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Frerichs, R.R. Future trends in addressing HIV/AIDS in Asia. 

SEA-AIDS Network, April 21, 1999.

R.R. Frerichs Posting

What does the future hold for non-governmental HIV/AIDS organizations in Asia?  How will the Kosovo crisis ripple East towards Asia, touching the lives of those with and without HIV?  Will AIDS mortality rates dramatically decrease in some Asian countries as they have in Europe and the United States?  Will wealthier Asian nations provide additional HIV/AIDS assistance to their poorer neighbors?  In this posting I will offer some general observations on what the next few years will hold, with hope that others will join in with views of their own.  Such discussion should hopefully also take place at the coming 5th International Conference on AIDS in Asia and the Pacific (ICAAP), to be held in Kuala Lumpur in late October.

1.  Shortage of funding

Assistance money from Europe and the United States will be greatly reduced in the next year or two due mainly to the enormous bill of the Kosovo crisis, but also to the success and absorbing cost of available AIDS treatments.   NGOs which receive international assistance typically are funded by two sources: governments and private donors.  Government money that typically flows to public health and other social agencies will be needed in Europe and the United States to pay for the current military campaign and once through, for regaining military readiness.  The United States has already been reluctant to pay full restitution of past and present dues to the United Nations, despite worldwide condemnation and internal embarrassment.  Given the military expenditures in Yugoslavia, full dues for the United Nations or increased support of HIV/AIDS NGOs will likely not be forthcoming anytime soon.  Money from private donors for HIV/AIDS, including foundations, may also slow down, as Americans and Europeans focus increasingly on assisting the displaced refugees in the Balkans.  Although support will continue for HIV vaccine trials, it is not clear that existing candidate vaccines will have a substantial effect, or that funding will greatly increase if the need arises.

2.   High cost of licensed drugs

While pressure will increase on pharmaceutical companies to lower the price of AIDS drugs, the cost shift will likely occur only with older drugs such as zidovudine (AZT), for which substantial profits have already been made.  Sufficient political pressure from AIDS activists in the United States or Europe is not appearing, so likely the licensing situation will not change.  Instead the arguments put forward by the pharmaceutical industry that lower profits means fewer new drugs continue to influence public thinking in the wealthier nations.  Since mutation and evolving resistance is a continuing problem for AIDS patients, few activists in America, Europe or the more prosperous countries of Asia, will challenge the manufacturers of vital new drugs.

3.  Increased influence of governments in Asia

With the decline in funding from the West for international AIDS efforts and the gradually improving economies in the East, countries such as Japan, Australia, Singapore and Korea will increasingly be asked to assist their neighbors in combating the epidemic.  This might bring a shift in thinking among local NGOs, perhaps away from the strong reliance on human rights and community activism, although much remains uncertain as the donor nations attempt to clarify visions of self and neighbors.

4.  Expansion of information

With the increased activity of the internet, more information will flow from one group to another, provide instant recognition of promising new efforts or rapidly evolving trends.  If philosophies or opinions do not ring true, people will quickly follow other voices, looking for logic and more appropriate assistance.  An important model for fostering international exchange has been SEA-AIDS, encouraging people to share opinions and programs, at first from a small base in Bangkok and now in Geneva.  NGOs with effective communicators will likely have websites of their own, providing unique views to an ever changing audience. There will be much dissension, an example of which SEA-AIDS participants witnessed in the testing arena (see Frerichs for more writings on the value of testing and SEA-AIDS for other views), but also new knowledge as ideas germinate and take hold.

In the United States and Europe, cable lines are rapidly being extended to individual homes, linking both computers and televisions to the wider world.  Satellite services are starting to appear as competitors to cable companies, and likely will become the dominant means for high speed internet transmission in the developing world.  Distance learning programs will become increasingly common, as universities, NGOs, governments and others compete for the attention of the interested public, but primarily in English.  Examples of HIV/AIDS educational activities abound, notably at the websites of CDC, WHO and UNAIDS.  Newer modes of learning will include visualizations (i.e., graphs and figures rather than text), animation, voice, and video, similar to television, but much more interactive and intellectually stimulating.  This will provide further choice for continued education, offering new knowledge for lower cost then ever before.

What is your view of the next few years in Asia, specifically with regard to programs and policies aimed at HIV/AIDS?  We hear and read much about increased HIV infections, AIDS cases and early deaths.  Yet other trends not of an epidemiological nature also deserve comment.  It is such thoughts on future trends that I would like to see posted in SEA-AIDS, perhaps as a prelude to the 5th ICAAP.