The many epidemiological faces of AIDS with special reference to Hong Kong and implications for prevention and control

By 1987, only 3 cases of acquired immunodeficiency syndrome (AIDS) had been reported in Hong Kong. All 3 involved males who had been infected through sexual contact with a European or North American. In 2 cases, the sexual contact was homosexual; the 3rd case involved a man who had frequent sexual contact in New York and Miami with female prostitutes. The Government of Hong Kong moved rapidly to establish an AIDS Expert Advisory Committee to carry out a public educational campaign and formulated clear guidelines for health workers. In recognition of the need for epidemiologic data, a seroprevalence program was initiated in 1985 to define risk groups and the prevalence of infection. During a 21-month surveillance period, 38,312 individuals were screened for antibodies to human immunodeficiency virus (HIV), 72 (0.2%) of whom were confirmed to be seropositive. Of the 61 individuals for whom a history was available, 12 (20%) were homosexual or bisexual men, 46 (75%) had a history of transfusions of blood or blood products (largely for hemophilia), and 3 reported sexual contact with female prostitutes outside of Hong Kong. Only 2 of the 72 positive tests involved women. None of the sera from the 1123 intravenous drug abusers and 1360 prostitutes screened contained antibodies to HIV. Consistent with a lack of documented local heterosexual spread of HIV infection is the absence of cases among infants and children. To reduce the risk of parenterally spread infection, universal blood donor unit screening for HIV antibody and the introduction of heat-treated Factor VIII have been implemented. In addition, an AIDS Education and Publicity Committee was established in 1986 to heighten public awareness of the risk factors involved in HIV infection.