David Brunnstrom

Asia's growing sex market underlines AIDS risk

HANOI (Reuters) — Asia may have beaten the worst of the AIDS epidemic with condoms, but the region's growing sex industry highlights the need to promote wider usage to prevent new infections, WHO experts say.

In media releases issued at the start of a five-day conference in Hanoi on Monday, the World Health Organisation (WHO) said the numbers of people in Thailand and Cambodia with HIV — the virus that attacks the immune system and leads to AIDS — had dropped steadily thanks to the wider use of condoms.

But 800,000 people were still expected to die of AIDS every year in Asia by 2005 and the course of the epidemic depended on how heavily populated countries like China and India responded.

"If we use the lessons learned in Thailand and Cambodia, we have a real chance to stop the growth of the epidemic in this part of the world," said Shigeru Omi, WHO director for the Western Pacific, in a media statement.

The reports warned the sex industry in Asia was expanding rapidly and most commercial sex in the region still took place without condoms.

Greater mobility and changing attitudes had contributed to this and the sex industry was also extremely profitable — accounting for an estimated two to 14 percent of GDP in Indonesia, Malaysia, the Philippines and Thailand.

Even in rich and highly developed Japan, the sex industry accounted for one to three percent of GDP, the WHO said.

Part-time prostitution

Many parts of Asia are witnessing an increase in part-time prostitutes, working in bars, health clubs, massage parlours, karaoke bars, restaurants and hotels.

The WHO said these women included students who did not see themselves as sex workers at high risk and therefore did not insist on condom use.

The WHO said while the percentage of the adult population in Asia with HIV remained relatively small, the region's large population meant this translated into huge numbers infected.

An estimated 3.9 million people were infected with HIV in India, more than any country in the world except South Africa.

The WHO said HIV infection was on an upward trend in Myanmar and some Indian states. The infection had continued to spread among needle injecting drug users, with more than 50 percent infected in Nepal, southern China and northeast India.

Cambodia was the worst-hit country outside Africa, with 2.8 percent of its adult population aged between 15 and 49 infected, while Thailand, Myanmar and some Indian states also had rates of 2-3 percent among adults, it said.

However, new infections each year in Thailand had dropped to 20,000 in 2000 from 143,000 in 1991, while in Cambodia, new infections among sex workers under 20 had fallen to 23 percent last year from more than 40 percent in 1998.

Sales of condoms in Cambodia, meanwhile, jumped to 11.5 million in 1998, from about 100,000 in 1994.

"Both Thailand and Cambodia managed to turn the tide of rising HIV by focusing on the main driving force of the epidemic — commercial sex workers and their clients," the WHO said.

Thailand's 100 percent condom use programme directed at sex workers and their clients prevented millions of HIV infections in the 1990s, it said.

Even so, 50,000 Thais were expected to die from AIDS every year up to 2006 and a similar number would develop their first serious AIDS-related illnesses each year.

Vietnam's Permanent Vice Minister of Health Pham Manh Hung said in the opening session of the conference that Hanoi's own efforts to promote condom use had been slower than in Thailand or Cambodia.

He said a total of 38,599 people had been diagnosed with HIV in Vietnam, more than 3,136 of whom had died of AIDS. By 2005, Vietnam could have 52,000 cases of AIDS and 46,000 fatalities as a result of the disease and programmes to promote 100-percent condom use were essential, he said.