US embassy cable - 04TAIPEI3043

UNCLAS SECTION 01 OF 05 TAIPEI 003043 
 
SIPDIS 
 
STATE FOR EAP/RSP/TC, S/GAC AND OES/IHA 
 
STATE PLEASE PASS TO AIT/W 
 
HHS FOR ERICA ELVANDER 
 
E.O. 12958:  N/A 
TAGS: TBIO, OSCI, OTRA, SENV, TW, ESTH 
SUBJECT: TAIWAN FIGHTS AN UPHILL BATTLE TO CONTAIN HIV/AIDS 
 
REF:  SECSTATE 168905 
 
1.  Summary. In response to reftel, AIT has assessed the 
scope and government response to the AIDS epidemic in 
Taiwan.  The Government is committed at the highest levels 
to controlling its spread and based on the numbers, HIV/AIDS 
rates are still manageable.  In close cooperation with NGOs, 
Taiwan has adopted a comprehensive approach to control and 
prevent the disease.  Taiwan's National Health Insurance 
also makes treatment affordable and universally available. 
Despite such efforts, however, Taiwan's rates of infection, 
while relatively low by Southeast Asian standards, are 
growing, particularly among young people.  Taiwan will need 
to remain vigilant if it is to maintain control of the 
uphill battle against the spread of HIV/AIDS.  End Summary. 
 
Political Will is Strong and Present 
------------------------------------ 
 
2. Political leadership in Taiwan appears to take the issue 
of containing the spread of HIV/AIDS seriously.  In 2001, 
the Executive Yuan (EY) established an inter-agency AIDS- 
Prevention Committee.  The Committee is chaired by the Vice 
Premier and overseen by Department of Health (DOH) in 
consultation with a team of medical professionals and 
experts from government, academia and NGOs.  President Chen 
Shui-bian demonstrated his support to the Committee's 
efforts by becoming personally involved in a campaign to 
raise awareness of the issue by publicly urging every 
citizen to get involved in HIV/AIDS prevention and control. 
 
Government Actions Support Words 
-------------------------------- 
 
3. Taiwan funds AIDS prevention, control and treatment 
activities in 12 different government agencies.  DOH 
receives the lion's share of approximately 1/3 of Taiwan's 
USD 3.8 million annual AIDS-prevention budget.  Furthermore, 
DOH has the lead in ensuring the coordination of all 
government-funded programs, which range from education 
campaigns, to screening programs, to treatment regimens. 
 
4. Taiwan is also committed to containing the global spread 
of HIV/AIDS and to this end contributed USD 1 million to the 
Global AIDS Fund both in 2002 and 2003.  Taiwan has also 
agreed to provide bilateral HIV/AIDS assistance to Haiti, 
one of the countries that maintains diplomatic ties with 
Taiwan.  Minister of Health Chen Chien-jen visited Haiti in 
August 2004 and committed USD 2 million to establish a 
disease research laboratory in Haiti.  Initially the 
laboratory will be dedicated entirely towards HIV/AIDS 
testing and prevention.  Taiwan is fully funding both the 
construction of the building and the internal laboratory 
facilities.  Construction of the laboratory is expected to 
be completed within one year.  Taiwan has also partnered 
with the US Centers for Disease Control (USCDC) to provide 
staff and technological support once the project is 
completed. 
 
5. Taiwan offers comprehensive and affordable HIV/AIDS 
treatment. The HAART (Highly Active Antiretroviral Therapy) 
drug cocktail treatment for HIV-positive patients has been 
completely covered by National Health Insurance Program 
since 1997.  According to Taiwan's Center for Disease 
Control (TCDC), HAART has been very effective and one study 
has shown that the provision of free HAART decreased HIV 
transmission by 53 percent in Taiwan.  TCDC also told AIT 
that, currently, the 10-year life expectancy rate for AIDS 
patients under the HAART treatment is up to 84 percent. 
 
6. Finally, since Dec. 17, 1991, Taiwan has had a regulation 
on AIDS prevention in effect, which imposes jail sentences 
of up to 7 years for any individual that knowingly engages 
in unprotected sex, sharing needles or donating blood, 
organs or other bodily fluids. 
 
The Numbers 
----------- 
 
7. Since its first recorded case of HIV in 1984 through July 
2004, Taiwan has 6,255 HIV confirmed infections.  This 
number includes 5,789 local citizens and 466 foreigners.  Of 
the 6,255 cases, 1,724 have developed AIDS, 971 of which 
have died.  In 2004 alone, already 602 new cases have been 
identified.  It is expected that the growth rate in 2004 
will represent a 20 percent increase from 2003.  This would 
indicate a growing rate of infections as, over the past five 
years, Taiwan's rate of infection has typically increased by 
10 - 15 percent annually.  While the above represent 
Taiwan's official statistics, Taiwan's Center for Disease 
Control (TCDC) has told AIT that the real number of 
infections may be five times higher than the reported cases 
and the projected number for Taiwan's HIV/AIDS patients is 
anticipated to reach 14,536 by 2011. 
 
