Five Myths about the HIV Epidemic in Asia

Published in PLoS Medicine (Vol. 3, Issue 10, pps. 1703-1707), this essay offers the perspective of implementers who have worked with HIV/AIDS programmes in several countries in the region - personnel who "are concerned...about a number of misinformed beliefs, or myths, about the epidemic - myths that are widely circulating in Asia, disseminated in both public and professional discourse, and often dominating policy and political debate." They explore 5 such myths, suggesting areas of policy related to each one that they feel need attention in order to guide focused, coherent, evidence-based HIV/AIDS programming in Asia and the Pacific.

The authors outline and then debunk these myths, which include:

1. "There is a major risk that the epidemic in many Asian countries will have the same disastrous 'development impact' as in sub-Saharan Africa, but on a much worse scale, given the huge population sizes of much of Asia." - In reality, in Asia-Pacific (unlike Africa), the epidemic is concentrated in identifiable high-risk situations, and women's sexual risk is curtailed by socio-cultural factors. Rather than attending to mythical generalised developmental challenges, practitioners might consider honing in on the challenges of developing targeted intervention programmes and ensuring effective, equitable services for vulnerable groups.
2. "The 'Three Ones' are an essential framework for an expanded and strengthened response." - The idea that 1 national coordinating authority, 1 strategic plan, and 1 monitoring and evaluation system is relevant to this region (click here to learn more) is "a troubling myth". The authors explain why this approach may be understood as important for donors, but argue that "simply establishing national coordinating bodies may often create more problems than it solves". What is important, they claim, is "ownership".
3. "Most of the progress made in controlling the epidemic in Asia has been made by non-governmental organisations [NGOs]; the governmental contribution has been limited, clumsy, and hesitating." - In fact, the authors suggest, the work of NGOs is almost always on a small scale. "Where governments choose to be pragmatic about the legality of high-risk behaviours, and work directly with high-risk groups, or in explicit partnership with NGOs, much larger-scale coverage can be achieved."
4. "The Global Fund to Fight AIDS, Tuberculosis and Malaria has recently made a very significant contribution towards controlling the epidemic by making large amounts of funding easily available." - For various reasons delineated here, monies from the Global Fund are "very difficult to use", especially in the Asia-Pacific context. For instance, as explored here, the Fund's agenda privileges responses that focus on building partnerships, involving civil society and those affected directly by the diseases. However, in much of Asia, countries tend not to plan and manage in partnership with civil society, and so new, costly, and inefficient mechanisms have needed to be set up...
5. "The 'expanded multisectoral response', beyond the health sector, is essential for effective control of the epidemic in Asia." - In reality, "The emphasis on multi-sectorality may be appropriate in situations where prevalence rates are so high as to seriously affect labour productivity, availability of human resources, and social infrastructure and institutions (as in parts of Africa); but nowhere in the Asia-Pacific region is prevalence so high, or likely to become so high..."

In conclusion, the authors stress that - to be effective - the response to HIV/AIDS in this region "must be based on good evidence of each country's specific epidemiological needs, proven and working mechanisms for developing programmes and channeling funds, and frankness, openness, and clarity of purpose and process."

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.