By Elaine Lies

KOBE, Japan, July 2 (Reuters) - AIDS is a silent tsunami that threatens all of Asia, but the deadly disease can still be conquered if governments take urgent action now, world health officials said on Saturday.

One in four new infections occurs in Asia and 1,500 die in the region each day. The disease has spread to all provinces in China, the world's most populous nation, while India has the second-highest number of AIDS/HIV patients after South Africa.

But political will to battle the illness is lacking in most of the region's governments despite the huge potential toll in lives and missed development goals as millions of households are pushed into poverty, officials said at an international AIDS conference in the western Japanese city of Kobe.

Failure to fight AIDS will have a critical economic impact on the region. The United Nations estimates losses could total $29 billion from AIDS alone by 2010 if nothing is done now.

Governments need to view AIDS as a threat on the scale of a natural disaster such as the tsunami last December that killed or left missing 232,000 people, said J.V.R. Prasada Rao, Director of the Regional Support Team for UNAIDS, the U.N. agency dedicated to fighting the disease.

"The only real barrier to scaling up he response to HIV is one of perception," he told a conference session.

"The virus doesn't kill hundreds of thousands at a thunderous stroke like the tsunami, and it doesn't provide vivid television pictures," he added. "It is more like a silent tsunami."

The U.N. estimates 8.2 million people are infected with the human immunodeficiency virus (HIV) in Asia, about 5.1 million of them in India. The Chinese government says there are 840,000 patients in China.

Worldwide, about 39 million people have HIV/AIDS, including 25 million in sub-Saharan Africa.

If no steps are taken, 12 million people are likely to be infected with HIV in Asia by 2010, UNAIDS warns.

MAJOR POLITICAL WILL

This figure could be cut by half with hard work over the next two or three years, but this would require major political will, UNAIDS director Peter Piot said on Friday.

In Asia, the AIDS epidemic is still mainly found among vulnerable groups such as homosexuals, injecting drug users and sex workers, but health officials say it could spread to the general population.

Rao said many politicians did not like to talk about injecting drug users, sex workers or men having sex with men -- a reflection of the heavy stigma and discrimination faced by HIV/AIDS sufferers across the region, which prevents many from being tested or even treated.

"Stigma and discrimination is an epidemic that is really killing people," said Manoj Pardeshi, an HIV-positive man who represents several HIV activist groups.

"We just want to live a normal life, and we just want our basic human rights," he told a news conference, exhorting governments to enact laws against discrimination.

Targeted prevention programmes are reaching only 19 percent of sex workers and 5 percent of injecting drug users in Asia. The figure for homosexual men is no higher than 2 percent.

There are success stories in Asia, such as Thailand, where annual new HIV infections fell from nearly 143,000 in 1991 to 21,260 at the end of 2003, thanks to mass education and condom programmes aimed at sex workers and other high-risk groups.

In contrast, affluent, well-educated Japan still has a relatively low number of infections, but experts say general apathy could lead to an explosion of cases over the next decade.

"Obviously, the problem is one not of resources or know-how," Rao said. "Japan is economically one of the most advanced countries in the world. The only explanation, surely, is low prioritisation."

Asia is more than capable of conquering the disease, Rao said, citing its response to emergencies such as SARS and the tsunami.

"When we need to, we can mobilize rapidly, assemble the resources and become extremely creative in figuring out solutions to all manner of problems," he added.

"We need an emergency-like response to this epidemic." (HEALTH-AIDS, reporting by Elaine Lies, editing by David Fogarty; Reuters Messaging: elaine.lies@reuters.com@reuters.net; +81-3 3432 8485))

Friday July 1, 03:16 PM

One in four new infections occurs in Asia. The virus has spread to all provinces in China, while India has the world's second-highest number of AIDS/HIV patients after South Africa.

The epidemic is still mainly concentrated among vulnerable groups such as homosexuals, injecting drug users and sex workers, but could spread into the general population unless determined efforts are made, says a report released in advance of an AIDS conference opening in the western Japanese city of Kobe later on Friday.

"The risk of AIDS spreading further in Asia and the Pacific is now higher than ever," said Peter Piot, executive director of UNAIDS, the U.N. agency devoted to fighting the epidemic.

Low condom use, limited access to HIV testing, gender inequality, widespread injecting drug use, and sex work are seen as a "dangerous cocktail" that could lead to a rapid expansion of the deadly disease.

"If HIV prevention programs are urgently scaled up, six million HIV infections could be prevented in the next five years in the region," he said in a statement.