8. Comment.  According to Dr. Fang Chi-tai, one of Taiwan's 
leading AIDS/HIV Researchers at National Taiwan University 
Hospital, the actual number is closer to two times CDC's 
confirmed number of cases.  Dr. Fang said that TCDC tends to 
exaggerate the situation in order to encourage more people 
to take the issue seriously.  He said the main reason for 
the discrepancy is that, due to the sometimes long 
incubation period, many people with HIV are asymptomatic and 
do not think to be tested.  He noted, however, that this is 
not the case among perceived high-risk groups such as 
homosexuals who tend to be more aware of the risks and test 
themselves regularly.  He added that even those who test for 
the disease may not know they have it because, in its early 
stages, testing sometimes results in false negatives.   End 
Comment. 
 
The Patients 
------------ 
 
9. Of the 5,789 Taiwan citizens confirmed to be HIV 
positive, 37 percent identified themselves as heterosexual, 
35 percent identified themselves as homosexual, 11 
identified themselves as bisexual, and 17 percent did not 
specify their sexual preference. 
 
10. Unfortunately, the number of infections among young 
people have grown at an alarming pace. Official figures show 
that the number of 15-24 year olds testing HIV positive 
increased from 58 in 1998 to 136 in 2002.  The proportion of 
new infections occurring in young people has also steadily 
increased over recent years.  In 1998, 15-24 year olds made 
up 14.9 percent of total new infections in Taiwan.  In 1999 
15-24 year olds made up 18.1 percent, in 2000 they made up 
19.4 percent and in 2001 they made up 21.5 percent of total 
new infections. 
 
11. Moreover, of the total 5,789 citizens infected with HIV, 
almost 40 percent of the patients (2,154) contracted the 
disease between 20-29 years of age.  Seventy percent of the 
5,789 cases contracted HIV when they were between 20-39 
years of age. 
 
12. Another population of concern is commercial sex workers. 
Sex workers in Taiwan fall into three categories: 1) career 
sex workers who, since commercial sex work was banned in 
1999, have either lost their licenses or are working in the 
approximately 100 remaining brothels grand-fathered under 
the new law; 2) women who work in the "entertainment 
industry" (teahouses, barber shops, and karaoke clubs), some 
of whom occasionally have sex for money; and 3) "escorts," 
generally recruited and managed by organized crime groups 
and include many women who have immigrated illegally from 
Mainland China. 
 
Transmission 
------------ 
 
13. According to TCDC, over 90 percent of the HIV infections 
in Taiwan are believed to result from unprotected sex. TCDC 
claims that over the past 3 years, however, transmission as 
a result of intravenous drug use has been a growing factor. 
As of June this year, the percentage of total infections 
resulting from shared needles is estimated to be 3.49.  More 
alarming is the growing rate of new infections resulting 
from drug use.  Where in 2002, 12 new cases were determined 
to have resulted from sharing needles, intravenous drug use 
has been linked to 63 new cases in 2003 and 65 new cases in 
the first half of 2004.   Other transmission routes in 
Taiwan of concern are those from mother to child and those 
from Taiwan businessmen who contract the disease while in 
Mainland China and then transmit it to their wives in 
Taiwan. 
 
Education Programs 
------------------ 
 
14. In an effort to address the growing rates of infection, 
particularly among young people, Taiwan has stepped up its 
HIV/AIDS education efforts.  Since 2002, Taiwan's Department 
of Education (DOE) has mandated that all high-school 
students receive two hours of information on HIV/AIDS per 
year.  To this end, in 2001, DOE established an "AIDS 
Prevention Education Committee."  The Committee is 
responsible for overseeing AIDS prevention activities, 
systematizing AIDS-related materials and curriculum, 
training educators on how to teach AIDS prevention, and 
protecting the rights of the HIV/AIDS infected students in 
all schools.  The Committee's goal is to ensure that at 
least 90 percent of high-school students understand what 
AIDS is and how to prevent its spread.  The Department 
typically partners with NGOs to facilitate its training 
programs for teachers (see paras. 16-18). 
 
15. In 2003, DOE designated the first week of December as 
"AIDS prevention week" and implemented a "Love's Red Ribbon" 
program, which involved distributing red ribbons to raise 
awareness about AIDS and AIDS prevention among young people. 
DOE also urged schools at all levels schools to promote 
HIV/AIDS awareness among their students.  Taiwan is a strong 
proponent of the AIDS-prevention slogan: ABC (Abstinence, Be 
faithful and Condoms). 
Role of NGOs 
------------ 
 
16. NGOs play an important role in controlling HIV/AIDS 
transmissions in Taiwan. Taiwan AIDS NGO Alliance consists 
of more than 27 private groups, that are working towards 
promoting safe sex, striving for basic human rights and 
addressing the stigma of AIDS and discrimination.  These 
groups are active in all aspects of disease control from 
education campaigns to testing and counseling programs. 
 
