A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 14: THIRDWORLDIZATION
How could we even be thinking of 30% to 40% HIV seropositivity?
Physically Subhash Hira had changed little over the years. But inwardly he was a very different man. Keeping track of Zambia’s horrific AIDS epidemic had taken away a bit of his soul, left scars on his spirit. “People said to me when AIDS started in Zambia, ‘You are looking at the bubonic plague in the Middle Ages, and ten years down the line you will see the same kinds of mass deaths.’ And I thought it was an exaggeration. How could we even be thinking of 30% to 40% HIV seropositivity? Six years ago, in 1985, it was only 3% in pregnant women in Lusaka.”
100,000 female prostitutes in his city were infected
“AIDS has come to India. I must do everything in my power to ensure that what I have witnessed this last decade in Lusaka does not occur in Bombay or Calcutta or Delhi or Madras. HIV is emerging all over India. It may even be too late already.” It was. Dr. I. S. Gilada, secretary-general of the Bombay based Indian Health Organization, estimated that 100,000 female prostitutes in his city were infected, 2 million nationwide, with the highest rates – up to 70% – seen among India’s Tamil women who worked as prostitutes in Bombay. Wherever poverty was high, HIV seemed to have made its entry into Asia well before 1991.
The infection rate among Chiang Mai prostitutes had soared to more than 70%
After touring India, Thailand, and the Philippines at the request of Speaker Tom Foley, Representative Jim McDermott, a physician and Democrat from the state of Washington, released the results of an AIDS investigation he conducted for the House of Representatives, reaching the conclusion that “Asia is the sleeping giant of a worldwide AIDS epidemic”, and predicting that Asia’s epidemic would, within perhaps just five years’ time, outstrip that of Africa. With all the prior warnings and clear evidence of the devastation AIDS was inflicting upon Africa, how could the microbe so overwhelm Asia? Why hadn’t humanity succeeded in preventing HIV’s emergence on the continent? As late as the fall of 1989 valid surveys of Thai drug users and prostitutes revealed infection rates below 0.04%. Yet within a mere twenty months the infection rate among Chiang Mai prostitutes had soared to more than 70%.
Lesson went unlearned
How could this have happened? In retracing the virus’s pathway across Asia, scientists and public health experts gained greater evidence supporting the GPA’s earlier theories that human rights violations, poverty, and the behavior of Homo sapiens played crucial roles in the emergence of disease. Indeed, the only way to comprehend Thailand’s astonishingly rapid HIV emergence was to recognize the intimate coupling of social, political, biological, and economic factors. African history, tragically, repeated itself in Asia. Lessons went unlearned. When officials at WHO plotted India’s AIDS growth rate the slope of Africa’s pandemic arched upward at a gentle angle for the 1990s, India’s forecast was a sharp line soaring up at a 60-degree angle. If India’s epidemic was racing, Thailand’s was moving at supersonic speed.
Thailand had two separate AIDS epidemics
Something strange and troublesome happened in Thailand: two separate lineage HIV-1 emerged, each exploiting entirely different population groups. Among Bangkok’s heroin injectors there appeared a B-class virus that looked genetically like a typical American HIV. But a very different HIV emerged in Thailand’s prostitute and heterosexual populations, one that closely resembled a virulent virus in Uganda. The two strains moved on separate paths in Thailand, and as of 1993 there was no evidence of cross-mixing of their genetic material. So Thailand, biologically speaking, had two separate epidemics, both of which grew at unprecedented rates.
HIV was handed a social gift: human chaos
At the most crucial moment in its emergence into Thai society, HIV was handed a social gift: human chaos. In February 1991 there was a coup in Thailand, bringing a military junta to power. AIDS programs came to a grinding halt; the flow of nearly all foreign aid, including monies earmarked for HIV control, stopped abruptly. There was little change in the sexual appetite of male customers and foreign sex tourists continued to flock into Thailand from all over the world, particularly Japan and Germany. Brothel owners began actively recruiting virgins and young girls, allowing them to market safety for their male clientele. The average ages of prostitutes plummeted and the number of Burmese women working in the brothels soared, topping 40% by 1993. Nearly all the Burmese female prostitutes were slaves. In September 1988 the Burmese government was overthrown in a coup that brought the most corrupt elements of the country’s business and military communities to power. The country sank into chaos. Like Africa, much of Asia was simultaneously undergoing other disease emergencies that could be expected to compound or synergize with HIV/AIDS, including dengue, hepatitis, drug-resistant malaria, tuberculosis, drug-resistant cholera, and virtually every known sexually transmissible microbe.
The U.S. Census Bureau issued dire forecasts
The U.S. Census Bureau issued dire forecasts for Thailand, based on HIV-prevalence rates as of early 1994: population growth down to -0.8%; 25 million fewer people in the country than in the absence of AIDS; a dive in life expectancy from 75 years to 45 years; child mortality rates would triple; and crude death rates would soar from 6 per 1,000 to 22 per 1,000.