"If Asian countries do not rise up to the challenge, then 12 million people will become newly infected."

Prevention and access to cheap medicine top the agenda at the 7th Asia-Pacific AIDS Conference in Kobe from July 1 to 5. The main concern is to ensure the disease does not proliferate in Asia as it did in Africa.

The United Nations estimates that 8.2 million people live with HIV in Asia, some 5.1 million of them in India alone. The Chinese government says there are 840,000 patients in China.

Worldwide, about 39 million people have HIV/AIDS, including 25 million in sub-Saharan Africa.

But targeted prevention programs are believed to be reaching only 19 percent of sex workers and 5 percent of injecting drug users in Asia. The figure for homosexual men is no higher than 2 percent.

"Universal access to prevention and treatment must not be a dream, but a reality," Piot said.

VAST DIFFERENCES

Funding to fight AIDS in the region is seen rising to roughly $1.6 billion by 2007, but this is still far from sufficient, the UNAIDS report said, estimating that $5 billion will be needed.

Vast cultural and political differences within Asia complicate the battle. Blood-selling scandals were initially covered up in China, where fear of being stigmatized has prevented many in China from getting tested -- a situation echoed across other parts of Asia.

There are other common threads, such as a need to promote the use of condoms, educating sex workers and injecting drug users to the dangers of the disease, and empowering women, who make up more than half of the new HIV infections worldwide.

In Asia, over 30 percent of girls are married before the age of 15, and 62 percent before 18, often to much older husbands.

The report called on world leaders to make tackling AIDS in Asia and the Pacific a global priority as with AIDS in Africa.

East Asia faces the fastest-growing HIV epidemic in the world, it said, due to the rapid spread of HIV in China, Indonesia and Vietnam. Papua New Guinea is also seeing a rapid expansion of the disease.

Even affluent and well-educated Japan is at risk due to a lack of awareness, official apathy and the stigma that prevents many from being tested.

But the number of Japanese cases are still relatively low at 10,070 over the last decade, giving Japan, along with nations such as the Philippines, the chance to still ward off a serious outbreak.

"We must not lose sight of the fact that 99 percent of people and the Pacific remain uninfected," Piot added. "Effective prevention programs must be scaled up now more than ever."

By Elaine Lies

TOKYO, June 29 (Reuters) - China is at a turning point in its AIDS fight, capable of building on current prevention measures or flagging and putting millions of lives at risk, a senior World Health Organisation official said on Wednesday.

The darker side of the economic boom in the world's most populous country is that greater mobility and wealth disparities have increased opportunities for the spread of the disease, said Jack Chow, WHO's assistant director for HIV/AIDS, tuberculosis and malaria.

"You have men that now have money that often engage sex workers, you have women from impoverished rural regions who enter sex work," Chow told Reuters.

"Wealth disparities also mean different abilities to get medical care. And wealth means an ability to travel."

Chow, in Japan to take part in the 7th Asia-Pacific AIDS Conference in the western city of Kobe from July 1 to 5, said Beijing was taking some good steps against the disease, but the situation remains perilous.

"We're at a tipping point in Asia, particularly in China," he said. "What we need to see is a collective response that matches, if not surpasses, the pace of the HIV/AIDS epidemic.

"Anything short of that and we'll see a potential skyrocketing in the number of cases."

China, which says it has only 840,000 cases among its 1.3 billion people, has only recently stepped up its fight after blood-selling scandals were initially covered up, and officials remain suspicious of volunteers and non-governmental organisations trying to fight the disease.

The United Nations estimates that 8.2 million people in Asia live with HIV, some 5.1 million of them in India alone, and that China could have 10 million patients by 2010 unless tough steps are taken.

Chow lauded recent moves by China's government to tackle the disease, including steps to remove the stigma attached to it such as when Premier Wen Jiabao shook hands with AIDS patients at a Beijing hospital on World AIDS day in 2003, but warned that much more needs to be done.

TENS OF MILLIONS

"There needs to be an assertive scale-up of health care interventions, of social messaging, a broad political commitment," Chow added.

"Just a small uptick of a percentage (of the population) in China means tens of millions of people. So it's really essential...that it magnifies its response in a comprehensive national scale."

An additional danger to AIDS patients in Asia is posed by tuberculosis, an infectious respiratory illness that accounts for up to one-third of all HIV/AIDS deaths worldwide. People with weakened immune systems are especially susceptible.

