The Coming Plague (137 page)
Authors: Laurie Garrett
63
B. Mangla, “India: HIVâPositive Blood Donors,”
Lancet
341 (1993): 1527â28. 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.
Lancet
341 (1993): 1527â28. 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.
British Medical Journal
299 (1989): 721.
66
“India: Prostitutes and the Spread of AIDS,”
Lancet
335 (1990): 1332.
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: 17â18.
India Currents,
August 1991: 17â18.
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: 25â29.
New Scientist,
April 20, 1991: 18; and O. Sattaur, “India Wakes Up to AIDS,”
New Scientist
, November 2, 1991: 25â29.
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 6â11, 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 12â16, 1993.
72
The populations that were regularly testedâsome on a voluntary basis, some compulsorilyâincluded 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, 6â7; B. G. Weniger, K. Limpakarnjanarat, K. Ungehusak, et al., “The Epidemiology of HIV Infection and AIDS in Thailand,”
AIDS
5 (1991): S71âS85; W. Sittitrai, S. A. Obremskey, T. Brown, and P. O. Way, “HIV/AIDS Projections for Thailand, 1990â2005,” Thai Working Group on HIV/AIDS Projections, Bangkok, 1991; R. Rhodes, “Death in the Candy Store,”
Rolling Stone,
November 28, 1991: 62â70, 113â14; W. Sittitrai and T. Brown, “The Asian AIDS Epidemic,” presentation to the Congressional Forum on the HIV/AIDS Pandemic, Washington, D.C., June 23â25, 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 19â24, 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 19â24, 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 6â11, 1993.
New York Newsday, Discovery
section, March 6, 1990: 1, 6â7; B. G. Weniger, K. Limpakarnjanarat, K. Ungehusak, et al., “The Epidemiology of HIV Infection and AIDS in Thailand,”
AIDS
5 (1991): S71âS85; W. Sittitrai, S. A. Obremskey, T. Brown, and P. O. Way, “HIV/AIDS Projections for Thailand, 1990â2005,” Thai Working Group on HIV/AIDS Projections, Bangkok, 1991; R. Rhodes, “Death in the Candy Store,”
Rolling Stone,
November 28, 1991: 62â70, 113â14; W. Sittitrai and T. Brown, “The Asian AIDS Epidemic,” presentation to the Congressional Forum on the HIV/AIDS Pandemic, Washington, D.C., June 23â25, 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 19â24, 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 19â24, 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 6â11, 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 1991âSeptember 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 6â11, 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 7â11, 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.
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.
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 ScourgeâVenereal 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.
San Francisco Chronicle
, May 7, 1987: A10; J. Mann, “China Starts Drive Against Once-Vanquished ScourgeâVenereal 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.
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): 204â7; and “AIDS: The Third Wave,”
Lancet
343 (1993): 186â88.
Lancet
343 (1994): 204â7; and “AIDS: The Third Wave,”
Lancet
343 (1993): 186â88.
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): 452â55.
American Journal of Public Health
84 (1994): 452â55.
89
P. Handley,”Pumping Up Condoms,”
Far Eastern Economic Review,
February 19, 1992: 31; and M. Viravaidhya, S. A. Obremsky, and C. Myers,”The Economic Impact of AIDS on Thailand,” Working Paper Series, Department of Population and International Health, Harvard School of Public Health, Number 4, 1992.
Far Eastern Economic Review,
February 19, 1992: 31; and M. Viravaidhya, S. A. Obremsky, and C. Myers,”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.,”Hospital Care Cost Analysis of ARC/AIDS Patients, Thailand,” presentation to the Ninth International Conference on AIDS, Berlin, June 6â11, 1993.
91
M. H. Merson,”Slowing the Spread of HIV: Agenda for the 1990s,”
Science
260 (1993): 1266â68.
Science
260 (1993): 1266â68.
92
C. N. Myers and T. Ashakul,”AIDS in Thailand: Some Preliminary Findings,”
TDRI Quarterly
Review 6 (1991): 8â12.
TDRI Quarterly
Review 6 (1991): 8â12.
93
Center for International Research (1994), op. cit.
94
See World Bank.
World Development Report
1993, op. cit.; P. Shenon,”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,”The Global AIDS Disaster: Implications for the 1990s” (Washington, D.C.: Government Printing Office, 1992); D. W. FitzSimons,”Further Asian Spread in 1994?”
AIDS Newsletter
8 (1993): 14: 1; and P. Piot,”AIDS: The State of the Epidemic,” speech delivered at the Opening Ceremony of Biotech 94, Florence, April 10, 1994.
World Development Report
1993, op. cit.; P. Shenon,”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,”The Global AIDS Disaster: Implications for the 1990s” (Washington, D.C.: Government Printing Office, 1992); D. W. FitzSimons,”Further Asian Spread in 1994?”
AIDS Newsletter
8 (1993): 14: 1; and P. Piot,”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): 631â34; 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): 353â57; Centers for Disease Control, “Isolation of Human T-Lymphotropic Virus Type III/Lymphadenopathy-Associated Virus from Serum Proteins Given to Cancer PatientsâBahamas,”
Morbidity and Mortality Weekly Repor
t 34 (1985): 489 91; R. Howell, “AIDS in Puerto Rico,”
Newsday
,
Discovery
section, December 11, 1990: 69, 74â75; 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): 883â94; 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), 109â26; and J. Sepulveda, “Prevention Through Information and Education: Experience from Mexico,” ibid., 127â44.
Journal of the American Medical Association
257 (1987): 631â34; 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): 353â57; Centers for Disease Control, “Isolation of Human T-Lymphotropic Virus Type III/Lymphadenopathy-Associated Virus from Serum Proteins Given to Cancer PatientsâBahamas,”
Morbidity and Mortality Weekly Repor
t 34 (1985): 489 91; R. Howell, “AIDS in Puerto Rico,”
Newsday
,
Discovery
section, December 11, 1990: 69, 74â75; 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): 883â94; 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), 109â26; and J. Sepulveda, “Prevention Through Information and Education: Experience from Mexico,” ibid., 127â44.
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