Expert urges prevention focus as number of cases hits 2,457 The city should prepare for an Aids explosion fuelled by injecting drug users, an expert warned yesterday. And it should brace for an increase in the number of patients needing treatment, which costs taxpayers $124 million a year, consultant Lee Shiu-shan, head of the Centre for Health Protection's special prevention programme, said. On the eve of World Aids Day, Dr Lee was reviewing HIV's impact on Hong Kong in the 20 years since the first case was detected, in 1984. He said the cumulative total of 2,457 included 73 people who tested positive for HIV in the third quarter this year. Of the total, 703 have developed Aids, including 14 confirmed in the third quarter. Although Hong Kong had a comparatively small number of cases, the number of people living with HIV had been rising, said Dr Lee. The number of HIV infections detected in the past six years, at 1,500, was seven times more than the 206 people detected in the first six years of the epidemic, 1984-90, and double the 751 cases in 1991-97. Dr Lee said the challenge for the next five years was to keep the incidence low, particularly among intravenous drug users, risk-taking elderly men, younger men under 25, and gay men. He said Hong Kong was surrounded by mainland cities where prevalence was as high as 45 per cent of injecting drug users. 'It seems we are a little island in the sea of high-infection cities. I do not know how long we can survive that way,' he said. 'So we do have to be very careful. There are a lot of things society needs to do to prevent Hong Kong going into an explosive epidemic.' Men over 55 and those below 25 accounted for 20 per cent of HIV infections in the past 10 years, which was a warning sign that prevention messages were not reaching these groups, he said. The proportion of gay men among the HIV-positive had fallen, from 42.2 per cent in 1990 to 19.7 per cent this year. But they were still a concern because the incidence was 'higher than the proportion of gay men in the population'. Dr Lee said 1,240 people with HIV were receiving cocktail drug therapy free at the two dedicated Aids clinics, at an annual cost of about $100,000 per patient. With 200 to 300 new cases diagnosed each year, the number of people receiving treatment would increase substantially, he said. A Chinese University study of 415 Hongkongers who used prostitutes on the mainland has found 56 per cent seldom use condoms. Joseph Lau Tak-fai, director of the university's Centre for Epidemiology and Biostatistics, said HIV prevention services should be aimed directly at such men. Another poll, of 600 South Asians by the Southern Democratic Alliance, showed between 47 per cent and 68 per cent believe they can get HIV by swimming, kissing and playing with infected people.