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Some of the consequences of globalization, including large populations movements, increasing economic inequalities, and the growth of the sex industry are all believed to contribute to the spread of HIV/AIDS in Asia. Women are particularly vulnerable to the negative economic effects of globalization and are often at greater risk of contracting HIV/AIDS. Experts predict that in the near future, Asia will be facing a potentially crippling AIDS crisis unless new strategies are developed to deal with the HIV/AIDS epidemic and slow the spread of the disease.
Globalization and the Spread of HIV/AIDS in Asia
The purpose of this research paper is to examine this spread of HIV/AIDS in the context of globalization. This paper will discuss how some of the consequences of globalization have affected the spread of HIV/AIDS, particularly in Asia, and how globalization and HIV/AIDS have affected women and individual Asian countries. Globalization can be defined as “the inter-connectedness of capital, production, ideas and cultures at an increasing pace” (Kennedy, 1996). In addition to resulting in the spread of ideas, information, people, goods, and technology across national borders, globalization has also forced the world to confront the rapid spread of infectious diseases such as HIV/AIDS (Gupta, 2004). In 1990, John O’Neill made one of the earliest attempts to relate the spread of HIV/AIDS to globalization, referring to AIDS as “a potentially globalizing panic on two fronts; namely (a) a crisis of legitimation at the level of global unisex culture; and (b) a crisis of opportunity in the therapeutic apparatus of the welfare state and the international medical order” (O’Neill, 1990).
The spread of HIV/AIDS across national borders illustrates many different aspects of globalization, including the interconnectedness of nation states; the concept of a “global problem” and of a “global response”; and the development of universal identities. “AIDS fits the common understanding of ‘globalization’ in a number of ways, including its epidemiology, the mobilization against its spread, and the dominance of certain discourses in the understandings of the epidemic” (Altman, 2001). The earliest reported cases of AIDS involved homosexual men in the early 1980s along both coasts of the United States (Hunt, 2004). Since then, HIV/AIDS has spread rapidly across the globe (Altman, 1999). It is likely that HIV/AIDS originally spread through the processes of urbanization and population shifts, and “that its rapid dispersion across the world is closely related to the nature of a global economy” (Altman, 1999). Researchers have found that the spread of HIV/AIDS has often followed huge population movements, whether by truckers moving across international routes, women joining the sex trade as a means of economic survival, or men migrating to seek employment, increases in tourism, or large refugee movements into neighboring states (Altman, 1999).
Globalization has resulted in an increase in international trade, and the rapid growth experienced by export-led economies has created a need for more advanced transportation systems and infrastructures. Large numbers of truck drivers are needed to transport the goods and materials destined for other countries across borders or to port cities along the coast. Studies have found these truck drivers to be one of the largest causes of HIV/AIDS transmission and one of the main methods by which HIV/AIDS is carried from rural to urban areas (Upadhyay, 2000).
Globalization has also resulted in rapid growth in manufacturing and other industries, and the corresponding increase in the number of migrant workers employed in manufacturing industries in urban areas has also contributed to the spread of HIV/AIDS. Many of these men live far from home and often frequent brothels, which has increased the demand for sex workers, another major cause of HIV/AIDS transmission, as well (Upadhyay, 2000). The internationalization of the sex and drug industries has also played a large role in the spread of HIV/AIDS (Altman, 1999).
The international responses to the spread of HIV/AIDS also illustrate the affects of globalization. The first major international response to the AIDS epidemic occurred when the World Health Organization established the Global Program on AIDS (GPA) in 1996. The GPA encouraged the creation of new, international networks for dealing with AIDS. In addition to developing global strategies to combat HIV/AIDS, these new networks also helped to form links between other international social movements, such as gay rights and women’s organizations (Altman, Globalization, political economy, and HIV/AIDS, 1999). A number of donor countries also proposed the creation of UNAIDS in 1996, UNAIDS is a joint and co-sponsored United Nations program which coordinates the activities of major international organizations involved in AIDS work (Altman, Globalization, political economy, and HIV/AIDS, 1999).
