Recent studies have demonstrated that treatment with multiple (2 or 3) anti-retroviral medications can confer marked benefit to persons living with HIV/AIDS (PWA), both in the late as well as the earlier stages of HIV infection. In many instances such therapy has enabled infected individuals to return to work and to lead a relatively normal and productive lives. They spend less time in hospitals, saving both time and money. These positive effects benefit not only the infected persons but also their families, who will be able to resume their own lives and careers, instead of tending to their ill relatives and loved ones.

Furthermore the community and society as a whole benefits. Keeping PWAs in good health and back at work reduces the need for expensive inpatient medical care facilities, and fewer medical and paramedical staff to maintain. The positive psychological and emotional benefits are enjoyed by all. Ultimately there may actually be a positive saving when both the indirect and direct costs are factored in.

These new medications range in price from $540 per month (for 2 drugs) to $1100 per month (for 3). These are prices which few PWA or their families are able to afford. Currently only about 30% of infected Singaporeans are receiving these new life-saving medications. None of these drugs are publicly subsidised at present.

In the light of these new medical developments, and the fact that many cannot afford the medictions, Action for AIDS will initiate a fund to subsidise anti-retroviral medications for PWA. Unfortunately as our funds are limited not all PWAs can receive assistance. We will therefore rely on recommendations from both physicians and counsellors on which PWA will benefit most from the subsidy, based on both medical as well as social criteria.

On our part AfA will place a higher priority on those who are active in community welfare and education programmes. On top of our list are PWA who have the courage to come out publicly about their infection. They would be our most effective counsellors and educators, much more useful that expensive mass media campaigns. We feel that they deserve our utmost support.

THE PRINCESS DIANA AIDS CHARITY GALA -
23rd SEPTEMBER 1997

The tragic and sudden death of Diane, Princess of Wlaes, stunned and saddened millions the world over. Well known for her generous patronage of AIDS charity events in the UK and USA, The Princess had most graciously agreed to be the guest-of-honour at the gala on the 23rd of September. She was also in her short trip to Singapore due to vist with PWA and CDC, and to have a private lunch with invited AIDS activitists from Malaysia, Thailand, Indonesia and Phillippines, where she was to learn about the AIDS situations in these countries and give moral support for their efforts.

Alas it was not to be.

The organising committee felt that it was fitting that the event must not be cancelled. The evening will carry on and be dedicated to the memory of Princess Diane, whose contribution to the AIDS cause has touched the lives of so many people.

This event has been made possible with the support of Club 21 Pte Ltd, in particular Mrs Christina Ong, and the gala organising committee comprising Ms Elizabeth Khoo and Ms Tina Lee. Mrs Ong and the Club 21 group of companies has in the past been one of our main supporters and sponsors. This time she and the committee have put in time and energy beyond the call of duty. They deserve our greatest admiration and most heartfelt gratitude.

AIDS is not a big topic in Italy ... I never heard anyone speak about AIDS or about how a person can get it or prevent it. Being a woman, I believe that people will speak about me behind my back and say that I must have slept around with lots of men in order to get it. If a prostitute got tested positive and lost her job, the government should help her start a new life with a place to stay and a job. This is so that she wouldn't feel as if she deserved to get AIDS because of a job she got pushed into doing by her family to get money. Women still get discriminated in the world and I think that AIDS should not be any excuse to treat them any differently.

Aged 18, Italy

My country is supposed to be so free, I guess then you would think that all kinds of people should be accepted. But the truth is, my country is made up of people who can't help being scared of what they don't understand.

Aged 17, Sweden

In Japan, people are not well-educated about AIDS, so AIDS patients are still in a very difficult position. If I had AIDS and lived in Japan, I would not tell anyone about it because I know that people would not accept me.

Aged 17, Japan

When a woman in China gets AIDS, everyone looks down on her and thinks she is a very licentious person. She not only suffers from the disease, but also from the prejudices of other people.

Aged 18, China

If I was tested positive for HIV in my country, I would definitely tell my close family and ask them to support me through the stages of the disease. I would not tell anyone else, except close friends, because in Indonesia and other developing countries, AIDS is still considered a frightening disease. If I found out who passed me the disease, I will not hate him for what he did. Instead, I will go through this disease with him. I wouldn't sleep with anybody else though, because this person will get the disease from me.
Just because ladies are not allowed to have sex before they get married, many think that AIDS does not play a big part in our society. The government should provide people with AIDS education and distribute condoms more often. The use of condoms should also be promoted. The government should air more commercials about the prevention of AIDS and how it is not curable. Instead, they try to cover up the number of AIDS patients in Indonesia ...

Aged 18, Indonesia

In England, I come from a small council estate where words are passed faster than lightning. If I was diagnosed with HIV, my neighbours would know about it before I would. People in my town, Orrel, Wigan, are not very educated about AIDS or any other STD. I would be put in immediate isolation ... some people would go to the extent of telling their children and others to go home or walk on the other side of the road if I was walking on their side. My friends wouldn't be able to come round anymore, I would get ridiculed at college and be labeled a slut, whore, a dirty girl. Not only would I get a bashing from people, but my family would as well, right down to my little cousins. Also, with the community being Roman Catholic, I would be called unorthodox, impure ... all kinds of vile things you could imagine, even though these people's daughters are out doing the same things I did - some even worse.
The only real support I would get would be from my family. Not so much from my grandmother because she believes AIDS is a punishment from God to promiscuous people and those who do what she calls unnatural sex.

Aged 17, England

If I got AIDS, I don't know how I would feel. May be I'll lose all my hopes, especially if I got it now at my age. To think that I wouldn't be able to graduate from college or get married and have children ... Especially since I'm a girl, people of the opposite sex will think I'm dirty or a prostitute. I hope that societies in the Philippines and other countries will teach people about AIDS - it's for their own good and also good for AIDS patients so they can gain the confidence they once had.