17. Most notably, the Department of Education cooperates 
closely with NGOs to implement its HIV AIDS education goals 
and activities.  NGOs are integrally involved in helping to 
design and teach AIDS prevention curricula both within and 
outside of schools.   For example, DOE helps fund the NGO 
Mercy Hill Medical Foundation, which jointly with Taipei 
Normal University runs programs to educate teachers to 
address sex and sexuality issues in classrooms.  Programs 
are available for educators at all levels (from elementary 
schools to college campuses).  These programs are held 3-4 
times a year and approximately 100 teachers attend each 
session.  Since 1989, over 4,500 teachers in Taiwan have 
been trained to teach AIDS education through these programs. 
 
18. The Taiwan Center for Disease Control (CDC) has also 
funded efforts by other NGOs including Light of Friendship 
and the Presbyterian Church of Taiwan-affiliated AIDS 
Education Foundation to train teachers and students at all 
levels. 
 
19. Another NGO involved in preventing the spread of AIDS is 
Taipei's Collective of Sex Workers and Supporters (COSWAS), 
an advocacy group for licensed and formerly licensed sex 
workers.  Taipei's Municipal STD Prevention Clinic has 
enlisted the organization to spearhead education efforts 
among acknowledged sex workers.  However, according to 
COSWAS, few women who work in the entertainment industry are 
willing to acknowledge that they have sex for money, while 
escorts, because of their connections with organized crime 
and/or illegal immigration status, are often impossible to 
reach. 
 
Public Reaction to AIDS Education 
--------------------------------- 
 
20.  While there is almost no resistance to sexual education 
in schools by parents, major education NGOs take markedly 
different approaches to the controversial issue of 
abstinence versus condom use in preventing infection.  As a 
result, the approach taken by each school depends entirely 
on which NGO the Administrators choose to help run the 
programs. 
 
Public Screening Programs 
------------------------- 
 
21. Since the outbreak of the AIDS epidemic, Taiwan has 
conducted more than 33 million HIV tests.  Furthermore, 
groups such as blood donors, expectant mothers, foreign 
workers, and inductees for military service are tested on a 
routine basis. 
 
22. In an effort to reduce transmission rates, the 
government has recently stepped up its screening efforts 
among pregnant women and individuals with other known 
sexually transmitted diseases (STDs).  Beginning in March 
2004, Taiwan's Department of Health worked with Taoyuan 
County (where the current rate of infection is six out of 
100,000) to test all pregnant women.  DOH is hoping to 
expand the practice throughout Taiwan in an effort to reduce 
the number of mother-to-baby HIV transmissions.  In 
addition, in early 2004, DOH initiated a Sentinel 
Surveillance System, which requires all doctors to screen 
individuals diagnosed with other sexual related diseases for 
HIV. 
 
Anonymous Screening Programs 
---------------------------- 
 
23. In Taipei, most anonymous tests are performed on-site by 
the Taipei Municipal STD Prevention Clinic.  There are also 
ten hospitals spread throughout Taiwan that perform 
anonymous testing.  In addition, several NGOS offer antibody 
testing (using blood or saliva samples) at homosexual 
meeting places.  Volunteers collect the samples and counsel 
clients; the samples are then forwarded to the STD Clinic 
for testing, and clients call the NGO to receive the 
results.  NGOs also mail testing kits and instructions to 
individuals who wish to conduct the test at home.  Activists 
justify these methods, which differ from the more rigorous 
counseling and privacy protocols in place in many testing 
facilities in the U.S., in terms of meeting the clients' 
comfort level and maximizing the number of tests performed. 
 
24. Despite these anonymous programs, TCDC is concerned that 
many people who think they may have HIV are using blood 
donation as a screening method.  TCDC told AIT that in 2003, 
60 blood donors were found to be HIV/AIDS carriers and there 
have been 10 cases of infection as a result of blood 
transfusion since 1998. 
 
Comment 
------- 
 
25.  Overall, Taiwan's commitment to tackling the disease is 
strong and visible.  Unfortunately, with rising rates of 
infection among 15-24 year olds, the efforts to educate its 
young population have not yet appeared to change behavior. 
Hopefully, it is a program, which simply needs more time to 
take affect.  In any case, Taiwan will need to remain 
vigilant if it is to maintain control of the uphill battle 
against the spread of HIV/AIDS in Taiwan.  End Comment. 
 
Paal