HIV/AIDS in Taiwan - Monitoring

Monitoring

Close monitoring of emerging HIV-1 subtypes related to intravenous drug use and implementing harm-reduction programs has been and continue to be vital in preventing similar outbreaks in other populations of intravenous drug users in neighboring countries. In 2005, Alex Wodak, Gerry Stimson, and other harm-reduction experts were invited to Taiwan to share their experiences with government officials, medical field-workers, and public-health professionals. After careful study of harm-reduction programs in place in Hong Kong and Australia, a pilot program was started in four of Taiwan's 23 administrative areas in September, 2005. This program has since been expanded nationally, and consists of 427 service sites for syringe exchange plus centres for methadone maintenance therapy. Free methadone is provided to HIV-1-infected intravenous drug users while HIV-1 seronegative intravenous drug users have to pay about US$1600 a year. The Taiwan Centers for Disease Control plans to provide methadone maintenance to intravenous drug users in prisons, and the country's Bureau of Controlled Drugs will start producing methadone to assist in the government's commitment to providing methadone maintenance to 30,000 intravenous drug users by 2009.

All parts of Asia are reporting rising numbers of HIV-positive and AIDS patients in male homosexuals and bisexuals. In Taiwan, HIV-1 infection rates in men who have sex with men in gay saunas in different cities currently range from 5.2% to 15.8%. The same population has high rates of syphilis, 8.1–13.8%, depending on the city. Taiwanese male homosexual and bisexual HIV-1/AIDS patients have also been diagnosed with significantly higher rates of syphilis than have heterosexual patients. Furthermore, the percentage of homosexual or bisexual HIV-1/AIDS patients under the age of 20 years is significantly higher than that of heterosexual patients, 3.0% versus 1.7%. In addition to the stigmatization of homosexuality in Taiwanese society, the lack of accurate information on homosexuality in sex education and on risk factors in AIDS education increases the risk of contracting HIV and other sexually transmitted infections within the country's population of men who have sex with men. Whilst a community-based prevention program for such men has been developed by a group of academic and grass-roots non-governmental organizations, a current challenge is the implementation of this program into a national program, and making it a priority.

Taiwan's clinical spectrum of AIDS patients is similar to those reported in other developed countries, but significant differences have been noted in incidences of opportunistic infections. For example, the incidence of tuberculosis in patients with advanced illness is high in Taiwan (24.6%) and the rate of endemic fungal (Penicillium marneffei) infections is increasing. On the positive side, the effort by the Government of the Republic of China since April, 1997, to distribute highly-active antiretroviral therapy for free has resulted in dramatic decreases in morbidity and mortality from HIV-1 infection.

Because of their high background prevalence, HBV and HCV coinfections with HIV are particularly important in Asian countries in terms of HIV transmission via injecting drug use. In a survey of 459 intravenous drug users infected with HIV-1, one of us (Y-MAC) found that 456 (99.6%) also had anti-HCV antibodies and 77 (16.8%) were seropositive for HBsAg. The long-term impact of hepatitis coinfections on HIV and on morbidity and mortality from liver disease requires monitoring.