The HIV/AIDS epidemic in South Asia is being fuelled by the sexual behaviour of wealthy men and not by poverty as is widely believed, says a new study by UNAIDS and the Asian Development Bank
Rich men who often have unprotected sex with commercial sex-workers are behind the spread of the HIV/AIDS epidemic in Asia, according to a revolutionary new study that reports that HIV does not necessarily spread under conditions of poverty.
"Clients of sex-workers account for most HIV cases in Asia. Typically, they are wealthy men," said Ross McLeod, an economist, while presenting the findings of the study to delegates at the Eighth International Conference on AIDS in Asia and the Pacific (ICAAP) held recently in Colombo, Sri Lanka.
In Cambodia, for instance, 12% of the richest men in the country were responsible for spreading the HIV virus, says the joint study by UNAIDS and the Asian Development Bank (ADB).
The study pinpoints men who have sex with multiple partners, including sex-workers, and do not use condoms.
McLeod added that HIV infections among wealthy Asian women too were on the rise. "Seventy per cent of cases in Asia are male, but this is beginning to change."
The multi-nation study has important lessons for many governments in Asia that victimise consenting adults, many of them underprivileged, who practise safe sex, while several wealthy men are passing the virus on to their unsuspecting wives.
The study also turns the long-held and widespread belief that poverty fuels HIV/AIDS on its head. "Poverty does not seem to increase the risk of infection in the first place. But AIDS increases the risk of poverty," says Jacques Jeugmans of the ADB.
A number of UN health experts told the conference that a majority of HIV-positive women in the region are married women who have only had sex with their husbands, leading them to conclude that these women contracted the virus from husbands who had had unprotected sex outside marriage. This is certainly true in a country like India, which has the third highest HIV caseload in the world and the highest one outside Africa.
Indian epidemiologist Swarup Sarkar, regional director of UNAIDS for South Asia, says that although the joint UNAIDS-ADB study is an ongoing project it already holds out major policy implications for the way HIV/AIDS ought to be tackled in Asia.
For instance, one important new finding is about the way the virus has spread in countries -- it usually started among Injecting Drug Users (IDUs) in the 1990s, moved on to sex-workers, and from there to male clients and their faithful wives. Homosexuals and men who have sex with men were infected well before the epidemic took root among the general population.
"Therefore, early intervention among IDUs is essential," says Sarkar, pointing out that Bangladesh, Malaysia and Pakistan were now at the stage where they could benefit from making such an intervention, whereas the priority group for a country like Cambodia would be commercial sex-workers.
"But resource allocation (funding) is disproportionate," says Sarkar. Whereas "condoms and clean needles avert most infections," money from a US presidential fund for AIDS -- known by its acronym PEPFAR, which is the largest such channel of aid to fight HIV/AIDS -- was going into programmes to promote abstinence and faithfulness.
Compounding the problem is the fact that far from adopting focussed health initiatives, many countries in the region -- including India -- instead criminalise sex-workers, drug users and people with alternative sexual orientations.
Source: www.spiritindia.com, August 24, 2007
-IANS, August 23, 2007