43 C. P. Lindan, S. Allen, A. Serufilira, et al., “Predictors of Mortality Among HIV-Infected Women in Kigali, Rwanda,†Annals of Internal Medicine 116 (1992): 320–28.
44 J. Decosas, “Demographic AIDS Trap for Women in Africa,†presentation to the Seventh International Conference on AIDS, Florence, June 16–21, 1991.
45 See Food and Agriculture Organization (FAO) publications, 1991 to 1993, by David Norse. They are varied and available upon request to FAO, Rome, Italy.
46 S. Armstrong, “South Africa Wakes Up to the Threat of AIDS,†New Scientist, February 16, 1991: 19.
47 C. Hemery, “Spectaculaire Propagation du SIDA en Ethiopie,†Afrique Nouvelle, July—August 1993: 38–39.
48 R. M. Anderson, R. M. May, M. C. Boily. et al., “The Spread of HIV-1 in Africa: Sexual Contact Patterns and the Predicted Demographic Impact of AIDS,†Nature 352 (1991): 581–89.
49 World Bank, “The Economic Impact of Fatal Adult Illness from AIDS and Other Causes in Sub-Saharan Africa,†Research Project, World Bank, Washington, D.C., 1991.
50 M. King and R. Hall, “AIDS Soon to Overtake Malaria,†Lancet 337 (1991): 166.
51 The Delphi approach, like Chin’s model at GPA, tried to factor for the enormous discrepancy between the numbers of officially reported AIDS cases and HIV infections in the world, on the one hand, and elusive reality, on the other. Chin’s approach involved creation of mathematical models of various types of national epidemics and infection spread rates. The Global AIDS Policy Coalition used Delphi techniques of surveying local experts all over the world. Prominent AIDS scientists and physicians were asked to give low- and highball estimates of their country’s epidemics, regional pandemics, and the global situation. Statistical methods were used to derive a regional range of estimated pandemic size and future proportions.
Neither technique was perfect. Both lacked crucial data and had to be considered educated guesses.
52 J. Mann, D. J. M. Tarantola, and T. W. Netter, “The Impact of the Pandemic,†AIDS in the World (Cambridge, MA: Harvard University Press, 1992), 9–132.
53 United Nations Development Program, Human Development Report 1993 (New York: Oxford University Press, 1993).
54 World Bank, World Development Report 1993: Investing in Health (New York: Oxford University Press, 1993).
This represented a marked policy shift for the World Bank. Just five years earlier Bank management, still unable to see how the AIDS epidemic imperiled development, withheld a $15 million loan for AIDS education efforts in Zambia because the Kaunda government had fallen behind on repayment of other, non-AIDS loans.
55 According to World Population Profile: 1994 (Washington, D.C.: U.S. Census Bureau, Department of Commerce, 1994), population growth rates between 1994 and 2010 for the sixteen hardesthit countries would be as follows:
Country Projected Annual Without AIDS Growth With AIDS
Brazil 0.9% 0.6%
Burkina Faso 3.1 1.6
Burundi 3.0 1.9
Cen. Afr. Rep. 2.4 1.9
Congo 2.3 1.0
C6te d‘Ivoire 3.1 2.5
Haiti 2.1 1.3
Kenya 2.5 1.0
Malawi 3.2 1.6
Rwanda 3.5 1.7
Tanzania 3.0 1.5
Thailand 0.9 -0.8
Uganda 3.3 1.5
Zaire 3.3 2.9
Zambia 3.4 1.4
Zimbabwe 2.1 0.5
56 A World Bank study demonstrated that families that absorbed AIDS orphans in Côte d’Ivoire were unlikely to provide the foster children with the same opportunities afforded to their own children. In a survey, foster children performed on average 20 percent more housework and 15 percent more fieldwork than their counterparts who were the natural offspring of the foster parents. And foster children were 30 percent less likely to be sent to school.
57 “Africa Will Suffer ‘Millions’ of AIDS Orphans,†New Scientist, February 23, 1991: 23.
58 E. A. Preble, “AIDS and African Children, Social Science and Medicine 31 (1990); 671–80. Other estimates of the region’s AIDS orphan burden include:
59 Center for International Research, World Population Profile: 1994, op. cit.
60 J. Decosas,â€Fighting AIDS or Responding to the Epidemic: Can Public Health Find Its Way?†Lancet 343 (1994): 1145–46.
61 J. McDermott, Report to the Speaker of the House of Representatives: The AIDS Epidemic in Asia, International AIDS Task Force, U.S. House of Representatives, June 6, 1991.