HIV/AIDS and Asia
Within Asia and the Mekong Region, the processes of globalization and market liberalization have occurring rapidly over the past two decades, as countries have moved from centrally planned to market economies. These countries have experienced unprecedented economic growth, often resulting in imbalances between urban and rural areas and increasing the income disparity between the rich and poor (Bain, 1998). This same area is also experiencing extraordinary levels of population mobility as both men and women respond to changing economic circumstances and new employment opportunities. Previous research has found that the resulting population migrations dramatically increase vulnerability to HIV (Bain, 1998). HIV/AIDS is now highly prevalent throughout the region, particularly in Myanmar and Thailand, and is especially common among mobile populations such as migrants workers, sex workers, truck drivers, and traders (Bain, 1998).
UNAIDS and WHO estimated that in 2007, between 3.7 million and 6.7 million people were living with HIV/AIDS in Asia, including the 210,000-1.0 million people who became infected that year. Overall, approximately 9 million Asians have been infected with HIV since it first appeared in the region more than 20 years ago. Although some countries have made progress in fighting the spread of the disease and recently reported declining rates of new HIV infections, AIDS currently accounts for more deaths per year among 15-44 year-old adults than tuberculosis and other diseases. HIV/AIDS transmissions in Asia share several common factors, including unprotected paid sex, the sharing of contaminated needles by drug users, and unprotected sex between men. Currently, men who pay for sex are the “single most powerful driving force in Asia’s HIV epidemics”, and because these men are either married or will get married, their wives or significant others are also exposed to HIV as well, furthering the spread of the disease (UNAIDS, 2008).
HIV/AIDS and Women
Some argue that globalization has lead to increasing inequality within and between nations, as well as an increase in the overall level of poverty around the world/ Women and children are often most at risk of the adverse effects of globalization, and in most parts of the world, women are more likely than men to live in poverty (Doyal, 2002). Researchers have found that the economic policies and adjustment programs promoted by international financial organizations such as the World Bank and International Monetary Fund and designed to open domestic markets to the global economy have unintentionally marginalized women and increased economic inequalities and the spread of HIV/AIDS in developing countries. Previous studies examining the effects of economic policies promoting growth and liberalized markets found that these programs may have increased poverty among women, creating an environment that has led to the growth of the sex industry and increasing the spread of HIV/AIDS (Upadhyay, 2000). In India, for example, despite experiencing real GDP growth after liberalizing its economy, the benefits of increased trade have failed to benefit the rural poor. The increase in prices and emphasis on commercial agriculture has forced many rural farmers into bankruptcy. This has disproportionately affected women, as they were employed primarily in the agriculture sector. These economic changes have forced women to migrant from rural to urban areas and seek new forms of employment in unregulated sectors, particularly in the sex industry (Upadhyay, 2000).
Because of their reduced social and economic power, women have a greater risk of contracting HIV/AIDS (Hunt, 2004). Over half of all people infected with HIV/AIDS are women, particularly young women between the ages of 15 and 24 (Gupta, 2004). Socially, within heterosexual relationships, men often have the power to control the aspects of sexual interaction, including how and with whom the act takes place. Due to this power imbalance, married women in monogamous relationships are often infected with HIV by their husbands because they lack the power to demand that they use condoms (Gupta, 2004).
Economically, although globalization has provided women with new employment opportunities, large numbers of women remain in low-paying, seasonal jobs in the informal labor market. The instability of women’s employment and their low wages also serve to decrease their power in their relationships with male partners, making it less likely that they will be able to negotiate the use of condoms with their male partners (Gupta, 2004). A woman in an uncertain economic situation may depend on her partner for support, and insistence on condom use may mean the withdrawal of this support (Doyal, 2002).