Aged 15, Philippines

If I found out I had AIDS, my mind would be filled with fears ... I might think I can't share drinks or spoons with my friends or family, I can't touch other people and I would choose to be alone - even though I know that AIDS does not transmit in such ways.
I would write my feelings in a diary, cry, shout, break things and try to commit suicide. If I could, I want to face the problem positively, go talk with my family or to someone who is in the same situation or does not care about AIDS. I would try to ease my fears by expressing my feelings.
Would the government do something for me? Even if they paid me money or prepared facilities, the cure for AIDS has not been found yet. I want to get drugs or therapy for free. Anyway, if I got money from the government, I'd do anything I like instead of using drugs. Why should I take drugs for a disease with no cure? I'd eat what I want to eat and travel around the world. If I get AIDS, that is my destiny - everyone dies at least once!

Aged 15, Japan

The thought of having AIDS at this age is hardly imaginable Although AIDS isn't an uncommon disease, there would most certainly be prejudice from other people, even my friends. My parents may still give me support, but I'm sure they would be disappointed I in me. However, in Hong Kong there are AIDS support groups that I could join, where I might share my experiences. Still, people eye me differently, and with all the pain and suffering É it isn't a pleasant thought.

Isabelle, Aged 15, Hong Kong British

If I got AIDS in my own country, I can say this is the worst thing I can think of. China is still a very conservative country and people don't know how you can get AIDS. People will think I am very casual with sex. All my friends will leave me and my family will be very disgraced because of me. In China, I don't think there is a special place for AIDS patients. Maybe now is the time we should have a place for them.

Sharon, Aged 17, China

If I found out I had AIDS, I would feel that I'd lost everything, even my family and friends. I know I could not face them - I'd feel embarrassed. However, AIDS is a disease that most people are afraid of and they are scared to die. But everyone has to die of something. I'd say that I'm not afraid to die, but I'm afraid of losing friends and feeling that no one loves me or likes me anymore because I had AIDS. So, if I got AIDS I'd enjoy my life and have fun, or find some friends who would talk with me and understand what I feel.

Aged 18, Thailand.

Pakistan is still backward in their approach towards sexual issues of any kind, including AIDS. It is a big taboo and even ads shown on satellite TV about AIDS and its prevention are looked down upon. If I, being a Pakistani woman, had AIDS, I would move and live in another country. If I stayed, I would be discriminated against. The only people who would support me would be my parents, even my friends and relatives would think that I deserved it. The only way for AIDS to be fought against is for people's attitudes to change. The government should also provide shelters for women and their babies who have AIDS. Free treatment clinics are also important, since most of the women can't afford the treatment.

Aged 17, Pakistan

Japanese people can buy condoms in drug stores or vending machines. But buying condoms is embarrassing for quite a number of people, so they tend to practice sex without contraception. You must also be over 18 to buy condoms which makes it harder for adolescents. The Japanese government should have public campaigns about the need to use condoms and overcome some myths about AIDS (e.g. some people think AIDS cannot be transmitted if they have sex within 5 minutes).

Aged 16, Japan

I don't know what to do if I got AIDS in Japan, because they don't educate us on the topic of AIDS. I wouldn't know where to go for help. My company would probably dismiss me if I were working. You may think that's not fair, but that's true.

Aged 15, Japan

In my country, AIDS is misunderstood because we don't get education on AIDS at all. People think that a person gets AIDS because of casual sex. If I had AIDS, I can't live without the help from other people with AIDS, as well as from family and close friends, because the public will not accept me. When I was still in Japan in 1994, I hadn't heard of any groups for people with AIDS. So, the government should form such groups. The government should also force AIDS education in secondary schools.

Mary, Aged 17, Japan

It is important that all of us face AIDS because the danger may come close to us - or it may already be next to us.

Satsuki Yabushita, Aged 17, Japan

The government thinks that if they teach students about sex, they will be interested in it and try it. But if they have insufficient information and have casual sex, it would be really dangerous.

Aged 17, Japan

AIDS is a very big and dangerous problem in India, especially in the rural communities. A majority are unaware of the dangers and consequences as there are many other diseases which affect more people than AIDS, like Malaria. The majority of men acquire HIV through blood transfusions or visiting prostitutes. It is a dangerous problem, but a sad one too, as many women can't afford to get proper treatment for the illnesses. Many women die young as their parents don't support them - it is very shameful to get AIDS.

Aged 16, India

For many years now, the staff of the International School of Singapore (ISS) have been exemplary in their efforts to educate their wards about AIDS and nurturing the right attitudes towards those affected by HIV/AIDS. The school staff, students and parents have also contributed large sums of money to AfA, through sales of greeting cards, calendars and participation in the World AIDS Day activities. These efforts have made the students of the ISS arguably the most informed of all youth in Singapore with respect to AIDS. They are armed with the knowledge and skills to protect themselves, and the humanity and love to care for those with the infection.

Action for AIDS would like to thank and honour the ISS for its marvellous contributions, not only to AfA but also to Singapore as a nation. We sincerely hope that other schools will follow their lead.

Some non-government organisations (NGOs) and individuals are using human rights approaches to challenge HIV-related discrimination. Respecting human rights means that all persons are treated as equal in human worth and dignity, whoever they are. A Universal Declaration of Human Rights was agreed upon in 1948 and has since been signed by almost all nations. There are more recent international agreements on rights which are legally binding for nations which have signed them.

Of course, human rights are not o APCASO (Asia Pacific Council of AIDS Service Organisations) has developed a set of guidelines based on internationally recognised human rights and applying them to HIV. The guidelines will help NGOs define and document HIV-related discrimination. The APCASO guidelines also make it easier to campaign for policies and programmes that respect nly relevant to HIV - many people do not have access to minimum basic human rights. But there are some forms of discrimination that directly affects people living with HIV or make some groups of people more vulnerable to infection. human rights as well as provide better care and enable people to reduce their risk of HIV infection.

