AIDS: Asia’s looming economic crisis

by Henrylito D. Tacio

* Name has been changed to protect privacy

THIRTY-FOUR-YEAR-OLD Jonathan Lim* could not exactly remember how he was infected with human immunodeficiency virus (HIV), the microorganism that causes AIDS. Although he was sexually active, he never thought it would happen to him.

“I was very well aware of HIV/AIDS issues,” says the information technology administrator who works in one of the multinational companies in Singapore. “I get my information by reading newspapers, magazines, and promotional materials.”

But Lim could recall precisely when his life changed drastically. He went for his HIV/AIDS annual check-up at a local testing center. When the medical technician hesitated about giving him the results and instead told him to talk with the doctor, he already had an inkling idea.

Lim thought he could take it, but when the doctor told him that he was HIV-positive, he was totally shocked. “I had never ever imagined myself with the disease,” he admits.

Today, he finally accepts his fate. “I will continue with my current career plans,” he says. “There is no big change with my life. The one big addition in my life is a sense of mortality. Being HIV-positive, I consciously treat my family members, friends and colleagues better.”

Such tragic story is becoming familiar in Asia. More than 20 years after AIDS claimed its first Asian victim – believed to be a 48-year-old male Japanese hemophiliac who received a tainted blood transfusion – the scourge continues to take its toll.

At the beginning of the AIDS epidemic, some experts believed that Asian cultural values would protect the region from the disease. Staggering as it is to contemplate, more than 8 million people in Asia and the Pacific region are living with HIV. In 2004, some 540,000 Asians died from AIDS-related diseases. “Every day, 1,500 people die from AIDS and 3,500 people are newly infected in our region,” said Dr Shigeru Omi, regional director for the Western Pacific Region of World Health Organisation (WHO) in Manila.

But compared with other continents, the extent of epidemic is still low: 0.4 percent in adult population in 2004. “But with Asia accounting for 60 percent of the world’s population, figures are more significant than a single low rate,” says Dr Bernard Fabre-Teste, an advisor with the sexually transmitted infection unit of the WHO regional office.

If business as usual continues, at least 12 million people will become newly infected with HIV in the region over the next five years,” warns Dr Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS), the UN agency dedicated to fighting the disease.

On the current situation, Dr Piot warns: “The epidemic in Asia threatens to become the largest in the world. The question is no longer whether Asia will have a major epidemic, but rather how massive it will be.”

Currently, the most affected countries are Cambodia, Papua New Guinea, Thailand, India, and Myanmar. HIV infection in the region remains largely confined to those people at higher levels of risk – sex workers, injecting drug users, men who have sex with men – and their sexual partners. Those at elevated risk represent anywhere from 7% to 25% of the adult population, making severe epidemics a possibility in all the countries of the region.

Besides the tragic human suffering caused by HIV/AIDS, the scourge causes tremendous economic disruption. In Thailand, for instance, over 90% of fatalities occur in people aged 20-44. “The majority of those who are – and will be – infected are in their prime or most productive years,” notes Dr Victor Mari Ortega, former UNAIDS representative in the Philippines who is now based in New York.

In Asian countries greatly affected by HIV/AIDS, economic activities may substantially decrease. “For one, the workforce becomes sick and businesses whose workers die of AIDS must recruit and train new staff,” explains Dr Jacques Jeugmans, principal health specialist of the Manila-based Asian Development Bank (ADB). “For another, foreign investors may become wary of investing money in affected countries.”

Indeed, business and economics have played a major role in the proliferation of HIV/AIDS in Asia. In the Philippines, for instance, the overseas contract workers are very important to the country’s economy. They are touted by the government as “modern-day heroes.” Every year, the country sends between five and 12 million Filipinos to work abroad. One in every 3 reported HIV/AIDS cases comes from returning overseas workers.

Why is this happening? According to experts, Filipinos working out of the country are at risk of contracting the HIV for three reasons. First, some of them work in occupations considered “high risk” like entertainers, some of whom as sex workers. Second, there are workers who are subjected to various forms of sexual abuse and exploitation, specifically those with questionable travel papers and work permits. Finally, loneliness drives some workers – particularly seafarers – to hire sex workers or to be engaged in man-to-man relationships.

Unprotected sexual intercourse between men and women is the predominant mode of transmission of HIV. In Southeast Asia, the top three countries hardest hit by the scourge are Thailand, Cambodia, and Myanmar. All three are also at the center of an AIDS epidemic in the Greater Mekong Subregion – thanks to an increase in mobility and worker migration.

In Sihanoukville, in southern Cambodia, the building of new port facilities has not only attracted migrant workers but also drawn many young women to work in the shack-like brothels with dreams of making money for themselves and their families by selling their bodies.

