EDITORIAL A case for strong action

2009/12/03

FIVE countries -- China, Vietnam, Malaysia, Cambodia and Papua New Guinea -- account for 90 per cent of the estimated HIV cases in the World Health Organisation's Western Pacific region. On the face of it, in a region of 37 countries and areas consisting mainly of small Pacific island states like the Cook Islands, Fiji, Guam, Kiribati, Mariana Islands, Marshall Islands, Micronesia, Nauru, New Caledonia, Niue, Palau, Pitcairn Islands, Samoa, the Solomon Islands, Tonga, Tuvalu, Vanuatu, and Wallis and Futuna, as well as Brunei, Hong Kong, Laos, Macau and Singapore, the numbers can be expected to be bigger in the top five countries owing to their larger populations.

At the same time, however, it's clear that our position relative to our regional neighbours is not just a matter of the size of the population. This is underscored by Australia, Japan and New Zealand, which together accounted for about 90 per cent of the cases in 1995, no longer topping the list. In these countries, as well as in the small states and big nations in the region such as South Korea and the Philippines, HIV is considered to be a "low-level" epidemic. In contrast, China, Vietnam, Malaysia and Cambodia have a "concentrated" epidemic, while Papua New Guinea has a "generalised" epidemic. It's clear that what counts most is the percentage of the population, and high-risk groups such as injecting drug users, living with the disease.

It's also clear that the HIV epidemic Malaysia faces today is not the same as when it was first reported here 23 years ago. Where it used to be driven by the sharing of needles among intravenous drug users, and though this remains the main mode of transmission, with unprotected sex by both heterosexuals and homosexuals currently responsible for more than a third of new cases, there are clear indications that sexual transmission has become a major route. And though the HIV-positive person is still predominantly male, there has been a worrying shift in the gender profile with the four-fold increase in the number of women infected over the last 10 years. While the number of new infections has declined over the last seven years, and there are signs that harm-reduction measures have been successful, the disease remains a threat. Our third position in the Western Pacific, the stigma and discrimination faced by fishermen, factory workers, lorry drivers and others living with HIV/AIDS, and the lack of access to treatment, care and support, make for a strong case to significantly strengthen our responses at all levels.