Increased clinic fees could spark an HIV epidemic in Hong Kong as sex workers cannot afford testing, advocates warn Hong Kong's 'shortsighted' medical charging policy is putting Hong Kong at increased risk of an HIV epidemic, Aids advocates warn. Gains made in controlling the spread of HIV and other sexually transmitted diseases (STD) were being jeopardised by the charges, introduced at the height of the Sars outbreak, because they deterred sex workers from undergoing testing. Fears of an escalation in HIV cases in the city were raised by an alliance of Aids concern groups on the eve of today's World Aids Day. HIV has struck 2,172 people in Hong Kong. From April 1, non-residents have been charged $700 for consultations at public social hygiene clinics. HIV treatment costs non-residents $1,910 per consultation. 'I am very concerned that the new fee-charging policy will cause attendances at STD clinics to drop,' said Graham Smith, chairman of Hong Kong Coalition of Aids Service Organisations. 'I am concerned that the people who most need that service are now effectively being screened out.' Mr Smith said many of Hong Kong's sex workers were not residents and therefore ineligible for the heavily subsidised services. He said it was difficult enough to encourage sex workers to get tested for HIV and other sexually transmitted diseases, without the added financial burden. 'It is critical for the government to know the infection rates of STD among sex workers as it is an indicator of the risk-behaviour patterns. It as an important component for an effective HIV/Aids surveillance programme,' he said. Mr Smith estimated the drop in clinic attendance would be 'significant'. The Department of Health was unable to provide monthly attendance figures at social hygiene clinics since the new charging policy. But figures released last week in connection with the quarterly Aids statistics indicate attendance has dropped significantly. The figures showed there were 19,672 samples obtained at the STD clinics for HIV testing from April to September - a 30 per cent drop from the same period last year. The department's senior medical officer, Chan Kam-tim, attributed the drop to the Sars outbreak, however. Four non-eligible people sought HIV treatment from April to August, a spokeswoman said. 'If there is a need, people have to seek treatment,' she added. The coalition, which comprises 10 Aids concern associations, has written to Director of Health Lam Ping-yan expressing concerns that 'the new charging scheme is shortsighted and likely to increase Hong Kong's vulnerability to an HIV epidemic'. The group pointed out the policy exempted attendances at tuberculosis and chest clinics. 'This is presumably on the ground of general public health interest,' Mr Smith said. 'We believe a similar exception should be made for attendance at social hygiene clinics for the same reason.' But in a letter to the coalition, the department dismissed its concerns, saying the charges followed the service-wide population policy, which seeks to limit public health services to Hong Kong residents. Previously they were also available to foreign domestic helpers, migrant workers and two-way permit holders. 'The policy is to achieve a balance among the interests of various sectors of the community while giving due regard to the long-term sustainability of the public health care system,' the letter said. 'Tuberculosis treatment is provided free exceptionally because prompt treatment is considered the single most effective and preventive tool.' The department said it could only advise non-residents 'to seek early medical advice from the private or public sector for the sake of their own and clients' health'. Legislator for the medical sector, Lo Wing-lok, said he did not realise the government had extended the new charging policy to the STD and HIV clinics and called on the administration to evaluate the policy's public health implications. He expressed surprise that TB was considered more critical than controlling STD and HIV. 'People with STD or HIV are very shy and try to avoid treatment. People with tuberculosis would not be stigmatised and would seek treatment readily,' Dr Lo said.