The following are excerpts from the APCASO Compact on Human Rights:

A. The Right to Privacy

Everyone has the right to live one's own life without any unnecessary interference from whatever source. A person's privacy, family and homelife, physical and moral integrity, honor and reputation should be respected and protected at all times.

No person should be compelled to divulge information regarding their HIV-positive status nor be compelled to undergo any examination or process designed to determine such status. When a person voluntarily agrees to undergo an examination to determine such status, pre- and post-test counseling should be provided. A person's identity and HIV-positive status should not be subjected to public or private inquiry and publication.

All information related to a person's health status should be considered private and confidential and may be shared only with the consent of the person voluntarily given after having been fully appraised of the purpose of such inquiry and the intended use of such information including the possible consequences of the use and publication thereof.

Any individual or entity acquiring such information has the obligation to use the same only for the purpose authorised.

There must be appropriate safeguards to protect such information from unauthorised use and access.

The standards would be breached in the following situations:

• Where an individual is made to undergo mandatory testing for HIV.
• Inaccurate or misleading media reporting regarding the epidemiology of the virus, including the exploitative use of specific cases of HIV infection in order to sensationalize the infection, including reporting of such cases, which bring disrepute to the persons concerned.
• Allowing unauthorised persons access to HIV/AIDS wards and the medical records of patients.

B. Right to Liberty and Security/Freedom of Movement

The right to liberty, security and freedom of movement includes the right against such measure as segregation, quarantine or isolation, unreasonable searches and seizures, as well as restrictions on the exercise of their right to movement within the country or any country, solely on the basis of health status, the suspicion of having HIV/AIDS, or by reason of association with identified 'high risk groups'. The guarantees and protection provided by law to the general population against unlawful intrusions into these rights, shall not be diminished or denied solely on the basis of health status.

The standards would be breached in the following situations:

• The compulsory quarantine, isolation and segregation of HIV-positive individuals.
• The refusal to medically treat and/or the denial of the use of appropriate diagnostic equipment to a person with HIV.
• Requiring the declaration of a person's HIV status as a precondition to the application and grant of a visa and/or entry into a country or the refusal to grant a visa or residential status (including political asylum) solely on the grounds that an individual is HIV-positive.

C. Freedom from Inhuman and Degrading Treatment or Punishment

Human dignity is inherent in any person regardless of one's sex, age, social, cultural, ethnic or religious affiliation, social standing and sexual preference. All measures for prevention and control of HIV/AIDS should not result in inhuman or degrading treatment or punishment. In addition, the state has the obligation to protect vulnerable groups against affronts to human dignity. The state should not initiate, encourage, condone or tolerate any act of omission which will result to ridicule, vilification, isolation, segregation of or discrimination against people with HIV/AIDS, those suspected of having the disease, or those associated with or involved in 'high risk groups'. The standards would be breached in the following situations:

• Isolation and segregation of HIV-positive detainees and inmates. This includes providing a different standard of treatment and rehabilitation of detainees and prisoners who are HIV-positive other than what is necessary for their care and medical treatment. Such individuals should not be denied access to privileges, opportunities, and services regularly enjoyed by other detainees and inmates solely on the basis of their HIV status.
• Involuntary participation in vaccine trials or denial of voluntary and informed participation in medical trials of promising treatments.
• Denial of burial rights, double-bagging of corpses, and any other practice that brings disrespect and dishonor to the dead.

D. Right to Work

The right to work includes the right of equal opportunity of employment, security of tenure, common and favorable conditions of work, and the right to form and join trade unions and workers organisations.

People with HIV/AIDS who are not otherwise incapacitated to perform work should be guaranteed access to opportunity for work, security of tenure, including the enjoyment of benefits and other terms and conditions which are extended to other workers.

The right to work includes freedom against all forms of discrimination in the workplace.

The standards would be breached in the following situations:

• Requiring mandatory HIV testing as a precondition for employment or the continued enjoyment of a persons work and/or practice of a profession.
• The practice of discrimination by the employer, including the condonation or tolerance of any discriminatory act by any co-employee against an HIV-positive person.
• Any acts done by the employer, his agents or servants which results in a breach of confidentiality of the HIV status of the employee.

E. Right to Education

The opportunity of access to, availment of and continued enjoyment of education and facilities to public or private education, which are offered to and/or regularly enjoyed by the general populace should not be denied, nor should restrictions be imposed upon, people with HIV/AIDS, those suspected of having HIV/AIDS, or those belongings to so-called 'high risk group'. In all educational institutions, people with HIV/AIDS, should be subject only to the same rules and regulations that apply to other, and should not be subjected to additional burdens by reason of their HIV status.

The standards would be breached in the following situations:

• Discrimination against a person with HIV/AIDS in access to the education system and educational privileges and opportunities which are available to the rest of the community.
• Denying such access to people who refuse to be tested for HIV/AIDS. or those who belong to so called 'high risk groups'.

F. Right to Social Security and Services

Social Security services and facilities, with particular emphasis on public insurance, medical and health care services, which are enjoyed by the rest of the community should not be denied to, diminished, nor should additional restrictions be imposed on their availment and enjoyment by people living with HIV/AIDS or so called 'high risk group' unless a proper medical or scientific justification can be shown.

The standards would be breached in the following situations:

• The requirement of mandatory testing as a condition for the enjoyment of social security and welfare services.
• The imposition of any reporting procedure that will violate the medical confidentiality of information provided by HIV-positive applicants for such services, or the use of other procedures likely to discourage people from pursuing a legitimate entitlement to such benefits or services.
• The denial of access to housing programs and the toleration of discriminatory tenancy practices such as non-renewal of tenancy contracts, eviction due to HIV status, or denial of the rights to participate in the homeowners' association and community.

G. Right to Equal Protection of the Law

Act. 7 of the Universal Declaration of Human Rights, should be respected at all times in dealing with the AIDS pandemic.

