The male clients of commercial
sex workers will determine the course of the HIV/AIDS epidemic
in Asia, Tim Brown, a researcher at the East-West
Center, said this week at the XV
International AIDS Conference in Bangkok, Thailand, the AP/South
Florida Sun-Sentinel reports (Ross, AP/South Florida Sun-Sentinel,
7/12). According to the 2004
UNAIDS Report of the Global AIDS Epidemic released by UNAIDS
on July 6, Asia accounts for 60% of the world's population and has experienced
some of the "sharpest" increases in numbers of HIV cases. In Asia, the
epidemic is still largely concentrated among injection drug users, men
who have sex with men, commercial sex workers and clients of sex workers
and their sexual partners, according to the report (Kaiser
Daily HIV/AIDS Report, 7/6). According to Brown, the Asian epidemic
eventually will cross over from high-risk groups to the general population
through male drug users and female commercial sex workers to their sexual
partners. "Men who visit prostitutes are going to be the crux of the Asian
epidemic," Brown said, adding, "It's the men who drive this."
Economics
An increase in affluence also has resulted in a rise
in the number of men who visit commercial sex workers, according to the
Financial
Times. During Thailand's economic boom during the early 1990s,
almost 20% of Thai men reported regularly visiting commercial sex workers
-- a figure that now has decreased to around 10% (Kazmin, Financial
Times,
7/14). The "fate" of HIV/AIDS in Asia, Brown says, therefore depends on
the conditions in the commercial sex industry, including the frequency
that men visit commercial sex workers, the control of other STDs, the frequency
of condom use among commercial sex workers and their clients and the control
of mother-to-child transmission if partners of clients of commercial sex
workers are infected. The clean needles provision also is considered important
because delaying the spread of HIV from injection drug users to commercial
sex workers provides the time to implement condom promotion initiatives.
Women
Unlike in sub-Saharan Africa, it is "unlikely" that
women will drive the Asian HIV/AIDS epidemic, and HIV prevalence among
men in the region will remain twice as high as among women, according to
Brown. "Women in Asia largely have sex within marriage and, for the most
part, premarital sex is mostly confined to their future husband," he said,
adding, "On the other hand, the men are generally given a great deal of
latitude in Asia. Sex remains a part of Asian
business culture and that creates an imbalance and creates the
demand for sex workers." However, Helene Gayle, director of HIV/AIDS
and TB and Reproductive
and Child Health at the Bill
& Melinda Gates Foundation and the incoming president of the International
AIDS Society, said that sexual behavior among Asian women is changing.
Young women may not "adhere to the sexual mores" of previous generations
and casual sex is becoming more frequent,
increasing concern about HIV/AIDS in the region, Gayle said (AP/South
Florida Sun-Sentinel, 7/12). Political leaders say that Asia's "conservative
family values" will help reduce the spread of HIV, according to the Times.
But the Times reports that the "relative concentration" of the disease
among high-risk groups could make effective prevention programs, such as
condom promotion, "still have a big impact in reducing the spread of HIV"
(Financial Times, 7/14).
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