On July 21, the House International Relations Subcommittee on Asia and the Pacific held a hearing to examine the challenge of HIV/AIDS in Asia. Chair James Leach (R-IA) called HIV/AIDS the “biggest public challenge and foreign policy issue of our time.” He expressed grave concern regarding the statistics highlighted by the 15th International AIDS Conference in Bangkok last week; about 20 percent of those living with HIV/AIDS live in Asia, while one in four new HIV infections in 2003 occurred in the region. Furthermore, experts believe that if these trends continue, Asia will have more people infected with HIV in 2010 than the roughly 30 million in sub-Saharan Africa today. Rep. Leach argued that “it is clear that the U.S. has a compelling national interest in working with others to help stem the spread of HIV/AIDS and care for the victims of this dread disease. Infectious diseases, like HIV/AIDS, know no borders…Out of a sense of self-preservation for mankind itself, if not simply a humanitarian concern for those currently affected, this disease must be eradicated, whatever the cost.”
Kathleen Cravero, deputy executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), asserted that “there is little doubt that in the fight against AIDS we once again stand at a crossroads and Asia is now at the center of the gathering storm.” She argued that in Asia, as in Africa, the problem is that only a small fraction of those in need are currently receiving lifesaving services. “For example: less than 1 in 6 of the estimated 2.2 million sex workers in South-East Asia receive basic prevention services…Only 1 in 50 pregnant women in the Western Pacific have access to efforts to prevent mother-to-child transmission of HIV. In Vietnam, only 1 in 150 of those who need treatment are currently receiving government-provided antiretroviral drugs (ARVs). In China, only 1 in 14 people have had access to HIV counseling and testing.” In response to the gravity of the situation, Ms. Cravero asserted that the U.S. has much to offer in the Asian fight against AIDS: “(1) by promoting leadership through diplomacy; (2) by providing and leveraging increased resources from both donor and impacted countries; and (3) by offering the training and technical assistance to enhance national capacity.”
In discussing her second argument on leveraging resources, Ms. Cravero supported the “ABC plus” model, “which encourages: abstinence, being faithful, and using condoms–while also promoting female controlled prevention methods, such as females condoms and microbicides, empowering women and effectively engaging men. Given that for many women and girls, negotiating A, B, or C is often not a realistic option, we must provide them with the tools they need to protect themselves. That’s what I heard from women leaders in the Mekong region when they launched their coalition on women and AIDS–and that’s what I’ve heard from women all over the world.” She concluded her testimony by saying, “We have the skill and science needed to stop AIDS. What we need now is the political will, the strategy, and the unity to turn the tide…We need a comprehensive strategy, a truly global response, and an arsenal of tools at our disposal to succeed.”
Freeman Chair in China Studies from the Center for Strategic and International Studies Bates Gill was concerned that “with resources for prevention, treatment and care coming well short of what is needed globally, the world is falling behind in its effort to reverse the deadly and destabilizing course of the epidemic.” Although the epidemic in Asia is centered around injecting drug users and commercial sex workers and their clients, Mr. Gill stated that “there is increasing evidence that the disease is spreading in the general population, driven by premarital, extramarital, and marital heterosexual contact.” In China, although the official count indicates 840,000 HIV-positive individuals at the end of 2003, many analysts believe the number is closer to 1 million or more, and that the figure could reach as high as 6 to 10 million by 2010 if current trends continue. Mr. Gill looked for support in China’s business community, media outlets, and international businesses. “Addressing the acute vulnerability to HIV of women and girls, as well as the growing number of AIDS orphans, increasingly will require enhanced support from communities, educators, and civil society,” he said.
Director of Clinical Research of The Metro Foundation Vijay Yeldandi testified about the problem of HIV in India. He asserted that with the introduction of the epidemic into the general population, “monogamous housewives and their children bear the brunt of this modern day plague.” When studies of HIV incidence and risk factors were conducted in rural Indian villages, Mr. Yeldandi pointed out that “women confidently proclaimed that they were married and faithful to their husbands and as such they were not concerned about HIV…Condom use was rare. Women associated condoms with family planning. Alcohol use was high among men. Women often complained of domestic violence related to alcohol.” Mr. Yeldandi confirmed that “an obsessive focus on ‘High Risk’ groups for prevention programs will leave large segments of the population vulnerable to infection with HIV.” Thus, he proclaimed, “An effective program to combat HIV needs to address basic health needs in a comprehensive manner. Only by addressing all essential health care needs will we have the credibility to address sensitive political, societal/cultural issues which impact on the risk of HIV infection.”
Holly Burkhalter, U.S. policy director at Physicians for Human Rights, defined the key factors in the Asian HIV/AIDS pandemic to be: “the weak state of most Asian countries’ public health systems; the region’s endemic poverty; the deeply engrained cultural, economic, and familial subordination of women and girls; the enormous commercial sex industry that includes hundreds of thousands of children and trafficking victims; the growing numbers of intravenous drug users and the stigma and discrimination experienced by people with HIV/AIDS.” Focusing on sexual exploitation and discrimination against women and girls, Ms. Burkhalter stated that factors such as “the frequent contact of many men with commercial sex workers, women’s economic dependence upon men, girls’ lack of education and opportunity and high levels of domestic violence have important bearing on HIV/AIDS in Asia and elsewhere.”
Ms. Burkhalter described the risks for married women. “In Thailand…one study found that 75 percent of HIV-infected women were likely infected by their husbands…Studies in India indicate an even more striking vulnerability among married women: Reportedly 90 percent of women who test positive at antenatal clinics report monogamous relationships.” She also affirmed that “women’s vulnerability to violence at home discourages them from seeking testing, counseling, or even care and treatment for HIV/AIDS.” In conclusion, Ms. Burkhalter argued that along with U.S. funded prevention and treatment programs for the most vulnerable populations, likely to be left out of national programs, the Asian countries need: “a concerted and unstinting effort to eliminate the grossest aspects of discrimination against and exploitation of women, girls, drug users, and people with AIDS; a large infusion of donor financial and technical assistance; immediate attention to dangerous conditions in medical settings that result in disease transmission through tainted blood supply and reused syringes; and safe public space for civil society.”
During the question and answer session, Rep. Barbara Lee (D-CA) mentioned a few negative responses she received at the 15th International AIDS Conference in Bangkok when she spoke out, saying that “women and girls often don’t have options to abstain.” Recognizing the need for overall equality for women, she asked the panel what the U.S. should focus on and how the American public should be properly educated. Ms. Cravero responded that a comprehensive prevention approach was needed and that the ABC program is a “good start,” but that “we need to go further” by empowering women through education and giving women property rights.
