AIDS in Asia

There was a tinge of irony in the fact that the U.S. Senate approved the General Agreement on Tariffs and Trade on the day designated by the United Nations as World AIDS Day. With the GATT, national economies are embracing the freedom of movement long practiced by deadly viruses like the one that causes AIDS.

When the U.N. first held a World AIDS Day seven years ago, most Americans still considered the disease a plague largely confined to gay men and intravenous drug abusers. That is not true around the world. Even in this country, AIDS is increasingly a heterosexual disease, with partners and children of intravenous drug abusers especially at risk.


But as awful as the toll continues to be, AIDS among Americans represents only part of the problem the epidemic poses for this country. These days, AIDS prompts serious studies by groups far beyond the world of public health.

One such study, from the Center for Strategic and International Studies in Washington, D.C., examines AIDS as a security threat, because of the syndrome's ability to undermine economic development and political stability in countries that are vital to U.S. interests.


Today, many countries in Africa are seeing large numbers of their adult citizens in their most productive years dying from AIDS. To date, more than 16 million cases of AIDS have been diagnosed around the world, and well over half -- more than 10 million -- are in sub-Saharan Africa.

Not only are African economies losing skilled workers, they are also inheriting enormous social problems as children are left orphans, many of them AIDS-infected themselves.

Soon, these same stories will be coming from Asia, where AIDS is swiftly taking hold. Countries that now are accustomed to basking in reports of economic miracles are beginning to feel the first waves of medical and social disaster and their economic effects.

Earlier this year, Rep. Jim McDermott (D., Wash.), who chaired the Congressional Task Force on International HIV/AIDS, reported on the rapid development of AIDS throughout Asia.

Many Asian leaders have maintained that their regions were immune to the plague. But Representative McDermott noted that no country is being spared.

"HIV transmission is raging in thriving democracies such as India and the Philippines, in constitutional monarchies like Thailand as well as in Indonesia, where power is more centrally concentrated," he said.

Meanwhile, the East-West Center in Honolulu has analyzed how the pattern of HIV transmission in Asia differs from other parts of the world. Unlike North America, where gay men and intravenous drug abusers were at high risk, and sub-Saharan Africa, where heterosexual transmission fueled the epidemic, Asian countries are establishing new patterns of transmission.

Drug use plays a role but so does sexual promiscuity, abetted in several countries by large-scale commercial sex trades. This combination of factors has helped AIDS spread more rapidly than in other parts of the world.


Sexual inequality also plays a big role. Women often lack the resources or power to control their exposure to the virus. A Johns Hopkins researcher who is tracking the epidemic in Thailand discovered that the group showing the fastest rate of increase in HIV infection was housewives.

In Thailand, where it is customary among men to visit prostitutes and women are expected to be virgins at marriage, a woman's vTC single biggest risk factor for AIDS is having a male sex partner. Marriage can cost them their lives and threaten their children as well.

Thailand already has a severe AIDS problem, but unlike some other Asian countries its government has taken active steps to slow the epidemic. Yet the statistics gathered there give a chilling idea of the scope of the problems ahead.

The East-West Center report notes that although widespread transmission of HIV only began in late 1987, some northern provinces are already reporting infection rates of 20 percent among 21-year-old males in the general population.

Thailand's open approach to its AIDS problem is still foreign to many Asian countries. China, for example, is having public health officials work with police in AIDS programs. As the East-West Center aptly notes, that is an approach destined to fail. Those most at risk of AIDS, like drug users or sex workers, will avoid contact with the police.

As AIDS spreads in Asia, the medical aspects of the story will be gruesome enough. But the social and economic burdens could well spark crises capable of spreading beyond national borders.


Sara Engram is editorial-page director of The Evening Sun. Her column appears here each week.