AIDS: A GLOBAL ASSESSMENT : ASIA : Scattered Cases Foster Precautionary Actions Against Visitors and Students

The AIDS epidemic has panicked some Asian nations, including China and India, into near-xenophobic reactions. While the AIDS virus remains stunningly rare throughout the continent, the world’s two most populous nations are taking extraordinary precautions, many directed against foreigners, to contain it.

By comparison, World Health Organization officials consider the spread of AIDS much more of a threat in what they call the “sentinel” countries of Asia, such as the Philippines, Sri Lanka and Thailand. These nations all have massive prostitution industries that cater to travelers.

Asian nations have reported a total of 106 AIDS cases. Of these, 43 are from Japan, where most of the infections have been caused by contaminated blood products.

Because the AIDS virus is so rare in Asia, it is infrequently transmitted. Most of the known transmissions have involved citizens who have become infected abroad or male and female prostitutes who have had sexual contact with infected foreigners.

China, a nation of more than 1 billion people, has reported only four AIDS cases, two of them in foreigners.

China’s principal AIDS control measures include required AIDS tests for foreign students, teachers and long-term residents. The import of foreign blood products is banned.

In a press conference last October, Cao Qing, director of the Health Ministry’s AIDS risk prevention bureau, said: “We appeal to you foreigners. If you suffer from AIDS, don’t, don’t come to China. It’s a moral question. We don’t yet have this disease in our country.”

Blood tests are also required for many Chinese who serve as translators, maids, cooks and embassy employees for foreign diplomats as well as Chinese residents who plan to marry a foreigner or a Hong Kong Chinese. Enforcement of the testing requirements has been irregular but is getting tougher.

China has no specific programs to educate the general public about AIDS, which is called ai zi bing or “sickness stemming from love.”

But AIDS has received extensive, although not always accurate, coverage in the Chinese press, where it is usually depicted as a product of capitalism and Western decadence. For example, a recent article in the Beijing Daily, without mentioning gays or intravenous drug users, gave the clear impression that AIDS is primarily transmitted in the United States through “wanton” heterosexual relations.

As evidence of their ability to control the spread of AIDS, Chinese public health officials point with pride to their unprecedented success in the early 1960s in attempting to eradicate venereal diseases from the country.

But health officials know that they cannot rest on their laurels. The incidence of such diseases as syphilis and gonorrhea is growing year by year, reflecting an increase in sexual activity among young Chinese as well as China’s open-door policy to foreigners.

India, a sexually conservative and religious society, also regards AIDS as a disease of the West and a reflection, if not a punishment, for what are viewed as its promiscuous sexual habits.

India has reported 12 AIDS cases, all of them in foreigners or in Indians who had been living abroad, according to S. P. Tripathi of the Indian Council of Medical Research in New Delhi.

“We do not yet have a problem of AIDS cases as such,” Tripathi said in an interview. “To our knowledge we have never had a case of AIDS infection originating in India.”

The prevailing view is that AIDS is at an early enough stage in India that a strong “surveillance” program, followed by a “search-and-destroy” effort when a virus carrier is discovered, may succeed in keeping the epidemic out of the nation of 780 million people, according to Dr. N. K. Shah, a World Health Organization official in New Delhi.

“In this part of the world the epidemic is not there,” Shah said. “So if you can have a good epidemiological surveillance program and identification program, maybe we can avoid the epidemic.”

Of greater concern to Indian health officials is the possibility that the AIDS virus will be rampantly transmitted through contaminated needles and syringes used for vaccinations and injections.

This is a huge problem in India, where disposable needles are too costly for most rural clinics to throw away and may be used hundreds of times. The reuse of these needles is blamed for India’s continuing epidemic of chronic hepatitis B infection, which can cause liver cancer and cirrhosis.

India has launched a nationwide effort to stop the reuse of disposable needles, but the campaign is only likely to be successful if cheaper disposable needles can be made available.

India also has an extensive AIDS screening program, including 40 screening centers across the country and required testing of all foreign students at the time of their admission into Indian universities. The government is considering mandatory testing for all foreigners staying in the country for more than a year, except for diplomats.

India’s testing program has prompted strong protests from African students, who represent approximately half of the nation’s 80,000 foreign students.

The protests have left India, one of the leading Third World nations, open to charges of racism for one of the first times in its history. Nevertheless, at least two of the tested students, both from Africa, were found to carry the AIDS virus and were deported.

In Japan, surveillance for the AIDS virus has been conducted through voluntary checks and testing of an increasing number of blood donations.

Through June, 255 AIDS virus carriers have been identified through millions of blood tests. About 85% were found to have been infected through imported blood products, many of which came from the United States.

The government is coordinating extensive AIDS educational programs for Japanese citizens, including leaflets about the disease that were sent to all households in March. Acupuncturists have also been warned to use their needles only once.

Some Japanese are shunning contact with foreigners because of AIDS fears, although there are no official AIDS-related restrictions on non-residents. Some public baths, bars and nightclubs have closed their doors to foreigners, including U.S. military personnel.

In South Korea, AIDS has been a serious concern since the death in February of a 62-year-old Korean who had founded a trading company in Kenya. His AIDS-related affliction was believed to have stemmed from a blood transfusion he received in Kenya in 1985 while under treatment for malaria.

Telephone counseling services were established in 13 cities. Hankook Latex Co., a leading manufacturer of condoms, was deluged with six months of advance orders.

Following the man’s death, the Health and Social Affairs Ministry decided to expand AIDS antibodies tests it had conducted periodically on 12,000 prostitutes “serving” U.S. servicemen stationed in South Korea to include about 100,000 women working at nightclubs, “room salons,” and other entertainment spots frequented by foreign tourists.

The ministry also announced plans to screen blood donations and to require that imported blood products be certified as free of the AIDS virus. It will also encourage Korean residents in foreign countries to take voluntary blood tests when they return home.

Thailand, which has reported 11 AIDS cases, including four in foreigners, has taken a different approach to AIDS control from other Asian nations. Rather than shunning foreigners, the government is seeking to allay their fears of contracting the AIDS virus from the country’s thousands of male and female prostitutes in Bangkok’s famous Pat Pong red-light district and the beach resort of Pattaya.

A proposed $14-million, four-year government program to combat AIDS calls for intensive blood testing of Thais at increased risk to contract the virus, including prostitutes, heroin addicts and prison inmates.

The program would also include funds for AIDS education in Thai secondary schools beginning in 1988 and shipment of 500,000 condoms a year to venereal disease clinics for free distribution to patients.

“Thailand depends a lot on tourism, and any AIDS scare will be considered detrimental to the industry,” the Bangkok Nation said in an editorial when the government proposal was announced in June. “But that line of thinking seems to have been replaced by the thinking that if it is widely known that Thailand has excellent AIDS control, there will be no fear in the minds of the people visiting the country.”

AIDS IN ASIA TOTAL CASES 87 China . . 4 China (Taiwan) 1 Hong Kong . . 4 India . . 12 Indonesia . . 1 Japan . . 43 Malaysia . . 1 Maldives . . 1 Pakistan . . 1 Philippines . . 4 Singapore . . 1 South Korea . . 1 Sri Lanka . . 2 Thailand . . 11