INTRODUCTION

I am very honoured to speak at this symposium today.

A record 40 million people were living with HIV at the end of 2001 [1]. The figure was 34 million about two years ago. In many parts of the developing world, the majority of new infections occurred in young adults, with young women especially vulnerable. Most of them do not know they carry the virus. AIDS strikes both women and men, heterosexual and homosexual, and children and newborns, regardless of their age, gender, sexual orientation and race.

ALARMING LACK OF KNOWLEDGE

The Chinese community, with close to 1.3 billion people worldwide, is also affected by this epidemic. As discussion about sex is traditionally a taboo in the Chinese culture, the related topic of AIDS is often shunned, until it may be too late.

A recent report on AIDS in a Hong Kong pop culture magazine describes how a 17-year old girl kept the secret of contracting AIDS for two years:

I was afraid to let my family know about my disease…Every time I went to see the doctor, I had to sneak out…I know that family support is important, but I dared not tell them [2].
This Hong Kong girl was heterosexual and contracted AIDS from sexual contact when she was only 15. Another 19-year old girl who got AIDS in a similar way told the magazine that it was common for young girls "to have different (sex) partners every night" and they were hardly aware of the risks involved in unprotected sex. What she said is not surprising as Hong Kong press has been reporting on our teens' appalling lack of sex knowledge. We frequently read about teenage mothers dumping their newborn babies saying that they were not aware of their own pregnancy for the last nine months and did not know how to handle the unexpected newborn. Many teens today have sex without thinking about the consequences. They are not concerned about AIDS partly because their parents were also not concerned and never talked to their children about how to protect themselves from the disease. They felt that AIDS was other people's problem.

According to Hong Kong's AIDS Prevention and Care Committee, high-risk sexual behaviours are common among youth [3]. Around 7% of in-school youth in 1996 have experienced sexual intercourse. For the out-of-school youth (aged 18-27), a higher rate of 31% in 1996 has been observed. Another local sexuality survey on youth-at-risk in 1996 had revealed that only 41% used condoms in the last sexual intercourse. These youth had a very low perceived vulnerability of HIV infection.

This is in line with a recent UNAIDS study which finds that there is an alarming lack of knowledge about HIV/AIDS among young people [4]. The report says the vast majority of the world's young people, those aged 15 to 24, have no idea how HIV/AIDS is transmitted or how to protect themselves from the disease. The surveys from 60 countries indicate that in some countries, the proportion of young people who have correct knowledge is as low as 20 per cent. Yet the study also shows that adolescence is the time when the majority of people become sexually active. The tragic consequence is that half of all new infections today are in people between the ages of 15 and 24. Each one of these infections can be prevented.

AIDS PERIL IN THE CHINESE COMMUNITY

Many people on China Mainland still think that HIV can be contracted through mosquito bites or shaking hands. Other problems include poverty and lack of access to condoms. The sheer size of China Mainland also makes education, surveillance, detection and treatment difficult.

In April, state media reported that intravenous drug use accounted for 68 per cent of infections in China Mainland, while blood-selling accounted for 9.7 per cent [5]. Chinese government data last year showed 30,736 people were carrying the HIV virus, 1,594 had full-blown AIDS and 684 people died from illnesses related to the disease. On the other hand, according to a recent UNAIDS report [6], China Mainland is on the brink of an "explosive" AIDS epidemic. The report estimates that the true number of people carrying the AIDS virus could be between 800,000 and 1.5 million. That figure could soar to 10 million by 2010, as the study warns that sexual transmission is fast growing as a means of infection. That would be the highest number of HIV cases in the world.

The UN calls for the Chinese government to take up urgent and effective countermeasures, such as setting safe blood banks and educating the public about AIDS and how it is spread.

PROMOTING ACCEPTANCE

Extensive education about the disease would help understanding and prevention and encourage testing and treatment. Until a vaccine is found, the prevention of HIV/AIDS will still rely on social measures, such as teaching people how to practice safe sex and not to share needles. Understanding also increases acceptance and reduces isolation and stigmatisation.

HIV/AIDS is not only a health issue for the Chinese communities. It is a socio-economic development issue as well as a human rights issue. To fight the disease, it is pivotal that all Chinese communities work together. We need to spread the message that even if the general population is not engaged in what traditionally is thought of as "risk-taking" or "socially disapproved" behaviour, they are still vulnerable to AIDS. One does not need to be drug abusers or sex workers to be at high risk.

We need to rally the involvement of the whole community in our fight against AIDS – the government, the media and the public. The newly established Global Chinese AIDS Network will play an important role in the Chinese communities worldwide in de-stigmatising AIDS and co-ordinating efforts in fighting AIDS.

In Hong Kong, the official figures up till the first quarter of 2002 were 1,798 reported HIV infection and 570 AIDS cases [7]. Sexual contact is the main route of transmission, accounting for 80.9% of all reported HIV infections [8]. However, the UNAIDS report on the Global HIV/AIDS Epidemic released earlier this month estimated that Hong Kong has up to 3,200 people with HIV/AIDS. Some academics have said that the figure could be as high as 5,000 and warned cross-border sex was putting Hong Kong at risk [9]. It is a known fact that many men from Hong Kong cross the border and have unprotected sex in Southern China.

