View source for HIV/AIDS in Taiwan

{{Short description|Overview of (typically) sexually transmitted disease in Taiwan}}
'''[[Taiwan]]''''s epidemic of '''[[HIV/AIDS]]''' began with the first case reported in December 1984. On 17 December 1990 the [[Government of the Republic of China|government]] promulgated the AIDS Prevention and Control Act. On 11 July 2007, the AIDS Prevention and Control Act was renamed the HIV Infection Control and Patient Rights Protection Act.<ref name="cdc.gov.tw">Centers for Disease Control, R.O.C. (Taiwan), [https://www.cdc.gov.tw/english/info.aspx?treeid=bc2d4e89b154059b&nowtreeid=ee0a2987cfba3222&tid=A0FA6F477C1C1D13 "Draft amendments to HIV Infection Control and Patient Rights Protection Act approved to address human rights"], ''Centers for Disease Control, R.O.C. (Taiwan)'',  February 5, 2015. 2016-05-03.</ref>

As of March 2016, there are 31,620 reported cases of Taiwanese testing positive, and 1,020 foreigners testing positive.<ref>{{cite web |url=https://www.cdc.gov.tw/downloadfile.aspx?fid=40CE068DC7A0F111 |title=HIV月報105-03(更新) |publisher=Centers for Disease Control, R.O.C (Taiwan) |format=PDF |access-date=2 May 2016}}</ref> Until January 2015, the original HIV Infection Control and Patient Rights Protection Act required foreigners who tested positive to be deported, therefore most of the reported foreigners are no longer in Taiwan. This policy was repealed in January 2015, allowing HIV/AIDS infected foreign individuals to remain in Taiwan.

HIV/AIDS patients' medical treatment costs are covered by [[Healthcare in Taiwan|Taiwan's National Health Insurance (NHI)]].<ref name="cdc.gov.tw"/>

==Epidemiology==
[[Image:Reported HIV cases in Taiwan (by year).png|250px|thumb|Reported HIV/AIDS cases in Taiwan from 1984 to 2010]]
The first reported case was reported in December 1984 on a foreign transit traveler. The first local infection was reported in February 1986.

According to the statistics of [[Centers for Disease Control (Taiwan)|Taiwan's Centers for Disease Control]], as of 6 February 2014, there were 26,646 cases of Taiwanese becoming infected with HIV.<ref>{{Cite web|url=https://www.cdc.gov.tw/info.aspx?treeid=1f07e8862ba550cf&nowtreeid=6c5ea6d932836f74&tid=65ED215C50763D72|title = 首頁-衛生福利部疾病管制署}}</ref>

Of all cases:
*93.39% are [[male]], 6.61% [[female]]
*72.24% are 20–49 years old, 20.08% are 15–24 years old

Another 893 foreigners have tested positive, most of whom have been deported by the Taiwan government before the policy change. The CDC has not published an analysis of foreigners who tested positive.

The ratio of patients of drug users increases rapidly. Since 1984, incidence of infections through sexual contacts had accounted for 90% of all cases for most of time. But in 2005, drug using patients accounted for more than 50%. To prevent the disease from spreading to general population rapidly, the CDC announced the "Harm Reduction Pilot Projects for IDUs". The program includes expansion of the existing education and rehabilitation network, and the establishment of a [[harm reduction]] program unprecedented to the country.{{ref|tw_hr}}

