Catalog

Killer at the Border
ADB Review [ December 2004 ]

Innovation and education are at the core of the battle to prevent the spread of HIV/AIDS in the subregion

By Ian Gill, (igill@adb.org)
Principal External Relations Specialist

MARKET THREAT Border areas like these can encourage the spread of disease

PHNOM PENH, CAMBODIA. The major causes of the spread of HIV/AIDs in the Greater Mekong Subregion (GMS) vary from country to country. In some, a severe though declining HIV/AIDS epidemic is driven by commercial sex.

In others, a concentrated HIV/AIDS epidemic is mostly transmitted through shared needles during injected drug use.

However, one common factor affecting the spread of the virus is location. Border areas, with their high proportion of migrant males and sex workers, consistently report above-average infection rates.

According to an Asian Development Bank (ADB) study, Mobility and HIV/AIDS in the Greater Mekong Subregion, the most vulnerable groups include the hospitality, transport, trade, construction, and manufacturing sectors. Military and police personnel are also susceptible, as are fisherfolk.

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Poor Backgrounds

Far from home, migrant workers can seek the companionship of sex workers. For their part, sex workers, often from poor backgrounds and lacking in education, can be uninformed about condom use or seeking treatment for sexually transmitted infections (STIs).

Improved road and air links are strengthening connectivity between GMS countries—but at the potential cost of increasing the cross-border spread of diseases.

BEWARE A poster warns of the dangers of HIV/AIDS

“HIV/AIDS infection is one of the major public health problems of the GMS,” says John Cooney, Director of the Social Sectors Division of ADB’s Mekong Department. “It affects all population groups, and the share of HIV/AIDS-related illnesses in the subregion is expected to triple in the next 20 years, unless stronger preventive measures are undertaken.”

Although antiretroviral (ARV) drugs— which can delay HIV turning into AIDS and significantly prolong life—are beginning to be more available in the GMS, “prevention is the most cost-effective strategy,” says Vincent de Wit, an ADB senior health specialist.

Two ADB projects aim specifically at prevention. One covering Cambodia, Lao People’s Democratic Republic (Lao PDR), and Viet Nam is an $8 million grant project, financed by the Japan Fund for Poverty Reduction, for Community Action for Preventing HIV/AIDS. Another is a $1 million regional technical assistance project for HIV/AIDS Preventive Education in the Cross-Border Areas of the GMS.

Although infection cuts across generations, the dangers are particularly acute for the young and the poor.

“Since young people are more likely to be infected by HIV/AIDS, the loss of human capital and earnings potential is staggering,” says ADB’s Mr. de Wit.

“Poverty can stimulate the spread of HIV by driving young women into sex work. At the same time, infections in households exacerbate poverty and social inequality, creating conditions for a larger epidemic.”

BORDER TRADE A crowd surges across from Thailand into Koh Kong, Cambodia, when the barriers open

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Breaking a Vicious Cycle

The community action project in Cambodia, Lao PDR, and Viet Nam seeks to break this “vicious cycle.” It supports communication and service delivery programs aimed at vulnerable groups.

In particular, the project has reached more than 2 million people using various communication messages aimed at reducing the vulnerability of women and encouraging behavior change in men; motivated about 150,000 people to use condoms for casual sex; provided STI prevention and treatment services to the local population; and developed models of care for people living with HIV/AIDS, including ARV therapy (see Condom Campaign).

In addition, the project is strengthening nongovernment organizations and surveillance systems.

The second project, for preventive education, focuses on the border areas between the People’s Republic of China (PRC) and its southwest neighbors (Lao PDR, Myanmar, Thailand, and Viet Nam).

These borders are porous and are conduits for the increased rate of population mobility, trade, and services. The problem of HIV/AIDS is related to drug addiction and sex work associated with cross-border traffic.

Many of the GMS’s 200 ethnic minorities live in the remote mountain ranges of the Mekong. “These minority peoples, especially the women, are at risk because of poverty, a lack of access to education and health care, a lack of culturally appropriate information in their own languages, cultural and social breakdown in some communities, nontraditional drug use, human trafficking, and involvement in the sex trade,” says Paul Chang, an ADB principal education specialist working on this project.

The project covers activities to increase awareness of the social dangers. One through radio programs, specifically soap operas in local languages, and the other through the use of computers and information and communication technology in schools. The projects are being implemented, respectively, by the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the Southeast Asian Ministers of Education Organization.

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