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Halting the March of HIV/AIDS
By Omana Nair ( onair@adb.org )
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Poipet, a small Cambodian town on the border with Thailand, is well known for its casinos, karaoke joints—and commercial sex trade.
Establishments cater to all economic classes, from palatial casinos to seedy, dimly lit shanties in an area known as Palelai Village.
The night spots have sprung up with the increased cross-border traffic and rising mobility and incomes in the Greater Mekong Subregion - GMS.
But along with this freedom of movement has emerged the growing specter of HIV/AIDS, which now defies borders and spreads quickly, hitting particularly hard the poorest, most vulnerable sectors of society.
One of those at risk is 22-year-old Ros Ry (not her real name), one of an estimated 100 women, mostly from neighboring provinces, working in the sex trade in Poipet.
Nervously clutching a teddy bear, she talks about her life and how poverty forced her to leave her village for the border town to become a prostitute. She usually has four or five clients a day, she says, earning her a total of $6 a day. When asked about HIV/AIDS, she hesitates and looks at the brothel owner, who is watching her closely. She says she is aware of the dangers of HIV/AIDS, and discreetly shows her medical card to prove that she gets regular checkups at the local clinic. Her concern is justified.
Cambodia has the highest per capita incidence of HIV/AIDS in Asia.
Although the HIV/AIDS epidemic is still in its infancy in parts of the GMS, it poses a serious health problem with disastrous economic and social implications.
Thailand alone has 800,000 people with HIV/AIDS; Myanmar, 500,000; and Cambodia, 250,000. Yunnan Province in the People’s Republic of China also has a major epidemic that has only recently been recognized.
Initially most of the people infected were men, but as the epidemic spread, more women and infants have caught the disease. With still no cure in sight and most of the available “drug cocktails” of anti-retrovirals to control the symptoms still prohibitively expensive for those in developing countries, prevention and behavior change are the key means to control the epidemic.
Unless stronger preventive measures are taken, the share of HIV/AIDS-related illnesses in the total burden of disease in the subregion is expected to triple in the next 20 years, according to Indu Bhushan, ADB Senior Project Economist.
“Despair, lack of knowledge about HIV/AIDS infection, widespread poverty, and social inequality are all creating conditions for a larger epidemic in the GMS.”
He stresses that priority must be given to implementing HIV/AIDS interventions among high-risk groups, such as sex workers and intravenous drug users.
Experience has shown that prevention and intervention activities can successfully bring about reductions in HIV/AIDS prevalence, provided they are combined with a strong commitment from governments.
Programs in Cambodia and Thailand, for example, have promoted safe sexual practices, leading to a reduction in HIV/AIDS prevalence and incidence. HIV/AIDS prevention programs in Thailand are estimated to have saved more than 200,000 people from infection since 1993.
Similarly, recent World Health Organization surveys in Cambodia indicate a decline in HIV/AIDS prevalence from 3.9% in 1997 to 2.8% in 2000, although the rate of HIV/AIDS infection in Cambodia is still the highest in Asia and the Pacific.
The HIV/AIDS epidemic in the GMS poses a serious health problem with potentially disastrous economic and social implications
Economic liberalization, intermittent political instability, improved major road systems, and increased exposure of formerly insulated communities and people to outside contacts have exacerbated the Cambodian people’s vulnerability to HIV/AIDS.
Realizing the seriousness of the epidemic, ADB implemented a technical assistance project in 1997 that examined how the GMS countries could cooperate to slow the spread of HIV/AIDS.
The study identified 18 possible regional projects, ranging from joint research to using Buddhist monasteries as care centers.
ADB followed this up in August 2001 with a community-based HIV/AIDS prevention project in Cambodia, Lao People’s Democratic Republic, and Viet Nam to help reverse the epidemic. The $8 million grant, financed through the Japan Fund for Poverty Reduction, targets high-risk groups.
These include migrant and mobile groups such as those in fishing communities; transport, construction, and sex and hospitality workers; and police and military personnel who are vulnerable to HIV/AIDS infection due to their work, living environments, and lack of social support.
ADB has also recently developed a tool kit for HIV/AIDS prevention among mobile populations in the GMS.
“As many of our projects in the region promote mobility, it is our moral obligation to provide guidelines on HIV/AIDS prevention and interventions, particularly among the mobile groups,” Mr. Bhushan says.
The program aims to provide a comprehensive range of HIV/AIDS prevention activities in strategic areas and “hot spots” where the virus is easily transmitted. It also aims to strengthen the capacity of national and local authorities and selected NGOs in developing community-based prevention and care programs.
Community-based activities include using communication campaigns to change behavior in communities and mobile populations; promoting the use of condoms through social marketing; and treating and managing sexually transmitted infections.
Also highlighted is the development of models for HIV/AIDS prevention and care in Cambodia that can be adapted for use in the other two countries; training teachers and community workers on HIV/AIDS prevention and control; and facilitating learning from Thailand’s experience.
Building on the success of the earlier projects, ADB is planning a new technical assistance project to improve capacities of border area schools and communities in preventing HIV transmission, through modern information communication technology.
With the rate of infection varying across the region, individual countries have their own views on how to manage social and behavioral issues that contribute to the spread of HIV/AIDS.
“There is no single cure for such a diverse epidemiological situation,” says Peter Godwin, ADB’s Regional Advisor for the project. “We’re working to discover the underlying commonalities and to use them to build a good network and coherence among the three countries.”
Awareness is still low, he says, particularly among poor people and those in remote areas. HIV/AIDS prevention activities need to be integrated into primary health care programs. Government leaders need to look to, and learn from, the African experience and respond to the epidemic in an open and pragmatic manner.
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