HIV and AIDS in southeast Asia

The study by Beat Richner and colleagues (May 17, p 1451)1Richner B Laurent D Sunnarat Y Bee D Nadal D Spread of HIV-1 to children in Cambodia.Lancet. 1997; 349: 1451-1452Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar describes the rapid spread of HIV in Cambodia. We report data from the neighbouring countries and examine the effect of migration on the HIV and AIDS epidemic in the greater Mekong subregion (Thailand, Myanmar, Cambodia, Lao People's Democratic Republic [PDR], China, and Vietnam).Since the explosive increase in HIV among injecting-drug users (IDUs) in Bangkok and among prostitutes in northern Thailand in 1988–89, HIV has spread throughout Thailand.2Weniger BG Limpakarnjanarat K Ungchusak K et al.The epidemiology of HIV infection and AIDS in Thailand.AIDS. 1991; 5 (suppl 2): 71-85Crossref Scopus (405) Google Scholar In 1996, HIV prevalence in all 73 provinces of Thailand was about 45% among IDUs, 28% among brothel-based prostitutes, 11% among bar-based or restaurant-based prostitutes, and 1·7% among pregnant women. In Myanmar, the epidemic has also spread rapidly: 1996 sentinel surveillance showed HIV prevalence of 70% among IDUs, 21% among prostitutes, and 2% among pregnant women. The highest prevalence of HIV is in eastern border communities of Myanmar.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google ScholarThe north of Thailand and the eastern Shan State of Myanmar form the epicentre of the HIV and AIDS epidemic in the greater Mekong subregion. The prevalence of HIV in young men from these border regions was about 10% in 1990, by 1996, 7–12% of pregnant women in eastern Shan State were infected with HIV. Apart from malaria, AIDS is now the leading cause of morbidity and mortality in these communities.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google Scholar Not much data are available for the neighbouring PDR and China, but up to 80% HIV prevalence is reported among IDUs in the southwestern border prefectures of Yunnan.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google ScholarIn Vietnam, 1996 sentinel surveillance (20 of 53 provinces) revealed that 11% of IDUs, 0·7% of prostitutes, and 0·04% of pregnant women were infected with HIV. Most of the HIV cases are still confined to the south of the country, with IDUs accounting for some 80% of cases. However, new evidence has confirmed a rapidly increasing rate of HIV among prostitutes in all southern provinces bordering Cambodia and among IDUs in two northern provinces bordering China.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google ScholarThe HIV epidemic in the greater Mekong subregion started among IDUs and prostitutes. The initial rapid spread among IDUs can be explained by the easy availability of heroin and the sharing of needles. But heterosexual contacts are increasingly becoming the major mode of HIV transmission, because of the large, frequently patronised, and often unregulated sex industry in this region. Migration is also important in the spread of HIV in this region.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google Scholar Urban areas and newly industrialised regions attract increasing numbers of men and women who leave their families in search of employment. Most of the cross-border movements are illegal and undocumented. Many of the prostitutes in the thriving Cambodian sex industry originate from Vietnam, and young women from Cambodia, Myanmar, PDR, and China continue to be recruited into Thai brothels. The marginalisation of these migrant workers, along with the lack of access to social services, renders them especially susceptible to HIV.Against this background, we call on all the countries in this region and on regional and international organisations to closely collaborate in implementing effective interventions targeted at IDUs, prostitutes, and migrants. The study by Beat Richner and colleagues (May 17, p 1451)1Richner B Laurent D Sunnarat Y Bee D Nadal D Spread of HIV-1 to children in Cambodia.Lancet. 1997; 349: 1451-1452Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar describes the rapid spread of HIV in Cambodia. We report data from the neighbouring countries and examine the effect of migration on the HIV and AIDS epidemic in the greater Mekong subregion (Thailand, Myanmar, Cambodia, Lao People's Democratic Republic [PDR], China, and Vietnam). Since the explosive increase in HIV among injecting-drug users (IDUs) in Bangkok and among prostitutes in northern Thailand in 1988–89, HIV has spread throughout Thailand.2Weniger BG Limpakarnjanarat K Ungchusak K et al.The epidemiology of HIV infection and AIDS in Thailand.AIDS. 1991; 5 (suppl 2): 71-85Crossref Scopus (405) Google Scholar In 1996, HIV prevalence in all 73 provinces of Thailand was about 45% among IDUs, 28% among brothel-based prostitutes, 11% among bar-based or restaurant-based prostitutes, and 1·7% among pregnant women. In Myanmar, the epidemic has also spread rapidly: 1996 sentinel surveillance showed HIV prevalence of 70% among IDUs, 21% among prostitutes, and 2% among pregnant women. The highest prevalence of HIV is in eastern border communities of Myanmar.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google Scholar The north of Thailand and the eastern Shan State of Myanmar form the epicentre of the HIV and AIDS epidemic in the greater Mekong subregion. The prevalence of HIV in young men from these border regions was about 10% in 1990, by 1996, 7–12% of pregnant women in eastern Shan State were infected with HIV. Apart from malaria, AIDS is now the leading cause of morbidity and mortality in these communities.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google Scholar Not much data are available for the neighbouring PDR and China, but up to 80% HIV prevalence is reported among IDUs in the southwestern border prefectures of Yunnan.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google Scholar In Vietnam, 1996 sentinel surveillance (20 of 53 provinces) revealed that 11% of IDUs, 0·7% of prostitutes, and 0·04% of pregnant women were infected with HIV. Most of the HIV cases are still confined to the south of the country, with IDUs accounting for some 80% of cases. However, new evidence has confirmed a rapidly increasing rate of HIV among prostitutes in all southern provinces bordering Cambodia and among IDUs in two northern provinces bordering China.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google Scholar The HIV epidemic in the greater Mekong subregion started among IDUs and prostitutes. The initial rapid spread among IDUs can be explained by the easy availability of heroin and the sharing of needles. But heterosexual contacts are increasingly becoming the major mode of HIV transmission, because of the large, frequently patronised, and often unregulated sex industry in this region. Migration is also important in the spread of HIV in this region.3Paul S Stern A Chantavanich S Report of The Second Technical Consultation on Transnational Population Movement and HIV/AIDS in Southeast Asian Countries (May 1997, Chiang Rai).Country Reports. Asian Research Center for Migration, Chulalongkorn University, Bangkok, Thailand1997Google Scholar Urban areas and newly industrialised regions attract increasing numbers of men and women who leave their families in search of employment. Most of the cross-border movements are illegal and undocumented. Many of the prostitutes in the thriving Cambodian sex industry originate from Vietnam, and young women from Cambodia, Myanmar, PDR, and China continue to be recruited into Thai brothels. The marginalisation of these migrant workers, along with the lack of access to social services, renders them especially susceptible to HIV. Against this background, we call on all the countries in this region and on regional and international organisations to closely collaborate in implementing effective interventions targeted at IDUs, prostitutes, and migrants.