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
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.
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.
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.
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.
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.
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.