IMAGINE this. You suspect you might have HIV. You are a responsible person, so you get tested. You learn that you are infected with the virus. You go to your doctor. But your doctor refuses to treat your 鈥渟inful鈥� infection, or tries to charge you four times the normal rate for the privilege.
Or you have been infected by your husband, the only man you have been with. He accuses you of adultery, beats you up and throws you down the stairs. Or the workmates you once chatted to and joked with will not let you come to work. Or your parents die of AIDS, then your classmates learn that you too have HIV and refuse to play with you or even touch you.
This unforgiving climate of discrimination is the reality for many HIV-positive people in Asian nations teetering on the edge of a massive AIDS epidemic. The stigma surrounding HIV and AIDS is not exclusive to Asia: some surgeons in the US refused to treat people with AIDS in the early days of the disease. But it is now especially acute in Asian countries such as India and China, where attitudes to sex are very different to those in the west or in Africa. Even talking about sex is taboo, and sex before marriage and outside marriage are condemned. The low status of women puts them at particular risk.
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What is clear is that the discrimination that HIV-positive people face in much of Asia is threatening to derail efforts to halt an explosion of HIV and AIDS, because it is discouraging people from coming forward for testing and from taking precautions to protect others from infection. 鈥淒ue to fear of rejection and reprisal, many people living with HIV do so in silence,鈥� says Joep Lange, outgoing president of the International AIDS Society and co-chair of last week鈥檚 XV International AIDS conference in Bangkok. 鈥淎nd what was true in the early years of the pandemic is still true today: silence equals death.鈥�
Some Asian countries, including India, have until recently blamed the spread of the disease on the deficiencies of western morals or on marginalised groups in their own countries. But throughout Asia, the virus is spreading from minority high-risk groups such as sex workers to the mainstream. 鈥淭o a large extent [the high-risk groups] are the general population,鈥� says Nafis Sadik, special envoy of the UN secretary-general for HIV/AIDS in Asia. 鈥淚t may be hard for Asia-Pacific societies to come to terms with unacceptable behaviour. The men who use drugs or the services of sex workers are the same men who go to family weddings, attend their church or temple and take their children to school. Men who sleep with men also sleep with their wives.鈥�
If Asia does not succeed in changing attitudes, the consequences could be dire. Already, India has the fastest-growing epidemic in the world after South Africa. The prevalence of HIV is relatively low in Asian nations, between 0.1 and 3.0 per cent, compared with African countries such as Botswana where almost 40 per cent are infected. But in the continent that is home to 60 per cent of the world鈥檚 population, small percentages add up to a lot of people.
One country that has done more than any other in the region to prevent the spread of AIDS is Bangladesh. Needle exchange programmes have kept HIV prevalence among the country鈥檚 injecting drug users below 5 per cent, compared with up to 50 per cent in India, Indonesia and Vietnam. But the government鈥檚 proactive response is being undermined by stigma and cultural issues. Doctors are reluctant to take on patients with AIDS, mainly because of the fear that many of their other patients will believe they are being put at risk and leave, says Ghulam Quader, an MP and vice-chair of the Bangladesh Parliament Members鈥� Support Group on Prevention of HIV, AIDS and Human Trafficking. Doctors have to resort to treating their AIDS patients in secret. Another major issue, he says, is the cultural discrimination against women, which makes it hard for them to manage their sexual health.
Quader鈥檚 group has taken an innovative approach to tackling stigma, by training 50,000 imams to spread the prevention message to their communities. The imams have been trained to assure people that developing AIDS is not a crime or a sin. It has also turned around the imams鈥� traditional opposition to condoms. 鈥淭he imams have a very big influence on the population, if they say something, they do it,鈥� says Quader.
Elsewhere, the picture is less clear. Battling discrimination is a complex task, and political declarations are not always matched by action on the ground. For example, China鈥檚 vice-minister of health, Wang Longde, spoke at the Bangkok conference against the discrimination people with AIDS face in China, and of a new law to protect them. But then news came in that four Chinese farmer-activists with HIV had been arrested and jailed. Their only crime was that they had travelled to Beijing to try and meet President Hu Jintao.
