Cablegate: Macau Health Care: Emerging Efforts to Combat

VZCZCXRO8348
RR RUEHCN RUEHGH RUEHVC
DE RUEHHK #2033/01 3080827
ZNR UUUUU ZZH
R 040827Z NOV 09
FM AMCONSUL HONG KONG
TO RUEHC/SECSTATE WASHDC 8879
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEHBK/AMEMBASSY BANGKOK 1250
RUEHBJ/AMEMBASSY BEIJING 3664
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RHMFIUU/DEPT OF HOMELAND SECURITY IA WASHINGTON DC

UNCLAS SECTION 01 OF 03 HONG KONG 002033

SENSITIVE
SIPDIS

STATE FOR S/GAC, EAP/CM, OES/IHB, MED
HHS PASS TO NIH/FIC
BEIJING FOR CDC, HHS HEALTH ATTACHE
BANGKOK FOR USAID

E.O. 12958: N/A
TAGS: AMED CH HK KHIV PHUM SOCI
SUBJECT: MACAU HEALTH CARE: EMERGING EFFORTS TO COMBAT
HIV/AIDS

1. (SBU) SUMMARY: During Econ Officer's recent visit to
Macau, officials from the Health Bureau's Center for Disease
Control and Prevention (CDC) and NGOs described their efforts
to control the spread of HIV/AIDS. The cross-border spread of
HIV/AIDS is a growing concern in Macau as the city attracts
more international visitors. Macau's efforts to improve
education and monitor and prevent new infections have also
expanded, but the high volume and relative ease of
Macau-Zhuhai cross-border travel makes surveillance
difficult. Macau's HIV/AIDS patients, health workers, and
NGOs struggle with near-constant discrimination against them.
END SUMMARY

New Policy Changes to Address HIV/AIDS
--------------------------------------

2. (U) In 2004 Macau reported 30 HIV cases, a 25 percent
increase from the previous year, prompting the Macau Special
Administrative Region Government (MSARG) in 2005 to establish
the AIDS Prevention and Control Commission (the Commission),
an interdepartmental body chaired by the Secretary of Social
Affairs and Culture aimed at increasing community awareness
and promoting collaboration amongst government agencies to
prevent the further spread of HIV/AIDS.

3. (U) The Commission conducted consultations in 2008 to
consider two health policy changes: to implement mandatory
HIV testing for all immigrants and to legalize the possession
and distribution of clean intravenous injection instruments.
Mandatory HIV testing for immigrants is still under
consideration, with departments questioning the proposal's
feasibility. Privacy concerns, however, have thus far not
been raised as an issue. The second policy change has been
more successful, as Macau now allows distribution of clean
needles and syringes to combat the spread of HIV infection
amongst IV drug users.

4. (U) Other MSARG efforts to monitor the spread of the
disease include offering anonymous HIV/AIDS screenings to all
Macau citizens at its single public hospital. Additionally,
the MSARG has partnered with local private clinics to expand
its monitoring network and to make free HIV/AIDS testing
available to members of high-risk groups.

Cross-border Efforts with the Mainland Underway
----------------------------------

5. (U) Macau has long cooperated with Hong Kong Health
officials on HIV/AIDS education, surveillance and treatment
measures but only in 2008 did it begin to partner with its
mainland counterparts in Zhuhai. Since then, it has embarked
on a series of exchanges and visits. In February 2008,
Commission members visited a methadone maintenance treatment
and needle exchange program in Guangdong, and in August 2008,
they met with Zhuhai counterparts to exchange views and draft
a HIV/AIDS collaboration plan for the two regions.

6. (U) In December 2008, the MSARG teamed up with Zhuhai
counterparts to raise public awareness of sexually
transmitted diseases amongst the rising number of
border-crossing travelers. Over 11 million mainland visitors
arrived in Macau in 2008, the majority via the Border Gate
separating Zhuhai and Macau. Therefore, officials see
HIV/AIDS education and safe sex awareness programs
administered by both governments as crucial to reducing the
spread of HIV/AIDS across the border. Macau and Zhuhai
governments, with support from NGOs, conducted a public
awareness campaign targeting frequent travelers themed "Be a
Healthy Traveler", using slogans such as "Don't Bring
Sexually Transmitted Diseases and AIDS Home". The campaign
was conducted at the Border Gate, the Outer Harbor Ferry
Terminal and the Macau International Airport. Volunteers
distributed HIV/AIDS prevention information as well as
information about community resources such as AIDS hotlines,
websites, and services in Hong Kong, Macau and
Zhuhai.

