Asia's burgeoning Aids epidemic

A nurse with an HIV-positive baby at a Thai hospital

By BBC News Online's Mangai Balasegaram

The numbers are nowhere as numbing as Africa's, but the Aids epidemic in Asia is growing ever greater, and creeping into the most remote corners of the continent.

There's ample room for growth... we're particularly worried about Burma

Peter Piot, UNAIDS chief

In many areas, all the ingredients for a disaster are there - a lack of education, a large and mobile population, and governments and societies ill-prepared or unwilling to cope.

And in some areas, that disaster is already apparent.

Remote towns in China such as Urumqi now face an HIV epidemic

Of particular concern is Burma, where experts have painted a very grim picture from the limited data available.

A staggering 48,000 Burmese died of Aids last year, says the United Nations Aids programme (UNAIDS), and most of them would have had little care or treatment.

Young epidemic

Aids researcher Chris Beyrer pointed out that it took African countries two decades to reach its tragic levels of infection, which rise to a third of adults in some areas.

In Asia, the Aids epidemic is still very young. Most infections in China, for example, have occurred in the last two years.

Burma's drug trade is fuelling addiction as well as an HIV epidemic in Asia

"So we really don't know what the picture is going to look like," said Mr Beyrer, director of the US-based John Hopkins University Aids Training and Research Programme.

"Asia hasn't learnt from Africa," said Marina Mahathir, president of the Malaysian Aids Council.

"Trying to get attention for the problem is still difficult."

Burma's mushrooming epidemic

Against a background of social and economic fragility, the epidemic in Burma has been particularly hard to deal with.

Much of Asia does not have the resources required to cope

The widespread availability and low cost of heroin, tremendous social mobility, lack of access to condoms and health-care in general had led to a mushrooming epidemic.

Experts say the vast majority of new infections are not even reported.

Mr Beyrer said many young people worked as seasonal labourers in gem mines, where use of drugs and sex workers was commonplace.

"There's very little prevention and treatment and care," he said.

"The levels of infection are approaching an African level."

"The reality is that it's extremely difficult to implement any form of public health measure," he said.

Even in wealthier Asian countries, only a small minority can afford new treatments

A recent World Health Organisation study rated Burma's health-care system as the second-poorest in the world, with only Sierra Leone faring worse.

Burma's Aids problem is slowly spilling over its borders. Yunnan province in China, Manipur state in India and northern Thailand - which all neighbour Burma - are some of the worst-hit areas in those countries.

Drugs and taboos

Drug use is also fuelling the Aids epidemic in all Asian countries except Cambodia and Papua New Guinea, and yet, very few effective programmes have been implemented to deal with drug use.

Asia's large drug trade also lies behind exploding epidemics elsewhere. The Russian city with the second-highest infection level is Irkutsk, which lies on a heroin smuggling route out of China.

There's some sort of Aids fatigue...[people have] grown a bit tired of Aids messages and are taking them less seriously

Jon Ungpakhorn, Thai Aids activist

Age-old cultural taboos on sex and the stigma attached to the disease also present clear obstacles.

Many governments only gingerly broach sex education, leaving populations painfully ignorant of the disease.

A new study on nearly 4,000 people in Chinese cities and villages by the Gunming Daily found only 3.8% of people knew how HIV was transmitted.

Half the people surveyed believed the virus could be transmitted by using chopsticks after an HIV-positive person had used them.

Drug injection is a major factor in nearly all countries

Few countries are able to mount the enormous and effective HIV prevention programmes seen in Thailand, which had led to a dramatic drop in new HIV infections.

Ethnic minorities from Burma living in northern Thailand are particularly vulnerable to infections, with their high amphetamine and low condom use.

But even in Thailand, there are signs of a growing complacency, and infection is spreading among migrant workers.