The low wages and instability of female employment opportunities also increases the likelihood than women will attempt to supplement their income by entering the sex industry, in which they can make more than 5 times the average wages they would receive in a menial day job (Gupta, 2004). Unskilled women facing financial difficulties often have few options, and for some, paid sex may be their only potential source of income (Doyal, 2002). Previous research on women employed in the sex industry have found that many cited “economic crisis” as their primary reason for entering the industry (Upadhyay, 2000).
The HIV/AIDS epidemic has become a growing problem for women throughout Asia largely due to the growth of the sex industry, the practice of sex tourism, and the socioeconomic status of women. Many see the AIDS epidemic as a direct result of a sex industry that employs 200,000-300,000 women in Bangkok alone (Neff-Smith, Spencer, & Tavai, 2001). Sex tourism has increased in popularity since the 1980s, becoming a vast international market (Petterman, 1998). Despite the AIDS crisis, the sex industry is as popular as ever, and the more popular tourist destinations, such as Thailand, import sex workers from poorer countries such as Myanmar and Laos, and even as far away as Eastern Europe. It has also been argued that AIDS has played a role in the demand for younger (and assumed to be uninfected) prostitutes, often from rural areas (Neff-Smith, Spencer, & Tavai, 2001).
HIV/AIDS in Asian Counties
HIV/AIDS has spread throughout Asia in similar patterns, mainly following large population migrations from rural to urban areas and across national borders. A majority of HIV/AIDS transmissions in Asian counties are due to the growth of the sex industry, unprotected sex, and drug use. Initially, the majority of HIV/AIDS transmissions in Cambodia occurred among heterosexuals with multiple sex partners, particularly those involved in the sex industry (Bain, 1998). The World Health Organization (WHO) reported that HIV infections among female sex workers in Phnom Penh increased drastically from 9.4% in 1992 to 39.4% only two years later (Prybylski & Alto, 1999). Port cities in Cambodia have a large sex number of sex workers who are hired by both domestic and international fishermen, and many towns also cater to international sex tourists as well. “Recruiting agents” employed in the sexual trafficking of women and children are common. Seasonal, cross-border migration into Thailand and Vietnam is also common, and this migration pattern has led to the development of shantytowns along the borders, where HIV/AIDS is often prevalent (Bain, 1998).
Although HIV/AIDS continues to spread primarily through heterosexual contact in Cambodia, recent reports suggest that sixty-nine percent (69%) of brothel-based sexual transactions are now protected. However, there has been an increase in non-brothel sex work, as men have begun “hiring” women working in bars, massage parlors and beer halls who do not self-identify as sex workers. Although HIV prevalence in Cambodia has decreased in recent years, almost half of all new infections now occur among married women infected by their partners, and a third of new infections are passed from mothers to their new-born children (UNAIDS, 2008).
The HIV/AIDS epidemic in Thailand began among IV drug users, and then spread to sex workers. HIV infections among brothel-based sex workers increased drastically from 3.5% in 1989 to 33% by the end of 1994 (Bain, 1998). By June of 1992, one in four Thai prostitutes tested positive for HIV. For many years, officials were hesitant to acknowledge the problem because they were afraid of scaring away potential tourists, which accounts for the largest source of revenue in the country (Belk, Ostergaard, & Groves, 1998). However, despite initially denying the existence of its AIDS problem, condom distribution and other public awareness campaigns have increased condom use from 14% in 1989 to over 94% (Bennett, 1999).
Large numbers of migrant populations have also entered Thailand over the last 20 years, contributing to the spread of the disease throughout Asia. Thailand is home to large numbers of illegal immigrants, migrant workers and refugees from Myanmar, China, Vietnam, Laos and Cambodia, and reports estimate that over 1 million guest workers enter Thailand each year in search of employment (Bain, 1998). Rural-urban inequalities have also contributed to internal population movements in Thailand. High poverty levels in rural areas, particularly among the hill tribes in Northern Thailand, have caused man and women to move to the cities, where they are employed in factories, construction, the service industry, or the sex industry (Bain, 1998).
