VZCZCXRO8348
RR RUEHCN RUEHGH RUEHVC
DE RUEHHK #2033/01 3080827
ZNR UUUUU ZZH
R 040827Z NOV 09
FM AMCONSUL HONG KONG
TO RUEHC/SECSTATE WASHDC 8879
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEHBK/AMEMBASSY BANGKOK 1250
RUEHBJ/AMEMBASSY BEIJING 3664
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RHMFIUU/DEPT OF HOMELAND SECURITY IA WASHINGTON DC

UNCLAS SECTION 01 OF 03 HONG KONG 002033 
 
SENSITIVE 
SIPDIS 
 
STATE FOR S/GAC, EAP/CM, OES/IHB, MED 
HHS PASS TO NIH/FIC 
BEIJING FOR CDC, HHS HEALTH ATTACHE 
BANGKOK FOR USAID 
 
E.O. 12958: N/A 
TAGS: AMED CH HK KHIV PHUM SOCI
SUBJECT: MACAU HEALTH CARE: EMERGING EFFORTS TO COMBAT 
HIV/AIDS 
 
¶1. (SBU) SUMMARY: During Econ Officer's recent visit to 
Macau, officials from the Health Bureau's Center for Disease 
Control and Prevention (CDC) and NGOs described their efforts 
to control the spread of HIV/AIDS. The cross-border spread of 
HIV/AIDS is a growing concern in Macau as the city attracts 
more international visitors.  Macau's efforts to improve 
education and monitor and prevent new infections have also 
expanded, but the high volume and relative ease of 
Macau-Zhuhai cross-border travel makes surveillance 
difficult.  Macau's HIV/AIDS patients, health workers, and 
NGOs struggle with near-constant discrimination against them. 
END SUMMARY 
 
New Policy Changes to Address HIV/AIDS 
-------------------------------------- 
 
¶2. (U) In 2004 Macau reported 30 HIV cases, a 25 percent 
increase from the previous year, prompting the Macau Special 
Administrative Region Government (MSARG) in 2005 to establish 
the AIDS Prevention and Control Commission (the Commission), 
an interdepartmental body chaired by the Secretary of Social 
Affairs and Culture aimed at increasing community awareness 
and promoting collaboration amongst government agencies to 
prevent the further spread of HIV/AIDS. 
 
¶3. (U) The Commission conducted consultations in 2008 to 
consider two health policy changes: to implement mandatory 
HIV testing for all immigrants and to legalize the possession 
and distribution of clean intravenous injection instruments. 
Mandatory HIV testing for immigrants is still under 
consideration, with departments questioning the proposal's 
feasibility.  Privacy concerns, however, have thus far not 
been raised as an issue.  The second policy change has been 
more successful, as Macau now allows distribution of clean 
needles and syringes to combat the spread of HIV infection 
amongst IV drug users. 
 
¶4. (U) Other MSARG efforts to monitor the spread of the 
disease include offering anonymous HIV/AIDS screenings to all 
Macau citizens at its single public hospital.  Additionally, 
the MSARG has partnered with local private clinics to expand 
its monitoring network and to make free HIV/AIDS testing 
available to members of high-risk groups. 
 
Cross-border Efforts with the Mainland Underway 
---------------------------------- 
 
¶5. (U) Macau has long cooperated with Hong Kong Health 
officials on HIV/AIDS education, surveillance and treatment 
measures but only in 2008 did it begin to partner with its 
mainland counterparts in Zhuhai. Since then, it has embarked 
on a series of exchanges and visits. In February 2008, 
Commission members visited a methadone maintenance treatment 
and needle exchange program in Guangdong, and in August 2008, 
they met with Zhuhai counterparts to exchange views and draft 
a HIV/AIDS collaboration plan for the two regions. 
 
¶6. (U) In December 2008, the MSARG teamed up with Zhuhai 
counterparts to raise public awareness of sexually 
transmitted diseases amongst the rising number of 
border-crossing travelers.  Over 11 million mainland visitors 
arrived in Macau in 2008, the majority via the Border Gate 
separating Zhuhai and Macau.  Therefore, officials see 
HIV/AIDS education and safe sex awareness programs 
administered by both governments as crucial to reducing the 
spread of HIV/AIDS across the border.  Macau and Zhuhai 
governments, with support from NGOs, conducted a public 
awareness campaign targeting frequent travelers themed "Be a 
Healthy Traveler", using slogans such as "Don't Bring 
Sexually Transmitted Diseases and AIDS Home".  The campaign 
was conducted at the Border Gate, the Outer Harbor Ferry 
Terminal and the Macau International Airport. Volunteers 
distributed HIV/AIDS prevention information as well as 
information about community resources such as AIDS hotlines, 
websites, and services in Hong Kong, Macau and 
Zhuhai. 
 
