HONOLULU (July 5) -- Asian countries are underestimating the HIV/AIDS epidemic and missing essential data on populations at risk, leading Asian policymakers to become complacent in fighting the epidemic, an East-West Center health specialist said.

While experts predict Asia's HIV epidemic will not reach sub-Saharan levels of 15 percent or more of the adult population, reaching 2-3 percent levels still means "huge trouble" for Asian countries, said Tim Brown, a senior research fellow who focuses on HIV/AIDS in Asia and the Pacific.

"The countries of this region have to wake up to reality," Brown said. "Two and three percent levels are possible in much of Asia. Those levels are sufficiently bad that leaders must take an active role.

"The most dangerous thing is that the numbers stay below the threshold of political attention while the epidemics continue to grow steadily," said Brown, whose work on developing the Asian Epidemic Model was featured in the June 25 issue of Science magazine. The model includes the populations driving HIV/AIDS in Asia, including sex workers and their clients, injecting drug users and men who have sex with other men.

Brown said there are major gaps in Asian data systems. Most countries don't know how many sex workers they have or what percent of males visit them, nor do they have counts on drug users. "These are what drive the epidemic, yet these key pieces of information are still not known 20 years into the epidemic."

This lack of data and the slower growth of HIV/AIDS epidemics in Asia have led policymakers, media and international aid programs to underplay and ignore the problem, leading to anemic responses. Brown conducted a seminar this summer at the East-West Center on integrated analysis for 30 researchers from Vietnam, Bangladesh, China, Thailand and India to help them get a "clearer picture" of the epidemic.

Brown said that while there have been some successes in Asia, most countries are not seriously addressing HIV/AIDS. In most of the region, small but well-funded "boutique" prevention programs remain far too limited in scale and reach. The coverage of the key populations driving the epidemic remains quite low and the programs to reach them are underfunded. In the last year, leaders in China and Vietnam have promised expanded and appropriate responses, but it remains to be seen if they will follow through on a scale that can turn their epidemics around.

Thailand and Cambodia have seen success in their prevention programs, but Brown questions if Thailand can sustain this success as antiretroviral costs climb. In half a decade providing antiretroviral drugs for the 1 percent of its population living with HIV will cost $100 million or more annually. The government now budgets $40 million for its HIV/AIDS programs. It will be a challenge for the country to sustain prevention efforts as care needs grow, but maintaining the balance is essential.

Other indicators of growing problems:

Increasing levels of HIV infection among sex workers, injecting drug users, and men who have sex with other men are being seen in countries around the region, including some of the world's largest countries: China, India, and Indonesia.

In many countries less than 10 percent of the at-risk population is being reached by programs.

In many parts of Asia people get arrested for carrying condoms or needles. "How can you engage in prevention if carrying these gets you arrested?" Brown asked.

The sex industry is a part of much of Asian business culture.

Brown said conservative attitudes in Asian countries often prevent data collection and limit work among the vulnerable populations. "Public service announcements don't have a big impact, but we do know that programs for sex work and drug use are effective in an Asian context. The problem is that we just aren't doing them on a scale that will make a difference."

Tim Brown can be reached at (808) 944-7476 or

*** International Seminar on HIV/AIDS: Social Behavior, Stigma and Discrimination, Beijing, July 6-9, supported by the Ford Foundation and hosted by the National Population and Family Planning Commission and the Network for HIV/AIDS Prevention in China, with help from the East-West Center in Honolulu.

*** XV International AIDS Conference, Bangkok, July 11-16.

*** Recent East-West Center publications on HIV/AIDS in the Asia Pacific: 1. "HIV/AIDS Awareness Is Improving in China," by Chen Shengli, Zhang Shikun, and Sidney B. Westley. Asia-Pacific Population & Policy, April 2004, No. 69, 4 pp. Free PDF file:

2. "Tackling the HIV/AIDS Epidemic in Asia," by Tim Brown. Asia-Pacific Population & Policy, January 2004, No. 68, 4 pp. Free PDF file:

The East-West Wire is a news service provided by the East-West Center in Honolulu. Any or all of this report may be used with attribution to the East-West Center or to the person quoted. For information, contact Susan Kreifels at (808) 944-7176 or  For a directory of all East-West Wire reports, see For daily news on the Pacific Islands, see For links to all East-West Center media programs and services, see

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