The city of Ruili in Yunnan Province, located on the old Burma Road bordering Myanmar’s Shan State, is a major transit route for booming regional trade. Many of those – particularly truck drivers, traders, and traffickers of contraband – who ply the route from Kunming, China to Mandalay, Myanmar and beyond take a rest at one of Ruili’s brothels where young women from the surrounding tribal hill work.

Migration, mobility, and HIV/AIDS are clearly interconnected, according to a document released by the Asian Development Bank. “High rates of HIV infection are generally found along transport routes, in border areas, and in regions experiencing higher seasonal mobility,” it said.

In like manner, many Asian nations are being promoted in Western countries as “tourist haven.” Unknowingly, tourism also facilitates in the spread of HIV infection. In Thailand, for instance, some tourists come to the country only for “sex tourism.” “These people heard from various sources that Thailand is a free sex country, which is not true,” clarifies Praween Payapyipapong, vice president of the Population and Community Development Association. “Some media are giving tourists the wrong information just to make Thailand tourism more interesting.”

Aside from sex, injecting drug use is another cause of rapid HIV infection in the region. In Indonesia, for instance, one in two injecting drug users in Jakarta now test positive for HIV, while in cities such as Pontianak more than 70% of drug injectors are being found to be HIV-positive. “Blood borne transmission of HIV is most common in Indonesia with over half of all new infections being attributed to injection drug use,” informs Professor Wayne Wiebel, who works as senior technical advisor on HIV/AIDS intervention with Asia-Pacific division of the Family Health International.

In Malaysia, three of every four HIV-infected are intravenous drug users. Shooting up drugs is also widespread in China, some states of India, Myanmar, Nepal, Thailand, and Vietnam. “Their number may be smaller compared to those engaged in sex work, but the transmission is riskier by sharing injecting equipment, which transmit HIV directly into the blood,” cautions Dr Fabre-Teste.

As one looks at the tragic penetration of the HIV into Asia, one could easily refer to the virus as ‘the poverty virus’ given is disproportionate effect on the poor,” Dr John M. Dwyer, former president of the AIDS Society of Asia and the Pacific, said in 1992. ADB’s Dr Jeugmans agrees: “The poor are likely to end up bearing the brunt of HIV/AIDS. They are less able to protect themselves. They have less information about health risks. They give priority to day-to-day problems.”

In a way, HIV/AIDS and poverty are inextricably linked. Take the case of Anne Guevara* an 18-year-old Filipina who once worked as a nightclub entertainer in Japan. Not finding job, she moonlighted as a guest relation officer at a videoke bar in Digos City in southern Philippines. Bored, she applied to work again in Japan but was turned down when she was discovered – after a medical check-up – that she was HIV positive. She reportedly had sexual contact with 40 persons, including government officials.

Already, the scourge is wreaking havoc to the region’s economy. In 2003, the annual economic loss was listed at $7.3 billion. According to the Asian Development Bank, if the current HIV infection trends continue, the figure would go up to $18.7 billion in 2010 and $26.9 billion in 2015. Resource needs to fight the disease are expected to reach at least US$5.1 billion per year between 2007 and 2010, the Manila-based bank says.

Governments in Asia and the Pacific can still avert a massive increase in infections and deaths, limit economic losses and save millions of people from poverty if they are willing to finance comprehensive AIDS programs,” Dr Piot urges. “The role of political leadership is more critical at this point than ever before.”

But there are encouraging stories going on in Asia. For instance, media are making waves. In Japan, while the series Kamisama Mo Sukoshidake was on the air, portraying a female student who becomes infected with the virus after prostituting herself, the number of HIV tests doubled.

Although media may play a big role, the government must take the initiative. A case in point is Thailand. When HIV infection increased dramatically in the early 1990s, the Ministry of Public Health instituted a 100-percent condom campaign – a program to promote safer sexual practices in all commercial sex establishments. Condoms were available in drug stores, supermarkets, convenience stores and gas stations. Every segment of Thai society – from the medical community to teachers, to monks, to prostitutes and to drug addicts – was involved. This resulted to only 20,000 people becoming infected each year now compared to 140,000 in the early 1990s.

Despite this success, only a few countries in the region are following suit. In Japan, condom use with non-regular sex partners is still low: less than 50 percent. In the Philippines, it’s even lower: only 37 percent of sex workers use condoms. This is a far cry from the 70-percent usage rate prescribed by the World Health Organization for a country, according to Dr Elena Borromeo, the UNAIDS’ country representative in the Philippines.

Some people believe that this low condom use is due to the intrusion of religious officials and politicians. In the predominantly Roman Catholic Philippines, for instance, condoms are still taboo. Manila Mayor Jose Atienza has even issued an order banning condoms and all other artificial birth control from the city’s health clinics.

