Kazuya Kawaguchi

Introduction

In the age of globalisation, no part of the world can be isolated from the HIV/AIDS epidemic. Countries in East Asia, too, are connected with the global forces which facilitate the spread of this disease. In East Asia, it was only in the early twenty-first century that responses to the HIV/ AIDS epidemic came to be considered on a regional basis, although individual countries had started to address the issue much earlier. Kihara Masahiro and his research group organised the first symposium on HIV/AIDS in East Asia in 2004 as part of the 18th Conference of the Japan Society for AIDS Research. At this symposium researchers from China, Korea, Hong Kong, Taiwan, Mongolia and Japan came together to exchange information and opinions. A report on the conference appeared in The Journal of AIDS Research (Yasuda et al 2005: 77-82). A second symposium on HIV/AIDS responses in the East Asian region was held in 2009, and reported in The Journal of AIDS Research (Kihara et al. 2009: 141-45).

As in other parts of the world, local responses to the issue depend on the local political system, medical establishment, stage of economic development, and socio-cultural conditions. Transmission patterns are different in each local context — depending on local conditions, transmission may predominantly occur through sexual contacts between sex workers and their clients, through men who have sex with men (MSM), through intravenous drug use, through inadequate sterilisation of needles used in medical procedures, through inadequate screening of blood donations, or through improperly regulated practices of the selling of blood. Responses to the HIV/AIDS epidemic are also a part of the development of global governance, and the globalisation of certain biomedical and socio-behavioural paradigms (Altman 2008: 146). As Altman argues, ‘AIDS is both a product and a cause of globalization’ (Altman 2008: 145). The HIV/AIDS epidemic is also increasingly being seen as a human security issue (Akaha 2009: 11—34).

To place East Asia in its global context, UNAIDS (Joint United Nations Program on HIV/ ADS) reported in 2010 that the number of people with HIV had reached 33,000,000 all over the world; and 4,800,000 in Asia as a whole. There were 770,000 people living with HIV/ AIDS in East Asia, of whom 220,000 were women over the age of 15, and 8,000 were children (HIVInSite 2011; UNAIDS 2010; unless stated otherwise, statistics in this chapter come from UNAIDS 2010). While the rate of increase of HIV infection has been 14.3 per cent in South

East Asia and South Asia, in the East Asian region it has risen by 90 per cent. Asia is actually the region with the second highest rate of HIV infection after Africa. The epicentre of HIV/AIDS infection has shifted from North America and Europe to Africa, Latin America and Asia. At the end of the year 2004, it was estimated that 39,400,000 people were infected with HIV all over the world with 110,000 in the Asian region.

The explosion of HIV infection in Asia started in South East Asia around 1990 and extended to other parts of Asia. One of the most prominent routes of infection is the contact of men with female sex workers. The epidemic trend among intravenous drug users (IDUs) began in the early days and recently there are cases among men who have sex with men (MSM). It has been estimated that 8,000,000 people may get newly infected with HIV between 2008 and 2020. Most of them will be MSM and sex workers. In East Asia the rate of infection among IDUs remains low and it is supposed that the rate of infection among women other than sex workers is low.

For the purposes of this chapter, I will focus on the People’s Republic of China, Hong Kong, Taiwan, Japan, Mongolia and the Republic of Korea (there is not sufficient information on the Democratic People’s Republic of Korea; on Vietnam, see Gammeltoft and Nguyen in this volume; on China, see also Hood in this volume). I will provide an overview of distinctive developments in each country in the region, before making comments on the responses of governments, non-governmental organisations, the media and academia. This essay will also provide a narrative of the shift from localised national responses to the development of regional communication and co-operation on the issue, with a concomitant consciousness of global developments.