Consonant with this principle, the state should adopt and promote the policy of inclusion in addressing the plight of people living with HIV/AIDS. In pursuit of this policy, the state should institute safeguards to ensure the equal protection of the law, and protection from discrimination for people affected by the AIDS pandemic.

States must regulate against discriminatory practices of private institutions aimed at HIV-positive individuals or those thought to be at risk of infection, such as the practices of insurance companies requiring mandatory testing or committing breaches in medical confidentiality, the denial or reduction of insurance coverage, and the conduct of threshold testing.

Policies and legislation which further marginalise the position of women in society and perpetuate gender imbalances must not be tolerated.

H. Right to Marriage and Family Life

Men and women of competent age have the right to marry and found a family. Even in the case of people with HIV/AIDS, their right to marry, found a family, form relationships, have children based on sound and responsible behaviour should be recognised and respected.

The standards would be breached in the following situations:

• When people living with HIV/AIDS are prohibited from exercising these rights.
• Compulsory HIV antibody testing for pregnant women or their children.
• Forced abortion on the grounds of the HIV status of the mother, father or both.
• Forced sterilisation of people with HIV/AIDS.

I. Right to Treatment and Care

Governments must make every effort to ensure that all people with HIV/AIDS receive the highest attainable standard of medical care, counselling, treatment and support, free from discrimination and undue financial burden.

Citizens are entitled to receive accurate, clear, current, culturally-sensitive and morally-impartial information about the nature of the AIDS epidemic and the means of transmission of the HIV virus. Equally, access to condoms and clean needles should be regarded as essential to the decision- making of individuals and the self-empowerment of communities.

J. Right to Self-Determination of Affected Groups

Affirmative action programmes for stimatised and disadvantaged groups such as people with HIV/AIDS, women, sex workers, injecting drug users and homosexuals should be implemented, having as their primary objective voluntary behaviour change, the empowerment of individuals groups and communities and the enhancement of human dignity.

It is incumbent upon the state to create and/or to stimulate a social, cultural, economic and political environment which eliminates barriers to the full participation by people with HIV/AIDS, and other affected groups, in all aspects of community life and decision-making. Such barriers include poverty, prejudice, discriminatory regulatory practices and the perpetuation of human rights abuses.

This can be done by:

• Resourcing, encouraging and fostering the formulation of self-help, counselling, peer support and advocacy groups for people with HIV/AIDS and other affected groups.
• The inclusion of such groups in all levels of policy development, implementation and decision-making in matters likely to affect them or the communities from which they are drawn.
• The resourcing and development of networks and partnerships between people with HIV/AIDS, other groups vulnerable to human rights violations, local communities, NGOs, governments, and the health and medical professions.

Since the beginning 1997, Citra Usadha Indonesia Foundation has served as the secretariat for APCASO. For more information on APCASO, you may write to:

Citra Usadha Indonesia Foundation
Jalan Belimbing Gang Y No 4
Denpasar, Bali
Indonesia 80231
Tel - 62 361 22 26 20
Fax - 62 361 22 94 87
email - ycul@denpasar.wasantara.net.id

The Ministry of Public Health has announced a national medium- and long-term plan of action for HIV/AIDS prevention and control. The plan involves central and provincial government departments responsible for budgets, education, scientific research, media campaigns, and law enforcement. Under the plan, a nationwide HIV/AIDS monitoring network of some 400 clinics is to be established by year 2000. In addition, an advanced national HIV/AIDS laboratory along with modern laboratories will be set up in all provinces, autonomous regions, and municipalities. Other areas include promoting AIDS awareness via government-controlled mass media and special agencies in schools and among high risk groups, adopting prevention methods used by other countries such as greater condom use, and making law enforcement agencies responsible for cracking down on illegal blood supply, drug abuse, and prostitution.

The current number of reported cases of HIV infection in China is low relative to its population of 1.2 billion. To date, there are 5,157 known cases of HIV infection, up by 856 cases from the 4,305 reported in early 1996. Experts, however, say that the actual number of HIV-infected individuals in China could amount anywhere from 50,000 to 100,000 owing to inadequate detection methods.

"Experts fear that the next battleground for HIV/AIDS after Africa may include China, even though China is still a low-incidence country in terms of reported cases of HIV/AIDS," says Arthur Holcombe of the United Nations Development Programme (UNDP). Similar sentiments were voiced by Chinese AIDS experts, Chinese government officials, and representatives of multilateral donors attending a national conference on HIV/AIDS prevention and control in Beijing last October.

Both experts and officials, however, are optimistic about controlling the spread of HIV in China. Screening clinics and testing laboratories are located across the country. In addition, 42 monitoring centres in China's big cities conduct tests twice annually on high risk groups. Experts urge the establishment of similar facilities in vast rural areas and smaller and medium-sized cities. Chinese pharmacologists are also developing Chinese herbal medicine to treat AIDS. In the area of prevention, government and non-government institutions and the mass media participate in large anti-AIDS publicity campaigns around World AIDS Day. Finally, financial and technological supports from multilateral donors aid in China's AIDS research and prevention. Donor financial support has totaled $17.4 million, while the UN and EC have assisted in China's understanding of other countries' efforts in combating HIV/AIDS.

Holcombe of UNDP says that: "Unlike India and Thailand, China still has the opportunity to stop the spread of HIV/AIDS. But we must not lose valuable time."

The survey on the HIV/AIDS situation in China conducted by Zhang Kong-Lai (professor and chairman at the Department of Epidemiology, Peking Union Medical College) and Chen Wei (director of Shandong office for HIV/AIDS surveillance) explored four key areas: unsafe blood, projections, testing, and Chinese remedies.

