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Cablegate: Taiwan Fights an Uphill Battle to Contain Hiv/Aids

This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 05 TAIPEI 003043

SIPDIS

STATE FOR EAP/RSP/TC, S/GAC AND OES/IHA

STATE PLEASE PASS TO AIT/W

HHS FOR ERICA ELVANDER

E.O. 12958: N/A
TAGS: TBIO OSCI OTRA SENV TW ESTH
SUBJECT: TAIWAN FIGHTS AN UPHILL BATTLE TO CONTAIN HIV/AIDS

REF: SECSTATE 168905

1. Summary. In response to reftel, AIT has assessed the
scope and government response to the AIDS epidemic in
Taiwan. The Government is committed at the highest levels
to controlling its spread and based on the numbers, HIV/AIDS
rates are still manageable. In close cooperation with NGOs,
Taiwan has adopted a comprehensive approach to control and
prevent the disease. Taiwan's National Health Insurance
also makes treatment affordable and universally available.
Despite such efforts, however, Taiwan's rates of infection,
while relatively low by Southeast Asian standards, are
growing, particularly among young people. Taiwan will need
to remain vigilant if it is to maintain control of the
uphill battle against the spread of HIV/AIDS. End Summary.

Political Will is Strong and Present
------------------------------------

2. Political leadership in Taiwan appears to take the issue
of containing the spread of HIV/AIDS seriously. In 2001,
the Executive Yuan (EY) established an inter-agency AIDS-
Prevention Committee. The Committee is chaired by the Vice
Premier and overseen by Department of Health (DOH) in
consultation with a team of medical professionals and
experts from government, academia and NGOs. President Chen
Shui-bian demonstrated his support to the Committee's
efforts by becoming personally involved in a campaign to
raise awareness of the issue by publicly urging every
citizen to get involved in HIV/AIDS prevention and control.

Government Actions Support Words
--------------------------------

3. Taiwan funds AIDS prevention, control and treatment
activities in 12 different government agencies. DOH
receives the lion's share of approximately 1/3 of Taiwan's
USD 3.8 million annual AIDS-prevention budget. Furthermore,
DOH has the lead in ensuring the coordination of all
government-funded programs, which range from education
campaigns, to screening programs, to treatment regimens.

4. Taiwan is also committed to containing the global spread
of HIV/AIDS and to this end contributed USD 1 million to the
Global AIDS Fund both in 2002 and 2003. Taiwan has also
agreed to provide bilateral HIV/AIDS assistance to Haiti,
one of the countries that maintains diplomatic ties with
Taiwan. Minister of Health Chen Chien-jen visited Haiti in
August 2004 and committed USD 2 million to establish a
disease research laboratory in Haiti. Initially the
laboratory will be dedicated entirely towards HIV/AIDS
testing and prevention. Taiwan is fully funding both the
construction of the building and the internal laboratory
facilities. Construction of the laboratory is expected to
be completed within one year. Taiwan has also partnered
with the US Centers for Disease Control (USCDC) to provide
staff and technological support once the project is
completed.

5. Taiwan offers comprehensive and affordable HIV/AIDS
treatment. The HAART (Highly Active Antiretroviral Therapy)
drug cocktail treatment for HIV-positive patients has been
completely covered by National Health Insurance Program
since 1997. According to Taiwan's Center for Disease
Control (TCDC), HAART has been very effective and one study
has shown that the provision of free HAART decreased HIV
transmission by 53 percent in Taiwan. TCDC also told AIT
that, currently, the 10-year life expectancy rate for AIDS
patients under the HAART treatment is up to 84 percent.

6. Finally, since Dec. 17, 1991, Taiwan has had a regulation
on AIDS prevention in effect, which imposes jail sentences
of up to 7 years for any individual that knowingly engages
in unprotected sex, sharing needles or donating blood,
organs or other bodily fluids.

The Numbers
-----------

7. Since its first recorded case of HIV in 1984 through July
2004, Taiwan has 6,255 HIV confirmed infections. This
number includes 5,789 local citizens and 466 foreigners. Of
the 6,255 cases, 1,724 have developed AIDS, 971 of which
have died. In 2004 alone, already 602 new cases have been
identified. It is expected that the growth rate in 2004
will represent a 20 percent increase from 2003. This would
indicate a growing rate of infections as, over the past five
years, Taiwan's rate of infection has typically increased by
10 - 15 percent annually. While the above represent
Taiwan's official statistics, Taiwan's Center for Disease
Control (TCDC) has told AIT that the real number of
infections may be five times higher than the reported cases
and the projected number for Taiwan's HIV/AIDS patients is
anticipated to reach 14,536 by 2011.

