From: portal!cup.portal.com!Arthur_T_Hu@uunet.UU.NET
Subject: AIDS Sweeps Asia Scare is Overblown
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6633
Organization: unspecified
Date: Mon, 14 Dec 92 23:02:59 PST

Hu's on First -
Dec. 7, 1992

Abstract - Current estimates that claim Asia will soon claim half of new
AIDS cases are completely without basis, but universally accepted without
question. Claims that this is proof that Asian Americans need to fear AIDS
is absurd because AIDS among Asian Americans is already higher than among
almost any nation in Asia - it just gets less publicity.

AIDS Sweeps Asia?

Until recently AIDS was considered to be nonexistent in Asia, with only 
413 cases of AIDS recorded by 1989. But now the World Health 
Organization (WHO)  and Doctor Jonathan Mann of Harvard's International 
AIDS Center  predicts that Asia will soon overtake Africa with nearly 
half of all HIV infections worldwide by the year 2000.   However, some 
of the scarier predictions just don't match up with the facts. And when 
Dr. Mann is ready to declare Indonesia is on the verge of a national 
epidemic on the basis of only 12 known cases.

What I've done is taken figures from the WHO, Harvard's AIDS center, and 
AIDS reports from the Center for Disease Control, San Francisco, Hawaii, 
California, Santa Clara County, San Francisco, and Los Angeles, combined 
with 1990 Census figures breaking down the population by race and Asian 
ethnic group, computed both cumulative and annual incidence rates, and 
ranked AIDS incidence by race and location to give some perspective on 
the true severity of the AIDS crisis. (Believe me, it's a lot of work, 
and a lot of collecting!) The existence of even one AIDS case is a 
reminder that no racial group or country is truly free from AIDS. But to 
declare a national epidemic in Indonesia with one of the world's lowest 
AIDS rates just because the number of cases can't be counted on two 
hands ignores the fact that there's an enormous difference between the 
incidence of AIDS in a place like Uganda or San Francisco where 2 or 3 
percent of the population is dying or already dead of AIDS, and South 
Dakota with an annual new AIDS case rate of only 1 per 100,000, or the 
infinitesimal 0.01 in Indonesia. Yes, anybody can get AIDS, but in real 
life, there are simple reasons why it hurts some groups more than 
others, and nobody seems to want to talk about how to be in a low-risk 
group out of fear of offending the high-risk groups.

Since Asians are just over half of the world's population, their 
infection rate would have to nearly equal the world average to match 
these projections. But estimates released by Harvard's same AIDS center 
puts the annual incidence of AIDS in Asia at only 1 / 15th the level of 
North America (which is about 34 cases per 100,000 population annually), 
and about one-tenth the world rate of 19. If we break out Southeast Asia 
with India and Thailand separately, there are only 3,500 cases in all of 
Northeast Asia, which includes China, Japan, Korea, and Vietnam, and 
one-third of the world's population. That is as many AIDS cases as are 
diagnosed in a single month in the United States, with an incidence rate 
150 times less.  This year, Asia only accounts for 6 percent of new 
infections and 3 percent of AIDS cases worldwide by these same 
supposedly pessimistic estimates. Even Southeast Asia's estimated 65,000 
cases ranks it no higher than Asian Americans in Los Angeles when 
converted to an annual incidence of 5, and both Asia's rank with the 
Middle East and Eastern Europe as continents with the lowest levels of 
AIDS.
 