Engaging NGOs to Counsel and Educate 
--------------------------------- 
 
 
HONG KONG 00002033  002 OF 003 
 
 
¶7. (U) Unprotected sexual contact is the primary mode of 
HIV/AIDS transmission in Macau, said health officials.  To 
address this issue, in 2008 Macau began providing funds to 
NGOs to counsel and provide prevention and treatment 
information to high risk groups - sex workers and men who 
have sex with men (MSM)- and to educate the larger Macau 
community about HIV/AIDS prevention. The MSARG recently ran 
an education campaign to get NGOs, schools, and other 
volunteer organizations to participate in educating the 
public about HIV/AIDS and offered participant organizations a 
maximum subsidy of 8000MOP or approximately US $1000 each. 
 
¶8. (SBU) Although there are a number of NGOs that are 
involved in public health awareness including HIV/AIDS, the 
Macau AIDS Care Association (MACA) is the first and currently 
only NGO in Macau focused on HIV/AIDS prevention, counseling, 
and education. Established in 2007, it began as an 
association of medical professionals whose careers were 
directly or otherwise related to HIV/AIDS patients and 
providing treatment for them. It provided HIV/AIDS training 
and information to its members and now also operates a 
hotline anyone can confidentially call for HIV/AIDS related 
information and assistance. In January 2009, MACA received 
100,000MOP or approximately US$12,500 from the MSARG to 
renovate its hotline center. Although MACA also receives 
quarterly and annual subsidies from the CDC and the Social 
Welfare Bureau, MACA expressed concern that subsidies were 
not paid on time and also that they were not sufficient to 
cover the cost of its staff. 
 
Everyday Discrimination 
------------------------ 
 
¶9. (SBU) Located inside a residential building with no 
visible signage, MACA keeps a low profile for fear that 
neighbors will discover that there is an HIV/AIDS NGO 
operating next door. It aims to provide a safe and 
confidential haven for counseling people struggling with 
HIV/AIDS. Dr. Tse described the constant discrimination that 
HIV/AIDS patients and the health care workers who treat them 
faced in Macau.  MACA had previously been asked to vacate 
several other locations after neighbors and landlords found 
out about their operations.  People living with HIV/AIDS in 
Macau were often shunned or fired from their jobs and had 
difficulty finding work due to the baseless fears of an 
uninformed public towards HIV/AIDS patients, said Tse. 
 
¶10. (SBU) MACA President Dr. Maria Fatima Tse compared 
HIV/AIDS patients to other disadvantaged members of society 
such as the elderly, the physically disabled and mentally 
challenged but noted that these other groups frequently 
received public and private services and support.  People 
with HIV/AIDS were often afraid to identify themselves and 
therefore did not receive the same sort of help or support. 
Tse said Macau government employees were required to disclose 
their HIV/AIDS status, highlighting the problem of lack of 
respect for medical privacy in Macau. 
 
Officials Statistics May Not Tell the Full Picture 
--------------------------------------------- ---- 
 
¶11. (U) As of September 2009, 419 HIV cases have been 
reported in this city of 544,000 residents. In the first 10 
months of 2009, nine HIV infections were recorded, which 
followed 2008's 22 new cases and 2007's 21 cases. According 
to official statistics, 50.6 percent of the total reported 
infections were of temporary residents working in the 
"entertainment" industry, and over 10 percent of these 
infections have developed into full-blown AIDS cases. 
Sixty-seven percent of HIV transmission in Macau has been 
through sexual contact, of which 87.6 percent was 
heterosexual transmission. 
 
¶12. (SBU) CDC health officials stated that people in Macau 
were not always honest about how they may have been infected, 
especially MSM.  Dr. Tse believed that there were probably 
many more cases unreported.  She estimated that fifty percent 
of all HIV infections in Macau were transmitted by drug users 
and fifty percent through unsafe sex. Tse also commented that 
although Macau's statistics showed a very low HIV infection 
 
HONG KONG 00002033  003 OF 003 
 
 
rate, its neighbors had a much higher rate of infection. 
(Note: Hong Kong recorded its highest-ever number of HIV 
infections in a single year in 2008, with 435 new cases. In 
the first half of 2009, Hong Kong reported 98 new cases of 
HIV infections, bringing its cumulative total to 4,249 since 
¶1984. Neighboring Zhuhai's HIV infection statistics are not 
readily available. However, according to the Guangdong 
Province Department of Health, in the first 10 months of 
2008, Guangdong province recorded 4,709 new HIV infections, a 
25 percent increase from the previous year, bringing its 
cumulative total to 23,031. End Note) 
 
¶13. (SBU) Dr. Tse also recounted her firsthand experiences 
with mainland Chinese female sex workers coming to Macau on 
short term tourist visas. Some of the workers contacted MACA 
for counseling and information on HIV/AIDS testing during 
their stays. According to MACA staff, several of them tested 
positive for HIV/AIDS.  MACA staff assumed that they received 
treatment when they returned to the mainland but also 
expressed concern about the possibility of further 
transmission to the population since some of these workers 
were later seen back in Macau. 
MARUT