In particular, heterosexual transmission through one's regular partner in the family is increasing. Typically, the husband gets infected through unprotected paid sexual contact and then passes the virus onto his wife. Often the husband avoids taking the test and the wife may not know about the risk or how to deal with it. In a Chinese community, it is culturally difficult for a wife to talk about these issues or to assert their needs in sexual relationships.

The data for Hong Kong indicate a rapidly increasing number of infections through heterosexual transmission for those aged 20–39. These are also the biologically productive years for women. It is therefore vitally important that women are empowered with information and knowledge of HIV/AIDS and that support is made widely available to them. Knowledge on the part of women in the family can help prevent transmission between spouses as well as from mother to child. Women in the family can also play a key role in multiplying the effect of knowledge and in teaching the young.

CREATING SUPPORTIVE ENVIRONMENT THROUGH LEGISLATION

Creation of a supportive and a more accepting environment for those living with HIV/AIDS involves many facets: public education, legislation, administrative measures and the judicial process. Among these, the law contributes significantly to the prevention of discrimination against people living with HIV/AIDS.

Hong Kong's Disability Discrimination Ordinance has been in effect since 1996. The law protects people living with HIV/AIDS by ensuring that they are not subjected to discrimination where education and employment are concerned. It also prescribes that services and facilities are to be made available to them. The law also helps to induce acceptance and achieve inclusion. Our settlement with two defendants on the basis of unequivocal apologies for harassing staff of a health clinic associated with HIV/AIDS services are cases in point. Upon settlement of these court actions, a few residents in the neighbourhood were willing to speak out in support of the clinic publicly. This was not the case 3 years ago.

It is extremely important to let persons with HIV/AIDS know that the law is on their side. The law requires the discriminator to cut the bad habit first and to start learning.

Anti-discrimination laws alone are not sufficient to meet the intended social objective behind these laws. Many living with HIV/AIDS are from the under-privileged and often underground communities, such as drug addicts and sex workers. To help them feel safe in seeking advice and help without fearing they will fall foul of the law, we need to consider decriminalising related offences in connection with solicitation by sex workers and needle exchange programmes to reduce the risk of infection through sharing needles. An environment in which those living with HIV/AIDS fear harassment and stigmatisation will not encourage those at risk to come forward, or, those who are not, to provide care and support. Such an environment will only drive the epidemic underground, frustrating detection, prevention and treatment.

CONCLUSION

A successful AIDS strategy must be built on respect for human rights, acceptance and knowledge.

1. Both the community and government must be open and frank about it. Fear that disclosure will deter investment will lead to the death of the young and the talented and the possible collapse of an economy.

2. There must be effective monitoring, surveillance and co-ordination on a national and regional level. An "explosive"epidemic will not be confined by borders.

3. Education must be bold and pervasive. Do not be shy teaching the young. It is the young and the families that must be able to talk about HIV and AIDS at dinner.

4. Prevention must be widely practiced and we must embark on this decisively. The number of affected persons will shoot up and the medical bill will quickly be beyond our means.

5. Reach the vulnerable groups that have not been reached before. Decriminalising solicitation by sex workers and legalising needle exchange may be controversial but we have to make a choice. We must consider harm reduction and prevention.

6. Last but not the least, those living with HIV/AIDS are entitled to maximal participation and enjoyment in life. It is individual rights which need to be recognised as a benchmark for services and participation. Right to health is now used more and more as a mitigator against the harshness of patented drugs.

The community response to HIV/AIDS must be built on realism, acceptance and knowledge. In the end it is knowledge that will save lives and it is ignorance that will wreck lives and communities.

End

---

[1] UNAIDS website (http://www.unaids.org/epidemic_update/report_dec01/index.htm)
[2] Ming Pao Weekly, 29 June 2002
[3] Hong Kong AIDS Prevention and Care Committee, "HIV Prevention and Care in Youth – Principles of Strategy, December 2000" (http://www.info.gov.hk/aids/chinese/publications/index.htm)
[4]“Young People and HIV/AIDS: Opportunity in Crisis”
(http://www.unaids.org/whatsnew/press/eng/pressarc02/PRypreport020702.html) (2002年7月2日)
[5] "Chinese officials reject UN report warning of huge AIDS epidemic" by Associated Press, dated 28 June 2002
(http://ca.news.yahoo.com/020628/6/ncqb.html)
[6]“HIV/AIDS: China's Titanic Peril” by The UN Theme Group on HIV/AIDS in China
(http://www.unaids.org/whatsnew/newadds/AIDSchina2001update.pdf)
[7] Department of Health, Quarterly HIV/AIDS Reported Statistics – Highlights of this Quarter (January – March 2002) at (http://info.gov.hk/aids/chinese/surveillance/quarter.htm)
[8] Hong Kong STD/AIDS Update (Quarter 4, 2001) at http://www.info.gov.hk/aids/english/surveillance/index.htm
[9]“HIV figures double official rate”, South China Morning Post, 3 July 2002