Richard Ingham

Drug use, prostitution put Asia's 'Big Three' at risk

China, India and Indonesia — which are home to 40 percent of the world's population — now face HIV epidemics that could leap out of risk groups and into the mainstream, UNAIDS and the World Health Organization warned Tuesday in their annual "AIDS Epidemic Update." "Injecting drug use and sex work are so pervasive in some areas that even countries with currently low infection levels could see epidemics surge suddenly," it said.

Of the estimated 40 million HIV infections worldwide, around 7.4 million live in Asia and the Pacific. A million people in this region will have become HIV-infected this year, and half a million will have died from the disease.

In China, "…serious, concentrated epidemics have been under way for many years in certain regions (such as Yunnan, Xinjiang, Guangxi, Sichuan, Henan and Guandong) and are poised to take off in several others." The current source: increasing numbers of injection drug users (IDUs) sharing needles, as well as low condom use among sex workers and gays.

In India, epidemics are under way in several states — including Maharashtra and Tamil Nadu (where sex worker HIV prevalence in some cities exceeds 50 percent), and in Manipur (with HIV prevalence among IDUs between 60-75 percent). The epidemic is spreading to rural areas and the wider populace, said the UN agencies.

In Indonesia, "Over 90 percent of injecting drug users have been found to use unclean injecting equipment in three major cities, and in one of these, as many as 70 percent report having had unprotected sex with sex workers." Fewer than 10 percent of the 7 million to 10 million Indonesian men who frequent sex workers use condoms consistently.

While Cambodia and Thailand got high marks for promoting condom use in the sex industry, Vietnam "faces the possibility of a serious epidemic" arising from drug users, and Mynamar "has little time to lose," with an epidemic growing among IV drug users and migrant workers.

[Source: CDC HIV/STD/TB Prevention News Update 11/26/03]