COLUMN ONE : AIDS Fuse Is Lit in Asia : The disease is taking hold in the region at an alarming rate. Poverty, ignorance and rampant prostitution worsen the outlook.

The last thing Fai Charoenkul ever expected was that she would become a symbol of the scourge of Asia.

A mere 15 years old, the shy, slender Fai is already married. She now appears regularly on Thai television to explain how her life was transformed when she found out in September that she had tested positive for HIV, the human immunodeficiency virus, which leads to the killer disease AIDS.

“I realized that all my dreams would never come true,” Fai said in a recent interview with The Times. “Can you imagine the shock of finding out that you will have a very short life?”

At first, a more unlikely candidate for acquired immune deficiency syndrome hardly seems possible. Fai was a virgin when she was married eight months ago, and she has never used drugs or received a blood transfusion. She worked as a cleaner in her sister’s beauty salon.

But her husband, Damri, eight years older and driver of a motorcycle taxi, was a frequent customer at massage parlor brothels. He visited so many that he has no idea where he contracted the illness.

Fai and Damri are victims of an epidemic of AIDS that is spreading in the developing countries of Asia at a truly astounding rate. Unlike in the West, where the disease has been primarily spread by homosexual relations and intravenous drug use, AIDS is being transmitted in Asia mainly by heterosexual activity, especially involving prostitutes.

“The AIDS time bomb is present in many, many countries of Asia,” said Meechai Viravaidya, a Thai government minister and the country’s leading campaigner against AIDS. “The fuse is lit. If we compare Asia and the rest of the world over the next 10 years, I can guarantee you the real hot spot will be Asia.”

Although Asian cases of full-blown AIDS now number just a few hundred, medical experts believe that by the year 2000, Asia will have more people testing HIV-positive than all of sub-Saharan Africa, where there are estimated to be more than 6 million people with the HIV virus today.

Estimates circulated within the World Health Organization suggest that Asia will have 50 million HIV-positive cases by the turn of the century.

Equally alarming, Asian countries have made almost no contingency plans to deal with the medical emergency or to provide treatment for AIDS patients. Most will be left to die on their own.

“It’s not an epidemic, it’s a pandemic, which means that it’s not only widespread but that it will devastate virtually the entire region,” said Richard Butler, Aus tralia’s ambassador to Thailand, whose government has funded AIDS research in Southeast Asia.

By far, the worst AIDS situation in the region is in India, where an estimated 1 million people are infected with HIV. Next is Thailand, with an estimated 400,000 people who test HIV-positive, followed by Myanmar, the Philippines, Bangladesh and Indonesia, where there are no reliable estimates.

In addition to raising awareness about the disease and how to combat it, medical authorities in many Asian countries are finding that they must also confront a vast cultural problem, common from Bombay to Bangkok: condoning promiscuous sexual behavior for men as long as the women involved are prostitutes.

Bombay, India, has more than 200,000 prostitutes. Dr. Anand Joshi, a deputy director of the city’s department of public health, cited a recent survey suggesting that 30% of the prostitutes are HIV-positive.

“The disease is like an immense iceberg, and we can only see a small part of it,” Joshi said. “The main problem is these sex workers and promiscuity among the low-income, high-risk groups.”

Joshi said it is still rare for prostitutes to require their customers to use condoms because the men are not convinced of the need. The women are so poor that they have no choice but to accept their customers’ demands.

India also has an immense problem with commercial blood donors, because blood is still not universally screened for HIV. Dr. Jai Naren of the World Health Organization office in New Delhi said that 27% of blood donors test HIV-positive.

There is also a flourishing population of 20,000 intravenous drug users in Manipur, the Indian state nearest Myanmar, the center of the world’s heroin trade. Half of the addicts are HIV-positive.

“It’s quite unexpected. The disease has spread quite rapidly over the last two years,” Naren said.

Thailand is another country where prostitution has been central to the transmission of the illness into the general population. Although estimates vary greatly, Thailand has between 250,000 and 750,000 full-time sex workers.

A landmark study of sexual behavior of new army recruits, involving 21-year-old rural males, shocked many Thais. About 3% of the recruits were found to be HIV-positive, including 10% of males from northern provinces.

Another surprise was the recruits’ answers to a sex survey. Seventy-three percent said their first sexual experience was with a prostitute, while virtually all had visited prostitutes by the time they were 21. Most of the prostitutes charged less than $5.

Although Thailand did not have a single case of AIDS until 1984, the spread of the disease has been incredibly rapid. Meechai, the Thai anti-AIDS campaigner, estimates that between 2 million and 4 million people will have the HIV virus--and 180,000 people will have full-blown AIDS--by the year 2000.

Meechai estimated that when the costs to the economy are added up, combining medical costs and losses to the commercial sector, Thailand stands to lose $16 billion a year, about 20% of the country’s gross domestic product.

Thai authorities are reporting more and more cases of brothels in which the women are 100% HIV-positive. But testing is not required, and once found HIV-positive, prostitutes can continue working.

Gruesome statistics appear in the newspaper virtually every day. More than 1% of pregnant Thai women are HIV-positive. A doctor in the northern city of Chiang Mai said that half the babies known to have been born HIV-positive have already died of AIDS.

