AIDS and HIV Prevention in Southern Asia
As the AIDS pandemic in Africa has shown us, the spread of this disease in an impoverished area of the world can be swift and devastating. Currently, we have a small window of opportunity to engage in education and prevention programs that can exponentially reduce the number of people in Southern Asia who will live and die with AIDS.
In 1999, one half of all new HIV infections worldwide were reported in Southern Asia. While Thailand and Cambodia have the highest percentages of population living with HIV, India and Indonesia have the fastest growing rates of new infections in the region. With its dense population, India is a country where even a relatively low HIV prevalence rate translates into a large number of infections. In fact, at the end of 2001, an estimated 3.97 million people were living with HIV/AIDS, more than any other country in the world except South Africa.
The rate of spread of this disease can be overwhelming in Southern Asia. In Indonesia, the world’s fourth-most populous country, HIV prevalence rose from 15.4% in 2000 to more than 40% by mid- 2001 at one drug treatment center in Jakarta. In Cambodia, Thailand and Myanmar, the rate exceeds 1% among 15 to 49-year-olds. In these countries, HIV is transmitted primarily through unsafe sex and drug injection practices.
As the occurrence of infection increases, the circle of those affected grows wider and wider. With each new case of illness at least three groups are touched. First, the person who becomes ill loses quality of life and suffers the effects of an extended and devastating disease. Second, members of that person’s family are touched, especially those who may depend on the individual for support, often children and aging parents. Finally, an unknown group may be affected if the ill person transmits the virus, starting the cycle again.
Three quarters of the world’s poorest people live in Southern Asia, making this region particularly vulnerable to the risk of HIV infection. Poor people and those of minority status often have the least access to education that could help them protect themselves and low rates of literacy mean any available resources may not reach all people. Often this group does not have access to quality healthcare and the daily realities of life, such as little clean water and poor sanitation, making it difficult to prevent and treat common diseases. Particularly at risk are women and children who may be abducted or tricked into leaving their homes by promises of work to support their families. When they are alone in a strange place, sex is often the only source of income available. Women and girls are made even more vulnerable by the propensity toward violence and sexual abuse.
The most potent way to avert the devastating impact of HIV/AIDS is to act before the epidemic takes hold. The World Bank has estimated that it would cost one billion dollars per year to provide just one drug to treat those already infected with HIV in India alone. Conversely, it would only cost $159 million per year to fund a prevention program for those most as risk – before the virus becomes more prevalent in the broader population.
According to the US Department of State’s Office of International Information Programs, Thailand’s well-funded ($1.30 per person spent last year on HIV/AIDS programs compared to less than ten cents per person in India), politically supported and comprehensive prevention programs have reduced the number of annual infections from 143,000 in 1991 to 29,000 in 2001. In fact, calculations indicate that the rate of return on investments in Thailand could yield a savings of 12 – 33% in the avoided medical expenditures alone by 2020.
Likewise, in Cambodia, consistent political commitment has resulted in the drop of HIV prevalence from more than 4% in 1999 to 2.7% in 2001. This improvement was achieved through a multifaceted response that included a condom usage program and steps to counter stigma. HIV/AIDS prevention has also been mainstreamed into the strategic plans of many areas of the government.
While political efforts have been largely successful, many people look to religious doctrines to define and legitimize moral and sexual behaviors. This makes the church a powerful influence in this area as the issue of birth control in Indonesia shows. In Indonesia, there was tremendous resistance to a national birth control program until Muslim leaders considered the question. They decided that family planning was a way of fulfilling the Koran’s teaching to care for one’s children and to only have the children that one could care for sufficiently. With Muslim leaders’ support in local communities, Indonesia has developed the most successful national birth control program in the developing world.
In Thailand, Christian theater groups have produced plays about HIV prevention that are shown on national television. Global Ministries partner, the Church of Christ in Thailand, has started special projects to help affected groups cope with HIV and AIDS. By training volunteers who provide home- based and community-based care, this outreach focuses on encouraging churches to serve as resource centers for AIDS information and care for all persons in their communities, regardless of their religious affiliation. In India, the church is providing HIV/AIDS training to healthcare workers in places where government programs have not been developed.
Advocacy Opportunities
1. Write to your congressional representatives asking that some of the $15 billion designated for global AIDS support be directed to prevention measures in Southern Asia. Be sure to point out the positive results achieved by existing prevention programs and the cost savings of prevention versus treatment.
2. Ask your global partners to initiate programs to ensure AIDS prevention.