Engaging NGOs to Counsel and Educate
---------------------------------

HONG KONG 00002033 002 OF 003

7. (U) Unprotected sexual contact is the primary mode of
HIV/AIDS transmission in Macau, said health officials. To
address this issue, in 2008 Macau began providing funds to
NGOs to counsel and provide prevention and treatment
information to high risk groups - sex workers and men who
have sex with men (MSM)- and to educate the larger Macau
community about HIV/AIDS prevention. The MSARG recently ran
an education campaign to get NGOs, schools, and other
volunteer organizations to participate in educating the
public about HIV/AIDS and offered participant organizations a
maximum subsidy of 8000MOP or approximately US $1000 each.

8. (SBU) Although there are a number of NGOs that are
involved in public health awareness including HIV/AIDS, the
Macau AIDS Care Association (MACA) is the first and currently
only NGO in Macau focused on HIV/AIDS prevention, counseling,
and education. Established in 2007, it began as an
association of medical professionals whose careers were
directly or otherwise related to HIV/AIDS patients and
providing treatment for them. It provided HIV/AIDS training
and information to its members and now also operates a
hotline anyone can confidentially call for HIV/AIDS related
information and assistance. In January 2009, MACA received
100,000MOP or approximately US$12,500 from the MSARG to
renovate its hotline center. Although MACA also receives
quarterly and annual subsidies from the CDC and the Social
Welfare Bureau, MACA expressed concern that subsidies were
not paid on time and also that they were not sufficient to
cover the cost of its staff.

Everyday Discrimination
------------------------

9. (SBU) Located inside a residential building with no
visible signage, MACA keeps a low profile for fear that
neighbors will discover that there is an HIV/AIDS NGO
operating next door. It aims to provide a safe and
confidential haven for counseling people struggling with
HIV/AIDS. Dr. Tse described the constant discrimination that
HIV/AIDS patients and the health care workers who treat them
faced in Macau. MACA had previously been asked to vacate
several other locations after neighbors and landlords found
out about their operations. People living with HIV/AIDS in
Macau were often shunned or fired from their jobs and had
difficulty finding work due to the baseless fears of an
uninformed public towards HIV/AIDS patients, said Tse.

10. (SBU) MACA President Dr. Maria Fatima Tse compared
HIV/AIDS patients to other disadvantaged members of society
such as the elderly, the physically disabled and mentally
challenged but noted that these other groups frequently
received public and private services and support. People
with HIV/AIDS were often afraid to identify themselves and
therefore did not receive the same sort of help or support.
Tse said Macau government employees were required to disclose
their HIV/AIDS status, highlighting the problem of lack of
respect for medical privacy in Macau.

Officials Statistics May Not Tell the Full Picture
--------------------------------------------- ----

11. (U) As of September 2009, 419 HIV cases have been
reported in this city of 544,000 residents. In the first 10
months of 2009, nine HIV infections were recorded, which
followed 2008's 22 new cases and 2007's 21 cases. According
to official statistics, 50.6 percent of the total reported
infections were of temporary residents working in the
"entertainment" industry, and over 10 percent of these
infections have developed into full-blown AIDS cases.
Sixty-seven percent of HIV transmission in Macau has been
through sexual contact, of which 87.6 percent was
heterosexual transmission.

12. (SBU) CDC health officials stated that people in Macau
were not always honest about how they may have been infected,
especially MSM. Dr. Tse believed that there were probably
many more cases unreported. She estimated that fifty percent
of all HIV infections in Macau were transmitted by drug users
and fifty percent through unsafe sex. Tse also commented that
although Macau's statistics showed a very low HIV infection

HONG KONG 00002033 003 OF 003

rate, its neighbors had a much higher rate of infection.
(Note: Hong Kong recorded its highest-ever number of HIV
infections in a single year in 2008, with 435 new cases. In
the first half of 2009, Hong Kong reported 98 new cases of
HIV infections, bringing its cumulative total to 4,249 since
1984. Neighboring Zhuhai's HIV infection statistics are not
readily available. However, according to the Guangdong
Province Department of Health, in the first 10 months of
2008, Guangdong province recorded 4,709 new HIV infections, a
25 percent increase from the previous year, bringing its
cumulative total to 23,031. End Note)

13. (SBU) Dr. Tse also recounted her firsthand experiences
with mainland Chinese female sex workers coming to Macau on
short term tourist visas. Some of the workers contacted MACA
for counseling and information on HIV/AIDS testing during
their stays. According to MACA staff, several of them tested
positive for HIV/AIDS. MACA staff assumed that they received
treatment when they returned to the mainland but also
expressed concern about the possibility of further
transmission to the population since some of these workers
were later seen back in Macau.
MARUT

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