==HIV-1 epidemic==
Taiwan is entering a new and dangerous phase of its [[HIV-1]]/AIDS epidemic, which by far accounts for the majority of its total number of HIV infection cases.
[[Image:Cumulative number of drug use HIV AIDS cases in Taiwan.svg|250px|thumb|Cumulative number of drug use HIV/AIDS cases in Taiwan, 1988–2006]]
By the end of 2006, 13,702 individuals (including 599 foreigners) had been reported as infected with HIV-1 to the [[Centers for Disease Control (Taiwan)|Centers for Disease Control of Taiwan]].<ref name="Centers for Disease Control, ROC (Taiwan). HIV/AIDS data. 2006">Centers for Disease Control, ROC (Taiwan). [https://www.cdc.gov.tw/website_en/health%20topics/Communicable%20Diseases%20&%20Prevention/Issues%20of%20HIV-AIDS/Statistics%20of%20HIV-AIDS/Download%20HIV-AIDS%20Data.files/2006.files/9512Monthly%20Report.pdf HIV/AIDS data] {{Webarchive|url=https://web.archive.org/web/20071129082847/http://www.cdc.gov.tw/website_en/health%20topics/Communicable%20Diseases%20%26%20Prevention/Issues%20of%20HIV-AIDS/Statistics%20of%20HIV-AIDS/Download%20HIV-AIDS%20Data.files/2006.files/9512Monthly%20Report.pdf |date=2007-11-29 }}. 2006
(accessed Jan 30, 2007).</ref> In 2003, HIV-1 rates in first-time [[blood donor]]s, [[military conscript]]s, and [[pregnant women]] were measured at 5.2, 57.0, and 12.0 per 100,000, respectively.<ref name="Centers for Disease Control, ROC (Taiwan). HIV/AIDS data. 2006"/> Data from that year indicated HIV-1 rates of 0.09% for intravenous drug users, 0.2% for female sex workers, 1.9% for patients with [[sexually transmitted infection]]s, and 6.7% for men who have sex with men in saunas or bath houses.<ref name="Centers for Disease Control, ROC (Taiwan). HIV/AIDS data. 2006"/> Since then, the number of people living with HIV-1/AIDS in Taiwan has jumped sharply, from an 11% increase in 2003 to a 77% increase in 2004 and a 123% increase in 2005.<ref name="Centers for Disease Control, ROC (Taiwan). HIV/AIDS data. 2006"/>

However, after the implementation of a [[harm-reduction]] program, a 10% decrease was seen in 2006. The current estimated number of HIV-1/AIDS cases in Taiwan is about 30,000, which suggests that the infection rate there could be greater than that in China: 30,000 per 23 million (1/767) compared with 650,000 per 1.3 billion (1/2000).<ref>Ministry of HealthPeople's Republic of ChinaJoint United Nations Programme on HIV/AIDSWorld Health Organization. [http://data.unaids.org/Publications/External-Documents/RP_2005ChinaEstimation_25Jan06_en.pdf 2005 update on the HIV/AIDS epidemic and response in China]. Jan 24, 2005: (accessed Jan 23, 2007).</ref>

A risk-factor analysis of reported cases showed that the proportion of intravenous drug users infected with HIV-1 increased from 1.7% (13/772) in 2002, to 8.1% (70/862) in 2003, to 41.3% (628/1520) in 2004, to 72.4% (2461/3399) in 2005, and dropped to 68.6% (2017/2974) in 2006.<ref name="Centers for Disease Control, ROC (Taiwan). HIV/AIDS data. 2006"/> The most important risk factor for Taiwanese [[intravenous drug use]]rs is needle-sharing, followed by the sharing of heroin diluents.<ref>Chen YM. Molecular epidemiology of HIV-1 infection among injecting drug users in Taiwan. 2005 Taipei International Conference on Drug Control and Addition Treatment, Taipei, Taiwan, Nov 22–24, 2005.</ref> A molecular epidemiological study showed that more than 95% of intravenous drug users with newly diagnosed HIV-1 in 2004 and 2005 were infected with CRF07_BC, a circulating recombinant form of subtypes B' and C.<ref>Chen YM, Lan YC, Lai SF, Yang JY, Tsai SF, Kuo SH. HIV-1 CRF07_BC infections, injecting drug users, Taiwan. ''Emerg Infect Dis'' 2006; '''12''': 703-705.</ref><ref name="Lin YT, Lan YC, Chen YJ, et al. Molecular epidemiology of HIV-1 infection and full-length genomic analysis of HIV-1 circulating recombinant form 07_BC strains from injecting drug users in Taiwan. ''J Infect Dis'' (in press).">Lin YT, Lan YC, Chen YJ, et al. Molecular epidemiology of HIV-1 infection and full-length genomic analysis of HIV-1 circulating recombinant form 07_BC strains from injecting drug users in Taiwan. ''J Infect Dis'' (in press).</ref> Previously, several studies suggested that CRF07_BC originated in China's [[Yunnan province]] as a mix of subtype B' from [[Thailand]] and subtype C from [[India]]. The subtype is believed to have moved to [[Xinjiang]] in China's northwest along a major [[heroin]]-trafficking route.<ref>Su L, Graf M, Zhang Y, et al. Characterization of a virtually full-length human immunodeficiency virus type 1 genome of a prevalent intersubtype (C/B') recombinant strain in China. ''J Virol'' 2000; '''74''': 11367-11376.</ref>

