Abstract

AIDS,likeplagues throughouthrunan

history, has been blamed repeatedly on foreigners. This has heightened ramifications,b r nthe personalto the geopolitical, in an era of escalating

HIV, International Travel and Tourism: Global Issues and Pacific Perspectives

popalation movement and rapid inter-

nationaltravel. By the end of 1990, the

World Health Organization had estimated that the total number of AIDS caseswotldwidewas closeto 1.3 million*.Recentest€matessuggestthat by the year 2000, 38-100 million adultsand over 10millionchildren w i l l have been infected with Seventy-5ve to elghty-five percent of that number will be from the develop ing world. AIDS has rapidly become pandemic, with wide-ranging consequences for hamanllad. Human population movement is an important component in the natural history of AIDS. With respectto this, a central consideration is the relationship between AIDS and international travel, especially tourism.In this paper, afterreviewing HIV in the Asia-Pacific region, we present the epidemiology of HIV in the Pacific Islands,discnssitsimpactwith partio alarreferenceto populationmovement, and explore some of the Specitic challenges that the Pacific Island regton faces. Asia Pac I Public Health 1992A 993;6(3):I5 9-4 7.

m.

Keywords: Epidemiology, HIV/ AIDS, international travel, Pacific islands, popnlation movement, tourism.

Nancy Davis L e ~ i s Department of Geography University of Hawaii

Jodi Bailey Department of Geography University of California, Berkeley Support for this project related toa larger study on tourism in the Pacific Islands, was provided by the Pacific islands Development Program, East-West Center, Honolulu.

Introduction Although to date relatively few cases of AIDS have been diagnosed in thePacificIslands(Figure 1;Table l), the relationship between AIDS and population movement has important implications for the region. The economies of many of these states are heavily tourism-dependent. For some oftheislandstatesthere isalsoconsiderable circular migration, particularly between the home islands and New Zealand, Hawaii and the mainland United States. There is also mobility between and within the islands, and some movement between the Pacific Islands and neighboring Asian nations.

HIV in Asia and the Pacific

Address for prints Assoc. Pro€ Nancy Davis Lewis. Departmenr OF oeography, University of Hawaii at hrlanoa, Portem HaIl 445, 2424 MLaile Way, HoxiolaIu, Hawaii 96822, USA.

The global epidemiology of HIV has been well documented and three basic patterns of transmission have been described’. The nations ofAsia represent most of the pattern I11 countries whose characteristics include a later onset of HIV/AIDS. I n the early phases of the AIDS epidemic very few cases were reported from Asia, and there was a commonly held misconception that somehow Asia and Asians were protected from the ravages of HIV. By mid-1991, there was an alarming increase in some of the nations in South-east Asia, e.g. Thailand, whereit was estimated that there were over 400,000 HIV positives and

a 2.3:l male to female ratio of infection3. Estimates suggested that there were as many as 2,500 HIV positives i n Indonesia (primarily homosexual4), 2,000 in Malaysia’ and increasing numbers in the Philippines as well. Seroprevalence is also escalating in India, where over 6,000 HIV positives have been identified primarily among prostitutes and their customers in Madras and surrounding Tamil Nadu, and Bombay and environs in Maharashtra state, as well as among IV drug users in the northeastern states along the Burmese border. Among 3,000 addicts tested in the state of Manipur, 54% showed signs of the virus6. Yunnan province in China, bordering Myanmar (Burma) on the north-east, has been a traditional source of opium. The proportion of drug abusers in Yunnan who used intravenous drugs increased from 13% in 1988 to 32% in 1990. Of those tested, 79.7% were HIV positive’. A core of diffusion appears to exist among the IV drug-using populations of the “Golden Triangle”, spilling over into the north-eastem states of India and the Chinese province of Yunnan. There is also evidence to suggest that as a result of the control of opium production among the hill tribes of Northern Thailand, opium smokers have turned to injecting heroin with increasing HIV infection*. Initially it appeared that HIV was first

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