HIV/AIDS in Asia: introduction.

The objective of this special issue of AIDS Education and Prevention is to familiarize interested health professionals with the history and the nature of the HIV/AIDS epidemic in Asia, Southeast Asia, and South Asia, including the intervention approaches that have been used and opinions on the future of the epidemic in these countries. We have been fortunate to obtain articles from leading experts in HIV/AIDS in each of the countries represented in this special issue. This introduction provides an overview of the epidemic in the region and analyzes key factors in confronting the epidemic successfully in Asia. Although there were sporadic reports of HIV-infected individuals in many of the Asian countries prior to 1988-1989, most were men who have sex with men returning from the United States, Europe, or Australia or were recipients of contaminated factor VIII from the United States. In 1988-1989, however, there was an explosive epidemic of injection drug use in the countries bordering the infamous Golden Triangle. HIV entered into the injection-drug-using population, and by 1989 high proportions of injection drug users (IDUs) in Thailand, Myanmar, southern Yunnan, and northeast India were found to be infected (Crofts, Reid, & Deany, 1988; Ma et al., 1990; Phoolcharoen, Ungchusak, Sittitrai, & Brown, 1998; Sarker et al., 1993; Sarker, et al., 1994; Zhang, et al., 1991; Zheng et al., 1994). The Thais implemented a sentinel surveillance program in 1989, which then documented the spread of HIV/AIDS from the IDU population into the commercial sex population from which it spread to the majority heterosexual population. In many of the countries of Southeast Asia and Asia, men are expected to have sex with multiple partners both prior to and after marriage, whereas women are expected to have only one lifetime sexual partner, their husband. To accommodate this disparity, there are many commercial sex workers (CSWs). In Thailand and Cambodia, the majority of CSWs work in commercial establishments, whereas in the other countries of the area CSWs include indirect sex workers working in bars, restaurants, and barber shops, as well as street-walking and establishment-based direct sex workers. Young IDUs tend to be more sexually active than non-drug users, and to have sex with CSWs, infecting them and promoting the spread to the general heterosexual population (Nguyen, Hoang, Pham, & Detels, 2001; Wu, et al., 1997). Even in the most severely affected countries in the region—Thailand, Cambodia, and Myanmar—the prevalence of HIV in the sexually active adult population has not exceeded 2%. The sexual mixing pattern in Asia, in which males have multiple partners but only a small proportion of females do, would seem to be a particularly efficient pattern for rapid spread of HIV, with the CSWs acting as a continuing reservoir AIDS Education and Prevention, 16, Supplement A, 1–6, 2004 © 2004 The Guilford Press