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November 30, 2000

From Our Correspondent: Hirohito and the War
A conversation with biographer Herbert Bix

From Our Correspondent: A Rough Road Ahead
Bad news for the Philippines - and some others

From Our Correspondent: Making Enemies
Indonesia needs friends. So why is it picking fights?

Asiaweek Time Asia Now Asiaweek story

NOVEMBER 5, 1999 VOL. 25 NO. 44

Aids Explosion
Time bombs along the Mekong call for a regional solution
By RUCHIRA GUPTA

Sanda's story tells why the rates of HIV infections in the Mekong area are soaring. Terrorized by Myanmar soldiers, the young Shan woman was desperate to leave her village near the Thai border. She once escaped rape by hiding in the jungle, but that wasn't a long-term solution. So she sold her gold chain and paid an employment agent $30 to get a job in Thailand. As so often happens, the Pattaya "restaurant" turned out to be a brothel where she was held captive. By the time she was rescued earlier this year, the 17-year-old was pregnant - and HIV-positive. Thai officials want to expel her as an illegal but to Sanda, that is equivalent to a death sentence. Once back in Myanmar, she says, she will be locked away to die along with other AIDS sufferers. "I don't want to go back," she says.

While Asia has so far escaped a large-scale outbreak, the dreaded virus is spreading in every country. UNAIDS (the Joint United Nations Program on HIV/AIDS) estimates that one quarter of the world's 33.4 million people infected with HIV at the end of 1998 were in Asia. That's about 8 million regionwide. And "the most rapid rise in HIV infection rates might be in the Mekong sub-region," says Chris Beyrer of Johns Hopkins University in the U.S.

The main causes are injected drugs and unprotected sex, exacerbated by a large, mobile population, trafficking of women and children and little or no information on safe sex. It's "a potentially explosive mixture," says Beyrer, who heads an international AIDS-training program. Needle-sharing has led to outbreaks among addicts and their sexual partners. In parts of Thailand, northern Burma, Vietnam and southern China, infection in such high-risk groups rose from 20% to 90% within months. Usually such outbreaks precede the virus's spread into the general population. Yet AIDS-prevention for intravenous drug users is neglected, delayed and often ineffective, notes UNAIDS director Peter Piot.

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Thailand was one of the first Asian countries to acknowledge it has AIDS. Local officials project the HIV population to swell from 850,000 to as much as 1.2 million next year. Matters could have been a lot worse but for the Thais' determined, broad-based and matter-of-fact way of tackling the disease. Although deaths have climbed as older patients succumb to the virus, the rate of new infections, especially among young men, has rapidly declined.

The reverse is true for many of the neighbors. In Cambodia, the current HIV population is touching 180,000 and rising. According to the vice-chairman of Vietnam's national AIDS committee, Chung A, the country's HIV numbers will more than double from 88,000 to 200,000. And experts worry over trends in China, where outbreaks have erupted among drug users in the mountains of Yunnan and in coastal provinces. About 400,000 people are estimated to be living with AIDS in the mainland. But accurate statistics are hard to come by. Many countries barely acknowledge the possibility of an AIDS epidemic and efforts to track the disease are elementary. But the experts agree: The problem will be acute and as much as half the workforce in the Mekong region is likely to be infected within a decade.

An unfortunate confluence of social and economic forces are driving up the rates of HIV transmission. A double whammy - the high proportion of men visiting prostitutes and the relatively large number of customers that a sex worker sees each week - amplify the effect of commercial sex on infection.

Women are often more vulnerable. Their unequal status, consequent lack of self-esteem - and of access to information - restrict their ability to protect or assert themselves. Consider 19-year-old Nee. Her parents refused to talk to her about sex, and when she married two years ago, no one suggested that her husband should use a condom. "Sex, safe sex and telling your husband how to have sex is a big no, no in our culture," she explains. The Chiang Mai housewife paid horribly for her ignorance. "My husband had HIV from visiting brothels and now I have it too," says Nee. "He never told me that he was HIV-positive as he felt he would be ostracized and nobody would marry him."

Most Cambodians know of the existence of AIDS, but few realize that sufferers can carry the virus without showing the full-blown symptoms, said a spokesperson of the Cambodian Women's Crisis Center in Phnom Penh. That's how HIV-infected men claiming the contrary sometimes pressure girls to have unprotected sex with them. In many cases, the stigma associated with AIDS is greater for women, even when the husband is the source of infection. The situation worsens when women try to treat themselves rather than endure the prejudice associated with clinics.

Activists argue that AIDS-prevention campaigns must also address belief systems. "When people discuss the issue, they become informed and develop accepting attitudes, even toward those whose behavior may diverge from their own," says Sasathorn Chaiyapeth of the Thai Red Cross. "This creates a new social sphere where preventive tools such as condoms can be used rather than remain an inapplicable piece of information."

Traditionally, young women assume greater responsibility in caring for family members. The debt of gratitude owed to parents is a strongly held concept across the Mekong area. For women in very poor families, that leaves little option. "I understand the importance of using condoms," says a 15-year-old girl in Phnom Penh. "But I have no income. Our field produces nothing. I have three younger sisters, two brothers and a mother who has tuberculosis. Nobody can work." So when a "customer" from China offered her more money to have sex without a condom, she agreed. "He told me he had AIDS and that if I were a virgin, he would be cured. Now I have tested positive, but I don't care. Why should my family starve?"

Decades of civil strife in Myanmar and Cambodia have swelled the river of people criss-crossing the borders. Some are migrants seeking a better life, others refugees from conflict. Then there are the women and girls sold into marriage, prostitution or as modern-day slave labor. All are transients, and all are associated with rising HIV infections. But the answer is not to crack down on migrants, argues Jackie Pollock of Empower, a Chiang Mai-based non-government organization. "Education on safe sex has to continue," she says. "We must be creative and find ways to communicate with difficult-to-reach populations."

Yet where high-risk groups are accessible, some prevention programs stumble because of competing priorities and lack of coordination among agencies. Notes a young prostitute in Phnom Penh: "First somebody from CARE asked me if I knew about AIDS. Then someone from Worldvision came to ask me the same questions." Hence the launch of an inter-agency program that would not only tackle trafficking of women in the Mekong area but also avoid overlap between agencies. AIDS workers in Thailand have been quick to recognize this. "We have to look at the issue regionally," says the Red Cross's Sasathorn. "Thailand is not an island. In the Mekong region, homophobia, sexism and other inequalities work hand in hand to further spread the epidemic."

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