US embassy cable - 05TAIPEI2205

UNCLAS SECTION 01 OF 03 TAIPEI 002205 
 
SIPDIS 
 
SENSITIVE 
 
STATE PLEASE PASS TO AIT/W, EAP/RSP/TC AND OES/IHA 
HHS FOR ERICA ELVANDER 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, ECON, SENV, SOCI, TBIO, TW, ESTH 
SUBJECT: TAIWAN:  HIV/AIDS SPREADING AT AN ALARMING RATE 
 
REF: A) 2005 TAIPEI 00990 B) 2004 TAIPEI 03043 
 
SENSITIVE BUT UNCLASSIFIED - PROTECT ACCORDINGLY 
 
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