AIDS in Japan has been getting some headlines, with some ranking Japan 
second only to Thailand in Asia. There is no controversy over Japan's 
leading AIDS expert predicting that in only 8 years, the Japanese will 
suffer an infection rate of one percent, double that of the Americans. 
They will reach today's American total of over 200,000 AIDS cases in 
that short period of time. Others have estimated that the Japanese will 
suffer a monetary impact due to AIDS evidently based upon an AIDS 
incidence equal to America. If there were any evidence that the rate of 
AIDS infection, or the mechanisms of transmission were anything close to 
that of the US, that might seem reasonable. But we're talking about only 
400 cases in a nation half the size of the United States. Even on an 
annual basis, that's 325 times less per capita than the US. It's even 20 
times less than South Dakota. Not only that, but half of these cases are 
foreigners. That alone implies that the HIV rate of the Japanese must be 
hundreds of times less than the most generous estimate of  1 percent of 
visiting Americans infected. If only 200 Japanese citizens are affected, 
that's as many cases as San Francisco sees in a month, and the city 
alone has logged 270 cases of Asian Americans with AIDS in a city where 
Asians are so conspicuously absent when it comes to their share of AIDS 
cases, people have mistaken it for proof Asians are immune to AIDS.

If their gay or IV drug user community were anywhere near as risky or 
prevalent as they were in the US during the 80's, their epidemic would 
have been an extension of our epidemic, which is exactly what happened 
to Europe. But even Japan's largest gay organization claims 0.3 percent 
of the Japanese are gay, and nothing resembling the massive drug 
shooting galleries of the Northeast exists anywhere in Japan. The 
Japanese do love sex, and extramarital sex is not uncommon, but 
heterosexual transmission outside of drug use is all but nonexistent 
even in the US, condom use is the most common form of contraception, and 
nothing like the 60's ethic of loving as many neighbors as frequently as 
possible exists there. 

Interestingly, Dr. Mann's estimates for all of Northeast Asia appear to 
be about the same as that of Japans reported cases. But that means 
they're applying Japan's AIDS rate for China, 50 percent foreigners 
included. Yet in all of China, they've only hit the one-thousand mark 
for AIDS cases this year, and a good proportion there are foreigners as 
well. High estimates are of maybe 10,000 HIV infections. However, over 
half of Chinese cases come from a tiny district call Ruili near the 
Burma drug trade . The 467 cases there gives an annual incidence in the 
ballpark with San Francisco's 252, but the rest of China comes out to a 
mere 0.007 which would put it at least ten times less than even Japan. 
Dr. Mann's prediction of Asian domination of AIDS depends on a China 
whose AIDS incidence is probably at least ten times smaller than the 
Japanese figure he evidently based it on. 

China's foremost sex researcher Dr. Liu Dalin found in a survey of six 
cities that 0.5 percent of urban residents and 2.3 percent of rural 
residents reported homosexual experiences, as did 8 percent of those in 
universities . That pretty much lines up with actual US surveys as 
opposed to the mythical ten percent figure. However, only one third had 
sex with their partners, and among those who did, 40 percent had only 
one partner. That's no way to spread an epidemic when the few American 
gay pioneers at the start of the epidemic literally flew across the 
nation and the globe infecting hundreds of partners each. Even San 
Francisco's Young Men's survey of gay men had a median of 24 partners by 
the age of 22. You combine China's laid back gays with the near total 
absence of massive drug abuse outside of Ruili, and you've got a limited 
problem, not a quarter of the world AIDS epidemic.

Indonesia has reported just 12 cases of AIDS, but we've got 6 cases of 
Indonesians here in California, and nobody is worrying about them here. 
Malaysia has 1212 cases of AIDS, and 4000 cases of HIV infection, a 
cumulative rate no worse than the Asian Americans at 4, and still far 
less than Africa, or the West. India has reported 125 deaths, and found 
6 percent of truckers infected on some routes. But if even one-half 
million are infected, that's 40,000 cases of AIDS, giving a rate less 
than the estimate for Southeast Asia, and comparable to Koreans in Los 
Angeles, or Santa Clara County, which sees only 5 Asian AIDS cases per 
year. Now maybe Thailand has a real crisis, with one guy predicting a 5 
percent infection rate by 2000. But today, their most pessimistic 
estimates give them an annual rate of around 25 or 30, which is 
comparable to the US average, or Asians in San Francisco. I suppose if 
the US is in a crisis, (and there are those that argue that a disease 
that afflicts only 0.02 percent of the population per year, mostly among 
a few small high-risk groups, is hardly a threat to most Americans) and 
it's going to get 3 or 4 times worse, it could get ugly if the 
pessimists are right. On the other hand, Joel Hay of USC is a little 
skeptical of estimates based on surveys of high AIDS areas that would be 
like using the Castro District or Hollywood as being representative of 
the United States. The actual number of confirmed cases are still tiny 
and nobody's seen anything like the phenomenon in San Francisco where 
half of an average gay person's circle of friends gets sick or dies in 
one short decade, or Africa where entire villages have been decimated.

