The Southeast Asian Component

AIDS in Asia and the Pacific

By Nicholas Ford

The Thai situation with an estimated 750,000 cases of HIV/AIDS is well known. It is probable that the second largest epidemic in the region is faced by Burma, in which authoritative estimates consider that there are around 500,000 cases of HIV at present. In contrast to Thailand, which, following vigorous educational and condom promotion programmes, is now registering some stabilization in the incidence of HIV, relatively little HIV prevention work has been undertaken in Burma. Other 'new' AIDS epidemics are being reported in Cambodia and Vietnam. Many other Southeast Asian countries have an enormous potential for HIV infection, evidenced by continuing high levels of other sexually transmitted infections (STIs).
The enormous range of papers and posters at the conference spanned basic science, virology, vaccine development, epidemiology and surveillance, socio-behavioral studies into sexual transmission (among commercial sex workers (CSWs), youth, husbands and wives, migrants tourists, soldiers, truck drivers, gay men) and injecting drug use (IDUs), social and economic impact assessments, the continuum of care and counselling, reflecting the increasing mobilization of governments, NGOs, and communities against AIDS in some countries of the region.

Mirroring the pattern of risk and the nature of societal concern about HIV/AIDS in Southeast Asia, there were numerous papers on HIV research and programmes among CSWs. These papers covered the tragic deepening intensity of infection, obstacles to consistent condom use, social background to involvement in sex work, and numerous (eg. outreach, peer-based, institutional, educational) HIV preventive programmes.
Incidentally our own presentation (by Professor Supom Koetsawang) concerned our multi- faceted intervention to promote consistent condom use in the sex industry in Thailand. In particular, we described our new video which has been designed to assist CSWs in raising their self-esteem and considering their future, which our prior research has indicated were major features in influencing their motivation to use condoms with all customers.

Realism vs moralism
There were considerable continuities presented across countries of Southeast Asia in terms of their sexual and IDU cultures. The form of the epidemic within the region was seen to have been shaped to a great extent by the interacting impacts of gender, social marginalization, economic development, and mobility. A number of studies from, for instance, Cambodia and Vietnam, implicated cross-border mobility in HIV transmission in relation to social change in the wake of market reform, liberalization, and increasing trade.

A major theme which permeated much of the discussion of policy formation and intervention implementation was the struggle between, what I would call, pragmatic and realistic, as opposed to moralistic, stances on HIV prevention in Southeast Asia. As Dwyer expressed it at the outset, too many governments are "basing their (HIV/AIDS) policies on how they would like people to behave, rather than on how they actually behave". National AIDS Programmes in Southeast Asia will have to pay continuing attention to surmounting the politico-religious and cultural obstacles and 'sensitivities' which can prevent them from undertaking effective actions.

At the close of the conference, the chairman Professor Natth Bhamarapravati (Mahidol University) expressed the hope of "Thailand as a phoenix rising out of the ashes of the disaster of AIDS as a better, stronger society -- more compassionate, with greater justice and well-being". This is perhaps typically positive of 'Thai-style', which rightly points towards the kinds of social measures which are needed, but also engenders a sense of concern about the enormity of what still needs to be done to combat HIV/AIDS in Southeast Asia.
My detailed review of the conference is forthcoming in Aids Care.

Dr Nicholas Ford is senior lecturer in Geography at the University of Exeter