Inexorably, the epicentre of the global HIV pandemic is moving from Africa to Asia. Despite many years of much-publicised analysis of the African epidemic, most countries in Asia and many in the Pacific have not introduced the public health strategies known to minimise the spread of HIV. What must be done now, and how can the developed countries in the region, such as Australia, assist their neighbours?
PIP: In the Asia-Pacific region, almost 5000 people become infected with HIV every day. The leading mode of HIV transmission is heterosexual intercourse. Sharing of injecting equipment among drug users is also a major mode of HIV transmission. Myanmar is the epicenter of the HIV epidemic in Asia. The political tensions there interfere with attempts to curb the spread of HIV in-country and to neighboring countries. The lack of effective cross-border programs has resulted in an explosive situation in China's south Yunnan province, especially among drug abusers. In many countries in the region, the blood supply is unsafe. Thailand is the only country politically committed to curbing HIV transmission. Government-facilitated massive education programs and other interventions preceded a decline in the overall rate of sexually transmitted diseases (STDs) in Thailand. Key strategies in Thailand include detailed epidemiologic studies to determine the incidence and prevalence of HIV infection nationwide, promotion of safer sex practices in commercial sex establishments (e.g., 100% condom campaign), and official willingness to work with nongovernmental organizations. The government of India has not responded appropriately to the HIV/AIDS epidemic and the outcome has been disastrous. India will likely soon have more HIV-infected people than any other Asia-Pacific country. Preventive programs may spare western Pacific countries, where HIV incidence is low. Obstacles to tackling the HIV epidemic include poverty, poor facilities for the treatment of STDs, failure to address discrimination against those infected with HIV, and problems associated with the very low status of women. Many years of national development can be lost to the HIV epidemic. Australia has model HIV prevention and control policies and can help its Asia-Pacific neighbors fight HIV/AIDS. Health professionals in only Thailand, Australia, and New Zealand are prepared for the future AIDS caseload. Australia offers clinical programs for the region's health professionals. Greater political commitment is needed in the region to minimize the HIV/AIDS epidemic.