MACAU HEALTH CARE: EMERGING EFFORTS TO COMBAT

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