62 AIDS in Asia
Cases Officially Reported by Respective Governments to the World Health Organization
The key exception was Japan. Though Japanese HIV infection rates had remained quite low, social response to AIDS was striking. Even before AIDS appeared on the public health radar screen, Japan had two cultural traditions in place that protected most of its citizens from emerging sexually transmissible microbes: condoms were the preferred mode of birth control, and very few Japanese ever had sex with a non-Japanese. Fear of AIDS only strengthened both those cultural traditions. See T. Kurima, “AIDS in Japan,†presentation to the Conference of Asian Solidarity Against AIDS, Florence, June 18, 1991; K. M. Chysler, “Japan, Alarmed at Arrival of AIDS, Blames Outsiders,†San Francisco Chronicle, April 26, 1987: A22; D. Rosenheim, “Spread of AIDS Threatens Japan,†San Francisco Chronicle, December 8, 1986: A10; and L. Garrett, “AIDS in Asia,†Morning Edition, National Public Radio, November 23, 1986.
63 B. Mangla, “India: HIV–Positive Blood Donors,†Lancet 341 (1993): 1527–28. For an uncanny analysis of India’s nascent AIDS epidemic and future crisis, see B. Mangla, “AIDS in India: An Alarming Diagnosis,†Express Magazine in Sunday Express (Delhi), March 19, 1989: 1, 7.
64 Rates of infection among prostitutes found in that survey included 2.65 percent in Madras and 2.7 percent in Poona. Just six months earlier, less than 0.4 percent of Poona’s prostitutes were HIV-POSITIVE.
65 K. S. Jacobs, H. Jayakumari, J. K. John, and T. J. John, “Awareness of AIDS in India: Effect of Public Education Through the Mass Media,†British Medical Journal 299 (1989): 721.
66 “India: Prostitutes and the Spread of AIDS,†Lancet 335 (1990): 1332.
67 A. Kumar, “AIDS in India: Fear and Ignorance Are Combining to Produce the Public Health Crisis of the Century,†India Currents, August 1991: 17–18.
68 O. Sattaur, “Doubts over Testing Hamper India’s AIDS Efforts,†New Scientist, April 20, 1991: 18; and O. Sattaur, “India Wakes Up to AIDS,†New Scientist, November 2, 1991: 25–29.
69 M. Grez, U. Dietrich, J. Maniar, et al., “High Prevalence of HIV-1 and HIV-2 Mixed Infections in India,†presentation to the Ninth International Conference on AIDS, Berlin, June 6–11, 1993.
70 Thailand: HIV Infection Rates in Key Groups (Source: Thai Ministry of Public Health)
Population Group Percent Positive for HIV Infection Year Tested
Prostitutes nationwide (average) 3.5 June 1989
6.8 December 1989
9.6 June 1990
People attending STD clinics 0.0 June 1989
2.0 December 1989
2.5 June 1990
IV drug users 39.0 Early 1989
46.0 Late 1989
50.0 1990
Prisoners 12.0 1989
Female prostitutes in Chiang Mai province 0.4 1989
50.0 Late 1990
70.0 1991*
Female prostitutes in Bangkok 18.0 Late 1990
Female prostitutes in Phuket 0.0 1989
* Prostitutes employed as sex workers for over 6 months.
71 G. L. Myers, “Global Variation of HIV Sequences,†presentation to the First National Conference on Human Retroviruses and Related Infections, Washington, D.C
., December 12–16, 1993.
72 The populations that were regularly tested—some on a voluntary basis, some compulsorily—included cohorts of injecting drug users in Bangkok, Cholburi, Pattaya, Chiang Mai, and Rayong; prisoners; all army recruits (which amounted to every twenty-one-year-old male in the nation); and prostitutes and barmaids in several cities.
73 For a sampling of reports on Thailand’s early epidemic, see C. Woodard, “Imperiled on Two Fronts,†New York Newsday, Discovery section, March 6, 1990: 1, 6–7; B. G. Weniger, K. Limpakarnjanarat, K. Ungehusak, et al., “The Epidemiology of HIV Infection and AIDS in Thailand,†AIDS 5 (1991): S71—S85; W. Sittitrai, S. A. Obremskey, T. Brown, and P. O. Way, “HIV/AIDS Projections for Thailand, 1990–2005,†Thai Working Group on HIV/AIDS Projections, Bangkok, 1991; R. Rhodes, “Death in the Candy Store,†Rolling Stone, November 28, 1991: 62–70, 113–14; W. Sittitrai and T. Brown, “The Asian AIDS Epidemic,†presentation to the Congressional Forum on the HIV/AIDS Pandemic, Washington, D.C., June 23–25, 1992; M. Sweat, T. Nopkesorn, T. D. Mastro, et al., “AIDS Knowledge and Risk Perception at Baseline in a Cohort of Young Men in Northern Thailand,†presentation to the Eighth International Conference on AIDS, Amsterdam, July 19–24, 1992; T. D. Mastro, D. Kitayaporn, B. Weniger, et al., “Estimate of the Number of HIV-lnfected Injecting Drug Users in Bangkok Using Capture-Recapture Method,†presentation to the Eighth International Conference on AIDS, Florence, July 19–24, 1992; K. Limpakarnjanarat, T. D. Mastro, W. Yindeeyoungyeon, et al., “STDs in Female Prostitutes in Northern Thailand,†presentation to the Ninth International Conference on AIDS, Berlin, June 6–11, 1993.