Of the 60,000–100,000 injecting drug users in Taiwan, 10–15% may be infected with CRF07_BC. If so, they probably represent the largest group of such intravenous drug users in [[northeast Asia]]. The circulating recombinant form might have followed a separate drug-trafficking route to Taiwan from Yunnan via southeast China, [[Guangxi]], and [[Hong Kong]].<ref>Piyasirisilp S, McCutchan FE, Carr JK, et al. A recent outbreak of human immunodeficiency virus type 1 infection in southern China was initiated by two highly homogeneous, geographically separated strains, circulating recombinant form AE and a novel BC recombinant. ''J Virol'' 2000; '''74''': 11286-11295.</ref><ref>Cohen J. Asia and Africa: on different trajectories?. ''Science'' 2004; '''304''': 1932-1938.</ref><ref name="Lim WL, Xing H, Wong KH, et al. The lack of an epidemiological link between HIV type 1 infections in Hong Kong and Mainland China. ''AIDS Res Hum Retroviruses'' 2004; '''20''': 259-262.">Lim WL, Xing H, Wong KH, et al. The lack of an epidemiological link between HIV type 1 infections in Hong Kong and Mainland China. ''AIDS Res Hum Retroviruses'' 2004; '''20''': 259-262.</ref> There have been enormous increases in the amount of heroin smuggled into Taiwan and in the number of intravenous drug users since 2002, when five intravenous drug users from southern Taiwan were diagnosed as the country's first HIV-1 seropositive cases infected with CRF07_BC.<ref name="Lin YT, Lan YC, Chen YJ, et al. Molecular epidemiology of HIV-1 infection and full-length genomic analysis of HIV-1 circulating recombinant form 07_BC strains from injecting drug users in Taiwan. ''J Infect Dis'' (in press)."/> Even though the Hong Kong authorities identified three cases of CRF07_BC infection in 2001, a serious outbreak in that city's population of intravenous drug users is believed to have been blocked by a methadone maintenance program.<ref name="Lim WL, Xing H, Wong KH, et al. The lack of an epidemiological link between HIV type 1 infections in Hong Kong and Mainland China. ''AIDS Res Hum Retroviruses'' 2004; '''20''': 259-262."/>

==Monitoring==

Close monitoring of emerging HIV-1 subtypes related to intravenous drug use and implementing harm-reduction programs has been and continue to be vital in preventing similar outbreaks in other populations of intravenous drug users in neighboring countries. In 2005, [[Alex Wodak]], [[Gerry Stimson]], and other harm-reduction experts were invited to Taiwan to share their experiences with government officials, medical field-workers, and public-health professionals. After careful study of harm-reduction programs in place in Hong Kong and [[Australia]], a pilot program was started in four of Taiwan's 23 administrative areas in September 2005. This program has since been expanded nationally, and consists of 427 service sites for [[syringe]] exchange plus centres for [[methadone]] maintenance therapy. Free methadone is provided to HIV-1-infected intravenous drug users while HIV-1 seronegative intravenous drug users have to pay about US$1600 a year. The Taiwan [[Centers for Disease Control (Taiwan)|Centers for Disease Control]] plans to provide methadone maintenance to intravenous drug users in [[prisons]], and the country's [[Bureau of Controlled Drugs]] will start producing methadone to assist in the government's commitment to providing methadone maintenance to 30,000 intravenous drug users by 2009.

