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With more than two-thirds of the world's AIDS cases, it's understandable why much of the world's attention is on Africa.
But more and more, experts are beginning to worry about Asia, where more than 6 million people are HIV-infected or have AIDS. Moreover, the number of infections is increasing rapidly, nearly doubling in the last five years, according to the Joint United Nations Program on HIV/AIDS (UNAIDS).
“There's a chance that this disease could get out of control in a country like India or China, with their huge populations,” says Jeff Jacobs, director of government affairs at AIDS Action, an AIDS advocacy group. “If something like that happened, imagine the cost.”
Until now, the AIDS spotlight in Asia has focused on Thailand, which seemed particularly at risk because of its huge sex industry. Indeed, the country has the highest number of reported HIV/AIDS cases in East Asia, more than 1 million.
Yet, Thailand has become something of an AIDS success story. When it became apparent in the early 1990s that the virus was spreading rapidly, the government initiated a massive AIDS education campaign and distributed millions of condoms, paying special attention to sex-industry workers. The efforts paid off, lowering new infection rates from 60 cases per 100,000 population in 1994 to 48 per 100,000 in 1998.
Other Asian countries, among them the Philippines and Vietnam, also have launched major efforts to halt HIV's spread. A government-run caf in Ho Chi Minh City even offers condoms and clean needles to patrons along with coffee.
But Jacobs is among many experts especially worried about larger Asian countries. In India, for instance, AIDS prevention efforts are scattered or non-existent. Slightly more than 2 percent of India's population -- 4 million people -- have HIV or AIDS, and the epidemic is spreading quickly. Moreover, the disease is not confined to high-risk groups, such as prostitutes, intravenous drug users and gay men, but has hit several sectors of Indian society, including young urban workers and professionals.
“India has a real problem on its hands because it already has a high rate of sexually transmitted diseases (STDs),” says Richard Laing, an associate professor of international health at Boston University's School of Public Health. Because STDs facilitate HIV transmission, “This really could lead to trouble for India.”
A poster promoting condom use at a World AIDS Day exhibition in Beijing in 1998 catches the eye of students. Beijing's first public exhibition on the disease featured photographs of drug users and AIDS patients. (AP Photo/Chien-min Chung)
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In China, an estimated 600,000 people have contracted HIV or AIDS, fewer than 1 percent of all adults. But new cases are increasing by 30 percent annually. And, as in India, the disease is no longer the provenance of traditional high-risk groups but is spreading to the general population, affecting everyone from rural workers to urban professionals.
Recently, Zeng Yi, an AIDS researcher in China, warned that his country is facing a “natural disaster” if the government doesn't act more forcefully to stop the epidemic.
“The central government doesn't seem to realize how serious this is,” said Qui Renzong, a bioethicist at the Chinese Academy of Social Sciences. “We have not yet had an effective risk-reduction strategy because [government] departments are very conservative. They think chastity is more important than condom use.”
Some experts predict that parts of Asia could begin to see a decline in economic activity, much like what has occurred in Africa, if the disease is allowed to spread unchecked.
Speaking of HIV carriers in India, Dr. Rohto Sob, a consultant with the World Health Organization says: “This is your working population. In the long run, industrial production will be hit as it has in Africa.”
But others are more hopeful. “I'm heartened by the fact that the virus has been in Asia for more than 20 years and, so far, hasn't gotten out of control like it has in Africa,” Laing says.
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