Lessons for Taiwan: The HIV/AIDS Pandemic

by Joseph Limoli Deyama MD - Harmony Home Volunteer

 

 

The 9th International Congress on AIDS in Asia and the Pacific (ICAAP)

The largest and most important meeting on Aids in Asia was held August 9-13 on beautiful Bali Island, Indonesia.  Harmony Home was well represented with 12 volunteers and staff attending.  Our informational booth also proved to be one of the most popular with thousands of visitors wanting to learn about Harmony Home and the HIV/AIDS situation in Taiwan.

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This year’s theme for the congress was “Empowering people, Strengthening Networks.” This could not have been more appropriate for those of us working or volunteering to support those with HIV/AIDS in Taiwan.  Hundreds of inspirational examples of successful battles against HIV/AIDS from our 20 or so Asian neighbors were presented over 5 days.

In Asia, the AIDS pandemic continues to spread and grow....Taiwan is no exception.  In Asia, about 6 million (of the 40 million or so in the world) people live with HIV/AIDS.  This population continues to grow despite about 500,000 dying from AIDS annually in Asia alone. The available figures in Taiwan don’t at first seem dramatic with about 16,000 cases since the first case was identified in 1984.  The most frightening figures are seen when the number of recently diagnosed cases are compared with the total case for the past few years.  Based on the CDC report on HIV/AIDS in Taiwan, the number of people diagnosed with HIV has doubled from 2003 to 2005 and went down in 2006. But despite the decrease of new cases reported in the past, there is are still thousands of people getting infected every year. AIDS cases doubled from 2005 to 2007 and went down a bit in 2008. In actuality this may even be worse since the figures are not approved by any worldly association such as the United Nations or the World Health Organization.

 

Lessons for Taiwan from ICAAP

After attending many of the lectures and presentations at the congress, one thing became obvious-- that the challenges facing HIV/AIDS were cross-cultural and similar amongst all Asian nations.  Discrimination, stigmatization, criminalization of the highest risk groups and the lack of adequate and safe support for the patients were severe barriers in every country.  As information and results from many neighboring Asian countries were presented, there was much hope seen from their successes.  In Thailand and India for example, through the assistance of major international groups such as the United Nations (UN) or the Gates Foundation, they were able to install aggressive nationwide prevention and supportive programs.  Even China has declared that an HIV/AIDS pandemic is ongoing and is pursuing aggressive means to combat the disease and vastly improve their supportive services through assistance from the UN, World Bank and the Gates and Clinton Foundations.

What bothered me most, however, was that because Taiwan is not a member of the UN or WHO, no international funding is available.  While the UN, World Bank, the Gates and Clinton foundations provide millions of dollars and actual physical help to most of our neighbors, Taiwan is left out in the cold.

This means that the vast majority of support, education and, perhaps most pressingly, shelter must be provided by the Taiwan government and/or through individual and community efforts.  Currently these efforts have not been adequate.

This frustrating situation is further compounded by the fact that despite China, though insisting that Taiwan is a province of the mother country, and despite receiving dozens of millions of dollars of international aid, gives none of that help to Taiwan. Taiwan is literally NOT on the map for international aid agencies and not even on the map for China.

Harmony Home currently supports and provides shelter and care to over 120 people living with HIV/AIDS (PLHA), including babies and children affected with HIV/AIDS, and other related problems. Although the Taiwan government has been providing free cocktail anti-viral medication for citizens living with HIV/AIDS, Harmony Home receives very little help to feed, house and care for PLHA in the shelter.  93% of the almost $40,000,000 NTD (Taiwan Dollars) or approx. 1.3million USD annual budget ($100,000 USD worth of expenses per month) is currently obtained through private or corporate donations.  Only 7% of the budget is provided by the Taiwan government.  The recent world economic downturn hasn’t helped.  None of the funding comes from any major local or international organizations. It is a major uphill struggle to find the necessary funding every single month…a struggle that is only getting tougher.

 

Current situation in Taiwan

According to the Taiwan Center for Disease Control (CDC), the number of new cases of HIV/ AIDS is increasing at an alarming rate.  As mentioned earlier, new cases have been doubling or getting worse every year in the past few years, with no end in sight.  Intravenous drug abusers (IVDA) are becoming much more common in Taiwan with Heroin more readily and inexpensively available mainly from Afghanistan.  Since IVDA in Taiwan are criminalized, users tend to stay underground and share needles even though the government is making an effort to give free needles, care and risk reduction schemes such as with Methadone treatment.  IV drug users in Taiwan are not only criminalized but subject to intense discrimination and stigmatization.  Many have been fired from work or kicked out of their families when discovered.  What people don’t realize is that many IVDA were or still are normal working citizens.  Many are single mothers, whose husbands have died or run away.  They need help in rehabilitation, not be put in jail, where they cannot contribute to society and forcing many to abandon their babies.  Several countries have de-criminalized IVDA with great success, making IVDA a medical condition, not a crime; because of this, the spread of HIV/AIDS have lessened considerably.

More and more new cases continue to come to Harmony Home. For example, children of HIV positive, IVDA mothers who have been imprisoned.  Luckily for the babies and children, many tested HIV negative. The existing major challenge for Harmony Home is to find a larger facility to house all these new children and patients and of course this means that more staff, food, clothing, medications and shelter are needed urgently.  Currently the 120 adults and children sheltered in Harmony Home are spread out in 4 facilities in Taipei (North of Taiwan) and Kaohsiung and Pingtung (South of Taiwan).

