UNICEF regional HIV/AIDS programming in the 1990s focussed on the Mekong subregion - six East and Southeast Asian countries that border the Mekong River. Increasingly, new countries in the East Asia and Pacific region are benefitting, particularly those where HIV/AIDS poses a serious threat.

The Mekong Subregion

For most of its 4,350-kilometre length, the Mekong River flows through a sparsely populated landscape of mountains, forest and farms. The countries along its course are all developing, particularly in big cities, many communities remain remote and isolated. Ethnic groups and subgroups, often with closer cultural and linguistic links to communities hundreds of kilometres away than to their nearest neighbours, are scattered through the subregion.

Infrastructure and opportunities are few in the villages and rural towns, so many young people migrate to the faster-developing cities, seaports and neighbouring countries, in search of work and wealth. Some find good jobs with a future, often in factories. But with little education, often no legal documents and unable to speak the local language, many young migrants end up in hazardous work, particularly in the sex industry. Others find no work at all, and end up as beggars or living on the street, where drug use, unsafe, often coerced, sex and other high-risk behaviour is common.

The Mekong subregion is undergoing changes more rapid and more profound than at any time in its history. In many cases, institutions and cultures are trying to adapt; others are falling back on stubborn conservatism. In the meantime, worsening HIV/AIDS epidemics are feeding off poverty, migration and the clash of cultures.

The first Mekong country to suffer a major HIV/AIDS epidemic was Thailand. Infection rates among commercial sex workers and injecting drug users were already rising steeply by the late 1980s. Today, many people are still becoming infected every year, but new infection rates have fallen gradually since the mid-1990s thanks to a sustained, well-resourced and proactive national response.

Our knowledge about the progress of the epidemic in other parts of the subregion is far less reliable. Estimates are based on reported cases (which usually represent only a fraction of real cases) and limited sentinel surveillance.

Cambodia is believed to have the highest HIV prevalence rate among adults in Asia, followed by Thailand and Myanmar. New infection rates in Cambodia recently levelled off after years of rising steeply. Sentinel data suggest that new infections in Myanmar are still soaring, in a very low-resource setting. So far, Lao PDR seems the country least affected, but its geographic, socio-economic and cultural situations make it extremely vulnerable.

To date, the epidemic in Viet Nam has been largely confined to male injecting drug users. However, unprotected sex is expected to become the predominant mode of transmission within the next five years, putting many more women and children at risk.

Until mid-2001, it was believed that China, too, had relatively low infection rates. However, as the full extent of the outbreak of infections through contaminated blood becomes clear, it seems China may now have prevalence rates of 1.7% in the general population, and more than 2 million people infected. Meanwhile, there is clear evidence that the epidemic is spreading rapidly from the remote border communities of Yunnan Province into the general population of Kunming and other provinces. With a population of 1.4 billion, the epidemic in China could take a devastating toll.

Other Countries

Papua New Guinea has the fastest-moving epidemic in East Asia and the Pacific outside the Mekong subregion. HIV/AIDS is clearly well established in the general population, and in some highland areas, prevalence rates of 58% have been recorded among men and women. Although it is believed overall HIV infection rates are still relatively low, there are fears that PNG could soon be facing an HIV/AIDS epidemic as grave as those in parts of southern Africa. The Mekong Partnership and Beyond provides special assistance to PNG.

The HIV epidemic appears to be evolving rapidly in Indonesia. Recent data from Jakarta, West Java and Bali show that between a quarter and half of injecting drug users in treatment were infected with HIV by 2001. In 2000, close to 10 percent of sex workers in the western province of Riau were infected with HIV, while in one port city in Irian Jaya, over a quarter of sex workers tested HIV positive. Condom use remains worryingly low among men visiting sex workers.

Although prevalence in the general population remains low, rates among blood donors rose six-fold up to 2000, a warning that the epidemic could spread much more widely. Present political uncertainties and conflict and displacement of people could undermine urgently needed prevention efforts.

Prevalence in the Philippines is low, probably thanks to the country's geography and the low incidence of commercial sex. However, around four million Filipinos work overseas, and they may represent an HIV risk during home visits. As a strictly Catholic country, the Philippines does not allow the promotion of contraceptives, including condoms.

HIV/AIDS came to Malaysia early, with the first case of AIDS identified in 1986. Prevalence rates are now relatively high, with infections through drug injecting and sexual transmission probably around equal. The Government has banned needle exchange programs and does not promote condom use.

Although there is only one AIDS fatality and one officially registered HIV-positive person in Mongolia, the rise in STIs carries with it the threat of a spreading HIV/AIDS epidemic.

The individual country reports contain more detailed information on the HIV/AIDS epidemics in priority countries in East Asia and the Pacific.