*EPF105 07/12/2004
U.S. Working with Asian Countries to Avoid AIDS Explosion
(Raising awareness in Asia important theme at AIDS conference) (890)

By Charlene Porter
Washington File Staff Writer

Bangkok -- For the first time in its almost 20-year history, the world's largest gathering of AIDS experts, clinicians, policy-makers and activists is being held in Southeast Asia. In this setting, one clear purpose of the XV International AIDS conference is to send a message to Asian leaders that they must face the presence of HIV infection in their populations and take rapid and aggressive steps to control it.

The Joint U.N. Programme on HIV/AIDS (UNAIDS) delivered a warning to Asia almost a full week before the conference began when it released an updated census on the status of the disease worldwide.

The report stresses the rapid expansion of the Asian epidemic, counting 7.4 million people currently living with HIV throughout the region with recent spikes in number of infections in China, Indonesia and Vietnam. UNAIDS found that the disease in Asia is currently concentrated among injecting drug users, men who have sex with men, and commercial sex workers and their clientele. Because of the region's dense populations, however, the report warns that a spread of HIV into the general population will cause an explosion in the numbers.

During the opening ceremonies of the XV International AIDS Conference, U.N. Secretary-General Kofi Annan said, "There is no time to lose if we are to prevent the epidemic in Asia from spinning out of control."

The potential magnitude of HIV infections in Asia may seem staggering, but at this meeting delegates are devoted to looking squarely at the challenges ahead and finding ways to overcome them. The key to doing that is the learning experience delegates share -- one nation to another, one example at a time. Thailand is considered a particularly appropriate host for the conference because the Thais have one of the world's best records in recognizing AIDS in the early 1990s and in confronting and containing the disease.

Describing his nation's efforts with pride at the July 11 opening ceremony of the conference, Prime Minister Thaksin Shinawatra of Thailand said his country aims for 100 percent condom use as a means to contain the spread of the virus.

"The rate of condom use has been significantly raised from a very low level to more than 95 percent in just a few years," Shinawatra said. "It is estimated that this simple program has averted more than 5 million infections among the Thai people."

The U.S. Agency for International Development (USAID) has a long history in helping Thailand confront its AIDS problem, supporting programs for disease study, transmission prevention and medical clinic improvement as far back as 1987.

Currently USAID is involved in wider regional programs throughout Southeast Asia to help prevent the explosion of cases that analysts warn is possible. Given the concentration of the virus in certain vulnerable populations, USAID is working to better identify and protect those people, according to Lois Bradshaw, a USAID health officer based in Bangkok.

"We are trying to determine where [vulnerable people congregate], get size estimations of those populations, and test models to bring together a package of interventions to those areas to increase coverage rapidly," Bradshaw said in a Washington File interview at Bangkok's Impact Center, where the XV International AIDS Conference is taking place.

The USAID HIV/AIDS Health Office in Bangkok is addressing AIDS issues in five Mekong countries -- Burma, Cambodia, Laos, Thailand and Vietnam -- as well as China's Yunnan and Guangxi Provinces. The Mekong Regional Program is supported through $20 million in U.S. funding each year.

Bradshaw said one critical element in designing these programs is to ensure that disease-prevention efforts are implemented in a way that is consistent with local conditions and responsive to local problems. "In the end, if you want to have any sustainable programs, they have to be culturally aware, they have to be fully engaged in and fully owned by the populations of the countries themselves," she said.

The U.S. National Institutes of Health (NIH) also has a long history of working to combat AIDS in Thailand. With NIH funding, researchers from Maryland's prestigious Johns Hopkins University have been collaborating with Chiang Mai University for 15 years to study epidemiological patterns of HIV/AIDS in northern Thailand. The United States has supported this work with about $25 million in funding, and the collaboration is currently testing prevention and treatment interventions that have potential worldwide application.

The largest HIV vaccine trial in the world is currently under way in Thailand. The trial is a collaboration between the U.S. Armed Forces Research Institute of Medical Sciences, the U.S. Centers for Disease Control and Prevention and the Thai Ministry of Health. The trial began in late 2003 and is designed to involve 16,000 healthy, HIV-negative adults in a test of vaccines developed by private sector pharmaceutical companies. It is set to continue for five years.

Although there is a strong emphasis on the potential explosion of the AIDS epidemic in Asia at the XV International AIDS conference, the problems of Africa are also at the forefront. Africa remains the continent most seriously affected at present, home to 25 million people living with HIV out of a world total of 38 million.

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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