In Malaysia, the government’s plan to distribute free needles and condoms to intravenous drug users has been attacked by critics as going against religious teachings and being a waste of public funds.

In many parts of Asia, ignorance about HIV/AIDS and its means of transmission is still rampant. In the Philippines, for instance, during a National Media Practitioners’ Symposium, a journalist asked if rice from Thailand could spread HIV. “In Thailand, a good number of people are HIV positives,” the journalist said. “Now, I would like to know if it was good to import rice from the said country considering the situation.” (At that time, the Philippines imported rice from Thailand to ease the local grain shortage.)

A recent survey in Malaysia revealed that four out of ten people believe that beautiful women cannot get infected. In other parts of Asia – like Indonesia, Japan, Malaysia, and Singapore – some people still believe HIV/AIDS is something that only happens to some groups of people. “As long as people are in denial that there is a problem, they are unlikely to take precautions to avoid becoming infected,” notes Prof Wiebel.

Like in other parts of the world, the battle against HIV/AIDS in Asia is a social and cultural one against the social stigma attached to the scourge. “When my friends knew that I was HIV-positive, some of them stopped visiting my home, fearing that they might get infected if they drank from the glasses in my house,” recalled Suzana Murni, the founder of Spiritia, a non-governmental organization aimed at providing help and support for people with HIV/AIDS in Jakarta.

Stigmatisation and denial is still very common. So people are afraid to get tested and many times won’t even tell their families if they test positive,” said Brenton Wong, honorary secretary of Singapore’s Action for AIDS.

Jonathan Lim is among them. When asked whether he is ready to come out in the open, he replied: “Only when HIV/AIDS issues are normalized in Singapore and there are lesser discriminations against HIV-positive people.”

Meanwhile, Asian governments must heed the words of Dr Piot: “There is no time to misread the signals, with Asia facing life and death choices in preventing a full-blown AIDS catastrophe in the region.” Adds Dr Dennis Altman, the current president of the AIDS Society of Asia and the Pacific: “The greatest tragedy of HIV/AIDS is that we know how to stop its spread, and yet in most parts of the world we are failing to do so.” — ###

Understanding HIV/AIDS

What is AIDS?

AIDS is a disease of the body system that fights infection. It is a lethal syndrome because the progressive damage to the body’s immune system leaves a person highly susceptible to contracting certain diseases. People infected with human immunodeficiency virus suffer from, among others, diseases caused by various types of protozoa, worms, fungi, bacteria, virus, and cancer.

What is HIV?

AIDS is caused by HIV, a slow virus (retrovirus). Unlike the flu virus, for instance, when you get it today, you might already present symptoms the following day. With HIV, you can be without symptoms for several years – as short as three years or as long as 12 years. Outside the human body, HIV is relatively fragile and can be easily killed by household disinfectants. Once inside the body, there is no way a person can eliminate the virus.

HIV progressively weakens the body’s immune defense system, until it is no longer able to fight off infections, many of which are normally harmless. Opportunistic infections or indicator diseases affecting people with human immunodeficiency virus (HIV) include tuberculosis, Kaposi’s sarcoma (a tumor primarily affecting the skin), pneumonia, herpes, shingles and weight loss. Death is caused by HIV but by one or more of the infections.

How HIV is transmitted?

HIV is transmitted in semen, vaginal fluid and blood. Its transmission can only occur in the following ways: through unprotected sexual intercourse – vaginal, anal, and/or oral – with an infected person; through infected blood in transfusions or blood products; from infected fresh blood on contaminated needles, syring­es or other skin-piercing instruments such as are used in inject­ing drugs; and from an infected mother to her child before or during birth. Although HIV is present in sweat, tears, and saliva, its concentration in these fluids is not sufficient to transmit the infection.

What are the possible symptoms?

Possible minor symptoms include: chronic cough lasting more than a month; itching in several parts of the body; repeated appearance of herpes zoster (an opportunistic infection indicated by shingles and extremely painful blisters on the skin); chronic spreading and worsening herpes simplex (indicated by serious ulceration of the skin and mucous membrane around the mouth, genitals, and eyes); and persistently swollen lymph nodes all over the body.

When the immune system starts to deteriorate, major symptoms may appear such as: weight loss exceeding 10 percent of the body weight in three months; fever that last for over a month; and repeated or persistent diarrhea lasting more than a month.

Can AIDS be cured?

There is still no known cure for AIDS. Drug cocktails currently recommended can control the infection but it comes back quickly if they are stopped. More than two dozen vaccines are being tested, but experts do not expect any of them to prevent HIV infection in substantial numbers of people.

Sources: UNAIDS, WHO, CDC

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