8. Comment. According to Dr. Fang Chi-tai, one of Taiwan's
leading AIDS/HIV Researchers at National Taiwan University
Hospital, the actual number is closer to two times CDC's
confirmed number of cases. Dr. Fang said that TCDC tends to
exaggerate the situation in order to encourage more people
to take the issue seriously. He said the main reason for
the discrepancy is that, due to the sometimes long
incubation period, many people with HIV are asymptomatic and
do not think to be tested. He noted, however, that this is
not the case among perceived high-risk groups such as
homosexuals who tend to be more aware of the risks and test
themselves regularly. He added that even those who test for
the disease may not know they have it because, in its early
stages, testing sometimes results in false negatives. End
Comment.

The Patients
------------

9. Of the 5,789 Taiwan citizens confirmed to be HIV
positive, 37 percent identified themselves as heterosexual,
35 percent identified themselves as homosexual, 11
identified themselves as bisexual, and 17 percent did not
specify their sexual preference.

10. Unfortunately, the number of infections among young
people have grown at an alarming pace. Official figures show
that the number of 15-24 year olds testing HIV positive
increased from 58 in 1998 to 136 in 2002. The proportion of
new infections occurring in young people has also steadily
increased over recent years. In 1998, 15-24 year olds made
up 14.9 percent of total new infections in Taiwan. In 1999
15-24 year olds made up 18.1 percent, in 2000 they made up
19.4 percent and in 2001 they made up 21.5 percent of total
new infections.

11. Moreover, of the total 5,789 citizens infected with HIV,
almost 40 percent of the patients (2,154) contracted the
disease between 20-29 years of age. Seventy percent of the
5,789 cases contracted HIV when they were between 20-39
years of age.

12. Another population of concern is commercial sex workers.
Sex workers in Taiwan fall into three categories: 1) career
sex workers who, since commercial sex work was banned in
1999, have either lost their licenses or are working in the
approximately 100 remaining brothels grand-fathered under
the new law; 2) women who work in the "entertainment
industry" (teahouses, barber shops, and karaoke clubs), some
of whom occasionally have sex for money; and 3) "escorts,"
generally recruited and managed by organized crime groups
and include many women who have immigrated illegally from
Mainland China.

Transmission
------------

13. According to TCDC, over 90 percent of the HIV infections
in Taiwan are believed to result from unprotected sex. TCDC
claims that over the past 3 years, however, transmission as
a result of intravenous drug use has been a growing factor.
As of June this year, the percentage of total infections
resulting from shared needles is estimated to be 3.49. More
alarming is the growing rate of new infections resulting
from drug use. Where in 2002, 12 new cases were determined
to have resulted from sharing needles, intravenous drug use
has been linked to 63 new cases in 2003 and 65 new cases in
the first half of 2004. Other transmission routes in
Taiwan of concern are those from mother to child and those
from Taiwan businessmen who contract the disease while in
Mainland China and then transmit it to their wives in
Taiwan.

Education Programs
------------------

14. In an effort to address the growing rates of infection,
particularly among young people, Taiwan has stepped up its
HIV/AIDS education efforts. Since 2002, Taiwan's Department
of Education (DOE) has mandated that all high-school
students receive two hours of information on HIV/AIDS per
year. To this end, in 2001, DOE established an "AIDS
Prevention Education Committee." The Committee is
responsible for overseeing AIDS prevention activities,
systematizing AIDS-related materials and curriculum,
training educators on how to teach AIDS prevention, and
protecting the rights of the HIV/AIDS infected students in
all schools. The Committee's goal is to ensure that at
least 90 percent of high-school students understand what
AIDS is and how to prevent its spread. The Department
typically partners with NGOs to facilitate its training
programs for teachers (see paras. 16-18).

15. In 2003, DOE designated the first week of December as
"AIDS prevention week" and implemented a "Love's Red Ribbon"
program, which involved distributing red ribbons to raise
awareness about AIDS and AIDS prevention among young people.
DOE also urged schools at all levels schools to promote
HIV/AIDS awareness among their students. Taiwan is a strong
proponent of the AIDS-prevention slogan: ABC (Abstinence, Be
faithful and Condoms).
Role of NGOs
------------

16. NGOs play an important role in controlling HIV/AIDS
transmissions in Taiwan. Taiwan AIDS NGO Alliance consists
of more than 27 private groups, that are working towards
promoting safe sex, striving for basic human rights and
addressing the stigma of AIDS and discrimination. These
groups are active in all aspects of disease control from
education campaigns to testing and counseling programs.