IVDA may be the most dangerous and most common cause of the spread of HIV/AIDS in Taiwan at the moment but this is further compounded by the severe stigmatization and discrimination against the MSM (men having sex with men) population, causing many gay men not to seek diagnosis or help even if given for free.  This only leads to an increasing number of gay men at risk of being infected with HIV.

Another compounding factor in Taiwan is the increasing number of teenagers and those under 25 who become sexually active. Like their Japanese counterparts, the percentage of teenagers having one night stands are increasing and casual sex has more than quadrupled in the past few years, especially with the help of the internet. Needless to say, condom usage amongst this group is extremely low.

Last, but not least, Taiwanese working men have Asia’s worst rate of using condoms.  Many go abroad for business, to “socialize” with prostitutes or entertainers and bring home the virus. Taipei also is now considered as one of the sex capitals of Asia, with sex readily available 24 hours a day at many clubs, on the streets and via the internet. It has even been said that the highest risk for a Taiwanese woman to get HIV/AIDS is to be married to a Taiwanese man!

When you put all these major factors together, Taiwan has a potential tidal wave or Tsunami-type situation.  The wave has already begun to grow.

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Hope for Taiwan’s future

It is literally through the generosity of individual Taiwanese citizens and not the Taiwanese NGO groups that so many HIV/AIDS children and are being lovingly cared for.  I still have trouble believing that the legendarily generous Taiwanese NGOs that provide help and assistance around the world still refuse to give any help to their own children afflicted with HIV/AIDS because of stigma and discrimination.

There is an epidemic of HIV/AIDS occurring in Taiwan at this moment and it will only continue to worsen. The rates are worse than for mainland China (which has now admitted having an HIV/AIDS epidemic).

The Taiwanese government is making an effort to help by providing Anti-Retroviral (ARV) medication, but there is much need to do more to provide good physical shelter and living support for adults and children infected or affected by HIV.  I have heard so many “red tape” stories of empty promises by the government to provide this urgently needed help.  Many building lay empty while an adequate new location cannot be “found” to house new patients by the government.  I can’t imagine where all these children would be without a place like Harmony Home to take them in.  Harmony Home makes a concerted effort to keep any semblance of a family structure together.  For example, Harmony Home has in many cases convinced the authorities to allow the mother to live and work in Harmony Home after they have served their sentence of imprisonment.  This has, with few exceptions, resulted in mothers getting off their drugs and being able to care for their child.  Because of this, Harmony Home was able to preserve a secure and loving environment for all involved. This kind of shelter needs a team of dedicated staff and volunteers around the clock.

Another positive occurrence was the passing of an amended “HIV Prevention and Protection of Patients Rights Act.”  This law technically makes it illegal for PLHA to be discriminated against with regards to residence, education, hospitalization and employment.  Reality, however, still remains a challenge, as a few children from Harmony Home were recently asked to leave their school once it was found that they were HIV positive.  Their fellow students and their parents actually boycotted the school to make certain the child was not allowed in the school!

Solutions for Taiwan

So what are the solutions?  This ICAAP meeting taught us that all our neighboring nations were faced with similar challenges.  Only through persistent education, sharing and community network building were they slowly able to change the attitude of an entire nation.  Luckily, concerted efforts are being made by several volunteer and governmental groups to educate the public about HIV/AIDS. The hearts of the Taiwanese people are in the right place, once they are all educated as to the reality of the HIV/AIDS pandemic in this wonderful country, I firmly believe that they and the Taiwanese NGOs will turn the tide and pour in their love and funding to help their babies, children, single moms and all others who so desperately need it now.  The entire world has bypassed helping Taiwan’s people living with and affected by HIV/AIDS. Your help means the world to a little helpless child.

There is currently an HIV/AIDS epidemic occurring in Taiwan and will only continue to worsen.  Each individual, group, community and government member must now get fully educated and work closely united together to help those affected and to battle this terrible disease.

 

Main references include but were not limited to the below:

1.      Center for Disease Control www.cdc.gov.tw  figures and statistics up to 2007

2.      AIDS prevention and Research Center www.ym.edu.tw/aids/

3.      Institute of Public Health Taiwan www.ym.edu.tw/iph/iph13.htm

4.      HIV/AIDS in Taiwan: Wikipedia.org/wiki

5.      UNAIDS: 2005update on the HIV/AIDS epidemic and response in China

6.      “Taiwan,” Fighting a Rising Tide: The Response to AIDS in East Asia: T. Yamamoto and S. Itoh. Tokyo Japan Center for International Exchange 2006 pp 226-246

 

About the author:

Dr. Joseph Limoli Deyama was born in Japan and graduated from Stanford University in the USA.  He trained as a Plastic Reconstructive surgeon and was active with volunteer surgery around the world. Now retired, he volunteers globally especially with HIV/AIDS facilities and orphanages.  His message is that every single person can do some little thing to make a huge difference in the life of an HIV/AIDS orphan.  Any questions and comments are appreciated at This e-mail address is being protected from spambots. You need JavaScript enabled to view it