A mother at 15 and widowed at 16, Widy has suffered betrayal and hardship on the streets of Jakarta. The teenage single mother was infected with HIV/Aids by her high school sweetheart, who had been using heroin during their relationship. He died when Ms Widy was eight months pregnant with their daughter. Only on his death did she learn that her husband died of HIV and that she herself was infected. By then it was too late for her child to receive crucial prenatal treatment. Although she delivered the baby by Caesarean section, her daughter was diagnosed with HIV at three months. 'I am very, very angry. I would stab him if he were still alive today,' said Ms Widy, now 18, of her husband. As if on cue, Ms Widy and several other women in their teens and early 20s in the Yayasan Pelita Ilmu (YPI) drop-in centre joined in a chorus of disapproval and anger. They each told a tale of being betrayed by a deceased husband, who had left them battling HIV/Aids. The women had gathered at one of several shelters scattered across the Indonesian capital. Formed in 1989, YPI was Indonesia's first NGO dedicated to fighting HIV/Aids. Its drop-in centre has three bedrooms and it often serves not only as a monthly meeting place for about 30 people with HIV, but also as temporary shelter for those whose families cannot accept their condition. Across Asia HIV/Aids is continuing to ruin millions of lives. 'Nearly half a million people in the Asia-Pacific region are infected with HIV every year and as many as 300,000 of those infected die - more than the total killed in the 2004 tsunami,' said Prasada Rao, Asia Pacific regional director of UNAids, at the International Congress on Aids in Asia and the Pacific in Colombo, held in August. He said growing political instability, the stigmatisation of those infected and conservative attitudes were hindering the fight against the disease. The number of infections is below the infection rate in Africa, and there have been success stories such as Thailand's condom distribution programme and Hong Kong's methadone programme, which has controlled the spread through intravenous drug users. But across Asia Pacific, the epidemic is being driven by deep-rooted cultural and religious beliefs against condom use, widespread prostitution, drug addiction and a low awareness of women's rights. Drug use is driving the epidemic in countries such as Indonesia and Vietnam, but Hong Kong's HIV/Aids rate has reached a plateau. It's still being spread through heterosexual sex and a sharp increase in transmission through men having sex with men in the past two years. Through genetic sequencing, Hong Kong researchers have identified three clusters of men having sex with men who met on the internet and infected each other. As of August, 87 men have been identified in these clusters. Eighty are Chinese and local residents, with a median age of 38. 'The expansion of existing clusters suggests the presence of local HIV transmission in Hong Kong,' said Dr Wong Ka-hing, a consultant to the Health Department. On a regional level, UNAids estimated in a report last year that the mainland had 650,000 people with HIV, exceeded by India with 5.7 million. Next was Thailand with 580,000, Vietnam 260,000, Myanmar 360,000 and Indonesia with 170,000. Shigeru Omi, the World Health Organisation's regional director for western Pacific (which includes the mainland, Hong Kong, Macau, and Vietnam), said progress had been apparent 'in both the declining prevalence of new cases in countries such as Cambodia, and the increasing number of people receiving antiretroviral therapy such as in Papua New Guinea'. Yet there are fears of HIV fatigue, which could allow the virus to become resistant to drugs further into the future. Last year, the Indonesian government decided not to allocate extra money for its campaign against HIV, instead investing scarce health funds to fight bird flu. Jakarta's YPI found that of 1,384 people who tested HIV-positive from 1994 to July 2007, 1,005 were infected through intravenous drug use, compared with 406 through heterosexual contact and 45 through gay sex. 'Among the general population, condom use is less than 10 per cent,' said YPI founder Toha Muhaimin, adding that if condom use was promoted, it would be seen as promoting promiscuity. Hong Kong's HIV evolution followed the pattern in most western countries: it was first considered a 'gay man's plague' and later seen as a 'foreigner's disease'. Just as perceptions of HIV have changed, so has the strategy for prevention. From blanket coverage directed at the general population during the first decade of HIV infections, the focus shifted towards targeted messages to marginalised sectors of society. Lately there has been talk of 'mainstreaming' HIV prevention messages as the issue is perceived by some to have dropped off most people's radar. In Vietnam, the deputy director of Ho Chi Minh City's Health Service, Le Truong Giang, said HIV rates had exploded among elderly opium users in 1993. 'The epidemic was quickly controlled via education camps and harm reduction [through needle exchange],' he said. He said that since 1996, young people using heroin had led to a second outbreak in the city, peaking at 30,000 in 2001 when local police sent people for 'education at detoxification centres'. Methadone clinics similar to those in Hong Kong were being planned at three sites catering for 200 addicts, he said. Dr Giang said the city had established a club called the Blue Sky Club, where about 1,000 gay men could meet for peer education and to socialise. Masami Fujita, a senior adviser on HIV/Aids from the WHO Representative Office in Hanoi, said HIV infection exploded among intravenous drug users in the late 1990s in Vietnam, after doing so in Thailand in the late 80s and Cambodia in the early 90s. 'Vietnam is a bit of a latecomer,' Dr Fujita said, adding that political commitment to HIV control had improved dramatically. It is estimated that the number of people in Vietnam living with HIV more than doubled, from 122,000 to 280,000, in the six years to last year. Aids deaths increased dramatically in the same period, from 3,000 to 17,000. The use of HIV treatment in the country is increasing rapidly, although its availability is still limited, with the level of basic antiretroviral treatment provided being just over 20 per cent of what is required. 'You can imagine it is very sensitive so far,' Dr Fujita said. 'Political barriers have been increasingly overcome and the political environment is much more favourable in terms of addressing this epidemic among drug users and sex workers.' But he said issues such as collaboration with the police were barriers to reaching these groups. On a regional level, empowering women to protect themselves against HIV is seen as a priority. 'Most Indonesian women do not realise they have rights in the family. As a wife, we have rights and as a mother, it is important to make them understand their reproductive rights and reproductive health,' said Siti Musdah Mulia, director of the Indonesian Conference for Religions and Peace. As HIV/Aids infection rates rise in many countries, co-infection with tuberculosis is an added concern. Experts say the co-infection rate is as high as 11 per cent in Cambodia. Tuberculosis and HIV have merged into a twin epidemic in the region in the past decade, giving rise to multi-drug resistant TB (MDR-TB) and extensive drug resistant TB (XDR-TB). The WHO has named the mainland, with 139,894 MDR-TB cases, and India with 87,413, as the two global hotspots for the problem. Worldwide, there are 424,000 new cases of MDR-TB each year and 25,000 to 30,000 new cases of XDR-TB, the WHO estimates. Leung Chu-chiu, of the Centre for Health Protection's tuberculosis and chest service, said HIV 'greatly increases TB disease risk', and in many dually affected areas, TB is the leading killer of Aids patients. The three commonest Aids-defining illnesses among Hong Kong's 893 Aids patients were pneumocystis pneumonia, tuberculosis and fungal infections. 'XDR-TB raises the possibility that the current TB epidemic of mostly drug-susceptible TB will be replaced with a form of TB with severely restricted treatment options,' Dr Leung said.