Deficiencies with the national blood supply system pose a potential risk of HIV infection via blood transfusion. The national blood supply system, which gets 70-90 percent of its blood reserves from commercial blood sellers, faces problems such as the detection of HIV among blood sellers and in blood bank stocks as well as inadequate infection control approaches in local hospitals. In response, the Ministry of Public Health issued regulations in 1994 for stricter management of blood donations. In addition, a campaign encouraging voluntary donation has been launched.

The projection of HIV infection in China in year 2000 by Chinese experts is dependent on the incidence rate. Assuming the current low level of incidence, 50,000-100,000 individuals are projected to be HIV-positive. A higher level of incidence results in the projection of 80,000-190,000 HIV-infected individuals. The authors believed in the worst case scenario where a considerably higher incidence rate is assumed and the number of HIV-positive individuals in China is projected to be 110,000-250,000 by year 2000.

There is no mandatory testing for individuals at risk for HIV infection in China. Instead, for all HIV testing, informed consent is required. The results are kept confidential and the HIV-infected are allowed to continue working. Staff at local prevention centres conduct periodic examinations on the HIV-infected and send them to local designated infectious disease hospitals when they develop symptomatic HIV disease.

Substantial research, including collaborative clinical trials between Chinese and Western physicians, have been carried out to determine the effectiveness of Chinese herbs in treating AIDS. The Academy of Chinese Traditional Medicine, which treats African patients with Chinese herbs, reports promising results.

In China, many of the behaviors at risk for HIV infection are also criminalised. Therefore, criminal law has been used as a public health mechanism to control the spread of HIV. On the other hand, public health efforts, which educate people on risk reduction measures, may be perceived to encourage illegal behavior and hence contradict criminal law.
The Confucian philosophy guides much of Chinese law and correction. Under this philosophy, individuals are seen to possess innate goodness but are subject to external corruption. Corrupted individuals can be reformed through education. In practice, however, this rule applies more to some offences than others. In particular, Chinese law and correction discriminates the 'victims' from the 'perpetrators' of corrupting social forces. Prostitutes and drug addicts, belonging to the former, undergo re-education, whereas traffickers in women, pornography, or drugs, making up the latter, face sentencing, fines, and/or death.

In the 1950s, prostitution in China was allegedly insignificant in numbers and punitive intervention was correspondingly low. After the end of isolation, in the face of rising prostitution and sexually transmitted diseases, punitive intervention started to increase. Currently, public security personnel are authorized to forcibly round up prostitutes and detain them in re-education facilities from six months to two years. In contrast, individuals who pimp, traffick in women, or peddle pornography face sentencing. For instance, individuals who commit serious offenses in the abduction and selling of females face a maximum sentence of 'up to and including the imposition of death.'

China's proximity to the Golden Triangle region of Southeast Asia (Thailand, Laos, and Myanmar) makes it prone to problems of drug abuse and trafficking. With Vietnam joining the Triangle countries in distributing and/or transporting a high grade, injectible heroin through the southern Chinese provinces to Hong Kong and Macau, increased internal cultivation of opium, and greater sophistication of drug traffickers, drug availability and, correspondingly, the risk of HIV infection increases. The Chinese response to the drug problem follows the 'victim-perpetrator' split. Drug addicts are coercively detained in detoxification centers to undergo treatment. On the other hand, individuals who traffick and/or distribute 1 kilogram or more of opium, or 50 grams or more of heroin are punishable by imprisonment for 15 years to life, or by execution.

Faced with increasing illegal behavior and perceived moral decline, public security forces have increased their enforcement. During the 100-day 'Strike Hard' campaign instigated on 28 April, at least 100,000 individuals made up mostly of prostitutes, their clients, and drug addicts were arrested within the first two months.

The use of criminal law as a public health mechanism, however, raises some concerns. First, the majority of the individuals not arrested continue practicing their high-risk behavior. Second, individuals who practice criminalised behavior develop more covert ways to evade punishment and are thus harder to reach via public education. Third, non-criminal behavior may later be criminalised when drastic measures are perceived to be necessary to combat HIV/AIDS. Fourth, legitimate enforcement can promote the use of the law as a device that discriminates, abuses, and harasses people who practice high-risk behavior. For example, for the 108,782 prostitutes arrested in the between 1985 and 1994, only twelve were found to be HIV positive.

Source: AIDS Analysis Asia Volume 3(2), March 1997

The skills development project for sex workers which was funded by Action for AIDS, Singapore, was aimed at increasing condom use among sex workers, and preventing AIDS and Sexually Transmitted Diseases among them. This project stressed on equipping sex workers with condom negotiation skills so that they can persuade their clients to use condoms. We decided to use this strategy because we found that the main reason for low condom use among sex workers was their inability to get their clients to use condoms. Almost all the sex workers (more than 90%) knew about the dangers and seriousness of AIDS and the benefits of condom use. They were keen to use condoms but they succeeded in getting only half of their clients to use condom. Some sex workers did not ask their clients to use condoms because their brothel keepers were not supporting them. Others were afraid that they might lose their clients to their friends if they insisted on condom use. Thus the skill development project was designed to address the underlying causes of the problems of low condom use.

The project was implemented in January 1994 and is still being followed up. It used three main strategies, namely: (1) developing the sex workers' ability to get their clients to always use condoms (2) getting the brothel keepers and health staff to support the sex workers to use condoms (3) getting the sex workers to support each other to use condoms and refuse non- condom-using clients so that none of them would lose their clients to others.

The programme for the sex workers consisted of two two-hour small classroom sessions (of about 16 sex workers in each class) held three to four days apart, and follow-up classes at three months, one year and two years thereafter. The classroom sessions were held in the Department of STD control and were conducted by the health staff and the project leader.

During the classroom sessions, sex workers were shown video clips and given comic scripts on how to persuade difficult clients to use condoms and how to refuse clients who did not want to use condoms. This was followed by group discussions and sharing of tips and experiences by the sex workers. The video clips and comic scripts were produced by the project team. Volunteers among sex workers acted in the video clips and demonstrated practical ways to negotiate condom use. Our male health staff at the Department of STD control acted as difficult clients. The follow-up sessions concentrated on discussing the problems of and solutions to condom use such as condom slippage, breakage and pain.