74 In February 1991 the military installed civilian front man Anand Panyarachun as Prime Minister. His reign was brief: by April the military had decided that Anand was in the way, and coup leader General Suchinda Kraprayoon took over. Mass demonstrations and resistance activities spread over Thailand, building over eleven months’ time to a confrontational peak in May 1992. Realizing they could not maintain power without slaughtering thousands of civilians and imposing a costly authoritarian regime, the military leaders stepped aside. The civilian front man, Anand, resumed office and scheduled national elections for September 1992. The military regime was swept out of power in those elections, replaced by a civilian pragmatist, Chuan Leekpai.
In terms of AIDS, the period of military rule and instability, February 1991—September 1992, was characterized by repression, chaotic to nonexistent education efforts, and general disarray.
75 Asia Watch Women’s Rights Project (1993), op. cit.
76 A joint Japanese/Thai study in 1992 showed that some of the HIV strains turning up in Japan were genetically identical to those circulating among female prostitutes and their customers in Thailand. Sixty-seven percent of HIV-positive non-Japanese males residing in Japan (immigrant workers) carried the Thai strain, as did 85 percent of their female counterparts.
In addition, five Japanese men were found infected with the same virus. Three had traveled to Thailand, but two had acquired the viruses in Japan, as a result of heterosexual intercourse with immigrant women. See Y. Takebe, C. P. Pau, S. Oka, et al., “Identification of Thailand and HIV-1 Subtypes in Japan,†presentation to the International Conference on AIDS, Berlin, June 6–11, 1993.
77 W. Sittitrai, P. Phanuphak, J. Barry, et al., “Survey of Partner Relations and Risk of HIV Infection in Thailand,†Seventh International Conference on AIDS, Florence, June 7–11, 1991.
78 In keeping with the practice of human rights advocates inside and outside the country, I have used the name Burma rather than Myanmar throughout this book. It is thought that recognizing the military’s change of Burma’s ancient name lends international credibility to the outlaw regime.
79 An exception to Burma’s otherwise universal pariah status was China. The Chinese government, which was accustomed to ignoring international cries of human rights violations, allowed vigorous trade with Burma. Among the items traded between the nations, openly or on the Burmese-sanctioned black market, were condoms, syringes, heroin, and military arms for the junta’s elite forces. See P. Shenon, “Burmese Cry Intrusion (They Lack a Great Wall),†New York Times, March 29, 1994): A4.
80 Sittitrai and Brown (1992), op. cit.
81 The Far Eastern Economic Review ran a strong summary of the Thai situation in its February 1992 issue, including a profile of Mechai.
82 “VD Cases Soar in China as Prostitution Returns,†San Francisco Chronicle, May 7, 1987: A10; J. Mann, “China Starts Drive Against Once-Vanquished Scourge—Venereal Disease,†Los Angeles Times, July 4, 1987: A10; E. A. Gargan, “China Taking Stringent Measures to Prevent Introduction of AIDS,†New York Times, December 22, 1987: Al; and N. D. Kristof, “Heroin Spreads Among Young in China,†New York Times, March 21, 1991: Al.
83 Global Programme on AIDS, “The HIV/AIDS Pandemic: 1993 Overview,†World Health Organization WHO/GPA/CNP/EVA/93.1, 1993.
84 M. H. Merson, “HIV/AIDS: Epidemic Update and Corporate Response.†Presentation to the AETNA/WHO Asia AIDS Seminars, Hong Kong, April 14, 1994.
85 INDICATORS OF ASIAN ECONOMIC GROWTH (Source: World Bank.)
86 Global Programme on AIDS (1993), op. cit.
87 T. D. Mastro, G. A. Satten, T. Nopkesorn, et al., “Probability of Female-to-Male Transmission of HIV-1 in Thailand,†Lancet 343 (1994): 204–7; and “AIDS: The Third Wave,†Lancet 343 (1993): 186–88.
88 D. C. DesJarlais, K. Choopanya, S. Vanichsenia, et al., “AIDS
Risk Reduction and Reduced HIV Seroconversion Among Injection Drug Users in Bangkok,†American Journal of Public Health 84 (1994): 452–55.
