North Korea is not known for its transparency. So when the communist government’s representatives, as well as staff of the World Health Organization, announced in December of 2018 that the country had zero cases of HIV, the claims seemed suspect.
Physician Thomas Fernando, the WHO representative to North Korea at the time, chalked up the incredible claims of success to prevention and testing, at least as far as he knew. Meanwhile, the Democratic People’s Republic of Korea was facing an exploding HIV crisis.
The first case of HIV was reported in January 1999 and the tranmission rate has soared in recent years. In 2018, that number had jumped to an estimated 8,362 individuals living with HIV. Despite the urgency of the situation, this type of revelation is not permissible in the totalitarian state where all information is tightly controlled. Anything that could be remotely considered a threat to the country or regime is quickly stamped out. Still, as far back as 2013, local experts and physicians had defied the authorities and reached out to the West for help.
“They first expressed concerns about HIV in rural regions and inquired whether we could do anything about this,” Taehoon Kim recently told Science Magazine. Kim, the co-founder of DoDaum, a non-profit organization that operates health and education projects in the closed state, added, “We started to travel to more distant parts of the country to meet with patients and understand the issues at play.”
The group soon learned the problem was far more extensive than imagined. National prevalence sits at an estimated 0.069 percent of the total population. While this rate is significantly less than the 0.6 percent rate of the United States, the numbers are likely to rise sharply due to a perfect storm of contributing factors.
Drugs used to treat HIV elsewhere in the world are not domestically produced in the country, and since North Korea is subject to sanctions, access to drugs from the international market is often difficult and unreliable with 30 percent to 40 percent turned away at the China-North Korea border.
Making matters worse is the high rate of tuberculosis among the country’s citizens. HIV progresses at a much higher rate when combined with TB. There is also rampant malnutrition outside the city of Pyongyang. Taken all together, the situation looks dire for the people of North Korea. Still, DoDaum currently has 3,000 patients on combined antiretroviral therapy.
Not unexpectedly, government officials had hoped to keep the situation secret, but the severity of the crisis eventually led a few brave officials to speak out.
Physician Kim Mun Song, the external affairs director at the North Korean Ministry of Public Health in Pyongyang and DoDaum’s in-country liaison, defied authorities and a potential backlash in order to bring awareness to the issue.
Of particular concern to those on the ground is the manner of contraction. Unlike other countries in the region where the virus is predominantly spread via sex between men, HIV is most common in North Korea among blood donors, intravenous drug users, and female sex workers and their clients. The country’s isolation is the most likely reason for the difference in the transmission profile.
Without help from the international community, there are fears the government could take extreme measures to clamp down on the rising rates, including forced removal of HIV-positive individuals to isolate them from the general population.
Rather than seeing this as an issue of public safety, the government will most likely view it as an existential threat to the regime that requires immediate and draconian action to prevent instability of an increasingly agitated population.