About 14 million people around the world are infected with both HIV and TB, a situation that increases the chance of spreading TB to the wider population, including a growing number of drug-resistant strains that are much harder to treat.

"If we have rising rates of drug-resistant TB, it could outstrip even developed countries' ability to mitigate it," Chow said.

"We've seen with SARS that an epidemic is only a plane ride away."

KOBE, Japan, July 4 (Reuters) - Expanding AIDS treatment to millions of patients in India and China could prove crucial to the course of the epidemic -- both in Asia, where it is spreading rapidly, and in the rest of the world, experts said on Monday.

One in four new infections occurs in Asia, home to more than half the world's people, and 1,500 in the region die from the disease each day. AIDS has spread to all provinces in China, while the number of HIV/AIDS patients in India is second only to South Africa.

Dr. Jim Yong Kim, head of the HIV/AIDS department at the World Health Organisation, told an international conference on AIDS in the western Japanese city of Kobe that global attention needs to focus on 20 countries that together account for 85 percent of unmet treatment needs.

"Among these 20 countries, millions of Chinese and Indian lives hang in the balance, and efforts made in these two countries now could determine the course of the global epidemic," he said.

"There is no country in the world that is completely out of danger of an explosion of HIV/AIDS."

While HIV/AIDS patients in advanced nations have access to life-saving drugs that can stave off the development and progress of the illness for years, such treatment is beyond the reach of many patients in developing nations.

The United Nations estimates 8.2 million people are infected with the human immunodeficiency virus (HIV) in Asia, about 5.1 million of them in India. The Chinese government says there are 840,000 patients in China.

Worldwide, about 39 million people have HIV/AIDS, including 25 million in sub-Saharan Africa.

"Only 6 percent of people in Asia who need treatment are getting it," said K.K. Abraham, a member of an Indian group for people living with HIV/AIDS.

"What happens to the other 94 percent? Who cares for them? What is keeping them from dying?"

VAST NUMBERS, VACCINE

The United Nations warns that 12 million people could be infected with HIV in Asia over the next five years if prevention programmes are not scaled up.

Beijing has recently stepped up its fight against the disease, but many hurdles to treatment remain.

In India, HIV/AIDS has moved beyond traditionally high-risk groups such as prostitutes, drug users and homosexuals into families, infecting mothers and children.

Seth Berkley, president of the International AIDS Vaccine Initiative, said the ultimate solution rests with development of a vaccine, some 30 of which are currently in clinical testing.

But he said it was impossible to predict when one might actually succeed, adding that further investment and political efforts were essential.

The consequences of AIDS in poor nations are widespread. More than 1.5 million children in Asia and the Pacific have been orphaned by AIDS, requiring urgent protection and care, the U.N. Children's Fund (UNICEF) said on Sunday.

The WHO set a target of having 3 million people on treatment by the end of 2005, but it said last week that goal was unlikely to be met.

Kim, though, said 1 million people were now being treated -- people who were unlikely to have been treated without the setting of the target.

"We're as determined as ever to reach the 3 million," he told Reuters on Sunday. "Even if we miss it by 18 months, still that's 3 million people whose lives we've saved in a very short period of time."

The conference, in which 3,000 people from some 80 countries have taken part, ends on Tuesday.

WHO likely to miss '3 by 5' AIDS drug target

Sunday July 3, 4:36 PM

Sex workers on frontline of Asia's AIDS battle

One in four new infections occurs in Asia, home to more than half the world's people, and 1,500 die in the region each day. The disease has spread to all provinces in China, while the number of Indian HIV/AIDS patients are second only to South Africa.

Tonette Lopez, a 30-year-old who worked in bars in her native Philippines for three years and has founded an NGO for sex workers, accused major international agencies of being out of touch with the very communities they were trying to reach.

"Sometimes because they are the funders, they think they know what's best for us, when in fact it should be the other way around," she told Reuters on the sidelines of an international AIDS conference in the western Japanese city of Kobe.

"We're the ones in contact with the community, not them," she added. "They're only in their offices, sitting down and waiting for their reports. And sometimes reports are not true."

Though she acknowledged that agencies can provide a badly needed structure for prevention efforts, she urged them to make more of an effort to include the sex workers, who as peers are able to reach out to their communities most effectively.

"There should be greater participation from us -- and they should put us first."

The UN estimates 8.2 million people are infected with the human immunodeficiency virus (HIV) in Asia, about 5.1 million of them in India. The Chinese government says there are 840,000 patients in China.

