Laos reports 3,395 cases of HIV/AIDS, 960 deaths

Landlocked, communist Laos has its isolation to thank for keeping the global AIDS epidemic at bay while its Southeast Asian neighbors struggle with some of the highest HIV infection rates in the world. But the United Nations fears attempts by the country to adopt a market economy and open up to the outside world could spark a surge in transmissions of HIV, the virus that causes AIDS. "Laos has been the quiet achiever at keeping the spread of HIV at bay, but this could all change," Tony Lisle, a top UNAIDS official in Southeast Asia, told Reuters in an interview. "The country is facing the same issues that its neighbors have faced in the past, and the threat of HIV/AIDS is as big as ever. As the pace of development increases, so does the AIDS risk." A UN-World Health Organization report at the end of 2001 said Laos had an HIV infection rate of 0.04 percent of adults between the ages of 15 and 49 -- a fraction of the equivalent rate of 2.7 percent in Cambodia and 1.8 percent in Thailand. Laos has around 5.4 million people. The UN said Laos has hardly any migrant workers, few intravenous drug users and the government had successfully educated its people about the disease when infections began to rise in the mid-1990s. Laos is one of the world's last remaining communist countries, and since the demise of the Soviet Union in 1991 the secretive state's economy has struggled. The nation's currency, the kip, lost 90 percent of its value against the U.S. dollar in the 1997-98 Asian financial crisis. In a bid to boost its fragile economy, Laos has promoted tourism and improved trade ties with its neighbors. ROAD TO SEX New roads are planned to link Laos with Thailand, Vietnam and China. A domestic north-south route is also proposed. But the social implications of this could be high. The UN fears improved roads could bring disease along with foreign income. "More truck drivers and construction workers will come across the borders -- single men or men living away from their families --which will inevitably increase the number of people working in the domestic sex industry," Lisle said. "Unlike its neighbors, Laos doesn't have a large sex-worker population or a large client base, but this could all change." Until the mid-1990s, the government restricted movement between provinces. Wealthy individuals and businessmen were the only people allowed to leave the country. But poverty means large numbers of people are expected to travel to China and Thailand to fish or work on building sites -- and the UN says many are likely to be lured toward prostitution. "Migrant workers may return to the country and spread the disease, especially those who've worked in the sex industry," Lisle said. "And those who stay in the country will inevitably move to the bigger towns and cities. The temptation is there for Laotian women to work in the sex industry and earn more money to support their families."

Can Laos keep AIDS at Bay?Land-locked Laos is surrounded by some of the highest rates of HIV infection in the world. Yet so far, Laos itself has largely escaped the disease. United Nations data says the number of people in Laos living with HIV at the end of 2001 was about 1,500 or 0.05% of the population. The HIV rate among women working in the nascent sex industry in Laos was about 1%, much lower than equivalent figures in neighbouring countries. So why has Laos been so successful at keeping the epidemic at bay? 'Safely cut off' One factor is the isolation of the country in recent decades. Laos has not seen the kind of large scale migration which has caused much social dislocation in other parts of East Asia. Laos also has virtually no recorded use of intravenous drugs - a key factor in transmitting HIV elsewhere. The Lao Government has won much praise for recognising the threat of HIV-AIDS early on, and for acting swiftly to educate its population. 'Imaginative education' The Lao authorities, supported by international agencies, have used imaginative means to get their message to even the remotest villages, from mobile puppet shows to elephants draped with condom adverts. During the World Cup in June 2002, condom advertisements were flashed on the television every few minutes to reach the mobile male population who are considered at most risk of spreading HIV. But there is growing concern that, as Laos opens up to the outside world, its record as one of Asia's Aids success stories could be at risk. Laos is building roads to connect itself to the rest of the region. Major all-weather routes are under construction linking Kunming in southern China to the northern Thai city of Chiang Rai. Also planned is an East-West economic corridor linking Thailand to Vietnam via Laos. 'Unwanted imports?' And soon it will be possible, for the first time, to drive the length of the country from north to south on a single highway known as Route 13. It is all part of the Lao Government's efforts to sell itself as "land-linked" rather than land-locked. The aim is to attract tourism and investment. But this is not all the roads could bring in. "What these roads will carry are drugs, girls and viruses," says David Feingold, one of the HIV-AIDS co-ordinators for the cultural section of UNESCO in Bangkok. He says the expected influx of construction workers from southern China and Thailand, along with prostitution and intravenous drug use, could overwhelm a country which is ill-prepared to cope with such dislocation. "Laos is a country of minorities," he adds. "Many of these minorities have been relatively isolated for centuries. "Now you have road building crews coming in, they're without women, and they are able to entice local women because they have good economic resources. People are not prepared to deal with the threat that that poses. "This is not necessarily an argument to say we should keep people in some sort of pristine nature reserves. But it is saying that if you build roads, you have to be careful not only of the environmental degradation that roads can cause but also the human degradation," he says. The international lending agencies who are funding the projects have agreed to provide HIV-AIDS education to the migrant workers who build the roads and the truck drivers who will use them. But many fear their efforts are too little, too late. "Organisations like the Asian Development Bank, like the World Bank that finance these large infrastructure projects have social impact studies,says David Feingold. "But these often get shoved in a drawer and ignored." The leading AIDS campaigner in Laos is Dr Chansy Phimphachanh, who heads the National Council for Control of Aids. She has done much to ensure that the international aid given to Laos to combat Aids has been spent wisely, no mean feat in a political culture where corruption is endemic. 'Increasing awareness' Dr Chansy's approach is energetic and decidedly low-tech. She thinks nothing of producing a bunch of bananas to demonstrate to a group of young Lao men how they should put on a condom. These days, she's a worried woman. "We really have to prepare our communities to be HIV resistant," she says. "We have to prepare them to raise their awareness so they can protect them from HIV-AIDS." But she insists that for Laos, remaining isolated is not an option. "For the development of the country, we mustn't be selfish. For the wealth of the country, we have to open ourselves up. But at the same, we don't blame anybody. We have to really teach our people to understand everything."Condom Promotion Could Have Helped Suppress AIDS in Laos Successful promotion of condom use in Laos may have helped forestall AIDS epidemic hitting some of its neighboring Southeast Asian countries. A study of sexual behavior in Laos found that, as in Thailand and Cambodia, many men have multiple sexual partners. But in Laos the rate of HIV infection is estimated to be just 5 adults in 10,000 or 0.05 percent. In Myanmar, also known as Burma, UN statistics say the rate is 1.99 percent, in Thailand, 2.15 percent and in Cambodia, 4.04 percent, or 80 times that in Laos.The survey of several thousand people in five provinces, conducted last year by the National Committee for the Control of AIDS under the Ministry of Health, found high levels of reported condom use in commercial sex transactions. It said that nearly 75 percent of female sex workers reported that they always used condoms when having sex with clients. Among active, high-risk groups of clients, two-thirds of police and soldiers and three- quarters of truck drivers said they always used condoms with paid partners.  

LAOS SPARK FEARS OF AIDS RISK The rising number of Laotians who cross illegally into Thailand to work may be putting Laos at risk of an AIDS epidemic, a researcher has claimed. From each village within 50 kilometres of the border, 30 to 40 young people were crossing the Mekong, said the researcher, who has conducted a survey in southern Laos, the nation's most productive and populous region, on behalf of a development project."A number of people work in the sex trade. And they return from time to time. There is a real risk of introducing AIDS to villages which have no means to protect themselves." Condoms were not available in some villages or were too expensive for poor farmers, he said. -- By DONALD MORRIS, SOUTH CHINA MORNING POST