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| 6 | HIV/AIDS |
Shack-like brothels line the streets of the port city of Sihanoukville, in southern Cambodia. In this hub mainly for fishermen from neighboring countries, dozens of young women aged 16 to 21 offer their bodies for as little as $2.
In Sihanoukville, new port facilities are being built with help from the Government of Japan, and while this growth attracts more migrant workers, it also draws many young women who come to work in the brothels with dreams of making money for themselves and their families. Too often, these young women leave not only with unfulfilled dreams, but also with HIV/ AIDS.
Cambodia, Myanmar, and Thailand are at the center of an HIV/AIDS epidemic in the Greater Mekong Subregion - GMS.
“Cambodia remains the biggest problem now, with 2.6% of the adult population infected,” says Indu Bhushan, Principal Project Economist, ADB Mekong Department.
Yet, ironically, it is in these countries that officials are coming to grips with the problem, and infection rates have stabilized, or are slowing.
“This is because of strong political commitment, and a wide range of effective prevention programs,” says Mr. Bhushan.
In Sihanoukville, as in the rest of Cambodia, all brothels have a policy of 100% condom use. Brothel workers are checked weekly for signs of sexually transmitted diseases (STDs).
UNAIDS says the Cambodian Ministry of Health recently estimated that without this intervention in the late 1990s, HIV/AIDS infections would have been three times higher than they are now.
More than 1,000 kilometers to the northwest of Cambodia, in Yunnan Province of the People’s Republic of China (PRC), and also in Myanmar, the spread of HIV/AIDS is causing concern.
The city of Ruili in Yunnan Province, located on the old Burma Road bordering Myanmar’s Shan State, is a major transit route for booming regional trade.
VICTIM An AIDS patient and her medicine
Cambodia,
Myanmar, and Thailand are at the center of an HIV/AIDS
epidemic in the Greater Mekong Subregion
Truck drivers, traders, and traffickers of contraband ply the route from Kunming in the PRC, to Mandalay in Myanmar, and beyond. Many will rest at one of Ruili’s brothels where young women from the surrounding tribal hills work.
Population Services International, nongovernment organization, says Ruili is a hub for intravenous drug users and sex workers from all over the PRC and Myanmar. It also says Ruili township has the PRC’s highest rate of HIV/AIDS infection.
Ruili is north of the Golden Triangle, the opium-producing area straddling northern Thailand, Myanmar, and the Lao People’s Democratic Republic.
ADB is participating in the Western Yunnan Roads Development Project, which will improve access between Ruili and Myanmar. However, with greater mobility of people, including seasonal migrant workers, comes the risk of an increase in the speed of transmission of HIV/AIDS.
Migration, mobility, and HIV/AIDS are clearly interlinked, according to an ADB document. “High rates of HIV infection are generally found along transport routes, in border areas, and in regions experiencing higher seasonal mobility.”
To help counter this, ADB is implementing an HIV/AIDS prevention program alongside the road project, a unique move that project officers say can be applied to other infrastructure projects in other countries .
HIV/AIDS first appeared in Yunnan Province in 1987, shortly after the first reported cases in the PRC. By the early 1990s, the epidemic was found mainly among intravenous drug users along the Myanmar- Yunnan border. According to the PRC Ministry of Health, the spread of HIV/AIDS increased at an annual average rate of 30% until 2000. It rose 58% in 2001, and 17% in the first half of 2002.
URGENT
More money is needed for campaigns to educate people about HIV/AIDS
Meeting
the HIV/AIDS challenge is key to achieving
the Millennium Development Goals
In Myanmar, meanwhile, there is no time to lose. The 2003 UNAIDS epidemic update says intravenous drug use and commercial sex are responsible for most HIV/ AIDS infections. It says migrant workers, especially gem miners and loggers, are becoming a major conduit for the spread of the virus.
“Among the three Asian countries hardest hit by the epidemic, only in Myanmar do national HIV infection rates continue to rise,” says UNAIDS.
“It remains to be seen whether Myanmar’s nascent prevention efforts will limit HIV prevalence to the 1–2% reported among 15–24-year-olds in urban areas,” says UNAIDS. Overall, urban adult prevalence (15–49 years old) was from 1.1% to 2.2% of the population in 2002.
In Cambodia and Thailand, the numbers remain high, but HIV/AIDS prevalence has been checked by promoting greater condom use in the commercial sex industry.
In 2001, 670,000 people were known to be infected with HIV/AIDS in Thailand. In Cambodia, 170,000 were known to be infected, and the infection rate has slowed to 2.6% in 2002, from 4% two years before. In Viet Nam, 130,000 people were known to be infected with HIV/AIDS in 2001.
In 1999, about 420,000 people were known to be infected with HIV/AIDs in South and Southeast Asia. That figure has increased to more than 5.6 million people in 2003.
“Thailand spends about $1 per capita and Cambodia about 50 cents per capita on HIV/AIDS prevention and care. Viet Nam spends less than 10 cents per capita and Myanmar less than one cent,” says Mr. Bhushan.
UNAIDS says crude estimates suggest public and donor spending on HIV/AIDS prevention in 2003 probably did not exceed $200 million. To adequately fund prevention efforts the amount would need to rise to $2.2 billion in 2004 and $5.1 billion by 2007.
Mr. Bhushan says that despite the apparent stabilization in the rate of new HIV/ AIDs infections in Cambodia and Thailand, the burden of HIV/AIDS-related illnesses will triple over the next 20 years unless known prevention measures are backed with funding.
He says ADB needs to do more. Among its programs, an $8 million project supported by the Japan Fund for Poverty Reduction to boost social marketing of condoms in HIV/AIDS hot spots is entering its third and last year. ADB is also promoting a “Toolkit for HIV Prevention” among mobile populations in the GMS.
Mr. Bhushan says a more comprehensive ADB policy would have three major focus points: an emphasis on policy dialogue for public expenditure management supporting HIV/AIDS during country programming; more effective integration of HIV/AIDS issues in infrastructure projects; and more stand-alone support for HIV/ AIDS prevention and care.
Meeting the HIV/AIDS challenge is key to achieving the Millennium Development Goals. Goal 6 targets a halt in the spread of HIV/AIDS by 2015 and the beginning of a reversal trend.
Much remains to be done.
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