All parts of Asia are reporting rising numbers of HIV-positive and AIDS patients in [[men who have sex with men]]. This is primarily because policy targets these groups of people for testing. Current Taiwanese HIV testing centers receive higher funding when they report testing homosexual men than any other gender or sexuality. This is due to the faulty belief that gay men are at higher risk for HIV contraction. Modern statistics indicate that heterosexual couples are at higher risk of contraction, in particular because they do not test as often as the homosexual population and are not targeted by country policy. What these skewed statistics show is that in Taiwan, HIV-1 infection rates in men who have sex with men in gay saunas in different cities currently range from 5.2% to 15.8%.<ref name="Lai SF, Hong CP, Lan YC, et al. [http://www.iasociety.org/abstract/show.asp?abstract_id=2172548 Molecular epidemiology of HIV-1 in men who have sex with men from gay saunas in Taiwan from 2000 to 2003.] XV International AIDS Conference, Bangkok, Thailand, July 11–16, 2004:  (accessed Jan 23, 2007).">Lai SF, Hong CP, Lan YC, et al. [http://www.iasociety.org/abstract/show.asp?abstract_id=2172548 Molecular epidemiology of HIV-1 in men who have sex with men from gay saunas in Taiwan from 2000 to 2003.]{{Dead link|date=August 2023 |bot=InternetArchiveBot |fix-attempted=yes }} XV International AIDS Conference, Bangkok, Thailand, July 11–16, 2004:  (accessed Jan 23, 2007).</ref><ref name="Ko NY, Lee HC, Chang JL, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections and risky sexual behaviors among men visiting gay bathhouses in Taiwan. ''Sex Transm Dis'' 2006; '''33''': 467-473.">Ko NY, Lee HC, Chang JL, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections and risky sexual behaviors among men visiting gay bathhouses in Taiwan. ''Sex Transm Dis'' 2006; '''33''': 467-473.</ref> The same population has high rates of syphilis, 8.1–13.8%, depending on the city.<ref name="Lai SF, Hong CP, Lan YC, et al. [http://www.iasociety.org/abstract/show.asp?abstract_id=2172548 Molecular epidemiology of HIV-1 in men who have sex with men from gay saunas in Taiwan from 2000 to 2003.] XV International AIDS Conference, Bangkok, Thailand, July 11–16, 2004:  (accessed Jan 23, 2007)."/><ref name="Ko NY, Lee HC, Chang JL, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections and risky sexual behaviors among men visiting gay bathhouses in Taiwan. ''Sex Transm Dis'' 2006; '''33''': 467-473."/> Taiwanese male homosexual and bisexual HIV-1/AIDS patients have also been diagnosed with significantly higher rates of syphilis than have heterosexual patients.<ref name="Chen YM, Huang KL, Jen I, et al. Temporal trends and molecular epidemiology of HIV-1 infection in Taiwan from 1988 to 1998. J Acquir Immune Defic Syndr Hum Retrovirol 2002; 26: 274-282.">Chen YM, Huang KL, Jen I, et al. Temporal trends and molecular epidemiology of HIV-1 infection in Taiwan from 1988 to 1998. J Acquir Immune Defic Syndr Hum Retrovirol 2002; 26: 274-282.</ref> Furthermore, the percentage of homosexual or bisexual HIV-1/AIDS patients under the age of 20 years is significantly higher than that of heterosexual patients, 3.0% versus 1.7%.<ref>Chen YM, Huang KL, Jen I, et al. Again, these statistics reflect policy and the groups of people that policy targets. Temporal trends and molecular epidemiology of HIV-1 infection in Taiwan from 1988 to 1998. J Acquir Immune Defic Syndr Hum Retrovirol 2002; 26: 274-282.</ref> One of the primary factors that leads to HIV risk is the lack of accurate information on risky behaviors that lead to HIV contraction increases the risk of contracting HIV and other sexually transmitted infections.

Taiwan's clinical spectrum of AIDS patients is similar to those reported in other developed countries, but significant differences have been noted in incidences of opportunistic infections. For example, the incidence of [[tuberculosis]] in patients with advanced illness is high in Taiwan (24.6%) and the rate of endemic [[fungal]] (''[[Penicillium marneffei]]'') infections is increasing.<ref>Hsieh SM, Hung CC, Chen MY, Hsueh PR, Chang SC, Luh KT. Clinical manifestations of tuberculosis in patients with advanced HIV-1 infection in Taiwan. ''J Formos Med Assoc'' 1996; '''95''': 923-928.</ref><ref>Hsueh PR, Teng LJ, Hung CC, Chen YG, Luh KT, Ho SW. Molecular evidence on strain dissemination of Penicillium marneffei: an emerging pathogen in Taiwan. ''J Infect Dis'' 2000; '''181''': 1706-1712.</ref> On the positive side, the effort by the [[Government of the Republic of China|Taiwanese Government]] since April 1997, to distribute highly-active [[antiretroviral therapy]] for free<ref>Fang CT, Hsu SM, Twu SJ, et al. Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. ''J Infect Dis'' 2004; '''190''': 879-885.</ref> has resulted in dramatic decreases in [[morbidity]] and [[Mortality rate|mortality]] from HIV-1 infection.<ref>Hung CC, Chen MY, Hsieh SM, Sheng WH, Chang SC. Clinical spectrum, morbidity and mortality of acquired immunodeficiency syndrome in Taiwan: a 5-year prospective study. ''J Acquir Immune Defic Syndr Hum Retrovirol'' 2000; '''24''': 378-385.</ref>

