UNAIDS executive director Peter Piot said the number of HIV/AIDS infections threatened to snowball in the Pacific, a development he said that would not only take a significant human toll, but potentially add to the region's economic woes and increase political instability. "The history of the AIDS epidemic has taught us that once things start moving it's like a snowball and it's going to get worse and worse," he said. "The stage is set for an expanding and widespread HIV epidemic in the region due to a dramatic increase in sexually transmitted infections and risky sexual behavior among young people aged 15 to 25."

    Piot said Papua New Guinea and the neighboring Indonesian province of Irian Jaya were the worst affected, with HIV infection rates up to 10 times higher than other Pacific nations.

    "PNG needs a very, very vigorous response, otherwise it will go the African way," he said. In some African nations, almost 40 percent of the population are HIV-positive, with rates rising to 60 percent in the worst-hit regions.

    "PNG has everything that's wrong-lots of migration within the country, family disruption within towns and villages, a lot of sexually transmitted infections and a sexual culture that makes HIV spread very rapidly, despite the influence of various churches advocating abstinence."

Devastating Women

    Earlier this month, UN Secretary General Kofi Annan said HIV/AIDS was taking a devastating toll on women. "In the world as a whole, at least half of those newly infected are women, and among people younger than 24, girls and young women now make up nearly two-thirds of those living with HIV," he said on March 8 to mark International Women's Day.

    "If these rates of infection continue, women will soon become the majority of the global total of people infected."

    Annan said factors such as poverty, abuse, and a lack of education were making many current prevention strategies ineffective. "Where sexual violence is widespread, abstinence or insisting on condom use is not a realistic option for women and girls," he said.

    UNAIDS deputy executive director Kathleen Cravero said women's infection rates in Asia-Pacific had jumped 10 percent in the past two years and would likely soon match that of men if governments failed to take action. "Women make up 30 percent of adult infections in Southeast Asia and in some countries this is fast moving towards 50 percent. "In Papua New Guinea more than half of all new infections are among women," she said.

    Cravero said marriage had proved to be a high risk factor for women throughout Asia, with many husbands having several extramarital partners and their wives powerless to object.

    "In Thailand a full 40 percent of new infections occur between spouses, with 90 percent of them from husband to wife, and we have seen a similar trend in other countries such as India," she said. "One of the biggest factors for this in Asia is the culture of silence, in which women cannot ask about sex or the sexual behavior of their partners."

    Malinee Sukavejworakit, advisor to the Thai Senate Committee on Public Health, said Thailand had made great strides in AIDS awareness but that cultural issues posed an obstacle to educating women about the disease.

    "We try to put condom machines in universities and public places but Asian culture is different, it is very difficult to persuade people to accept that condoms must be accessible, but this needs to be done," she said. "Girls at school and the wife at home, who were once the lowest risk group, are now high risk because of the behavior of their husbands and boyfriends."

    Cravero said there were fears that the epidemic in Asia could develop into a situation similar to sub-Saharan Africa, where of the 29.4 million people with HIV/AIDS some 58 percent are female.

    One possibility being explored is that women may be clinically more vulnerable to HIV than men, but another factor is that they face a high threat of rape by acquaintances or coercive sex with infected husbands.

    The UN says one in every five HIV infections worldwide occurs in the Asia-Pacific region. It estimates over eight million people in the region had been infected with the virus by the end of 2002, of which more than 2.5 million were between the ages of 15 to 24.