On the one hand, it not a bad idea to worry about AIDS no matter how 
small it is. Even if AIDS is not a problem, it only takes a little 
attention to make sure it stays that way. On the other hand, given 
limited resources where American style AIDS treatment for one would 
bankrupt the resources of a city, it may not make a lot of sense to give 
AIDS the number one per-capita priority it has been given in the US, a 
policy some even question here. It seems that Asia is simply the newest 
fountain of bad news the activists can use into scaring people to pump 
more money and attention into AIDS. They're trying to put to bed the big 
political problem of why over half the world has practically no AIDS 
cases in relative terms, although they've managed to avoid explaining 
why Asians, Mexican and Native Americans have such low AIDS rates in 
America.

The truth of the matter is outside of a few problem areas, AIDS in Asia 
is still not much bigger than the fact it does exist, and still has a 
long way to go before it is even minor compared to other health problems 
like starvation, diarrhea and our old friends like TB. Fortunately the 
extreme practices that spread AIDS throughout Africa and West just 
aren't very common in Asia. The biggest weapon against AIDS remains to 
educate and inform, and that doesn't mean telling everybody to have lots 
of safe sex. Teach people that no sex among multiple partners is 
completely safe, and anal sex is the riskiest kind, a message that still 
scares even Americans afraid of betraying the sexual revolution. 
Swapping needles is the fastest way to transmit the virus, and careless 
health workers can do just as much damage as addicts. If you indulge in 
any of the half-dozen high risk behaviors and contract AIDS, you will 
die, and your friends will die. If you don't do these things, your 
chances of catching AIDS are virtually nil. It's that simple.
 McNeil Lehrer (PBS television) interview Dec. 3, 1992
 "AIDS in the World 1992" Press Kit June 3, 1992 by International AIDS 
Center, Harvard School of Health.
 "After Years of Denial, Asia Faces Scourge of AIDS" Philip Shenon, New 
York Times, Nov 8, 1992 p.1
 "Burma Road Heroin Breeds Addicts, AIDS along China's Border" Jame 
McGregor, Wall Street Journal, September 22, 1992 p.1
 "China easing up on homsexuals" Uli Schmetzer (Chicago Tribune) San 
Francisco Examiner, September 29, 1992 p. A11

doc924\worldaid.wk1
Arthur Hu Dec 1992

World AIDS - Harvard U. International AIDS Center predicts
By the year 2000, AIDS in the World estimates that the largest proportion o
HIV infections will be in Asia (42%), surpassing sub-Saharan Africa (31%),
Carribean (6)
                              HIV infect         AIDS               HIV/AID
                              92 est    95 proj  92 est     95 proj
North America                   1167000  1495000     257500  534000    4.5
West Europe                      718000  1186000      99000  279500    7.3
Australia/Oceania                 28000    40000       4500   11500    6.2
Latin America                    995000  1407000     173000  417500    5.8
Sub-Saharan Africa              7803000 11449000    1367000 3277500    5.7
Caribbean                        310000   474000      43000  121000    7.2
East Europe                       27000    44000       2500    9500   10.8
Southeast Mediterranean           35000    59000       3500   12500   10.0
Northeast Asia                    41000    80000       3500   14500   11.7
Southeast Asia                   675000  1220000      65000  240500   10.4
Total                          11799000 17454000    2018500 4918000    5.8
Asia total                       716000  1300000      68500  255000   10.5

