Fridae

Dec 1 is World AIDS Day. It is time for a minute of silence. It is a time designated by The United Nations 15 years ago to reflect and remember those who are living with, those who have died or those who are dying of AIDS and/or other AIDS-related illnesses. Dec 1 is also a day that should be spent to re-examine the past and the present impacts and trends of the greatest pandemic of mankind. This year's designated theme is 'Stigma and Discrimination,' is to emphasis the importance of eradicating fear, shame and ignorance from the people who have HIV and AIDS. Discrimination against HIV positive people is real and poses serious negative impacts for their mental and physical well being.

According to the 2003 AIDS Epidemic Update published by UNAIDS, over 1 million people in Asia and the Pacific acquired HIV this year while an estimated 7.4 million people are now living with the virus. A further 500,000 people are estimated to have died of AIDS in 2003.

In Australia, HIV notification rates for New South Wales (NSW) peaked in 1987 and declined significantly from the late 1980s to the mid-1990s. Notification rates were relatively stable from the mid-1900s to 2001, with one small increase in 1995.

From 2001-2002 there was a 15 percent increase in HIV notifications in NSW. This was predominantly concentrated among gay and homosexually active men. For Australia, this represents the largest increase in HIV since the epidemic was brought under control in the late 1980s. Presently there are approximately 20,000 HIV positive people in Australia, which accounts for 0.1 percent of the Australian population.

The first HIV case reported in Singapore was in 1985 and by 1990, there were 17 new cases; by 2000, the number was 226, followed by 237 and 234 in 2002. According to the latest figures released by the Health Ministry in late November, 201 were found to be infected in the first 10 months of the year, compared with 189 in the same period last year. With a total of 2034 people who have been infected since 1985 and since 1991, the most common route of HIV transmission was via heterosexual sex, reported The Straits Times.

While Thailand's highly successful AIDS awareness and education campaign in the mid 1990s was held up as an example for other countries, the country is now witnessing a HIV/AIDS resurgence at levels it has not seen for many years. The Asian Economic Crisis forced Thailand to cut up to 60 percent of its health care spending since 1997-98. This time the majority of new infections are from young adults who do not believe that they will only contract HIV from sleeping with sex workers and not their friends, reports Reuters. An estimated 600,000 Thais are living with the disease today.

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Whilst prevalence rates in Japan remain well below one percent, with just 12,595 infected, experts fear the actual number is five times higher. Unprotected sex amongst young people is a major cause of new infections fuelled by lack of awareness, increasing sexual activity and declining condom use. Since 2001, nearly 40 percent of new infections have been in the age group 15 to 24, said ActionAid-Asia.

According to Time to Act, a recently released report by ActionAID-Asia, HIV/AIDS has reached a critical point in the region and is threatening millions of lives in India, China and other populous nations; and warns that if governments do not address the problem, Asia could overtake Africa in the sheer number of people afflicted with the disease.

The report faults complacent governments, inadequate health care and widespread prejudice for exacerbating the Asian Aids epidemic. Unprotected sex, drug abuse and unsafe medical practices are the triggers that are helping the epidemic to spread.

"Asia may not be Africa, but the early warning signals are scary and clear. Africa's experience shows HIV/AIDS can destroy development gains of several decades and social composition of peoples in a single stroke," the report said.

It warns that seemingly low prevalence rates in countries such as India and China are disguising huge actual numbers and the existence of hotspots of infection. "At the same time grossly inadequate surveillance systems are compounding and encouraging complacency," it said.

In order to combat the AIDS crisis in Asia, Asian governments must take a multi-level approach to HIV/AIDS. It needs to unify every member of its community including religious organisations and resources must be directed at high prevalence groups and it must apply scientifically sound prevention strategies that have been proven to work to HIV prevention.

HIV/AIDS intervention strategies best suited must reflect the needs of its communities and it must also be cultural sensitive, ethically sound and linguistically appropriate, in addition, it also must aim to empower its community with the appropriate tools so people are able to make sound choices in relation to their own sexual health.

To ensure equity and social justice, Asian governments must legislate anti-discriminatory laws to protect and ensure HIV/AIDS positive citizen are not being discriminated against, as this will prevent the living standard of HIV/AIDS positive people from being further eroded.

Asia must continue to actively provide sex education to its young adults and at times take measures to ensure that young adults and other vulnerable groups have sufficient preventative knowledge that enables them to make appropriate decisions that will affect their health and well being. This should tie in well with this year's "Live and Let Live" theme. In doing so recognises the basic human right values that all citizen are entitled to.

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In addition, Asia must also come to terms with its homosexual population by officially recognising it, it must also provide and fund education campaigns, social and peer support, health care services for gay men, bisexuals, lesbians and transgender communities with the view to prevent the spread of HIV. Moreover, Asia must also recognise the important role of sex workers, injecting drug users, transitory migrant workers, young people and others in the fight against HIV/AIDS.

"The choice is clear to me. It's either act now or pay later, said the UNAIDS Executive Director Peter Piot.

At the end of the day, if Asian governments cannot be compassionate, they must be considerate of the economic consequences of their denial.

In Australia, the Return on Investment in Public Health Study found the estimated present value of the benefits of HIV/AIDS programs for all exposure groups is about A$3.149 billion and the estimated present value of the costs of HIV/AIDS programs is A$607 million. Therefore the net benefit of the programs is more than A$2.5 billion. Investing on sexual health preventative care is logically worthwhile.

Finally, Asian governments must deviate from endorsing non-condom based HIV/AIDS interventions used in the prevention of HIV/AIDS, namely 'abstinence.' Simply put 'abstinence' as a HIV prevention measure does not work.

In a study of 'Abstinence and Safer Sex HIV Risk Reduction Interventions' for African American Adolescents (Jemmott et al, 1998), scientists discovered that young adults who practiced 'abstinence' as a means to prevent HIV over sex education, are more likely to contract HIV and other STIs due to the lack of condom usage and are more at risk of pregnancies.

The study, which surveyed 659 adolescents with an average age of 11.8 years to evaluate the effects of sexual abstinence and safe-sex interventions, found that young adults who engaged in previous sex education are better equipped to deal with HIV/AIDS issues than otherwise. The researchers also found that young adults who were exposed to sex education have less sex than those ones who practice 'abstinence.' The study also revealed that while the young adults may aspire to practice 'abstinence' in the first three months, thereafter, they are much more inclined to indulge in sex and unsafe sex than those who participated in sex education.

HIV/AIDS affects all people irrespective of age, culture, gender, religion, sexuality or relationship status. While there is still no cure for HIV, effective treatments are available and the earlier the HIV is treated the better. People who find out that they have HIV can lead a healthy and productive life.

The writer works as a Health Promotion Officer at the Central Sydney Sexual Health Service, Royal Prince Alfred Hospital.

For further information on HIV testing (some clinics offer anonymous testing), please click on the 'Asia-Pacific HIV/AIDS organisations' link below for more info on how to contact your local sexual health clinic.