Because of their high background prevalence, HBV and HCV coinfections with HIV are particularly important in [[Asian countries]] in terms of HIV transmission via injecting drug use.<ref>Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. ''J Hepatol'' 2006; '''44''': S6-S9.</ref><ref>Law WP, Dore GJ, Duncombe CJ, et al. Risk of severe hepatotoxicity associated with antiretroviral therapy in the HIV-NAT Cohort, Thailand, 1996–2001. ''AIDS'' 2003; '''17''': 2191-2199.</ref> In a survey of 459 intravenous drug users infected with HIV-1, one of us (Y-MAC) found that 456 (99.6%) also had anti-HCV antibodies and 77 (16.8%) were seropositive for HBsAg. The long-term impact of [[hepatitis]] coinfections on HIV and on morbidity and mortality from [[liver disease]] requires monitoring.

==Control==
By the end of 2006, 19 confirmed cases of [[vertical transmission|vertical HIV-1 transmission]] have been reported to the Taiwan [[Centers for Disease Control (Taiwan)|Centers for Disease Control]].<ref name="Centers for Disease Control, ROC (Taiwan). HIV/AIDS data. 2006"/> In January 2005, the agency started a national program focused on prevention of mother-to-child transmission, and five cases of vertical transmission were reported in 2005. By June 2006, the screening rate had reached 97.4%, and 47 of 338,452 pregnant women (13.9 per 100 000) tested in Taiwan have been identified as having HIV-1 infections and have received antiretroviral therapy to prevent mother-to-child transmission. To increase the participation rate, there is discussion of changing the voluntary [[counselling]] and testing strategy from opt-in to opt-out.

==Health Care==

HIV/AIDS patients' medical treatment costs are covered by [[Healthcare in Taiwan|Taiwan's National Health Insurance (NHI)]].<ref name="cdc.gov.tw"/> 

===NHI Coverage===

In 2011, Taiwan's [[Centers for Disease Control (Taiwan)|CDC]] was considering switching from providing HIV/AIDS treatment for free to a subsidized model. The cost of treatment for each AIDS patient in the country is estimated at NT$30,000 (US$930) per month, which is equivalent to the average monthly salary of an office worker.<ref>Staff Writer, with CNA, [http://www.taipeitimes.com/News/taiwan/archives/2011/12/02/2003519747 "Taiwan’s HIV infection rate rising: group"], ''Taipei Times'', December 02, 2011. Retrieved 2016-05-04.</ref> In 2013, CDC Deputy Director Chuang Jen-hsiang (莊仁祥) said that the rise in the rate of HIV/AIDS cases was outstripping public funds, and that the NHI was NT$600 million (US$2 million) in debt due to treating HIV/AIDS patients. Chuang added that the [[Ministry of Health and Welfare (Taiwan)|Ministry of Health and Welfare]] was still considering a plan to reducing coverage for HIV-positive Taiwan nationals from their current full coverage, in addition to requiring foreign nationals to pay in full for their treatment.<ref>Wei Yi-chia and Jake Chung, [http://www.taipeitimes.com/News/taiwan/archives/2013/10/20/2003574951 "HIV/AIDS law changes may stop deportations"], ''Taipei Times'', October 20, 2013. Retrieved 2016-05-04.</ref>

Other [[Sexually transmitted infection|STIs]] and illnesses were covered under National Health Insurance during this time of debate. Criticism of reducing coverage and expecting HIV/AIDS-related treatments to be paid by the individuals, included that it further promoted the faulty idea that HIV/AIDS contraction is the fault of the individual.{{citation needed|date=May 2016}}

===Organ Transplants===

Currently, HIV/AIDS patients are eligible for organ transplants. Plans exist to allow HIV/AIDS positive patients to donate organs to other HIV/AIDS positive patients by the end of 2016. Until March 2016, HIV/AIDS patients were "ineligible to receive organ transplants, including transplants of the heart, lungs, liver, kidney, pancreas, cornea and small intestines."<ref>Stephanie Chao, [http://www.chinapost.com.tw/taiwan/national/national-news/2016/02/05/457834/HIV-AIDS-patients.htm "HIV/AIDS patients eligible for transplants: MHW"], ''The China Post'', February 5, 2016. Retrieved 2016-05-04.</ref>

