Research on HIV/AIDS in East Asia
When HIV/AIDS was first recognised in North America and Europe, people living outside those regions displayed little concern. Especially in East Asia, the number of people infected with HIV was few or, if any, those people were assumed to have been infected outside of their own country. In the early 1990s, however, concern on the HIV/AIDS issue came to be shared worldwide among African, Latin American and Asian countries as well.
AIDS: Prevention Through Education: A World View (from 1992) was one of the early works to deal with the AIDS issue from the perspective of prevention education and from a worldwide perspective. Contributors to this book shared the idea that even if and when effective drugs and vaccines were developed, education would still play an important role in contending with the epidemic. Reflecting on the failure of the original education methods based on fear, this book insists that these should be replaced with more optimistic and humorous campaign models. Here, the health promotion model was focused on in the global fight against AIDS. However, although the subtitle of this book says ‘A World View’, there is no mention of AIDS or AIDS responses in Asian countries even though it mentions Africa and Mexico. So, at that time AIDS in Asia and especially in East Asia was invisible in the Anglophone academic and research literature (Sepulveda et al. 1992).
Economic Implications of AIDS in Asia is perhaps the first book to consider the economic dimensions of the AIDS epidemic in the Asian region. The editors of this book argue that AIDS reaches further into society than other diseases because it affects people during their most productive years when they are typically responsible for the care and support of both children and elderly parents. In addition, transmission of the virus generally goes unrecognised; and no cure is available, and probably will not be in the foreseeable future. These characteristics of the epidemic laid the foundation for social and economic stresses that have gone largely unrecognised in the Asia-Pacific region (Bloom and Lyons 1993: 1). Bon-Ming Yang deals with the economic impact of AIDS in Korea and calculates direct and indirect costs. The author concludes that in the short run the cost of the AIDS epidemic is not so high for the country because Korea at that time was in the early stages of the epidemic. However, he also points out that Korea is not immune to the epidemic and suggests that indirect costs will be nearly sixty times the magnitude of direct costs (Yang 1993: 35-52).
In the early 1980s, medical perspectives dominated the AIDS issue because we did not know the cause of AIDS; how the virus was transmitted from person to person; what medicine would be effective for people infected with HIV; and so on. From the early 1990s the fact that the number ofpeople with HIV/AIDS visibly increased and that those people came out as HIV-positive and as AIDS patients made society concerned with the method of transmission. There was also concern with how people with HIV/AIDS could lead their lives. Accordingly, in the 1990s researchers started to get interested in how people with HIV/AIDS would face their problems and how the epidemic affected them. At the same time, some researchers paid attention to the sexual behaviour of the people affected by the epidemic.
The Time of AIDS: Social Analysis, Theory, and Method is one of the representative works based on anthropological and sociological perspectives toward the HIV/AIDS issue. The articles involved in this volume were all oriented toward the cases in Europe and North America, though (Herdt and Lindenbaum: 1992). Sexual Cultures in East Asia: The Social Construction of Sexuality and Sexual Risk in a Time of AIDS is along the same lines as the books by Herdt and Lindenbaum but concentrates on the East Asian region. The book consists of two parts: the first part deals with issues related to sexual cultures such as the role of commercial sex work, the kinship system, matrimonial strategies, gender roles in the family, gendered power relations in society and in the building of these cultures in transition. The second part examines specific issues related to the HIV/AIDS epidemic and the social construction of sexual risk. From various disciplines such as sociology, anthropology, history, medicine and so on, the contributors approach how East Asian sexual identity and sexual risk are socially constructed. The editor, Micollier, cites Parker’s concept of the social construction of sexuality (Micollier 2004: xiii).
The social construction of sexual excitement and desire, ways in which sexual identities are formed and transformed, the relations of power and domination that may shape and structure sexual interactions, and the social/sexual networks that channel and condition the selections of potential sexual partners may all be salient issues that must be taken into account in developing more effective strategies for AIDS prevention (Parker 1995: 362 cited by Micollier 2004).
The idea of social construction helps us to understand that to resolve and fight against the AIDS issue we need to look at the social conditions and social interactions that put people at risk of infection with HIV. Moreover, this suggests that we should think about social and cultural specificities when we describe the HIV/AIDS issue; design interventions such as prevention education campaigns or outreach activities; and provide care, support and services to people affected by AIDS. The chapters of Micollier’s book cover not only China, Japan, the Republic of Korea and Taiwan, but also Cambodia and Vietnam.