Werasit Sittitrai, who heads the Thai Red Cross AIDS prevention program, said that since he opened a clinic in central Bangkok in July to conduct HIV tests, more than 10% of the 4,025 people tested were found to be infected.

“The scary part is not the involvement of commercial sex,” Werasit said in an interview. “The really scary part is the involvement in casual non-commercial sex. We’re not seeing prostitutes. We’re seeing housewives.”

Werasit said he believes the HIV virus is now so prevalent in society that even a massive campaign against the commercial sex industry would have little impact on the spread of the illness.

Debhanom Muangman, head of the public health faculty at Bangkok’s Mahidol University, said that two groups are at particularly high risk--truck drivers and fishermen.

Truck drivers commonly use amphetamines to stay awake and then use sex with prostitutes to relax, Debhanom said. Like the truck drivers, Thailand’s large fishing fleet is highly mobile, so that AIDS is spread not only in Thailand but also throughout Southeast Asia.

Debhanom said it is common for inexpensive prostitutes to have 10 customers a night for $1 each. On holidays the number might increase to 20 or 30.

Virtually all authorities agree that there is an inverse relationship between price and incidence of the disease: The cheaper the prostitute, the greater the chance of contracting AIDS.

Use of condoms in Thailand has accelerated rapidly as publicity about AIDS has appeared. The government gave away 68 million condoms last year and spent $10 million on AIDS prevention programs.

In an effort to counter Thailand’s dependence on commercially available sex, the government is beginning sex education programs in elementary school to make boys realize that it is no longer considered manly to visit a prostitute.

But many diplomatic and medical observers have noted that it will be difficult to control the spread of AIDS until the government acts forcefully to contain prostitution, which is protected by the police even though it is illegal.

In neighboring Myanmar, formerly known as Burma, AIDS is flourishing through prostitution and intravenous drug use, but little is known about the incidence of the disease because the military-led government refuses to acknowledge that a problem exists.

Dr. George Loth, a Dutch physician with the World Health Organization’s Bangkok regional office, said that between 70% and 80% of drug users being screened in Myanmar were found to be HIV-positive.

Many thousands of Myanmar’s women travel to Thailand each year to work as prostitutes, then return home when they have saved enough money. Myanmar is so poor that condom use is virtually unknown and drug users share needles for years.

“A lot of girls with the virus are sent back to Burma (Myanmar) every year,” Debhanom said. “Nobody is notified that they have the disease because the girls are afraid they will be killed when they return home. So they keep working as prostitutes or settle down and get married.”

Prostitutes are also being recruited for the Thai market from Laos, which has no medical infrastructure, and southern China. When they return home, the women carry the disease with them.

In the Philippines, sex workers are required to take mandatory tests for venereal diseases, but Dr. Enrique Hernandez said he believes that the level of HIV infection is at least 50 times higher than the 253 cases discovered so far.

Hernandez said the testing has been primarily limited to prostitutes and should be expanded to include young men before a true picture of the AIDS problem will emerge.

“It’s scary,” Hernandez said in an interview. “We are at the same point Thailand was two years ago. We now know they did more tests and discovered far more HIV than they previously believed. We must start testing low-risk groups because a lot of men are becoming infected heterosexually.”

In conservative Muslim countries such as Malaysia and Indonesia, governments have to grapple with public attitudes that condemn public discussions of sexual attitudes even while the problem of prostitution exists.

“We have a religious barrier against speaking about sex,” said Khurshida Khanom, a public health expert from Muslim Bangladesh.

Indonesia has begun placing infected prostitutes in quarantine. Two prostitutes found to be HIV-positive in Surabaya, a city in eastern Java, were brought to Jakarta in November, according to the Kompas newspaper.

While there are relatively few prostitutes in Malaysia and Singapore, for example, men from those countries frequent brothels just inside the Thai border or in Indonesia. In Singapore, where 99 people have officially tested positive for HIV, sex tours to neighboring countries have fallen off sharply. “My business has gone down 30% because of the AIDS threat,” said Johnny Lim of the Raya Travel Agency.

In Malaysia, intravenous drug use is still the main problem, with 1,783 HIV-positive cases among addicts as opposed to 58 among heterosexual men.

In Hong Kong, homosexuals have been the group most affected by AIDS so far, but officials predict a sea change in the statistics in 10 years as the number of cases hits the tens of thousands.

“I believe homosexuals are the most receptive to health education and have been very helpful in promoting safe sex,” said Dr. Lee Shiu-shan, head of the Hong Kong health department’s AIDS prevention unit. “I think heterosexuals will be the group of people that originally thought they would not catch AIDS because they did not belong to any risk group, but they will top the list.”

Even isolated Cambodia has recorded its first two cases of HIV infection. In neighboring Vietnam, prostitution is flourishing once again under the country’s liberalized economy. But neither of these countries has the means to test for HIV.

“I feel rather saddened by the way many Asian leaders today are still sitting with their heads in the sand,” said Thailand’s Meechai. “Unfortunately, they will not pay for it, but the younger generation will pay for it with their lives.”