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AIDS pulls up at the crossroads of Asia
By Henry Hoenig
Photos by Steve Sandford

UDOMXAI, Laos - A historic trading outpost, Muang Xai, as the locals call this town, has long been at a crossroads of regional commerce. Now, as it is being transformed into a 21st-century transportation hub, the character of its trade is being transformed as well - not always for the better.

Under plans financed by the Asian Development Bank and individual member countries, this remote area eventually will link Kunming, China, to Bangkok and ultimately Phnom Penh and Ho Chi Minh City; Hanoi to northern Myanmar and ultimately Yangon. As a matter of geographical fate, all of these routes will intersect in Udomxai, bringing to town large numbers of men from regions with some of the world's worst AIDS epidemics, men who frequently engage in high-risk activities. It will further fuel the sex trade and create "enormous potential for the rapid spread of HIV", a United Nations Development Program (UNDP) report said.

Udomxai has long been a place where ethnic-minority hill tribes come to sell tree bark and bamboo shoots and whatever else they can gather from the jungles of this rugged region. Now it is also a place where young hill-tribe girls come to sell sex.

As the daylight fades, tractor-trailer trucks line up along the main strip. Inside a karaoke club at one of the town's several Chinese hotels, Noy, a pretty, shell-shocked 14-year-old girl, braces herself for another night of work. Like everyone else in her Kamu village, Noy had never heard of AIDS or the human immunodeficiency virus (HIV) that causes it before she arrived in town just 10 days earlier. She first heard it mentioned, she said, after being coerced into selling her body to Chinese and Laotian truck drivers and businessmen - up to 10 men a night.

Not that it will do her any good. She has no idea how a person gets infected. Many experts fear that if Noy catches HIV she will have plenty of company.

They use phrases such as "unseen epidemic" and "wholesale destruction" to describe the dangers facing the hill tribes of northern Laos, which make up 90 percent of the area's population. Udomxai is ground zero, the most dangerous of several potential HIV/AIDS "hot spots" identified by the United Nations. No one really knows how many people in the area now have HIV, but the number is believed to be rising quickly. The only statistics are so outdated and unrepresentative that they are dismissed as nearly irrelevant. A more comprehensive study is now being conducted, but so far, a lack of money for testing has made it a guessing game.

The question is an urgent one. The hill tribes' isolation has protected them from the AIDS epidemics that literally surround them in neighboring countries. Until now.

"We really need to work hard and fast," said Lee-Nah Hsu, manager of the UNDP's Southeast Asia HIV and Development Project, who went so far as to compare the situation to sub-Saharan Africa before catastrophe struck. AIDS "is there, but it will take time before we can get some concrete numbers out. By the time the information gets out, it might be too late," he said.

The minority hill tribes in northern Laos are especially vulnerable; the poorest and most isolated people in a poor and isolated country. Many already are enduring tremendous upheaval, including forced relocation as part of government efforts to eradicate opium-growing and slash-and-burn agriculture.

They are being dragged from a subsistence living into a cash economy but have few ways to earn additional money. One result has been an increase in the prostitution and trafficking of hill-tribe girls both within northern Laos and to China and Thailand.

Commercial sex has become commonplace as tens of thousands of foreign workers, mostly Chinese men, have crossed the border in recent years to work on new dams and roads, and the number of Chinese and Laotian truck drivers carrying Chinese goods across the border has increased. Yet AIDS awareness is low, and the area's few hospitals would provide little comfort - never mind retroviral drugs - to AIDS sufferers were a widespread outbreak to occur.

At this point, local health-care officials said, those in Udomxai who are known to have contracted HIV generally were told so only after appearing at the hospital with their first AIDS symptoms. Then they simply returned home to die.

"There is the potential for some of these groups to be both physically and culturally wiped out, because you are dealing with small populations," said anthropologist David Feingold, an expert on hill tribes, trafficking and HIV/AIDS with UNESCO's (United Nations Educational, Scientific and Cultural Organization) Bangkok office.

One indication of the potential for an HIV epidemic is the high rate of sexually transmitted diseases (STDs) among so-called "service girls" - defined as any girl working in a restaurant, nightclub or guesthouse - in Vientiane and two lowland southern provinces, where awareness of HIV and condoms is considered relatively high. A 2000 survey sponsored by the National Committee for the Control of AIDS found that 39 percent of 800 service girls had at least one STD. Not all service girls sell sex - only 65 percent reported doing so in the previous year - so the rate of STD infection among those who do is likely much higher. Condom use, of course, was found to be rare.

The same study found that 1 percent of service girls tested positive for HIV. But the threat is clear: if these practices continue, eventually the numbers of HIV infections will explode, and the virus will move quickly into the general population, as the majority of the girls' customers are white-collar businessmen and government officials. And given the length of time between HIV infection and the onset of AIDS, as well as the length of time passed since the last survey, it might be happening now.

Non-governmental organizations (NGOs) have been scrambling to get the message out in the north but there are almost no mass media - most villages don't have electricity - and the literacy rate is about 20 percent. So instead of airing television ads, NGO workers are performing skits on public buses and driving into remote mountain villages with battery-powered videocassette recorders (VCRs).

Still, progress has been made, and the Laotian government has been given high marks for its willingness to tackle the problem. AIDS-awareness posters and condom advertisements hang on the walls of virtually every restaurant and nightclub in Udomxai. Buses and songthaew taxis are covered with stickers touting Number One condoms. Old men walk down the street wearing new baseball caps emblazoned with the Number One logo.

Today, most people in Udomxai have at least heard of condoms, something that was not true as recently as a year ago, local health-care officials said. Nevertheless, AIDS awareness among sex workers remains low, said Sihamano Bannavong, communications manager for Public Service International, one of many NGOs active in the area. And there is a great difference between teaching sex workers about condoms and empowering them to demand that reluctant customers use them.

Meanwhile, the job of raising awareness is becoming more difficult. Those men who are wary of HIV/AIDS are increasingly stopping at small roadside restaurants and drink stands in the countryside in search of "clean" girls. Often these places are little more than a thatched hut next to the road, where one or two girls sit staring into a bamboo fire, waiting for customers to stop for a bowl of noodles and a bottle of Beer Lao. Now the men are increasingly buying sex as well as dinner.

These are frequently more than one-time encounters. In fact, Sihamano said, many drivers have "minor wives" at several points along their routes, offering families a regular stipend for the sexual services of their daughters. Just as the men have more than one such relationship, so do the girls. "Of course, they don't use condoms," he said.

Officials are particularly worried about Highway 3, which runs from Luang Namtha, near China's Yunnan province, south to Huay Xai, just across the Mekong River from Thailand's Chiang Rai province. For most of its 160 kilometers it is little more than a dirt track hacked through jungle floors and carved on to mountainsides, and flanked by hill-tribe villages as yet mostly untouched by the changes seen in Udomxai.

But the road has been designated a major corridor between China and Thailand. Construction has been scheduled to begin for months, and small armies of workers are due to arrive any day. The scale and pace of change in the years ahead will be profound.

Meanwhile, the race is on to warn villagers of the dangers they will soon face. So far the villagers' worries are few. One Kamu headman said he looked forward to the highway's completion. He spoke eagerly of such things as cheaper bus fares and shorter travel times to see relatives in other villages.

"Also, we want to see it," he said of the highway. "We have never seen such a thing before."

(Copyright 2004 Henry Hoenig. All rights reserved. Please contact for information on our sales and syndication policies.)

Apr 28, 2004


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