Although the growth of the Thai economy has offered Thais increased economic opportunities, outside of the sex industry, these opportunities often benefit men more than women (Bain, 1998). A majority of Thailand’s prostitutes come from poor, rural areas in the northern part of the country. Women and young girls from neighboring Burma, Cambodia and Vietnam also cross the border to work as prostitutes in major tourist areas such as Bangkok, Pattaya and Phuket. It is not uncommon for families living in poverty to sell their daughters into brothels as well (Belk, Ostergaard, & Groves, 1998).
HIV was first reported in India’s urban centers in the mid-1980s. Researchers have found that the spread of the disease followed the country’s main transport routes and along the border of Burma, where drug use is common. Although homosexual sex and drug use have contributed to the spread of the disease, the majority of new transmissions occur from heterosexual contact, primarily between commercial truckers and sex workers. Many women in monogamous relationships are also exposed to HIV due to the high number of Indian men who have extramarital affairs or sexual encounters with prostitutes. High levels of illiteracy among Indian women and the public stigma associated with sexually transmitted diseases has also resulted in a lack of available information on HIV risks for the country’s female population (Eberstadt, 2002).
During the 1990s, the majority of the new HIV/AIDS cases in China were undocumented, and as a result, often untreated. Despite new strides in prevention and education, HIV/AIDS is still considered by many to be a taboo subject. Official Chinese reports on HIV/AIDS infections are often drastically underreported. For example, in August of 2001, Chinese health authorities reported that only 600,000 Chinese were HIV positive; however, a June 2002 UN report suggested China had between 800,000 and 1.5 million people infected with HIV, and U.S. intelligence reports found that the number may have been as high as 2 million (Eberstadt, 2002). In China, HIV/AIDS is transmitted primarily through extramarital heterosexual sex (particularly through the commercial sex industry), through illegal drug use, and through the sale of unsafe blood (Eberstadt, 2002).
The main causes of the HIV/AIDS epidemic in China include economic reforms which led to large-scale population movements; an increase in high-risk behaviors such as IV drug use, prostitution, and homosexuality; the presence of other STDs among the population, which increase the spread of AIDS; untested blood transfusions; and the “sex revolution,” which has resulted in changing patterns of sexual behavior among younger generations (Bain, 1998). Population migration in China has occurred both internally and externally. Increasing numbers of foreigners, especially Vietnamese, are entering China looking for work, and at the same time, large numbers of Chinese are traveling abroad for tourism or employment. Within China, many rural Chinese (between 80-100 million) have moved to urban areas in search of employment in manufacturing and construction industries. Major factors contributing to this population shift include rural underemployment, regional and sectoral income disparity, and the development of new and improved transportation infrastructures. China’s “National Poverty Alleviation Plan,” which encouraged rural-to-urban resettlement in the 1990s, and the increase in the number of large construction projects such as the Three Gorges Dam also contributed to China’s population shifts (Bain, 1998).
Although the major causes of HIV/AIDS transmission in Laos are not as well-documented as in other countries, commercial sex work and drug use are thought to be the most common causes of transmission. Large population migrations are also thought to be a contributing factor. International migration occurs mainly between Laos and Thailand, with many undocumented Laos workers entering Thailand to look for employment. Laos officials have stated that they are concerned with the large number of workers traveling between Laos and neighboring countries with high HIV infection rates. New infrastructure projects within Laos also attract international migrant populations from other countries, particularly Vietnam, and rural farmers continue to migrate from the countryside into the cities in search of wage labor (Bain, 1998).
HIV/AIDS transmission appears to be increasing in Vietnam, particularly among drug users in urban areas. Reports suggest that infection rates have also been increasing among young men and women, particularly those involved in the sex industry as well. As in other countries, population shifts have also contributed to the spread of the disease. International migration in Vietnam has increased, with large numbers of Vietnamese seeking employment in neighboring countries. Internal migration has increased as well due to high levels of poverty and unemployment in rural areas, improved infrastructure, and large urban construction projects (Bain, 1998).