89 P. Handley,â€Pumping Up Condoms,†Far Eastern Economic Review, February 19, 1992: 31; and M. Viravaidhya, S. A. Obremsky, and C. Myers,â€The Economic Impact of AIDS on Thailand,†Working Paper Series, Department of Population and International Health, Harvard School of Public Health, Number 4, 1992.
90 S. Kongsin, S. Rerks-ngarm, L. Suebsaeng, et al.,â€Hospital Care Cost Analysis of ARC/AIDS Patients, Thailand,†presentation to the Ninth International Conference on AIDS, Berlin, June 6–11, 1993.
91 M. H. Merson,â€Slowing the Spread of HIV: Agenda for the 1990s,†Science 260 (1993): 1266–68.
92 C. N. Myers and T. Ashakul,â€AIDS in Thailand: Some Preliminary Findings,†TDRI Quarterly Review 6 (1991): 8–12.
93 Center for International Research (1994), op. cit.
94 See World Bank. World Development Report 1993, op. cit.; P. Shenon,â€After Years of Denial, Asia Faces Scourge of AIDS,†New York Times, November 8, 1992: Al; Asian Development Bank, Annual Report, 1992; U.S. State Department,â€The Global AIDS Disaster: Implications for the 1990s†(Washington, D.C.: Government Printing Office, 1992); D. W. FitzSimons,â€Further Asian Spread in 1994?†AIDS Newsletter 8 (1993): 14: 1; and P. Piot,â€AIDS: The State of the Epidemic,†speech delivered at the Opening Ceremony of Biotech 94, Florence, April 10, 1994.
95 Latin America was, of course, also experiencing a rapidly growing HIV pandemic during the late 1980s and the 1990s. The microbe successfully emerged in every island nation of the Caribbean well before 1986, and reached endemicity in that region before the close of the decade. Some Caribbean nations, notably Haiti, the Dominican Republic, Bermuda, and the Bahamas, had per capita HIV/ AIDS rates by the late 1980s that ranked among the highest in the world, exceeding most of Africa.
Mexico’s evolving AIDS epidemic was strongly linked with that of the United States, as tens of thousands of Mexicans traveled back and forth between the two countries every year.
Of greatest concern in Latin America was Brazil, the largest nation on
the continent. With its economy in a shambles and external debt astronomical, Brazil was in no shape to take on an additional burden. AIDS hit Brazil hard and fast, spread initially through the country’s blood supply. As late as 1993 there were still private blood banks that failed to properly screen potentially contaminated blood.
Brazil’s long tradition of sensuality and overt sexuality also contributed to the spread in that many young adults had several sexual partners each year. In addition, the society had long-standing ambivalence about homosexuality: men who self-identified as “gay†were vilified and scorned, yet a sizable percentage of Brazil’s married “heterosexual†men engaged in gay anal intercourse outside their marriages. This duality and secrecy made the task of AIDS education extremely difficult.
See: R. E. Koenig, J. Pittaluga, and M. Bogart, “Prevalence of Antibodies to the Human Immunodeficiency Virus in Dominicans and Haitians in the Dominican Republic,†Journal of the American Medical Association 257 (1987): 631–34; S. Siebert, A. Guillermoprieto, and R. Marshall, “An Epidemic Like Africa’s,†Newsweek, July 27, 1987: 38; T. Golden, “AIDS Is Following Mexican Migrant Workers Back Across the U.S. Border,†New York Times, March 8, 1992: A3; M. Schecter, L. H. Harrison, N. Halsey, et al., “Coinfection with Human T-Cell Lymphotropic Virus Type 1 and HIV in Brazil,†Journal of the American Medical Association 271 (1994): 353–57; Centers for Disease Control, “Isolation of Human T-Lymphotropic Virus Type III/Lymphadenopathy-Associated Virus from Serum Proteins Given to Cancer Patients—Bahamas,†Morbidity and Mortality Weekly Report 34 (1985): 489 91; R. Howell, “AIDS in Puerto Rico,†Newsday, Discovery section, December 11, 1990: 69, 74–75; M. Hernandez, P. Uribe, S. Gortmaker, et al., “Sexual Behavior and Status for Human Immunodeficiency Virus Type 1 Among Homosexual and Bisexual Males in Mexico City,†American Journal of Epidemiology 135 (1992): 883–94; R. G. Parker, “AIDS Education and Health Promotion in Brazil: Lessons from the Past and Prospects for the Future,†in J. Sepulveda, H. Fineberg, and J. Mann, eds., AIDS Prevention Through Education: A World View (New York: Oxford University Press, 1992), 109–26; and J. Sepulveda, “Prevention Through Information and Education: Experience from Mexico,†ibid., 127–44.
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