Your editorial of November 29 headlined, 'Fighting ignorance' was timely, being published on the eve of the annual World Aids Day. This year, I have been impressed by the remarkable media attention paid to HIV/Aids. Unfortunately, in Hong Kong, we are still debating the same issues of ignorance and insufficient awareness as we were 15 years ago. Though the routes of HIV transmission have remained the same, there have been considerable changes in society which are reshaping Aids in Hong Kong. Are we responding to these changes? When HIV first hit Hong Kong in 1984, many people imagined it would soon disappear. Activities were organised on a one-off basis, and no community organisations were interested in devoting their efforts to Aids. Today, we understand Aids is going to be with us for decades (at least). It is more like a chronic disease or a persistent social issue, not too different from ageing, cancer and drug abuse. There is certainly a major difference in strategy development between handling a one-off crisis and dealing with a long-term, chronic condition. Unfortunately, attitudes treating HIV/Aids as a crisis remain largely unchanged. Another major change is our perceived relationship with the mainland in the context of the spread of HIV. Ten years ago, only a handful of cases had been reported over the border. Mainland officials were concerned about Aids being brought into the country. There has been a dramatic change, as China now has a high HIV rate, much of it associated with intravenous drug use. What has to be realised is that HIV can spread from the mainland to the SAR and vice versa. Tens of thousands of people are crossing the border in the Pearl River Delta region every day. We need genuine collaboration, as well as consistency in the messages delivered to the public. Advances in medicine have brought new hope to people living with HIV/Aids. Unlike most other parts of Asia, where antiretroviral treatment (cocktail treatment) is generally unaffordable, the medicines are available here. We can now considerably reduce the chance of mother-to-child HIV transmission by prescribing a course of such treatment. We can also reduce the complication rates in people living with the disease. Expanding the access of pregnant women to HIV tests is a sensible strategy. All these measures mean that many more patients will be living rather than dying. Promoting acceptance to people living with HIV/Aids is a new dimension of activities relating to Aids. Rather than hospice and hospital care, we are once again reminded of the importance of affordable treatment, access to community care and acceptance by every member of the public. Are we prepared to respond to the changes that have taken place? At present, the Department of Health's Aids Unit, an Aids service in Queen Elizabeth Hospital and five Aids non-governmental organisations (NGOs) all work exclusively in the fields of prevention and care of HIV/Aids. They cannot succeed, if other sectors in the community remain uninvolved. Good HIV education relies on the collaborative efforts of other government departments, the health sector, mainstream NGOs and the academic community. We need the effective integration of Aids, sex and drug education. We also require the active input of service providers in providing social support to people living with HIV/Aids. We must create effective partnerships with politicians, policymakers, service providers and NGOs. Otherwise, the criticisms lodged against Hong Kong during this year's World Aids Day will be repeated next year. Dr HOMER WK TSO Chairman Advisory Council on Aids