Fighting a Rising Tide: The Response to AIDS in East Asia (Yamamoto and Itoh 2006), is based on a research and dialogue project launched by the Japan Center for International Exchange (JCIE) and the Friends of the Global Fund, Japan (FGFJ). One of the editors, Yamamoto, explains that the goal of this project was to better understand the impact of and responses to the epidemic from the perspectives of those who are involved in fighting its spread throughout the region. The project was expected to promote ‘functional cooperation’ in dealing with the common challenges of HIV/AIDS in East Asia. A prominent characteristic of the book is that the diversity of experiences and responses, including the social and economic conditions, the challenges faced by each country, governmental responses, civil society responses, media responses, multisectoral responses, and international and regional cooperation, are covered in one volume.
There is very little literature dealing with transnational cooperation and responses to HIV/ AIDS in East Asia. Fighting a Rising Tide is significant in its focus on international and regional cooperation on the HIV/AIDS issue and the authors make recommendations based on the discussions in the papers. Their conclusions can be summarised as follows. The most important step in dealing with the AIDS crisis is raising the level of awareness of the risk posed by HIV/ AIDS. While the general public in the region has a basic awareness of HIV/AIDS, it is rarely linked to any personal risk or to a broader risk to society at large. The media, NGOs, businesses, educators, and governments all have a role to play. It is then necessary to strengthen political leadership and create more opportunities for cross-border and regional cooperation. While this is being achieved to a certain extent in some parts of the region, much more needs to be done. Cross-sectoral collaboration is needed to treat the HIV/AIDS epidemic holistically, and not just as a health issue. The respective roles of governments and NGOs need to be clarified in order for partnerships to be effective. Sound national politics are needed for dealing with HIV/AIDS based on epidemiological evidence from within each country and evidence of successful responses in other countries. For example, needle-exchange programs for IDUs have produced favourable results in some countries and might be replicated elsewhere. The trafficking of people and of illicit drugs is an enormous problem throughout the region, and this has had a profound impact on the spread of HIV. This is an area where a regional response is indispensable. Although HIV is still found predominantly in men, the impact and burden of this disease falls most heavily on women. Programs are thus needed to address the full spectrum of women’s roles and rights in society. Finally, Yamamoto discusses the importance of respecting the rights of PwA/PwH and others affected by the disease, and argues that overcoming stigma and discrimination is a precondition for any successful response to the threat of the epidemic (Yamamoto 2006: 17).
Each of the nations surveyed in this essay has experienced the HIV/AIDs epidemic in distinctive ways. The predominant patterns of transmission vary from country to country. In China, the routes of transmission are predominantly through heterosexual sex and intravenous drug use (IDU); in Japan it is mainly men who have sex with men (MSM); in South Korea, sexual contact or MSM is the main route, with very few cases attributed to IDUs. In Hong Kong, sexual contact is the major mode of transmission.
The capacity to respond to the crisis varies according to each nation’s economic prosperity, social welfare system and medical infrastructure. The East Asian region includes countries which rank high on human development indicators (Japan, Hong Kong, South Korea) and countries at a medium level (China and Vietnam). These disparities ‘indicate a great variability in the ability of the national and local governments to assist their citizens [to] maintain good health and healthy behavioural habits’ (Akaha 2009: 14). The rate of infection ‘tends to be higher in the developing countries’, while these countries are ‘less capable of looking after the infected and affected individuals’ (Akaha 2009: 14).
HIV/AIDS is also, however, a regional issue, for the increased mobility of people means that infection spreads across national borders. Migration, the movement of unfree labour, drug trafficking, and travel for the purposes of purchasing sexual services are aspects of globalisation which are intimately linked with the HIV/AIDS epidemic in East Asia, as in other parts of the globe. Sex workers and intravenous drug users are particularly at risk. This means that there is a pressing need for close regional networks and cooperation to challenge the HIV/AIDS issue.
There has been regional co-operation on this issue through such gatherings as the above – mentioned HIV/AIDS in East Asia symposia in 2004 and in 2009. There are also regional networks of NGOs, such as the Asia-Pacific Council of AIDS Service Organisations (APCASO), which includes affiliates from several East Asian countries. HIV/AIDS has also been addressed by Asia-Pacific Economic Cooperation (APEC) which includes the membership of the East Asian countries covered in this essay. In October 2011, APEC endorsed a ‘Strategy on HIV/AIDS and Other Infectious Diseases’, calling for co-operation in ‘electronic networking, surveillance, outbreak response, capacity building, partnering across sectors and political and economic leadership’ (Akaha 2009: 26). In this and subsequent statements, it can be seen that HIV/AIDS is increasingly seen as an economic issue and a security issue, as much as an issue of public health, human welfare and human rights.