Thailand's success against AIDS now at risk

Infection increasingly reported in pregnant women, public

By Tom Paulson
July 12, 2004

Thailand's celebrated success at containing the spread of AIDS is on display every night in places like Soi Cowboy or Nana Plaza off Sukhumvit Avenue in downtown Bangkok.

Tourists walk through the smoke wafting off the sidewalk grills and are greeted by an elephant and his handler offering to do tricks for a small fee. Music from the bars and clubs competes with the car horns and beeping scooters. Roadside hucksters sell bad imitations of Rolex watches, Disney character T-shirts or fake designer sunglasses.

Sex is also for sale here.

"Sex workers were identified, early on, as the high risk for AIDS, and the government responded by treating them as criminals," said Noi Apisuk, director of a prostitutes' rights organization called the Empower Foundation (also known on the street as the Bad Girls).

But through the positive efforts of activists like Apisuk and public health advocates like movie star-legislator Mechai (Mr. Condom) Viravaidya, the Thais eventually launched what has been widely regarded as one of the world's most effective AIDS prevention efforts.

An aggressive condom promotion campaign among sex workers significantly reduced the HIV infection rates that had initially threatened to spread through this Asian kingdom as they have in many countries. Thailand reduced its rate of new HIV infections by more than 80 percent between 1991 and 2003.

"There's no question that we had great success in the commercial sex arena," said Pawana Wienrawee, director of AIDS prevention efforts at the Thailand office of Seattle-based PATH (Program for Appropriate Technology in Health).

But success in one arena doesn't mean total, lasting success against AIDS, Wienrawee said by telephone last week.

"We aren't having much success with young people right now," she said.

PATH, which has been working on a variety of AIDS prevention programs in Thailand for more than a decade, recently launched a a school-based sex education program. Despite Thailand's international reputation for sex tourism, Wienrawee said most Thais are quite conservative about sex.

"There's still a lot of denial in Thai society about young people being sexually active," she said. "You're not supposed to have sex until you're married."

This lack of frank discussion about sex -- and how to be safe when engaged in it -- is putting people at risk and threatening to provide an avenue for AIDS to spread rapidly, Wienrawee said.

But it's not just Thailand's young people who are increasingly at risk of an infection they have so far been able to hold at bay. A recent U.N. report found that new infections are increasingly being reported in pregnant women and the public. People with HIV or AIDS are often treated poorly or stigmatized, it said, which helps to drive the disease underground.

Apisuk noted that prostitution is illegal in Thailand. This, she said, puts many sex workers at risk of being abused or coerced and undermines her organization's efforts to empower prostitutes to protect both themselves and their customers.

The Thai government has cut funding for many of its AIDS prevention programs and has not come through on promises to provide drug treatment for many of those infected.

It's hard to make any progress solving these problems if people continue to see Thailand as the place where they won the battle against AIDS, Wienrawee said.

"We're not winning anymore," she said. "We need to admit that we have problems. We are still at risk."

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