==Responses==
Several positive responses to the HIV/AIDS epidemic in Taiwan should be mentioned. Since 1992, 16 non-governmental organizations registered or established in Taiwan have provided shelter, care, counselling, anonymous testing, and AIDS education. One in particular, the [[People Living with HIV/AIDS Rights' Advocacy Association]], has been addressing [[human rights]] issues related to HIV/AIDS since 1997. However, most such organizations have their headquarters and facilities in northern Taiwan, and two-thirds of the country's intravenous drug users live in central and southern parts. In addition, many [[social work]]ers employed by non-governmental organizations are still unfamiliar with issues related to [[drug abuse]] and inexperienced in interacting with intravenous drug users. There is a clear and immediate need for counselling workshops for medical staff and social workers. In the long-term, there is need for more funding for [[AIDS research]], especially [[vaccine]] development.{{citation needed|date=May 2016}}

==Society and Culture==

===Stigma===

While Article 6-1 of original 1990 AIDS Prevention and Control Act stated that "HIV-infected individuals shall not be discriminated against, nor shall they be deprived of their rights," a lack of specifying what those individuals' rights were left many loopholes open in the interpretation of the Act. In addition, the [[Taiwan under Japanese rule|Japanese-era]] 1944 Communicable Disease Control Act contained articles that could be used to circumvent the protections intended by the 1990 AIDS Prevention and Control Act, particularly Article 35 and Article 40. Some institutions would cite the 1944 Act as a legal defense for discriminatory practices, including a school which turned away a student.<ref>Vincent Rollet, [https://chinaperspectives.revues.org/498 "Taiwanese NGOs and HIV/Aids: From the National to the Transnational"], ''China Perspectives'', July-August 2005. Retrieved 2016-05-03.</ref>

    {{Quote|text=When communicable diseases occur or are expected to occur, local competent authorities may impose restrictions, prohibitions or other adequate measures on farming, husbandry, swimming or drinking water of certain area under their jurisdiction; when necessary, they may request various central enterprise competent authorities for assistance.<ref>Ministry of Health and Welfare, [http://law.moj.gov.tw/Eng/LawClass/LawAll.aspx?PCode=L0050001 "Communicable Disease Control Act "], ''Laws and Regulations Database of the Republic of China'', December 30, 2015. Retrieved 2016-05-03.</ref> |author=[[Ministry of Health and Welfare (Taiwan)|Ministry of Health and Welfare]]|source=Article 35, Communicable Disease Control Act}}

    {{Quote|text=When medical personnel other than physicians, in the course of their duties, detect patients, suspected patients or the remains that they consider to have been affected by communicable diseases, they shall immediately report such cases to physicians or to competent authorities of the locality in accordance with regulations of Paragraph 2 of the preceding Article.
Medical institutions shall assign a full-time person who is responsible for the supervision of subordinate medical personnel to ensure the regulations of the preceding Paragraph or the preceding Article are followed.<ref>Ministry of Health and Welfare, [http://law.moj.gov.tw/Eng/LawClass/LawAll.aspx?PCode=L0050001 "Communicable Disease Control Act "], ''Laws and Regulations Database of the Republic of China'', December 30, 2015. Retrieved 2016-05-03.</ref> |author=[[Ministry of Health and Welfare (Taiwan)|Ministry of Health and Welfare]]|source=Article 40, Communicable Disease Control Act}}

As the HIV-1 infection threat increases, there are many signs of persistent denial and resurgent discrimination in Taiwan. Several important issues need to be addressed: sentinel surveillance of female sex workers, social welfare institutions and housing for homeless people with HIV/AIDS, financial support for non-governmental organizations, training and re-education programs aimed at changing the attitudes of medical staff toward people with HIV/AIDS.{{citation needed|date=May 2016}}

===Economic impact===

The original 1990 AIDS Prevention and Control Act did not explicitly protect the right to work and had no penalties for refusing employment to HIV-positive people. Work discrimination in Taiwan became common, with even some state-run enterprises and government agencies requiring mandatory HIV blood tests. Examples of discrimination include the discharging of a [[Taipei]] police officer in 2001, the lay-ing off a healthcare worker in 2002, and a [[Taipei Metro]] driver who came under pressure and gave up his job.<ref>Wang Hsiao-wen, [http://www.taipeitimes.com/News/taiwan/archives/2004/12/19/2003215746/2 "Foreign HIV victims face a quiet struggle to work"], ''The Taipei Times'', December 19, 2004. Retrieved 2016-05-03.</ref>

