No Condom, No Sex
AIDS battle reaches new climax in Asia with aggressive condom policy
By P. Parameswaran
Agence France-Presse
MANILA
In an aggressive policy to stem the growing HIV/AIDS problem, the World Health Organization wants sex workers in Asia to adopt an uncompromising "no condom, no sex" stand when facing clients.
WHO is working together with authorities in China, Myanmar, Mongolia, Vietnam, Laos, and the Philippines to implement 100-percent condom use in commercial sex establishments in these countries. The "100-percent condom use program" has been highly successful in Thailand and Cambodia where new infections have nosedived by more than 80 percent since the peak of the HIV/AIDS epidemic in the two Southeast Asian countries in the last decade, WHO officials say.
The program involves distributing condoms to sex workers, teaching them about safe sex, and enlisting the support of the police.
"There has been amazing success with this strategy," said Shigeru Omi, WHO regional director for Western Pacific. "We need to make sure this continues. Any gains can be undone quickly."
"Condoms save lives. We need to vigorously step up promotion of this life-saving device to prevent millions of people from getting infected," said Dr. Giovanni Deodato, the WHO representative to Laos where Asian health authorities met in mid-August to secure a consensus on the 100-percent condom use program.
During the meeting, central and local government health officials from across the region agreed to expand the 100-percent condom use program in a bid to prevent the escalation of the HIV/AIDS epidemic. Representatives from national AIDS programs concluded the evidence showed that it was a highly effective response to address Asia's AIDS epidemic, the WHO said.
"There are few success stories in AIDS. This is one of them," said Dr Bernard Fabre-Teste, who heads the HIV/AIDS and sexually transmitted infections unit at the WHO Western Pacific office in Manila. "The epidemic in Asia is still concentrated in certain areas. If this program is expanded, we have a real chance at containing this epidemic."
The WHO said pilot programs begun in several countries over the last few years had effectively boosted condom use and reduced new HIV infections.
"This is a response developed in Asia, for Asian countries, to address an AIDS situation that is quite unique to the region," added Deodato.
Not Without Opposition
But the WHO policy has been criticized by some nongovernmental groups, which argue that the UN agency is effectively condoning prostitution by encouraging condom use among sex workers.
Some governments in the region, including in the Philippines where the Church strongly campaigns against artificial contraceptives, are also treading carefully on the issue, considering religious and cultural taboos.
But health experts underline the need for a swift response as commercial sex is fueling the spread of HIV/AIDS in the Asia-Pacific region, where already seven million people suffer from the deadly disease.
As most Asian women have few sexual partners, high-risk sexual behavior is usually centered in the clandestine and thriving sex trade, which is sometimes brothel-based and often linked to entertainment establishments like karaoke lounges, the WHO said.
Warned the agency: "Relatively high rates of HIV infection have been seen among sex workers in many parts of the region, including in Cambodia, Myanmar, and Vietnam with the virus rapidly spreading into the general population. Epidemics can explode with only a small pool of sex workers infected with HIV, as seen in Thailand."
Although the HIV/AIDS problem has not reached dangerous levels as in Africa, the Asia-Pacific region "is set to become the epicenter of the global pandemic in the next decade," according to the WHO. It warns that at least 30 million people are expected to be infected with HIV/AIDS in the world's most populous nations China and India by 2010.
To contain the crisis, the WHO is working together with governments to push the 100-percent condom use policy in brothels and other commercial sex establishments mushrooming in the region.
WHO officials acknowledge that they initially faced difficulties in getting the message across to governments but that the authorities in the region are now far more open because of the urgency of the issue.
The adoption of the 100-percent program has led to sharp declines in HIV infections, the global health body said.
Often cited by the WHO are the efforts of Cambodia and Thailand, which had pushed for maximum condom usage in sex establishments as a key pillar of their battle against HIV/AIDS.
"The program has prevented a few million HIV infections in Thailand. This year, the Thai Ministry of Public Health will distribute 26 million condoms free to vulnerable groups," said the WHO.
In Cambodia, 20 million condoms were sold last year-or 50,000 a day-representing a massive 200-percent growth in sales over the last 10 years.
"We want to replicate the success we had in Cambodia and Thailand elsewhere in Asia, where AIDS is becoming a big problem," said Fabre-Teste.
The program is also currently being piloted in sex establishments in China, Myanmar, Mongolia, and Vietnam. Similar projects were also initiated recently in the Philippines and Laos.
"In all these countries, condom use needs to be considerably expanded, particularly in the sex industry," the WHO said, pointing to the high prevalence of sexually transmitted infections in China, Laos, Mongolia, the Philippines and among Pacific islanders.
A study of men attending clinics treating sexual diseases in southern Vietnam found 75 percent had visited a sex worker in the last three years but only seven percent used condoms regularly, the WHO said. Seventy percent of them had never used condoms.
In China, 26 percent of Chinese sex workers have never used a condom even once, according to government surveys. In 1995, this figure stood at 70 percent.
"Nearly everywhere in Asia, more efforts are needed to promote condoms. In many countries, they are unavailable or costly and there may be little public knowledge about their benefits," the WHO said.
Participants at the conference stressed that strong political and financial support for the program was essential. "There has been good progress but we still have many hurdles to cross to expand the program. Political support is critical. We need to advocate to parliamentarians and ASEAN that this program works," said Fabre-Teste.
24 Billion Condoms
The 100-percent condom use program would require distributing worldwide about 24 billion condoms a year, four times the current six to nine billion being distributed.
Of this total, over one billion condoms are needed for China's estimated six million sex workers, the WHO said, citing studies last year showing that fewer than 20 percent of Chinese sex workers use prophylactics regularly.
The WHO considers China a "potential AIDS tinderbox," noting that one million people are infected with the virus and knowledge about how to prevent its transmission was poor.
"The 100-percent condom use program will be crucial in our efforts to contain AIDS, particularly in the world's most populous country China," said Ong Gaik Gui, a WHO technical officer. "If we do not act quickly to prevent infection, the epidemic will spread very quickly into the wider community."
Aside from China, the new campaign will focus on Laos, Mongolia, Myanmar, the Philippines, and Vietnam, where condom use is low and prevalence of sexually transmitted infections is high, WHO officials say.
For example, 20 percent of sex workers in China have never used a condom before. In Vietnam, nearly a quarter of sex workers in bustling Ho Chi Minh city are infected with HIV/AIDS. In southern Vietnam, only seven percent of men surveyed while attending clinics for sexually transmitted infections said they had used condoms.
Cambodia and Thailand are the only two Asian countries where HIV/AIDS cases are declining, largely because of widespread condom usage-more than 90 percent-in their commercial sex establishments. Prostitution is also no longer the driving force of HIV/AIDS infections in these countries, the WHO says.
Today, only 16 percent of HIV/AIDS cases in Thailand and 21 percent in Cambodia developed from the sex industry compared with 80 to 90 percent during the peak of the epidemic in the last decade. At one time, about half the number of sex workers in Thailand's northern Chiang Mai city and Cambodia's Sihanoukville city were ill with HIV/AIDS. with a report from Ben Rowse in Hanoi
|
