Timebomb of Aids menaces bloom of Asia's youth

UN secretary-general tells leaders to stop "sticking heads in the sand," as one quarter of new victims are Asians, writes Jan McGirk
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Asian governments, long in denial about infection rates from HIV/Aids, face a health crisis which may eventually outstrip the suffering in sub-Saharan Africa.

The United Nations is predicting that China, India and Indonesia, which account for nearly half of Asia's population, are Aids time-bombs.

Some 11 million children in sub-Saharan Africa have lost one or both parents to HIV/Aids. And the UN is projecting that China will have 10 million HIV/Aids patients by 2010 if preventive steps are not taken immediately. India already has nearly five million HIV victims.

In a speech opening the 15th annual international Aids conference in Bangkok yesterday, the UN secretary general, Kofi Annan, told 17,000 delegates from 160 countries that Asia had reached a crucial juncture. He urged governments to co-ordinate an emergency response to treat the millions of people struck down by the disease and to prevent its spread.

Someone new is infected with HIV every 12 seconds, resulting in 14,000 new cases every day around the globe. A quarter of these victims are Asians. More than half are under 25 years old.

The so-called tiger econom-ies of Asia, which comprise 60 per cent of the world's population, have recovered from hard times over the past seven years, but economic calamity looms again unless the region's leaders make a concerted effort to combat Aids.

Mr Annan's warning followed a demand by UN health experts for doctors to give routine Aids tests in the developing world, and not wait for requests. Because the bulk of people infected with HIV are unaware they have the virus, too few seek out treatment. Many people are afraid of test results, fearing the stigma when others learn they are infected.

A record five million people contracted HIV last year, the biggest annual rise since the acquired immunodeficiency syndrome surfaced in 1981.

"Left unchecked, Aids will not only devastate millions of lives; it will also impose huge burdens on the region's health systems and soak up resources that are badly needed for social and economic development," Mr Annan said.

"In recent decades, more people have escaped from poverty in Asia and the Pacific than in any other part of the world, but these gains may slip away from you," he added.

"We need leaders everywhere to demonstrate that speaking up about Aids is a point of pride, not a source of shame. There must be no more sticking heads in the sand, no more embarrassment, no more hiding behind a veil of apathy. Leadership means respecting and upholding the human rights of all who are vulnerable to HIV/Aids ­ whether sex workers, drug users, or men who have sex with men."

A new generation is reaching puberty and sex-education campaigns for youngsters in high-risk groups are paramount, health workers said in Bangkok. Only about 20 per cent of sexually active young people practise safer sex. The safer-sex message needs reinforcement. Needle-exchange programmes, uncommon in authoritarian Asia, are also crucial to stop the spread of infection through blood-contaminated syringes, they said.

Aids outbreaks in Asia first started among drug abusers and gay men, then quickly jumped to sex workers and their clients ­ the "main engine", according to Tim Brown, an epidemiologist from the East-West Centre, based in Hawaii.

The pace of contagion in any country is linked to what percentage of the population visits prostitutes. "What's particularly dangerous about slow growth [of infection] is that it won't motivate the kind of aggressive response we've seen in Thailand and in Cambodia," Mr Brown said. "The story of HIV in Asia is far from over."

The main issue at the conference, which promotes "access for all", will be how to supply developing countries with cheaper generic copies of the antiretroviral drugs used in the West. Activists called for drug makers to "stand down" on patents so the drugs could become more affordable.

Health workers will also debate how the medicines can be used widely without the risk of the virus mutating and developing immunity to drug cocktails. Thailand, India and Brazil have already developed cost-effective alternatives. These cost as little as $140 (£75) per patient a year, compared with $470 for branded products.

"It is so frustrating that you know we have the tools to make sick people healthy again, to let them live relatively normal lives, yet here we have only a happy few in the rich countries that have access to these medications," said Joep Lange, co-chairman of the conference.

Only about 440,000 infected people in the developing world can obtain antiretroviral drug therapy (ART), in contrast to the West, where 95 per cent of Aids patients prolong their lives with expensive pharmaceutical cocktails devised by major pharmaceutical firms. UN health officials have set a goal of treating three million people by 2005, but most experts say this target is unfeasible.

Without proper treatment, some six million people are expected to die of Aids by the end of this year.

"I see dead people," Jim Yong Kim, the head of the World Health Organisation's Aids division, told reporters. "We are living with this terror. We are all going to have to account for all these people we aren't reaching." He said he felt a moral obligation to push harder to meet his targets.

Aids is rising fastest among young women, with teenage girls in southern Africa now five times more likely to be infected than teenage boys. Understandably, empowering women to demand safer sex is a major theme of the conference. Prostitutes in the Third World are often slow to insist on clients using condoms as potential customers might then choose more reckless sex workers. Other women are subject to rape.

Organisers of the meeting also lamented Washington's decision to send a minimal American delegation to Bangkok. The low-profile presence was attributed to the conference's failure to stress sexual abstinence as a tool to combat Aids.

US President George Bush promotes the Christian right's "ABC" strategy ­ Abstinence, Being faithful, Condom use ­ in that order. But condoms should be the top priority, according to more pragmatic health authorities at the conference.

"These ideological games are very counter-productive," Mr Lange complained. He viewed the reduced US participation as "a strange signal" from America, the largest donor nation to anti-Aids efforts.

Senator Mechai Viravaidya, 63, is an outspoken Thai Aids activist who runs a restaurant chain called Cabbages and Condoms which dispenses condoms in place of after-dinner mints. "HIV is just another very personal affliction, not unlike diabetes or having warts on your bottom," he said. "It should not lead to discrimination. You don't need to have it pointed out every time you are introduced to someone." He added: "Only a dirty mind sees a condom as something dirty."

Religious groups are increasingly active in battling Aids. More than 100 faith-based organisations are joining medical specialists and scientists at the Bangkok conference.

Because HIV infection is associated with homosexuality, promiscuity and drug addiction, Aids sufferers used to face religious condemnation instead of compassion. But as congregations themselves came to be hit heavily by Aids, some religious leaders changed their message and found a new role. Most at the conference now provide care for orphans, and counselling for sufferers.

The Christian Aid charity cautioned that the availability of antiretroviral drugs might cause preventive measures to be neglected, and result in a spike in the number of infections. No treatment programme can keep pace with the number of people who need therapy unless new infections fall sharply. Wealthy countries have set an alarming example.

"ART doesn't mean we can stop worrying about HIV. Look at the UK ­ ART is available to all, yet the incidence of HIV increased last year," said Dr Rachel Baggaley, the head of Christian Aid's HIV Unit.

Activists assailed wealthy countries for being tight-fisted and not contributing enough to the UN fund established 30 months ago to fight Aids, malaria and tuberculosis.

"The US is prepared to spend billions for war, even while calling Aids the greatest crisis affecting humanity. We must have the courage to say no to this hypocrisy," said Dr Paul Zeitz, spokesman for the Global Aids Alliance. "Progress will come to a screeching halt."

About a thousand demonstrators staged a sit-down protest outside the conference centre, waving placards saying "Access for All Denied".

"The pharmaceutical companies have created a massive business out of people's lives," said a Honduran activist, Carlos Martel. "They must give better access to treatment."

Some 17,000 Aids patients, policymakers, scientists and activists have converged in Bangkok, along with showbusiness activists wearing lapel ribbons. Celebrities who have lent support with their presence include Richard Gere, Oprah Winfrey, Ashley Judd and Rupert Everett. South Africa's elder statesman Nelson Mandela is planning to sing alongside a chorus of children with Aids.