==Infected foreigners and human rights==

Identification of HIV/AIDS-positive foreigners usually occurs during mandatory blood test for teachers, government agencies workers and some state-run enterprises employees. There are no penalties for enterprises refusing to hire a foreign person carrying HIV thus allowing work and employment discrimination.<ref>Wang Hsiao-wen, [http://www.taipeitimes.com/News/taiwan/archives/2004/12/19/2003215746/2 "Foreign HIV victims face a quiet struggle to work"], ''The Taipei Times'', December 19, 2004. Retrieved 2016-05-03.</ref>

===1990 AIDS Prevention and Control Act===
In 1990, the government of Taiwan promulgated the AIDS Prevention and Control Act (後天免疫缺乏症候群防治條例). Under the AIDS Prevention and Control Act, foreigners who tested positive for HIV were required to be deported. The AIDS Prevention and Control Act was renamed the HIV Infection Control and Patient Rights Protection Act (人類免疫缺乏病毒傳染防治及感染者權益保障條例) on July 11, 2007,<ref name="cdc.gov.tw"/> and will be referred to as such hereafter.

The "original HIV Infection Control and Patient Rights Protection Act allowed the government to order HIV tests on foreign residents in Taiwan and short-term visitors staying in the country for three months or longer. Those whose tests came back positive were required to be deported."<ref>Chen Wei-ting and Y.F. Low, [http://m.focustaiwan.tw/news/asoc/201501200010.aspx "Taiwan lifts deportation requirement for foreigners with HIV/AIDS"], ''Focus Taiwan News Agency'', January 20, 2015. Retrieved 2016-05-02.</ref> During the process of deportation, "their visas [were] annulled and their names [were] permanently listed in official records, resulting in automatic refusal of any future application for an entry visa."<ref name="HIV deportations reconsidered">Wang Hsiao-wen, [http://www.taipeitimes.com/News/taiwan/archives/2004/11/09/2003210294 "HIV deportations reconsidered"], ''The Taipei Times'', November 09, 2004. Retrieved 2016-05-03.</ref> Foreigners infected by their Taiwanese spouse or from medical procedures conducted in Taiwan could appeal to be taken off of the black list, but only from abroad after being deported.

The strict requirements for appeal were laid out in Article 20 of the HIV Infection Control and Patient Rights Protection Act. As summarized by the ''Taipei Times'', "foreign nationals who were infected by spouses who are Taiwanese nationals, or who were infected while receiving medical care in Taiwan, and who have relatives within two degrees of kinship who have household registration and current residency in Taiwan may ask those relatives to prepare a written petition—only once—within six months of their deportation."<ref>Wei Yi-chia and Jake Chung, [http://www.taipeitimes.com/News/taiwan/archives/2013/10/20/2003574951 "HIV/AIDS law changes may stop deportations"], ''The Taipei Times'', October 20, 2013 . Retrieved 2016-05-02.</ref>  Petitions appear to have been infrequently approved. Even in cases where both spouses tested positive for HIV/AIDS, petitions could fail if the couple was unable to prove that it was the Taiwanese spouse who infected the foreign spouse.<ref name="cdc.gov.tw"/> In 2004, the secretary-general of the Persons With HIV/AIDS Rights Advocacy Association of Taiwan reported that the association had "filed applications on behalf of 24 couples to prevent a spouse's deportation. All 24 applications were turned down."<ref name="HIV deportations reconsidered"/>

No other foreigners, not even those with permanent residency or victims of rape / human trafficking, were allowed to appeal.