Worldwide, about 39 million people have HIV/AIDS, including 25 million in sub-Saharan Africa.

Commercial sex is one of the main forces behind the spread of HIV in many countries in Asia, where the United Nations says that 12 million people could be newly infected in the next five years if prevention programmes are not intensified.

HUGE NUMBERS

Though the infection rates of AIDS are highest among injecting drug users in Asia, the huge numbers of people involved in buying and selling sex makes it a critical concern.

"How we deal with the sex trade will have a decisive effect on HIV epidemics in Asia and the Pacific," Cheryl Overs, an activist with International HIV/AIDS Alliance, told a session of the conference, which lasts until July 5. "The effort must be massive in scale and as diverse as the region itself."

Prevention efforts face new challenges, however, as the sex industry changes in response to modernisation.

The spread of karaoke bars, where sex workers can often make more money than in brothels, and widening use of mobile phones that mean sex workers no longer congregate in specific "red light" areas, make it harder to target specific prevention programmes to the people who need them most.

While women still make up the overwhelming number of sex workers, there is also a need to reach other groups, such as men who sell sex to other men, and transgenders such as Tonette, who tend to be ignored altogether.

The conference is stressing the importance of condoms, whose use varies widely according to the nation and the situation.

One survey conducted last year in East Timor, Asia's newest nation, found that four out of 10 sex workers did not recognise a condom when shown one.

Even when condoms are available and their effectiveness known, decisions on using them can be highly arbitrary. Young men in Laos often base their choice on the woman's body temperature and whether she seems "promiscuous," researcher Soutchay Pheualavong said.

Thailand and Cambodia have had noted successes with education and condom outreach programmes among sex workers and other vulnerable communities. In Thailand, annual new HIV infections fell from nearly 143,000 in 1991 to 21,260 at the end of 2003.

For the greatest success, such outreach programmes should involve other sex workers, Tonette said.

"You have the experience, you know how it is, you know how it feels -- and you can get through the message to everyone."

Women becoming new face of AIDS in Asia

Stigma of AIDS still hampers war on killer virus in Asia: experts

Thursday June 30, 12:31 AM

Muslim nations face AIDS reality

In one of the most comprehensive reports on AIDS covering the Muslim world, experts warned of serious repercussions if governments continued to sweep the problem under the carpet.

In a report released by the Seattle-based think tank, the National Bureau of Asian Research, they said "if leaders continue to ignore the problem, AIDS could debilitate or even destabilize some of these societies by killing large numbers of people in the 15 to 49-year age group."

This would deprive the Muslim countries of some of their best, brightest, and most economically productive members, said Laura Kelley and Nicholas Eberstadt in the report.

A private infectious disease specialist, Kelly had previously undertaken AIDS research for the US National Intelligence Council as well as other diseases for the USAID, the principal foreign aid agency of the United States, while Eberstadt is a scholar at American Enterprise Institute, a conservative Washington-based think tank.

"An important take home message for all Muslim nations is that real behaviours on the streets are sometimes in marked contrast to the expected behaviours of good Muslims and that is something that leaders in these countries must deal with," Kelly told AFP.

The report said that even though the Muslim world was home to behaviors such as premarital sex, adultery, prostitution, homosexuality, and intravenous drug use -- which help spread the HIV virus that causes AIDS -- many governments have been slow to respond to the rapidly spreading disease.

"What is especially troubling to behold is the reluctance to admit that Muslims engage in exactly those same dangerous behaviors that support the transmission and spread of HIV/AIDS elsewhere," it said, blaming "deeply rooted cultural and religious attitudes.

"This reluctance even to recognize the problem will only accelerate the epidemic and make it more difficult for the international community to provide meaningful support and treatment," the report said.

"We would have thought the Muslim world was in a sense vaccinated from this kind of pandemic but in fact the dreadful news is that it is not, said Michael Birt, the director of National Bureau of Asian Research's center for health.

"Now with the Muslim world becoming involved, its truly a global crisis," he told AFP.

Kelly proposed "sweeping legal changes" to reduce the social stigma associated with the disease and protect the AIDS sufferers in Muslim nations "to ensure them medical treatment, employment and discourage suicide."

The Muslim world of more than one billion people covers three continents -- from Albania and Turkey in Europe, across countries bordering the Sahara in Northern Africa, and through the Persian Gulf and South Asia to Malaysia and Indonesia in the east, the report said.

