Bangkok urged to focus on HIV/Aids among drug users

November 7, 2000

Bangkok - Thailand's Aids control program is a model for developing nations, but the country should reverse sharp cuts in spending to fight the pandemic and shed legal inhibitions in tackling it, the World Bank said here Friday.

In the past seven years, a highly successful program centered on the commercial sex industry and carried out by government agencies, non-governmental organizations (NGOs) and community groups, is estimated to have prevented 200,000 HIV cases in the Southeast Asian nation. Thanks to a dramatic increase in condom use in the sex industry from 14 to 90 percent, the number of new HIV cases reported annually has plunged by more than 80 percent in the last decade, says a new report released by the World Bank's Thailand office.

"This is an accomplishment that few other countries, if any, have been able to replicate. Thailand's response is widely cited as one of the few examples of an effective national Aids prevention program anywhere in the world," said the study.

The number of new HIV infections in Thailand dropped from about 137,000 per year in 1990 to 29,000 per year in 2000, says the study entitled "Thailand's Response to Aids - Building on Success, Confronting the Future".

"However, efforts to check the spread of HIV will have to move beyond sex industry because the nature of the epidemic is changing in Thailand," added the study.

J Shivakumar, head of the World Bank in Thailand who presented the report, urged the Thai government to step up spending on preventing HIV/Aids in the country. Thailand's Aids control budget has been slashed by 28 percent in the last three years. Last year, the government earmarked 1.4 billion baht (US$37.9 million) on programs against the spread of HIV and treatment of Aids patients. However, less than one tenth of this was for programs aimed at preventing HIV among adults. The cut in budgetary spending was due to the economic crisis which began in 1997, but the World Bank expressed concern that the maximum cut was in preventive expenditure.

Aids has so far claimed 300,000 lives in the country and there are 700,000 people living with HIV/Aids. HIV is now being mainly spread by unprotected sex between spouses, young boys and girls, and injecting drug use. But these groups are being neglected by the official anti-Aids programm says the study.

"This country has been a leader in the fight against HIV/Aids. However, Aids in Thailand is evolving, moving from one population group to another. The country's response - and in particular the government's response - needs to be flexible to respond quickly to the changes in the epidemic," Shivakumar said.

According to two of the study's authors - World Bank expert Martha Ainsworth and Chris Beyrer of John Hopkins University in the United States - Thailand will have to overcome "policy barriers" in tackling the spread of HIV among the new high-risk group of injecting drug users.

The report cites estimates that show that half of the 29,000 people expected to test positive for HIV in 2000 will get the virus from spouses, or be boys and girls who engage in unsafe sex. One out of every four persons expected to test positive for HIV this year will be an injecting drug user, while only one out of five will be a commercial sex worker or client. One in seven new infections will be among children.

"Some of the riskiest behaviors in Thailand have not been addressed and now stand out as major causes of continued HIV transmission," said the report. While advising the government to keep up the "enormous achievements" in promoting condom use in commercial sex, the report urges that this be spread to all sexual relationships. Any let-up in condom use in commercial sex would lead to a resurgence of the spread of HIV, but it is also vital to encourage safe sex among other groups, it says.

This is specially needed in sexual relations among unmarried young people in the country, where condom use is a mere 12 percent. "They (young people) need broader messages concerning condom use and better access to condoms at affordable prices," said Ainsworth.

However, tackling HIV spread among injecting drug users is "not going to be easy" for Thailand, says Beyrer. HIV is spread by the practice of sharing of needles and syringes among injecting drug users with HIV and others, and it is major method of transmission in neighboring countries like Malaysia.

However, the Thai government is said to be reluctant to distribute needles and syringes - a controversial step in many countries - because it sees this as encouraging illegal drug abuse. Thailand will have to help injecting drug users just as it promoted condom usage in illegal brothels, say the World Bank experts.

"However, the pragmatic approach followed in preventing HIV transmission in commercial sex, which is also illegal, has not been followed for IDU (injecting drug users), who remain highly stigmatized, and frequently incarcerated," said the report.

The report states that nearly half of all injecting drug users in the southern parts of Thailand have HIV. "IDU will continue to be a reservoir of infection and will pass HIV not only to other IDU, but their sexual partners and children," it added.

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