Clients of Commercial Sex Workers Will Determine Course of HIV/AIDS Epidemic in Asia, East-West Center Says
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."
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.
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).