The two were effectively fired at the same time they were informed they'd contracted HIV.
Such discrimination is compounded by AIDS legislation, of which the first law was passed in February, 1990. The legislation has brought in screening and removal policies for certain types of jobs and also required testing of all foreign nationals applying for visas of three months or longer, barring entry to those who are HIV-positive. The law was amended in July, 2000, to allow entry to foreign HIV carriers in some cases, though none has yet crossed Taiwan's borders under the new criteria.
`Where are all the rest?'
Different from known PWA/Hs, HIV's unidentified carriers possess a second level of invisibility. According to the estimates of the CDC, at least two-thirds of the people who have HIV don't know they have it. Other studies suggest that many of them would rather not even find out.
Of the identified HIV carriers in Taiwan, 46.4 percent are men who engage in sex with men, 45.7 percent are men who say they engage in heterosexual sex and 7.8 percent are women. The percentages of hemophiliacs (1.7 percent), intravenous drug users (1.7 percent) and infants infected by their mothers (0.2 percent) are relatively insignificant.
According to the CDC's Lin, the major high-risk group continues to be male homosexuals, for whom studies have consistently shown the highest infection rates. Surveys conducted by the Taipei venereal disease clinic showed a 5 percent HIV-positive rate in patrons of gay nightclubs and a 9 percent rate in gay saunas.
Light of Friendship's Lee, however, is wary of tying AIDS exclusively to homosexuals. "The gay community is one of the easier targets we can find," he said. "We know where they are, and we go test them. Still, they're less than half. Where are all the rest?"
A quick answer to this question is hard to come by. Generally, testing among males in Taiwan is fairly widespread, a factor that many believe contributes to the imbalance in the male-to-female ratio of known HIV carriers. Routine mandatory screening exists in the military, which processes almost all males in Taiwan, and certain male-dominated segments, including police officers, prison inmates, certain food service workers such as chefs and employees of many foreign companies. The Taipei City government also requires routine screening of all employees. Many women, meanwhile, have never been tested for the disease.
Another reason for the lopsided male-female ratio may be something more simple. "Some of [the male HIV carriers who say they are straight] may be lying about not being gay," said Sister Theresa. "We once encountered a man who's family could accept that he was HIV-positive, but they couldn't accept that he was gay."
The only forced screening for women comes as a result of the HIV/AIDS Control Act, which requires that all arrested sex workers be tested for the virus. Of more than 5,900 women hauled in across Taiwan last year through raids on brothels, saunas, hostess bars, KTVs, barber shops and other fronts for illegal prostitution, only three were found to be HIV-positive.
Based on such figures, the CDC puts the HIV/AIDS infection rate among sex workers at 0.05 percent to 0.5 percent, or one in 200 to one in 2000. Still, as in every other aspect of Taiwan's AIDS question, the figures for prostitution present as much a labyrinth as a picture of reality.
According to a CDC study dated November, 2000, of 227 females with AIDS, 164 were married and 52 had husbands who admitted to having sex with prostitutes. According to Lin, another CDC study shows a greater than 90 percent condom use rate among sex workers, though 25 percent of them were willing to accept sex without a condom.
In the face of such seemingly contradictory statistics, it's hard to draw any final conclusions. It can be said, however, that the male-female ratio of PWA/Hs is closing, from 42:1 in 1989 to 11:1 in March, 2001.
"You know, there might not be a big problem now," said Lee of Light of Friendship, when confronted with these statistics, "but there sure is a good opportunity for it to get bigger."
Covered by the state
In addition to handling all non-AIDS/HIV sexually transmitted diseases, the Taipei Municipal Venereal Disease Institute has handled roughly half of Taiwan's HIV/AIDS sufferers at one time or another. At least 600 PWA/Hs pay the clinic monthly visits to pick up a shopping bag full of the drugs that make up the HAART regimen, better known as drug cocktail therapy.
The treatment's real cost is in excess of NT$30,000 per patient per month, but national law guarantees that it be completely covered by the national health insurance program, save a NT$50 visit fee. France is the only other country in the world to offer a similar complete drug subsidy to PWA/Hs. Patients also come to the center once every four months for blood tests that monitor changes in the disease.
Last year, the cost of the government's drug program amounted to NT$450 million. Those costs could reach NT$4.3billion in 10 years if current projections are correct, said the CDC's Lin. "The funding for treatment is guaranteed by law," she remarked, "but the prevention and research budget keeps getting tighter as the government cuts back its spending. Lately, it has been decreasing by 10 percent to 20 percent per year."
The austere edifice of the venereal disease center sits in a quiet pocket only a couple hundred meters from the throbbing heart of Hsimenting, where thousands of hormonally charged teenagers walk past promotional posters for a fitness gym featuring Magic Johnson, the LA Lakers star who announced he was HIV-positive in 1991 and has gone on to become an icon of AIDS activism as well as of basketball.
Taiwan, however, has not had a wake-up call like Magic Johnson, and ironically, when Magic wanted to come to Taiwan in 1995, the government refused him a visa. But with the massive culture gap between generations in Taiwan and younger people's freer lifestyles, including a loosening of sexual mores, the country needs a role model to encourage responsible sex.
At the CDC, a recent study says there is cause for alarm, because, while Taiwan's youth is not especially promiscuous, it is still more sexually promiscuous than ever before. Thirteen percent of male high-school students and 11 percent of female high-school students are sexually active, averaging one to two partners each. More worrisome is the statistic that 80 percent say they don't use condoms.
Sense of invincibility
So far, the CDC has identified 155 students (mostly in colleges and universities) in Taiwan who are HIV carriers, 55 percent of whom are gay men, 13 percent hemophiliacs, and the other 32 percent presumed to be heterosexual. In its last report, issued in May, the agency expressed concern at the accelerating rate of HIV-positive incidence among students, although such cases are still rare; there were 28 cases reported in 2000 and 20 cases in 1999. HIV infection rates among military conscripts also make up one of the fastest rising demographic sectors.
On a recent Saturday night in a trendy Taipei disco, a woman named Paula, a sexually-active 23-year-old, talks of why most Taiwanese women of her generation don't think it's important to use condoms.
"If you're in a long relationship, sometimes you just don't want to [use condoms] anymore," she says. "You're thinking, hey, this is my boyfriend, what's the problem?" How long is a long relationship? "About a year, more or less," she said.
"Sometimes the more conservative a girl is, the more she'll be against using condoms. Maybe she's thinking that she's only had a couple of boyfriends and that she's, you know, very pure. It's the more liberal girls who care more about [using condoms]."
Asked if she's ever had an AIDS test, Paula says she has. One time when she went in for a check-up, she saw the test was available and didn't cost extra, "so why not?" Lee of Light of Friendship calls Paula a brave woman for her honest approach to testing. "Most girls wouldn't dare," he says. Paula agrees. Most of her friends have never been tested.
And to think about Paula's friends, who represent a whole generation filling the nightclubs, one wonders whether the infection rate really is 2000 to 1, as the CDC suggests. One also wonders whether that rate will stay that low, or whether it will rise. There is an echo of Lee's warning in all of this, and though it's been said once already, there's no reason not to say it again: "you know, there might not be a big problem now, but there sure is a good opportunity for it to get bigger."
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