The Department of STD control also held regular group sessions with the brothel keepers to encourage them to support the sex workers. They were checked regularly to ensure that they supported the sex workers and reminded clients to use condoms. Posters with specific messages directed at clients to always use condoms were distributed to all sex workers and brothel keepers.

We have been monitoring the project regularly and found it to be effective in increasing condom use and reducing sexually transmitted diseases among sex workers. In 1997, three years after the project's implementation. condom use has increased to 96% and gonorrhoea (one of the sexually transmitted diseases) has been reduced by more than 75% The project team would like to thank Action for AIDS for their generous funding this project.

Today's children are growing up in a world with AIDS. They are having to cope not only with issues and problems that have long existed and are now being revealed by the HIV/AIDS epidemic, but also with those that result directly from the epidemic and which, until recently, people only had to face as adults.

More children are contracting HIV than ever before, and there is no sign that the infection rate is slowing.

Children below the age of 18 are vulnerable to infection through mother-to-child transmission, unsafe blood and injection practices, sex - including sexual abuse, coercion and commercial exploitation - and injecting drug use. Much of this vulnerability stems from failure to respect their rights, including those guaranteed under the United Nations Convention on the Rights of the Child.

All children of the world henceforth face a life-time of risk from HIV. They are exposed to the risk of HIV infection at different life stages as they grow into adulthood, because of circumstances such as sexual exploitation and abuse, or simply due to violation of their rights to information, to education and services. There is a need for greater recognition of the specific needs of girls and especially vulnerable children, both boys and girls, such as refugees, street kids, and children exposed to drug use.

In short, children and young people in all countries, and those who care for and are responsible for them, are having to adjust and adapt to this new world. The global epidemic is continuing to accelerate. There is, as yet, no vaccine against the virus. Neither is there a cure. For all the welcome recent advances in scientific treatments, there also remains great uncertainty as to whether and how such treatments could ever be made accessible to the vast majority of people living with HIV who are in the developing world.

AIDS has changed the world for children. The United Nations Convention on the Rights of the Child provides a framework for promoting and protecting the rights of children which can minimise the impact of the HIV/AIDS epidemic on them. Yet, despite its almost universal ratification, the response to infected, affected and vulnerable children has remained inconsistent. Internationally, AIDS programmes for children have been ad hoc and fragmented and have lagged behind those for adults. In many developing countries, this situation is worsened by poverty and other factors, such as wars and the resulting social breakdown of many communities.

The United Nations Convention on the Rights of the Child defines a child as every human being below the age of 18 years.

UNAIDS, the Joint United Nations Programme on HIV/ AIDS, estimates that there are already over 23 million people world-wide living with HIV, over 40% of whom are women. In some of the worst affected countries, up to 40% of women attending antenatal clinics in urban areas are HIV- infected.

By the end of 1997, a million children under the age of 15 are expected to be living with HIV, over 90% of them in developing countries.

Since the beginning of the epidemic, according to UNAIDS and WHO estimates, well over 2 million HIV-infected children under the age of 15 have been born to HIV-infected mothers, and hundreds of thousands of children have acquired HIV from blood transfusions or through sex.

Because HIV infection often progresses quickly to AIDS in children, most of the close to 3 million children under 15 who have been infected since the start of the epidemic have developed AIDS, and most of these have died.

In many developing countries, some 50% of the population is under the age of 18 years. Directing prevention efforts to children is crucial in minimising the further spread of the epidemic.

Adolescents are especially vulnerable to infection through sex or drug injecting.

Commercial sexual exploitation and domestic sexual abuse of children are contributing risk factors for HIV infection among children. Figures reported to the 1996 World Congress Against Commercial Sexual Exploitation of Children indicated that world-wide more than 1 million children enter the sex trade every year.

Through the 1997 World AIDS Campaign, UNAIDS and its partners aim to bring to the attention of the international community the many facets of the epidemic's impact on the lives of children. The campaign will offer a platform for children and their communities to voice their concerns and aspirations in relation to the epidemic and to support the development of appropriate responses.

This briefing summarises how the epidemic is having an impact on children who are infected by HIV, those who are directly affected by HIV/AIDS in their families or communities, and the children who are at risk of HIV infection. It outlines the global and national action needed to support children and their families as they face life in a world with AIDS.

The socio-economic costs of AIDS are affecting the ability of developing economies to sustain their development gains - and this has enormous repercussions on children.

While children are an increasing part of the AIDS problem, they are also a critical part of the solution. "We have a window of hope between the ages of 5 and 18 years", says Dr Sam Okware, Uganda's Commissioner for Health. "If that group can be educated, if their behaviour change can be modulated to ensure they do not have risk behaviour, I think we have a future".

Education and empowerment combined with the promotion of children's rights are believed to be key to HIV/AIDS prevention by leading agencies such as UNICEF and UNESCO.

If children really do offer a "window of hope" for influencing the future course of the AIDS epidemic, understanding their needs and perceptions will be critical. At the same time, it must be recognised that children are not in this world alone. Parents, school teachers, religious and community leaders must also be involved in developing programmes for children if they are to be accepted by the community and help build a safe and supportive environment.

AIDS is the most publicised disease in the world, but its impact on children has received an inadequate response. Adults can and must do their part to ease the suffering of children infected with HIV, help children in AIDS-affected homes and communities, and enable all children living in the shadow of HIV risk to grow up uninfected.

N.B.: Information in this article is taken from the UNAIDS webpage at the following URL: http://www.us.unaids.org/highband/events/wad/1997/wac.html

Ever ridden for the cause of Aids? Meet Audrey Tang, a Singaporean jazz drummer, in Boston, Massachusetts. Come 12 September, Audrey will be joining three thousand riders to ride 275 miles from Boston to New York in three days. She will raise $1500 for Boston's AIDS crisis centres involved in research and prevention. All this and would you believe that Audrey didn't own a bike in the first place? The following is an account of my interview with Audrey.