Officially, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates the total HIV population of North Africa, the Middle East, and predominantly Muslim Asia at nearly one million people.

At the end of 2003, UNAIDS estimated that up to 420,000 in Mali, 180,000 people in Indonesia, 150,000 in Pakistan, and 61,000 in Iran had HIV/AIDS.

"Those numbers, however, are severely understated," Kelly and Eberstadt said in a separate report on Foreign Policy magazine, published by the Carnegie Endowment for International Peace in Washington.

They said UNAIDS figures depended upon surveillance data -- "thus a lack of information can be taken as a lack of infection."

UNAIDS data on the number of people living with HIV/AIDS is completely missing for Afghanistan, Turkey, and Somalia, "all nations with large numbers of at-risk populations," they said.

The study cited Iran and Bangladesh as among Muslim governments that seem to be combating the problem effectively.

"Iran's President Mohammad Khatami and his administration have been very forthcoming about the extent of the epidemic and the urgent need to control the further spread of the disease," it said.

"Perhaps surprising, given the Iranian regime's conservative reputation, needle exchange programs also have been offered in high drug-use areas of Tehran, and syringes are now sold over the counter in many pharmacies," the report said.

Kelley said some of Iran's anti-AIDS programs "are more liberal than some overseas programs funded by United States," citing condom distribution as among areas opposed by some Christian groups.

Hopefully, she said, the incoming administration of hardliner President Mahmood Ahmadinejad would continue and expand upon the education and prevention efforts.

More aggressive government programs needed to fight AIDS in Asia-Pacific

Monday July 4, 3:04 PM

Japan faces potential AIDS-tuberculosis dual-epidemic, experts say

Japan and other countries in Asia face a potential dual-epidemic of AIDS and tuberculosis that is being neglected by health officials here despite the danger of emerging drug-resistant strains of TB, doctors warned on Monday.

HIV-positive people are 50 times more likely to develop tuberculosis, or TB, a sometimes fatal bacterial infection spread through the air.

While overall TB cases have been on the decline in Japan, a rapidly surging number of HIV infections could lead to a sudden explosion of TB/AIDS cases among certain vulnerable sectors of the population, according to experts at the Seventh International Congress on AIDS in Asia and the Pacific in Kobe, Japan.

"When an ordinary person becomes infected with TB, they can usually be cured. But if inappropriate treatment is administered (to someone also infected with HIV), it can result in multiple drug resistance, which in the worst case can be more frightening than AIDS," said Dr. Nobukatsu Ishikawa from the Research Institute of Tuberculosis in Kiyose, Japan.

No figures are available for the number of people in Japan co-infected with HIV and TB. Worldwide, one-third of HIV-positive people, or 14 million, are co-infected with TB.

The overall decrease in TB cases in Japan are misleading because many elderly who were infected long ago are now dying, said Ishikawa.

About 30,000 new cases of TB are being reported here every year and many more could be going undetected because the disease is spreading quickest among vulnerable groups _ the poor, the homeless, low-income immigrants and young people _ who are unable or unwilling to seek medical help, Ishikawa said.

Takashi Sawada, a Japanese doctor and chairman at the congress, said as much as 40 percent of foreign HIV-patients he is treating in Japan are co-infected with TB.

"Within an overall decrease, pockets of crises are emerging," Ishikawa said.

As HIV-infections double here at a rate of every four years, calls for the government to take more urgent action have gained momentum.

But the TB threat has gone virtually unacknowledged, said both Ishikawa and Sawada.

TB funding is on the decrease, while upcoming changes in the health care system threaten to decrease coverage of TB treatment and shut out those most likely to have the disease, Sawada said.

"TB is one of the leading causes of death among HIV-positive people, especially in the developing world," said Javid Syed from New York-based Treatment Action Group.

A delay in addressing the HIV/TB threat in New York cost the city US$1 billion as multi-drug resistant strains of TB developed, he said.

Whereas treatment of an ordinary TB case costs between US$11 to US$20, the city saw those figures surge by more than a 100 times, he said.

"That's what Japan might be facing," Syed said.

The World Health Organization says, "HIV/AIDS and TB are so closely connected that the term 'co-epidemic' or 'dual-epidemic' is often used to describe their relationship."

Tuberculosis, or TB, is caused by a bacteria that is spread, like the common cold, through the air and normally enters the body through lungs. When it infects a person with HIV, TB progresses more rapidly to symptoms like coughing up blood, fever and weight loss that can ultimately be fatal.

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