17. Most notably, the Department of Education cooperates
closely with NGOs to implement its HIV AIDS education goals
and activities. NGOs are integrally involved in helping to
design and teach AIDS prevention curricula both within and
outside of schools. For example, DOE helps fund the NGO
Mercy Hill Medical Foundation, which jointly with Taipei
Normal University runs programs to educate teachers to
address sex and sexuality issues in classrooms. Programs
are available for educators at all levels (from elementary
schools to college campuses). These programs are held 3-4
times a year and approximately 100 teachers attend each
session. Since 1989, over 4,500 teachers in Taiwan have
been trained to teach AIDS education through these programs.

18. The Taiwan Center for Disease Control (CDC) has also
funded efforts by other NGOs including Light of Friendship
and the Presbyterian Church of Taiwan-affiliated AIDS
Education Foundation to train teachers and students at all
levels.

19. Another NGO involved in preventing the spread of AIDS is
Taipei's Collective of Sex Workers and Supporters (COSWAS),
an advocacy group for licensed and formerly licensed sex
workers. Taipei's Municipal STD Prevention Clinic has
enlisted the organization to spearhead education efforts
among acknowledged sex workers. However, according to
COSWAS, few women who work in the entertainment industry are
willing to acknowledge that they have sex for money, while
escorts, because of their connections with organized crime
and/or illegal immigration status, are often impossible to
reach.

Public Reaction to AIDS Education
---------------------------------

20. While there is almost no resistance to sexual education
in schools by parents, major education NGOs take markedly
different approaches to the controversial issue of
abstinence versus condom use in preventing infection. As a
result, the approach taken by each school depends entirely
on which NGO the Administrators choose to help run the
programs.

Public Screening Programs
-------------------------

21. Since the outbreak of the AIDS epidemic, Taiwan has
conducted more than 33 million HIV tests. Furthermore,
groups such as blood donors, expectant mothers, foreign
workers, and inductees for military service are tested on a
routine basis.

22. In an effort to reduce transmission rates, the
government has recently stepped up its screening efforts
among pregnant women and individuals with other known
sexually transmitted diseases (STDs). Beginning in March
2004, Taiwan's Department of Health worked with Taoyuan
County (where the current rate of infection is six out of
100,000) to test all pregnant women. DOH is hoping to
expand the practice throughout Taiwan in an effort to reduce
the number of mother-to-baby HIV transmissions. In
addition, in early 2004, DOH initiated a Sentinel
Surveillance System, which requires all doctors to screen
individuals diagnosed with other sexual related diseases for
HIV.

Anonymous Screening Programs
----------------------------

23. In Taipei, most anonymous tests are performed on-site by
the Taipei Municipal STD Prevention Clinic. There are also
ten hospitals spread throughout Taiwan that perform
anonymous testing. In addition, several NGOS offer antibody
testing (using blood or saliva samples) at homosexual
meeting places. Volunteers collect the samples and counsel
clients; the samples are then forwarded to the STD Clinic
for testing, and clients call the NGO to receive the
results. NGOs also mail testing kits and instructions to
individuals who wish to conduct the test at home. Activists
justify these methods, which differ from the more rigorous
counseling and privacy protocols in place in many testing
facilities in the U.S., in terms of meeting the clients'
comfort level and maximizing the number of tests performed.

24. Despite these anonymous programs, TCDC is concerned that
many people who think they may have HIV are using blood
donation as a screening method. TCDC told AIT that in 2003,
60 blood donors were found to be HIV/AIDS carriers and there
have been 10 cases of infection as a result of blood
transfusion since 1998.

Comment
-------

25. Overall, Taiwan's commitment to tackling the disease is
strong and visible. Unfortunately, with rising rates of
infection among 15-24 year olds, the efforts to educate its
young population have not yet appeared to change behavior.
Hopefully, it is a program, which simply needs more time to
take affect. In any case, Taiwan will need to remain
vigilant if it is to maintain control of the uphill battle
against the spread of HIV/AIDS in Taiwan. End Comment.

Paal

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