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.

The Challenge


--------------------------





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.

Paal