Introduction to special issue

A Time for Action

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Science  25 Jun 2004:
Vol. 304, Issue 5679, pp. 1931
DOI: 10.1126/science.304.5679.1931

Several countries in Asia are at a critical point in their efforts to curb the spread of HIV. The virus is devastating some high-risk groups and making inroads into the general population. So far, however, the epidemic has not taken off anywhere in Asia the way it has in sub-Saharan Africa. In the following pages, Science correspondent and veteran AIDS reporter Jon Cohen examines the trends in the spread of HIV across Asia, and he reports an emerging view that Asia may not see the high prevalence rates now haunting much of Africa. But even so, there's no room for complacency: Given Asia's large population—more than half the world's people live on the continent—tens of millions of Asians still could become infected in the next decade even if prevalence in the general population remains low.

This special section draws heavily on reporting Cohen has conducted over the past 18 months. Cohen and freelance photographer Malcolm Linton made three visits to Asia to report on the spread of HIV across the continent. They focused on the countries with the largest problems. Cohen's reports from Southeast Asia (Science, 19 September 2003), India (23 April 2004), and China (4 June 2004) provide vivid accounts of the epidemic from the perspectives of epidemiologists, clinicians, basic researchers, health policymakers, and people in the communities most affected by the virus. Cohen had extraordinary access to areas that have been restricted to journalists, including Myanmar (formerly Burma), parts of China, and Manipur state in India. And he met with literally scores of key individuals, from top policymakers and leading researchers to sex workers and injecting drug users (IDUs).

The four-part series culminating in this special section has at least one positive message: Asia has a good chance to put the brakes on the epidemic. It is still largely confined to high-risk groups, especially IDUs and sex workers, who can be reached by condom promotion, education, and “harm-reduction” programs that provide needle exchange and substitution drugs like methadone. Two countries—Thailand and Cambodia—have indeed blunted their epidemics by aggressively promoting condom use among sex workers. But, as Cohen's reporting makes clear, it requires political will to focus on groups that are on the fringes of society, it will take enormous resources and training to provide anti-HIV drugs to those already infected, and foreign collaborations will play a critical role in increasing the scientific capacity in the region to combat the virus. Policy Forums by Piot et al. (p. 1909) and Coplan et al. (p. 1911), and a Perspective by Emini and Koff (p. 1913), also make the case for working together more effectively to attack HIV/AIDS worldwide.


Myanmar's National Health Laboratory in Yangon (formerly Rangoon) has no modern equipment for monitoring HIV or CD4 immune cells in patients' blood


Cohen's reporting provides a rich context for the XV International AIDS Conference, which will take place in Bangkok, Thailand, from 11 to 16 July—the first of these high-profile meetings to be held in a developing country in Asia. (Also see Editorial, p. 1875, by conference co-chairs Joep Lange and Vallop Thaineua.) And Linton's compelling photographs, including the cover shot for this issue and those in this special section, portray the human face of the epidemic and the people working hard to stop it from spiraling out of control. More of Linton's photographs, and the stories behind them, can be seen on Science's Web site (

A media fellowship to Jon Cohen from the Henry J. Kaiser Family Foundation ( helped support the reporting for this series.

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