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Nearly 20 years have passed since AIDS claimed its first Asian victim, believed to be a 48-year-old male Japanese hemophiliac who received a tainted blood transfusion. Despite advances in treatment, the scourge continues to bully its way into new regions and new demographics. Every day in Asia, 1,192 people die of AIDS-related diseases. Another 2,658 become infected, according to UNAIDS, a U.N. group that monitors the disease globally. Even countries such as Japan and South Korea, which responded aggressively to curb the threat at the outset, are seeing an upsurge in contagion. More than 7 million Asians contracted HIV or AIDS by the end of last year; new cases reported in 2001 totaled 1.07 million, up 17% from the previous year.
Fatalities are still far lower than in AIDS-wracked Africa. But researchers are worried that the mechanisms for transmission are more numerous in Asia, and it's just a matter of time before the slow-simmering epidemic erupts. Asia is more populous than Africa, and Asians are more likely to move from country to country seeking jobs, trading goods and hunting for pleasure. In Africa, HIV is mainly transmitted by sex, while Asia is hit by the double whammy of sexual transmission and infection among intravenous drug users. The virus is striking a younger generation that has become sexually active and believes that AIDS is no longer a killer. Of course it is. Vaccine programs are still in the experimental stages; anti-retroviral drug cocktails can prolong life but are too expensive for most afflicted Asians, even at the bargain price of $24 a month in India. (Treatments cost $850 a month in the U.S.) Because the virus can hole up in the body for up to 10 years without triggering symptoms, it can spread quietly through a community—or even a country—before it breaks the surface like some terrible Leviathan. Warns Chris Beyrer, an Asian AIDS expert and epidemiologist at Baltimore's Johns Hopkins School of Hygiene and Public Health: "This could become an enormous time bomb."
What researchers fear most: AIDS is about to explode in the world's most populous nations—China and India. Each has more than a billion citizens, most of them impoverished. Neither country has comprehensive AIDS awareness programs or adequate health care. India has an estimated 4 million HIV sufferers; that number is growing exponentially as migrant laborers carry the virus from the cities back to the villages. "India may not reach the prevalence of 30% as in Africa, but even a 1% increase for HIV would mean about 1 million new cases," says Dr. Sunithi Solomon, an AIDS worker in Madras who diagnosed the first Indian case in 1986. Ominously, the epidemic has got out of hand in India's northeastern state of Manipur, a locus of Burmese heroin trafficking. Says Dr. Narendra Singh of the Jawaharal Nehru Memorial Hospital in the state capital, Imphal: "Manipur is now doomed."
China, with its 1.3 billion people, looms as an especially large and potentially devastating target for the virus. Per capita, the HIV/AIDS rate in China is still relatively low at 0.08%, or 1 case in every 1,300 citizens. But in a June report titled "China's Titanic Peril," researchers for UNAIDS warned that unless the epidemic is checked swiftly, it could strike 20 million Chinese by 2010. "China is on the verge of a catastrophe that could result in unimaginable human suffering, economic loss and social devastation," according to the report, as the virus spreads from high-risk groups, mainly drug users, to the general population. They placed most of the blame on ineffective government response, characterized by "insufficient openness in confronting the epidemic ... a lack of commitment and leadership ... a crumbling public health care system and severe stigma and discrimination" against AIDS victims.
Mainland health officials—who have been reluctant to acknowledge a disease linked to homosexuals, drug users and prostitutes—are awakening to the threat. This month, official estimates of the number of people in the country infected with HIV were raised from 850,000 to more than 1 million, an encouragingly frank admission for a country that has long handled the problem like a dirty secret.
For TIME reporters, China's AIDS trail began in Ruili, the Chinese border town in Yunnan province. With a centuries-old jade market that draws fortune seekers from as far away as Pakistan and Bangladesh, Ruili is a melting pot of cultures and ethnicities. Here, a new branch of the AIDS family tree, a group of viral substrains broadly referred to as "B/C," has been identified. Dr. Mong, the town's first line of AIDS defense for Burmese prostitutes, collects HIV-positive blood samples from many of the locals, packs them into coolers and sends them to molecular biologists in the U.S., China and Japan. Some of the highly contagious Ruili samples are stored in seven-milliliter vials behind five locked doors in a basement vault of Tokyo's National Institute of Infectious Diseases. There, researchers don rubber gloves, sterile masks and surgeons' gowns as safety precautions before they extract genetic material from the corrupted plasma. Unlocking the structure of the B/C strain could help the Chinese develop better methods for combating it. Similar work is being carried out at Beijing's Center for Disease Control (CDC). Says its chief, Dr. Shao Yiming, China's foremost AIDS expert and a pioneer of B/C molecular research: "The more we understand about the virus and the nature of the host it attacks, the more chance we have of designing an effective vaccine."
There is an urgency to the work. HIV is a mutable germ. As it spreads worldwide, it multiplies into a menagerie of genetically distinct substrains—there are at least 10 different types in Asia—making it more difficult to understand, harder to control and impossible so far to eradicate. A vaccine or drug created for one strain isn't necessarily an effective treatment for another. "The AIDS virus uses very smart [survival] strategies," says Yutaka Takebe, 52, chief of molecular virology and epidemiology in the Tokyo institute.
Variants make drug discovery difficult, but genetic differences at least make it easier to follow the tracks of the disease as it spreads. From blood samples taken from the citizens of Ruili and elsewhere, the Japanese scientists have drawn road maps of the progression of AIDS through China's southwest. For example, HIV-positive blood taken from a Burmese prostitute is likely to harbor the "B" strain, which swept up from Thailand. Scientists say Type B HIV, one of the first to hit Asia, was probably brought in by homosexuals and foreign students returning from the U.S. and Europe in the mid-1980s. Meanwhile, a sample taken from a drug-shooting Indian gem dealer in Ruili would probably belong to the "C" strain common in India. Scientists tracked that virus back to sailors from South Africa, who passed it on to sex workers in Bombay.