E: How did you first get to know about the Ride?
A: My apartment is right around the corner of the Aids ride office, so for 2 years I had seen their posters and banners but didn't think much about it.

E: What prompted you to get involved?
A: I finally picked up a brochure at a neighborhood party and went to an orientation. In the orientation, I was touched by the number of people who had done the ride before and were going to do it again; some of them were HIV positive. Everyone said that it was a great experience and that the ride changed their lives. When they screened a video of the previous 2 rides, I was moved by seeing real people (3000 of them) do something together for Aids: partners, siblings, parent & child, friends and individuals who felt compelled enough by Aids to raise US$6 million and ride 275 miles! I felt the challenge and I took it.

E: You earlier expressed regret at not being more active in the fight against AIDS in Singapore. Could you think of plausible reasons as to why you were not more aware or involved in Singapore?
A: Perhaps I didn't get involved with the fight against Aids because Aids didn't affect me, my friends or my family. Even though I knew about Aids and I sympathized with the victims, I guess I did not know that I could do something -- anything -- to help. I blame myself for my inaction; when I was in Singapore, I was rather self-absorbed, with my band and business. I forgot to stop and look around at people hurting.

E: Did you know anyone with HIV or Aids before taking part in the Ride?
A: When I was first moved to do this Ride, I didn't know anyone in my family, or my circle of friends that is suffering or has died from AIDS. But as my Rider Representative said, that if I didn't know anyone with AIDS before the Ride, I will after the Ride. Now 5 months after my decision, I know a handful of friends who are HIV-positive. Some of them are taking part in this Ride too; and it touches me to see them climb those training hills ahead of me.

E: How, if at all, did your initial impressions of persons with HIV or Aids change once you got to know them at a personal level?
A: I hate to admit it, I used to think that people who contracted Aids were asking for it. But when I saw that movie "And The Band Played On", my perceptions changed quite a bit. I was sobbing my eyes out at Cathay Picturehouse when I saw that film because I realized that Aids victims don't "ask" for Aids; I realized that the spread of the epidemic is caused by people's inaction, the lack of knowledge, apathy and a false sense of invulnerability. When I got to know people who were HIV-positive, I saw an executive, an ex-banker, a homeless man, a mother of two, a baby; I didn't see "HIV-positive person".

E: What is the hardest part in participating in the Ride?
A: Personally, the training is the hardest part because the terrain from Boston to New York City is very hilly and some of the hills are more than a mile long. I wasn't a cyclist before this Ride and I didn't even own a bike. Now in my training, with all my physical incapabilities, I've come to feel a token of the pain of physical weakness and mental and emotional impotence. However, I do realize that my difficulties are nothing compared to what AIDS patients and their families go through.

E: What are some of the things that came out of training for the Ride besides the body ache?
A: Muscles!!! Jokes, aside, I met some great people and made many good friends: riders, volunteers and crew.

E: How's the atmosphere like over there - what does it feel like to train and be involved in the fight against AIDS in Boston?
A: The atmosphere among the people involved is a sense of excitement and support. Even cynics can sense that we are doing something grand and noble.

E: Is taking part in the Ride a first step to getting more involved in raising HIV/AIDS awareness and/or promoting AIDS research?
A: Yes, it is. Since I had to appeal to my friends and family for sponsorship, I've not only talked about the ride, I've had to talk about Aids: the cost of Aids care and drugs like "protease inhibitors".

E: What is your family's response to your participation in the Ride?
A: My parents are warily supportive. I say "warily" because I'm the one in the family that always goes out and does "crazy" things. My dad, who is 59 and still runs 4 to 6km a day, is quite pleased that I'm trying to get healthy. He advised me to wear knee guards, shoulder pads, elbow guards, etc. He was worried that I would fall and hurt myself. Personally, I would rather fall than look like an American football player on a bike! My mom told me to be careful, my sister said that I was crazy, but she's behind me.

E: What would you say to a Singaporean who resists volunteering for the fight against AIDS simply because she or he doesn't know anyone with HIV/AIDS to begin with and feels that HIV/AIDS is irrelevant?
A: If we as Singaporeans want our society to be a more caring one, then we have to discard apathy; which means that we have to recognize pain and suffering and change our attitudes. There is not one kind of suffering that is irrelevant. As long as there isn't a cure for Aids, it is the problem of every Singaporean. We already have proof that Aids is not a gay disease; we also have overwhelming numbers of Aids cases in Asia and a rise of Aids cases in Singapore. Women get it, straight men get it and babies get it. The fastest rising numbers are with women and teenagers. Singaporeans are not invincible to Aids. No amount of morality, self-righteousness and discretion can prevent Singaporeans from the Aids virus. Compassion, education and volunteerism can. If you can't give your time, give your money, call Action for Aids at 2951153.

E: What is your ultimate aim in taking part in the Ride?
A: Since I don't really have anyone specific that I'm riding for, I wish to ride and express my love for and solidarity with the following: 1) Those are suffering from the effects of AIDS -- patients and parents alike. 2) The memory of Singaporeans who have died from AIDS. 3) All the volunteers in AFA and those of you, who give of yourselves to the cause of AIDS in Singapore.