===Amendments===
The AIDS Prevention and Control Act was amended six times before it was renamed the HIV Infection Control and Patient Rights Protection Act in 2007. After its renaming, the act was further amended.<ref name="cdc.gov.tw"/>

In 2004, Taiwan's Department of Health proposed "a revision that would allow foreign HIV carriers to stay in Taiwan for less than 14 days, without restricting the number of times they can apply."<ref name="taipeitimes.com">Wang Hsiao-wen, [http://www.taipeitimes.com/News/taiwan/archives/2004/11/09/2003210294 "HIV deportations reconsidered"], ''The Taipei Times'', November 09, 2004. Retrieved 2016-05-03.</ref> The revision came under criticism by patient groups and health experts as being only a small change that did not address the central issues of human rights and the lack of evidence showing a link between deportation and decreasing the HIV infection rate.<ref name="taipeitimes.com"/> Eventually, the revised Article 18 of the HIV Infection Control and Patient Rights Protection Act allowed deported foreign nationals to apply, once per quarter, for a short-term visa that lasted no longer than 14 days.<ref>Wei Yi-chia and Jake Chung, [http://www.taipeitimes.com/News/taiwan/archives/2013/10/20/2003574951 "HIV/AIDS law changes may stop deportations"], ''The Taipei Times'', October 20, 2013. Retrieved 2016-05-04.</ref>

===Deportation Requirement Lifted===
On January 20, 2015, the Legislative Yuan passed an amendment that repealed the requirement for foreign nationals diagnosed with HIV/AIDS to be subject to deportation.<ref>{{Cite web|url=http://focustaiwan.tw/news/asoc/201501200010.aspx|title = Taiwan lifts deportation requirement for foreigners with HIV/AIDS - Focus Taiwan}}</ref> However, foreign residents are subject to additional barriers from treatment. In addition to being a legal resident, joining the NHI after staying in Taiwan for a minimum of six months, and having their HIV status confirmed by a hospital, foreign residents are required to pay the full costs of their HIV/AIDS treatment for two years, after which the costs will be covered by the NHI. 

The CDC estimates that two years of treatment costs approximately US${{To USD round|400000|MEX|sf=3}}.<ref>{{cite news |last1=Lee |first1=I-Chia |title=CDC dispels rumor of easy health coverage for HIV-positive foreigners |url=http://www.taipeitimes.com/News/taiwan/archives/2017/02/07/2003664511 |access-date=15 February 2020 |publisher=Taipei Times |date=7 February 2017}}</ref>

==See also==
* [[Healthcare in Taiwan]]
* [[Ministry of Health and Welfare (Taiwan)]]
* [[Centers for Disease Control (Taiwan)]]
* [[Epidemiology of HIV/AIDS]]
* [[HIV/AIDS in Asia]]

==References==
{{reflist|2}}

==Sources==
*{{in lang|cmn}}{{note|2005nhi}}[https://web.archive.org/web/20070928120424/http://www.nhi.gov.tw/information/bbs_detail.asp?bulletin_ID=556&menu=1 中央健康保險局公文]
*{{in lang|cmn}}{{note|tw_stat}} 疾病管制局 [https://web.archive.org/web/20090327013949/http://www.cdc.gov.tw/file/%E7%96%BE%E7%97%85%E4%BB%8B%E7%B4%B9/%E6%B3%95%E5%AE%9A%E5%82%B3%E6%9F%93%E7%97%85/%E5%85%B6%E4%BB%96/%E6%84%9B%E6%BB%8B%E7%97%85/%E7%B5%B1%E8%A8%88%E8%B3%87%E6%96%99%E4%B8%8B%E8%BC%89/950531%E7%B5%B1%E8%A8%88%E8%B3%87%E6%96%99%E4%B8%8B%E8%BC%89.pdf HIV/AIDS統計月報表] (5月。[[PDF]]格式)
*{{in lang|cmn}}{{note|tw_hr}} 疾病管制局 [https://www.cdc.gov.tw/file/38743_4085069444941111總計畫(修正版).doc 毒品病患愛滋減害試辦計畫] {{Webarchive|url=https://web.archive.org/web/20090320152846/http://www.cdc.gov.tw/file/38743_4085069444941111%E7%B8%BD%E8%A8%88%E7%95%AB(%E4%BF%AE%E6%AD%A3%E7%89%88).doc |date=2009-03-20 }} ([[MS Word]]格式)

==External links==
{{wikinews|Taipei mayor Ma hopes local HIV midway home "patients out only"}}
*[https://web.archive.org/web/20160807030114/http://www.cdc.gov.tw/ Centers for Disease Control] — Taipei, Taiwan

{{AIDS}}
{{Asia topic|HIV/AIDS in}}

{{DEFAULTSORT:Hiv Aids In Taiwan}}
[[Category:1984 establishments in Taiwan]]
[[Category:HIV/AIDS by country|Taiwan]]
[[Category:Health in Taiwan]]