AIDS in Asia

Abstract

In the mid-1980s, when AIDS (acquired immune deficiency syndrome) was well established in North America and Africa, it was little known in Asia. Now the World Health Organization (WHO) estimates that before 2000 most new cases of HIV (human immunodeficiency virus) infection, which causes AIDS, will occur in Asia (Mann 1992, 4; World Bank 1993, 33). Worldwide the number of HIV-infected persons will increase from nine million in 1990 to twenty-six million by 2000 (World Bank 1993, 99). During that period the number of infected people in south, east, and southeastern Asia will rise from fewer than half a million to nine million, which means that an additional 8.6 million cases will be recorded for Asia by the end of the twentieth century. The corresponding tally for Africa is 6.2 million (World Bank 1993, 33). The Global AIDS Policy Coalition asserts that by 2000 Asia will overtake Africa as the most Aids-afflicted continent (Mann 1992). HIV is transmitted primarily by three methods: sexual intercourse; intravenous exposure to HIV-infected blood through transmission, donated organs, and drug use; and vertical transmission from mother to child (Over and Piot 1993, 460). The patterns and prevalence of these three modes of transmitting HIV vary geographically. On the bases of data from the period when the virus began to spread significantly, the prevalence of each mode, and its specific mechanisms, WHO distinguishes three epidemiological patterns of HIV infection (Mosley and Cowley 1991, 20). Pattern I is typical of western Europe, North America, Australia, and New Zealand, where the most common form of transmission is male homosexual or bisexual intercourse and the second most is intravenous drug use. Pattern II, in which heterosexuals are the main group affected, is found in sub-Saharan Africa, the Caribbean, and parts of South America. Pattern III is typical of countries where HIV has recently been introduced. Much of Asia and eastern Europe fit this pattern. Prostitutes, their clients, and intravenous drug users account for most cases. The first AIDS case in Asia was reported in Israel in 1980, post diagnosis (Dossier 1988, 154). No AIDS case was detected in any other Asian country for the next three years. The Philippines, Thailand, and Turkey reported AIDS cases in 1984; first-time reports of cases came from China, Hong Kong, Japan, and Qatar in 1985. By 1 January 1992, as many as twenty-eight Asian countries, outside the former Soviet Union, had officially reported cases (Fig. 1). A relatively large number of countries reported cases for the first time in the mid-1980s, in contrast with the early and late years of that decade. Thirty new cases were reported in 1985 (Fig. 2). The number rose steadily to 1990, when 403 were officially reported. The tally dropped in 1991 but sharply increased in 1992 and soared to more than three thousand in 1993. One source (Economist 1994b, 128) used WHO data to assert that a total of 10,387 AIDS cases had been officially recorded in Asia as of February 1994. That tally is less than for the Americas in 1984 or for Europe by 1987. But if the current trend persists, Asia will have the largest number of AIDS cases in the world in a decade. Without proper intervention programs to slow the spread of AIDS in Asia, the epidemic will bring catastrophe to many countries. The main objective of this article is to examine the spatial patterns of AIDS distribution in Asia. Data were available from twenty-eight countries, all outside the former Soviet Union. Three variables are usually used to study distribution patterns of AIDS: HIV-infected cases, AIDS cases, and deaths attributed to AIDS. Data on the first and third variables are available only for a few Asian countries. Therefore, the AIDS cases alone are used to show the spatial distribution of the disease in Asia. Additionally, I examine the status of AIDS in Thailand and India in detail as case studies. …