AFA is part of a cadre of AIDS organizations that was formed to perform and address the needs of PWAs that so many traditional health care organizations seem to ignore especially during the early years of the epidemic. They are set up, as a space, to provide an exchange of ideas by its members, to function as a supportive environment and to develop an important public health role in education, prevention and dissemination of HIV information. In the eighties, we witnessed a global explosion of AIDS voluntary organizations to care for and work with PWAs and sero- positive individuals (read Altman, Kayal and Shilts ). The passion, strength and vitality of volunteers have to be channelled into appropriate roles where they can be tactically and strategically used in the fight. At the same time, they can be slotted into positions where their needs are gratified. Like many community-based organizations, AFA runs on a tight budget and staffed only by the will of committed volunteers and a few poorly paid staff. It can be quite frustrating for volunteers who are eager to help, care and assist - diluting their sense of immediacy and at times, saps their energy and patience from unresponsiveness. And this could be sometimes aggravated by the -cliquishness+ of volunteers, the lack of coordination and high-turnover rate of volunteers (for the history, strength and problematics of AFA, please refer to Leong ). And with the rise in the number of HIV cases last year, the work of volunteers and AFA are more important and crucial.

It is 6pm. Meng Khim crouches over the desk on the third floor office at Race Course Road, reading the Straits Times. On the desk, he has a packet of cut fruits and his bottle of Evian water. He says that he spends his time reading when he is performing his shift for the AIDS Counseling Hotline. With slow elaborate movements, he chews his fruits - masticating the cut edges of pears, apples and sapping the Vitamin C-rich juices of the oranges. Occasionally, he switches on the TV to be mesmerized by the flickering screen. Sometimes, the phone will ring. He fields two or three calls a night. As Meng Khim describes, -It is quite boring!+ This scene has repeated itself for the last two years.

Every six weeks, Martin works in the Anonymous counseling site. Because he is a nurse by profession, AFA has placed him in a unique position to draw blood from its clients. At this stage of the process, the client has undergone the pre-test counseling. Initially, Martin wants to be a counselor. He wants to talk to clients, assuages their anxieties and soothes their tension. (Un)fortunately, his training places him in a unique position to tender to the tricky problem of drawing blood. His acquiesce may be a blessing since he told me that he finds that clients have more questions, are more anxious and more nervous, even after the pre-test counseling. While he draws blood, he suckles on their anxiety and calms their nerves.

Volunteers congregate in AIDS organizations for a myriad of reasons. In a study by Suzanne Ouellette and her colleagues of AIDS carers in New York+s Gay Men+s Health Crises. She found that volunteers descend and gather in organizations for these reasons, namely, to make some response to the AIDS crises; to be able to have some contact with others who are afflicted by the epidemic; to do something besides worrying about getting sick; and to increase the purpose and focus of life. Not unlike the predominantly gay volunteers and straight women in Ouellete+s study, I found that the very few AIDS volunteers that I spoke with descended on AFA for the same reasons. AFA volunteers are stirred by a sense of social injustice, moved by passionate pleas from within to perform their caring responsibilities and struck by friends with AIDS. They come to AFA wanting to help, desiring to be useful and anxious to care. Martin: I know of many friends with HIV+ and I witnessed a lot of deaths when I was working on my post- graduate training. When I was in England, I worked with a diverse group of friends. He gotten to know them, learned about people+s attitudes towards AIDS and wanted to help. I want to give back to the people who have changed me. I have a sense of mission to help. For Lai Lai, she met a friend who was afflicted with the HIV+: I have a lot of gay friends in Sydney and some of them are HIV+. But the impact of AIDS did not hit me when I ran into a she-friend who is HIV+, apparently gotten from her promiscuous husband. She was suicidal when I spoke to her. It sparked my interest and catalyzed my reactions towards AIDS. Having done my stint as a volunteer for a couple of years, it is easier for me to retreat behind the monitor and type out my musings about volunteering. Volunteering is filled with ambivalences. It rewards yet it could also levy a cost. It invigorates but it also drains our spirit and energy. It can be exciting but also, tedious. However, when I talked to AFA volunteers, the rewards are abundant:
Because of my volunteering, I learn to cherish my life more dearly and how to place more value on people. I want to make use of every opportunity and time to render help and provide care. If it is within my efforts, I want to help as much as I could (Martin). Volunteering satisfies a part of our needs. There is a sense of gratification that one has made a difference in someone+s life. It allows us to be able to assist someone while making ourselves feel useful. Unfortunately, rewards are not immediately forthcoming. They trickle and come in slow doses, just like a commitment to a relationship. It takes time, effort and a lot of patience to accumulate the badges of rewards and merits. Over-exposure may lead to burnout and exhaustion. And some delineation of boundaries between self and other is necessary. But simply caring is not a simple feat, especially when volunteers have to contend with the aura of opprobrium that surrounds AIDS. For instance, the straight women have to construct excuses to volunteer. They deceive and lie to their families on what they are doing. Jo told her mom that she is giving tuition on the days of her volunteering. Lai Lai told her parents that she is attending a course, sponsored by her company. When I first told my mom that I was working with PWAs, she complained about contagion and infectious diseases. To care is itself a difficult task, But compounded with an extra layer of oppression, it is made almost impossible. Furthermore, the act of volunteering, in itself, is never an easy task. The possibility that one may not have the answers to a desperate caller. What about breaking the news to someone who is tested positive. Or entertaining what Meng Khim has termed as -inane calls+ who refuse to believe that they are not HIV+. Or when you are waiting for the next caller, repetitious tasks like stuffin+ envelopes, routinized caring, waiting for the next client, assignment or chore. Waiting taxes on the psyche, and drains our spirit. We face the monotony and the tedium of waiting. And this is not even considering the psychological demands placed when we work with PWAs, against an unresponsive bureaucracy, encountering ignorance about HIV+ and/or educating our family, friends, neighbors about the myths of HIV. Psychological demands and organizational problems tax the psyche and a symptom, of what psychologists, have termed as -burnout.+ This is characterized by -sian-ness,+ and just unwilling and unable to carry out one+s volunteering tasks. Burnout plagues many voluntary organizations, resulting in dropouts and exits. Regardless, AFA and her cadre of volunteers persist. They know that to live and be part of our -gracious society,+ they, amidst their own personal conflicts, fight and persist in caring. They, in their volunteering capacity, trying to create and imagine a society where injustices and exclusions are of a distant past.