Myanmar has one of the highest HIV/AIDS infection rates in Asia. The epidemic began among IV drug users, then spread to sex workers. Myanmar is also the source of a large number of refugees and migrant workers, many of whom enter Thailand in search of employment, although an increasing number of migrants have been crossing the border into India as well, particularly those involved in narcotic and sex trafficking. Within Myanmar, there has also been an increase in internal migration to gold and jade mining towns (Bain, 1998).
The Future of HIV/AIDS in Asia
Economic inequalities, new employment opportunities, and large population movements have all increased the spread of HIV/AIDS throughout Asia, particularly among women, and the region is now facing what some refer to as an “AIDS crisis”. Thailand was the first country in the region to report a drastic increase in the number of HIV infections, but other countries such as Cambodia, Vietnam, and Myanmar are not far behind (Prybylski & Alto, 1999). In 2004, Dr. Peter Piot, UNAids Executive Director, reported that more people were diagnosed with HIV in Asia alone than in any previous year and warned that Asia was facing a potential “full-blow AIDS catastrophe” (BBC News, 2004).
Asia is home to a majority of the world’s population, and some predict that if the rate of HIV infections continues to increase, the “coming pandemic” may ruin the economic prospects of the entire region (Eberstadt, 2002). Researchers have estimated that assuming even a mild epidemic, the total number of new HIV infections in China and India alone may reach 62 million by 2025, with approximately 40 million deaths due to HIV/AIDS, while a severe epidemic may result in over 240 million new infections and 145 million deaths. If such an epidemic were to occur, it would drastically alter population characteristics in these countries and significantly reduce the working-age population (Bennett, 1999).
Despite improved efforts in HIV/AIDS detection, prevention and cooperation in recent years, Asia could benefit from a greater degree of cooperation between regional governments, health ministries, and NGOs in the future. Problems such as regional migration have increased the spread of AIDS throughout the region, and these problems extend beyond the borders of individual countries. Pre- and post-departure programs and information campaigns aimed at international migrant workers may be an important step in decreasing the spread of the disease (Bain, 1998).
Any efforts to combat the spread of HIV/AIDS in Asia must also focus on education and prevention in the sex and drug industries. Recent estimates suggest that approximately 10 million Asian women and 75 million men participate in the sex industry as workers and customers, respectively. Around 20 million men who engage in homosexual sex or are IV drug users are also at risk of contracting HIV. These men are highly likely to pass HIV/AIDS on to their wives or significant others. This suggests that strategies aimed at these high-risk populations will help to decrease the spread of HIV/AIDS in Asia (UNAIDS, 2008).
Asian nation-states and NGOs must also work to minimize the social stigma associated with HIV/AIDS and increase the provision of information on the causes of HIV/AIDS infection and methods of prevention. In addition, although political commitments to HIV/AIDS prevention have increased in Asia over the past decade, only two countries have a Head of State that has played a significant role in the country’s response to HIV/AIDS. Increasing political commitments and support is a necessary step in minimizing the spread of HIV/AIDS. Asia also lacks community level HIV/AIDS programs and activists. Previous studies have found that peer outreach workers succeeded in reaching drug users and sex workers where government employees have failed. Increased community involvement is also crucial in fighting the AIDS epidemic (UNAIDS, 2008).
Thailand’s success with the “100% Condom Use” campaign illustrates that these strategies can have a significant effect on the spread of HIV/AIDS. If Asian nations are able to take some of the necessary steps of working together, targeting high-risk populations, minimizing the social stigma attached to HIV/AIDS, increasing HIV/AIDS education and strengthening government commitments to fight the disease, hopefully they will be able to minimize the spread of HIV/AIDS and avoid the predicted HIV/AIDS crisis.
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