Piot: Asia AIDS at crossroads By ED SUSMAN

The 7th International Congress on AIDS in Asia and the Pacific
opened Friday in Japan in the wake of a prediction by Dr. Peter
Piot, of the Joint United Nations Programme on HIV/AIDS, that unless
there is a vigorous response to the Asian AIDS threat by 2010 more
than 20 million people there will become infected or die.

"If HIV prevention programs are urgently scaled-up," said Piot,
UNAIDS executive director, "6 million HIV infections can be
prevented in the next five years in the region. If Asian countries
do not rise up to the challenge, then 12 million people will become
newly infected."

Piot noted 8.2 million people in Asia and the Pacific already are
living with human immunodeficiency virus, the organism that causes
AIDS. That includes 1.2 million new infections in the past year. In
2004 an estimated 540,000 people in the region died from AIDS --
three times the number of people who died in the tsunami in December
2004.

"The risk of AIDS spreading further in Asia and the Pacific is now
higher than ever," Piot said. "Low condom use, limited access to HIV
testing, gender inequality, widespread injecting drug use and sex
work are a dangerous cocktail that could provoke a rapid expansion
of the epidemic."

The spread of the incurable, but treatable, disease was noted in a
UNAIDS report:

-- The number of women living with HIV has increased by 20 percent
since 2002, to around 2.3 million.

-- HIV has now spread to all of China's 31 provinces, autonomous
regions and municipalities. Much of the current spread in China is
attributable to injecting drug use and paid sex.

-- While the prevalence of HIV remains low in the region, its vast
population means even low HIV-prevalence rates translate into
millions of HIV infections. For example, India, with an adult HIV
prevalence just under 1 percent, has nearly as many people living
with HIV

-- an estimated 5.1 million -- as South Africa, where
prevalence exceeds 20 percent.

-- In India, serious epidemics in at-risk populations are under way.
In the southern city of Chennai (formerly Madras), for example, 26
percent of drug injectors already were HIV positive when a sentinel
site was established there in 2000; by 2003 about 64 percent of
injecting drug users were infected. In southern Tamil Nadu state in
India, HIV prevalence of 50 percent has been found among sex workers.

-- In Indonesia, one in two injecting drug users in the capital of
Jakarta now test positive for HIV, while in Pontianak, an industrial
provincial capital, more than 70 percent who request HIV tests
discover they are HIV-positive.

-- Papua New Guinea has the highest HIV prevalence in the Pacific
with 1.7 percent of adults age 15 to 49 infected, or close to 50,000
individuals. More than twice as many young women, age 15-24, as men
have been diagnosed with HIV. A high incidence of rape, sexual
aggression and other forms of violence against women appear to be
aiding the epidemic.

-- A large number of new HIV infections in Asia-Pacific occur when
men buy sex -- an estimated 5 percent to 10 percent of men in the
region do so. Many of these men are married or in steady
relationships and therefore risk not just contracting HIV, but also
passing it on to their wives and partners.

On the other hand, Piot said: "Countries like Bangladesh, East
Timor, Japan, Laos, Pakistan, and the Philippines are still seeing
extremely low levels of HIV prevalence, even among people at high
risk of infection. They have golden opportunities to pre-empt
serious outbreaks of the epidemic if urgent action is taken.

"We must not lose sight of the fact that 99 percent of people in
Asia and the Pacific remain uninfected," Piot said. "Effective
prevention programs must be scaled up now more than ever. Universal
access to prevention and treatment must not be a dream, but a
reality."

In China, the government and pharmaceutical giant Merck & Co. are in
a joint venture to attack the epidemic at the treatment, prevention,
patient care and support levels.

"The first AIDS case was reported in China 20 years ago," said Kyra
Lindemann, a spokesperson for New Jersey-based Merck. "Now there are
an estimated 840,000 cases of HIV infection in China and 80,000
cases of AIDS."

She said the Chinese government in the past two years has turned its
full attention to the developing AIDS epidemic in that country of
1.3 billion people.

"The government has given high priority to HIV/AIDS," she told
United Press International. "This is the target and it is very clear
and transparent."

The core elements of the Merck/Chinese government program involves
targeting high-risk populations that drive the epidemic, such as
intravenous-drug users and commercial sex workers; conducting
disease awareness and education programs; expanding prevention and
harm-reduction strategies, such as condom distribution, needle
exchange and methadone maintenance therapy; offering care and
treatment programs, including counseling and testing, antiretroviral
treatment, healthcare worker and patient management training; and
providing programs that will alleviate the negative social and
economic impact of HIV/AIDS in affected communities, such as job-
skills training.

Lindemann said the Chinese government has sought Merck's expertise
in scaling up a comprehensive fight against AIDS -- expertise gained
in working with governments in Botswana, Romania and elsewhere.
In Botswana, the African nation with the highest prevalence of HIV
infection -- 40 percent of the adult population -- a consortium
involving the Gates Foundation, Merck and the Botswana government
has enrolled more than 40,700 people into Masa, the nation
antiretroviral program. Masa personnel have initiated treatment of
more than 36,400 individuals.

It is estimated that 100,000 people in Botswana should be receiving
antiretroviral treatment. The program has been up and running for
about three years.

Copyright 2005 by United Press International. All Rights Reserved.
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