Thailand's AIDS battle falters

From 1991 to 2003, Thailand registered a drop in annual new infections from an estimated 143,000 to about 19,000, an achievement credited to a combination of political leadership, increased funding, public awareness campaigns and a pragmatic effort to work with prostitutes to promote condom use. But there are fresh indications in some sectors of Thai society that the danger has not passed.

A Thai waiter wears a condom on his head at Bangkok's Cabbages and Condoms restaurant, founded by Mechai Viravaidya to promote safe sex education. Mechai said the government must take new steps against AIDS. Reuters

July 10, 2004, 12:30 By By Ellen Nakashima

Mechai Viravaidya bounded through the hallways of a local bank one lunch hour this week, cheerily dispensing green and orange condom packets to clerks, accountants and analysts, many of them young and single.

"Condoms are a girl's best friend!" he said -- part comic, part missionary -- to the women.

"Looks like you need a green one," he deadpanned to one man, joking that the greens and oranges were different sizes. Mechai, who is known by his first name, is Thailand's condom king, set on getting people to protect themselves against AIDS by using condoms during sexual intercourse. He has been one of the central figures in Thailand's remarkable effort, begun in earnest in 1991, to combat a disease with no cure and no vaccine that has killed more than 20 million people worldwide. From 1991 to 2003, Thailand registered a drop in annual new infections from an estimated 143,000 to about 19,000, an achievement credited to a combination of political leadership, increased funding, public awareness campaigns and a pragmatic effort to work with prostitutes to promote condom use. The 15th International AIDS Conference, which opens Sunday in Thailand, has recognized the country as a model, one of just a few nations that have reversed the explosion in rates of infection.

"Thailand is a leading light in the global fight against AIDS," said Hakan Bjorkman of the U. N. Development Program, who led a team that wrote a new report on Thailand's response to AIDS.

But there are fresh indications in some sectors of Thai society that the danger has not passed. U.N. officials said new infections are rising and remain high among drug users and homosexuals. They also said a growing majority of young people are not protecting themselves during sex. "Now the epidemic has evolved, and there are warning signs that Thailand may be in for a nasty surprise," Bjorkman said. About 600,000 Thais have HIV, the virus that causes AIDS, and 53,000 of those infected die as a result of AIDS each year, according to official estimates. About 12 percent of prostitutes are still infected, with rates highest in brothels near the Burmese border. One study of gay men in Bangkok found that 17 percent of those tested were infected. HIV is beginning to spread in the general population in southern Thailand, especially among pregnant women. Though the number of intravenous drug users has decreased, the number of those infected has climbed to as high as 50 percent, according to official estimates. Human Rights Watch, a New York-based organization, this week charged that the government's hard-line crackdown on drug dealing has driven individual drug users underground, making treatment and prevention harder. Most worrying, the U.N. report said, HIV/AIDS is now the leading cause of death among people ages 15 to 44 in Thailand. Only 20 percent of sexually active young people use condoms consistently, and only 15 percent of young gay men report using condoms consistently. Thailand's financial commitment to prevention has dwindled, the U.N. agency said. Between 1997 and 2003, according to the report, the prevention budget was sliced by 62 percent, to $2 million. Now, prevention commands only 8 percent of the AIDS budget, the report said. "There's been a loss of momentum," said former prime minister Anand Panyarachun. There is "no top-level political commitment. AIDS is still a serious problem in Thailand."

Activists for change Mechai has been a public face of the AIDS prevention program -- so much so that in Thailand, his name has adorned condom wrappers and become slang for the word condom in the Thai language. 
He became involved with AIDS awareness shortly after Thailand's first documented AIDS case in 1984 -- a gay man who had studied in the United States, where he had become infected with HIV. While infections among gay men remained low, by 1988, rates had exploded among injected-drug users in Bangkok. In those years, the government was largely in denial, recalled Mechai, who was then a government spokesman. Officials feared the country's image would suffer and tourism might collapse, he said. When the health minister tried to raise awareness in a speech, travel industry workers burned his effigy. The government then banned discussing AIDS education in official media, Mechai said. But in some quarters, officials were beginning to argue for change. In 1989, a health ministry official, Wiwat Rojanapithayakorn, piloted an innovative campaign for universal condom use to drive down infections among prostitutes. The program would monitor every brothel, massage parlor, teahouse and sex worker in the province of Ratchaburi, south of Bangkok, where HIV infections were higher than in neighboring provinces. He invited all 370 prostitutes known to be working in the province to a meeting. The rules were simple: no condom, no sex. If everyone cooperated, no one would lose business.