1. (U) Summary. The number of HIV/AIDS infections in Taiwan has skyrocketed over the past year. In fact, with 1,606 new cases in 2004, the new infection rate was 77 percent higher than in 2003. The primary cause of the spike in cases is due to an increased number of infections among intravenous drug users. The rise in the number of new infections among criminals and females is particularly notable. The government has stepped up measures to curb this rapidly rising infection rate, but efforts to implement programs most likely to have an effect are facing political and bureaucratic hurdles. End Summary.
Alarming Increase In Cases
2. (U) The spread of HIV/AIDS has accelerated its pace in Taiwan as the number of new infections soared to an unprecedented 1,606 people in 2004, representing a 77 percent increase from the number of new cases reported in
2003. The bulk of the new cases were reported in the second half of the year and the exponential increases have continued in early 2005. A 77 percent increase is surprising when considering that the average annual increases in new cases between 1997 and 2004 were only approximately 15 percent. In 2005 alone, already 1,066 new cases have been identified, three times the number of cases reported during the same time last year.
Intravenous Drug Users
3. (U) According to Taiwan's Center for Disease Control (TCDC), the drastic rate of increase in new infections is largely due to the growing number of transmissions among intravenous drug users. Between 1984 when the first AIDS case was reported in Taiwan and 2004, 90 percent of the HIV/AIDS cases in Taiwan were transmitted via unprotected sexual intercourse. Also, prior to 2004, the number of new cases each year resulting from shared needles was less than 4 percent. Now, in just the first 4 months of 2005, shared needles have been responsible for 80 percent of new HIV/AIDS infections in Taiwan.
HIV/AIDS in Prisons
4. (U) A primary concern is the significant increase of HIV/AIDS among prison populations-- the number of HIV/AIDS infected inmates doubled from 280 to 551 between November 2004 and January 2005. According to Taiwan's Ministry of Justice (MOJ), the spike is also the result of increased transmission via intravenous drug use prior to incarceration.
Increased Rates Among Women
5. (U) Although the ratio of HIV-infected women in Taiwan is small compared with many nations, 116 of the 1606 new cases reported in 2004 were women, marking a three-fold increase since 2003. Within just the first 4 months of 2005, already 111 of the new cases have been women, twelve of them expectant mothers. By the end of April 2005, the total number of HIV/AIDS infected females rose to 583 and women comprised 7.4 percent of the total HIV-infected population in Taiwan. As shown in the chart below, this continues a trend of rising numbers of HIV-infected women over the past several years.
Year # of HIV infected women
2002 318 2003 353 2004 469 2005 583
IV Drug Use- Primary Culprit
6. (U) Although in the past, the low rate of condom usage and lack of HIV/AIDS awareness were the primary causes of HIV transmission among women, the recent sharp increase of HIV/AIDS infections among females is also largely a result of intravenous drug use. While only three female drug users were infected with HIV in 2003, the figure climbed to 53 in 2004, and to 55 in only the first four months of 2005. As with men, over 80 percent of the women who contracted HIV- infections within the past four months did so via needle sharing.
7. (U) TCDC believes another factor behind the increase in the number of infections among women is importation of foreign brides. One out of every five newlyweds is married to a foreigner and almost half of the HIV-positive women in Taiwan were foreign brides (mostly from China).
Rising Rates in the Military
8. (U) Upon commencing Taiwan's two year mandatory military service for men, all cadets undergo a medical examination, which includes an HIV screening. According to the Taipei County Government, prior to 2004 on average 4-5 HIV positive cases were discovered annually. Within just the first four months of 2005, that number has increased to 18.
9. (U) Until 2004, Taiwan's comprehensive approach to control and prevent the disease as described in reftel B appeared to have been effective, with new infection rates remaining relatively low and increasing no more than 15 percent per year. It is not clear whether the recent spike in HIV/AIDS cases due to IV drug use is an indication that IV drug use has increased or that the disease has found its way into a high risk population and then spread rapidly among an already large network of IV drug users and their social contacts. In either case, the recent jump in transmissions via IV drug use is presenting a major new challenge for the government in its battle against HIV/AIDS.
10. One survey of intravenous drug users conducted by TCDC found that 90 percent of the IV drug users were unaware of the risks of HIV/AIDS via sharing needles and 10 percent of those surveyed had not heard of HIV/AIDS. Furthermore, Taiwan does not boast success in reforming IV drug users. Taiwan's success rate for rehabilitating heroin addicts is below 1 percent.
Bureaucratic and Political Hurdles
11. (SBU) As the bulk of the recent increase in new transmissions has occurred among prisoners and their contacts, TCDC is concerned about Taiwan's law that makes it illegal for HIV/AIDS criminals to stay in jail (HIV/AIDS criminals are currently sent back to their communities). TCDC is pressing to have the law repealed and to have funds provided for the Department of Health (DOH) and the Ministry of Justice (MOJ) to work together to implement treatment, preventative education, needle exchange and condom promotion programs in prisons.
12. (SBU) Unfortunately, DOH and MOJ do not have a history of cooperation and establishing that collaboration is not simple. Due to a lack of understanding about how the disease is transmitted, MOJ and prison officials are scared of contracting HIV/AIDS from infected prisoners and are therefore reluctant to see the law that makes it illegal to incarcerate HIV/AIDS criminals repealed (ref B). Furthermore, there is political resistance in the Executive and the Legislative Yuans to support needle exchange and condom promotion programs. Despite the demonstrated success of such programs, some politicians are concerned that supporting them will make it appear that they support drug use and promiscuity.
13. (SBU) Comment. If Taiwan is to get on top of the rapidly rising number of HIV/AIDS cases due to IV drug use, cooperation between MOJ and DOH will be crucial. Programs that effectively reduce transmissions among and via IV drug users need to be implemented both within and outside of prisons. In addition, Taiwan needs to step up its efforts to reduce IV drug use overall. According to TCDC, these problems are being worked on, but will likely take some time to resolve. End Comment.