MANILA — Asia is likely to fall victim within the next five years to an AIDS epidemic as disastrous and deadly as the one that has ravaged much of Africa unless governments radically improve health standards and public-health education, an international authority on AIDS said here Tuesday.
Speaking at the First International Congress on AIDS in Asia, Dr. John Dwyer, of Australia, warned Asian nations against "a false sense of security," and predicted that the 208 confirmed AIDS cases recorded in Asia by the World Health Organization as of Oct. 1 "is only the beginning of what easily could become a disaster of African proportions."
"You have the recipe here for a big-time problem," he added.
Dwyer, who founded the AIDS unit at Yale University in 1982 and now heads Australia's foremost AIDS detection and treatment facility in Sydney, was one of the doctors, scientists and researchers who gathered in the Philippines this week to analyze the future dimensions of acquired immune deficiency syndrome in Asia, a continent that has appeared largely immune from the deadly disease.
Medical observers have been puzzled by the relatively low number of AIDS cases and carriers in Asia, and some have theorized that Asians may have a natural resistance to the virus.
But Dr. Ofelia Monzon, chairman of the AIDS conference and head of the Institute of Tropical Diseases' AIDS research unit in Manila, said in opening this week's congress that "the most likely explanation of the low incidence of AIDS in the Asian region . . . is the late introduction of the virus into Asian countries."
"In Asia, we are where the United States was approximately 10 to 15 years ago."
Dwyer added, "What is happening in Asia today . . . will not show up for another four to five years."
When it does show up, he said, the dimensions of the disease will be comparable to Africa, where there now is a reported total of 4,924 cases of AIDS and 5 million suspected carriers.
"I see the spread of AIDS in Asia as something terribly important and a great danger to the people of this region," Dwyer said. "They should be looking, for a model, to what's happening in Africa, not what's happening in Europe or the United States.
"The factors that have made AIDS spread so rapidly through heterosexual activity in Africa--those factors are all here in Asia. And I think that once the reservoir of the virus is built up in this community, they could have an explosion just like what happened in Africa and worse than the United States."
Dwyer said in an interview that the comparison of Asia with Africa rests mainly on the method of AIDS transmission--primarily heterosexual--and the state of genital health on the two continents.
Dwyer said that studies he and his staff did in Australia indicate that heterosexual women with poor genital health are highly susceptible to the virus through vaginal ulcers and warts. In addition, factors such as malnutrition, intestinal worms and hepatitis--all of which are endemic in Asia and Africa--further weakened immune systems and helped the disease spread in Africa.
Dwyer said that most Asian health ministers are unprepared to begin mass education campaigns and design prevention strategies because they understand very little about the sexual practices of their own people.
"I don't believe they (the health officials) have any idea of the sexual attitudes of much of their people, let alone their behavior," he said, referring to a recent meeting between international AIDS experts and Asian health officials.
Referring specifically to anal sex, believed to be a common method of transmitting the virus, Dwyer said, "In many countries in this area, there isn't even the language to ask such a question.
Under a Microscope
"In this day and age, you do have to put people's lives and their sexual behavior under a microscope."
In the Philippines, which Health Secretary Alfredo Bengzon said is staging the AIDS congress as part of an effort to educate the country, there are only initial efforts to determine details of sexual behavior, according to Monzon.
A paper presented by Monzon said Philippine sexual behavior is "a classic and frightening breeding ground" for AIDS.
She said her research unit recruited a test population of 2,065 men and women working as prostitutes in bars, discotheques, massage parlors and commercial sauna baths in Manila and two of its suburbs, Quezon and Mandaluyong.
Most of the prostitutes admitted to a large number of sexual partners per month. And the overwhelming majority said they rarely, if ever, use condoms.
Nearly half of the 1,770 females in the study said they have had more than 60 sexual partners per month for the past half year. Only 30% of the male prostitutes admitted to that frequency. An additional 13% of the women and 24% of the men said they had between 31 and 60 sexual partners each month during the same time period.