Percent of World Cases        HIV infect         AIDS               HIV/AID
                              92 est    95 proj  92 est     95 proj
North America                       9.9%     8.6%      12.8%   10.9%   0.8
West Europe                         6.1%     6.8%       4.9%    5.7%   1.2
Australia/Oceania                   0.2%     0.2%       0.2%    0.2%   1.1
Latin America                       8.4%     8.1%       8.6%    8.5%   1.0
Sub-Saharan Africa                 66.1%    65.6%      67.7%   66.6%   1.0
Caribbean                           2.6%     2.7%       2.1%    2.5%   1.2
East Europe                         0.2%     0.3%       0.1%    0.2%   1.8
Southeast Mediterranean             0.3%     0.3%       0.2%    0.3%   1.7
Northeast Asia                      0.3%     0.5%       0.2%    0.3%   2.0
Southeast Asia                      5.7%     7.0%       3.2%    4.9%   1.8
Asia total                          6.1%     7.4%       3.4%    5.2%   1.8
Total                          11799000 17454000    2018500 4918000

Est Annual  92-95             HIV                AIDS
North America                   109,333      5.8%    92,167     9.5%
West Europe                     156,000      8.3%    60,167     6.2%
Australia/Oceania                 4,000      0.2%     2,333     0.2%
Latin America                   137,333      7.3%    81,500     8.4%
Sub-Saharan Africa            1,215,333     64.5%   636,833    65.9%
Caribbean                        54,667      2.9%    26,000     2.7%
East Europe                       5,667      0.3%     2,333     0.2%
Southeast Mediterranean           8,000      0.4%     3,000     0.3%
Northeast Asia                   13,000      0.7%     3,667     0.4%
Southeast Asia                  181,667      9.6%    58,500     6.1%
Total                         1,885,000             966,500
Asia Total                      194,667     10.3%    62,167     6.4%

AIDS in the World 1992
Ranked by Annual Incidence
                                        Pct                 Rate per 100,00
Location        Population    est AIDS  World    est HIV    CumulatiAnnual
Uganda             17,190,000   500,000    24.77% 3,438,000  2908.7  969.6
China Ruili           103,000       467     0.02%       467   453.4  151.1
Sub-Saharan Afri  488,830,000 1,367,000    67.72% 7,803,000   279.6  130.3
Caribbean          20,160,000    43,000     2.13%   310,000   213.3  129.0
North America     272,280,000   257,500    12.76% 1,167,000    94.6   33.8
Thailand           54,540,000    40,000     1.98%   400,000    73.3   24.4
Latin America     405,290,000   173,000     8.57%   995,000    42.7   20.1
World           5,207,450,000 2,018,500   100.00%11,799,000    38.8   18.6
Latin America     405,290,000   173,000     8.57%   995,000    42.7   14.2
Australia/Oceani   19,820,000     4,500     0.22%    28,000    22.7   11.8
West Europe       531,880,000    99,000     4.90%   718,000    18.6   11.3
Southeast Asia  1,168,690,000    65,000     3.22%   675,000     5.6    5.0
Malaysia           16,920,000     1,212     0.06%     4,000     7.2    2.4
Asia Total      2,809,270,000    68,500     3.39%   716,000     2.4    2.2
India             796,600,000    40,000     1.98%   400,000     5.0    1.7
Middle East       236,750,000    59,000     2.92%    35,000     1.5    1.3
East Europe       423,170,000     2,500     0.12%    27,000   0.591  0.551
Northeast Asia  1,640,580,000     3,500     0.17%    41,000   0.213  0.223
Japan             122,610,000       200     0.01%       900   0.163  0.054
China           1,104,000,000     1,000     0.05%    10,000   0.091  0.030
China non-Ruili 1,104,000,000       241     0.01%       241   0.022  0.007
Indonesia         174,950,000        13     0.00%        26   0.007  0.002
Ranked by annual incidence among adults
Press reports, continent estimates by Harvard AIDS Center
Newsgroups: sci.med.aids