SAFETY FIRST! Text by Nanni Fontana

“Average awareness on HIV and Aids among the population is still incredibly low. Increasing knowledge and educating the next generations on the epidemic is the major challenge we face today” says Professor Praphan Phanuphak, long time Director of The Thai Red Cross AIDS Research Center in Bangkok and co-founder of the HIV-NAT, a research organization born thanks to the collaboration between Thailand, the Netherlands and Australia.

In the shifting landscape of the global HIV/Aids epidemic, Thailand is one of the very few developing countries in the world where public policy has been an effective response in preventing the spread of HIV and Aids on a national scale. Since its very first case of Aids, reported back in 1984, HIV prevention and control have always been a national priority at the highest level. In the last fifteen years, HIV prevalence was reduced by an estimated 45% while in the last decade the incidence of new infections among the population has fallen by more than 25%.

Despite the industry disapproval, Thailand was also among the first countries to break patents on Aids drugs. “Today we’re still on the pharmaceuticals’ black list – admits Mongkol Phocee, a nurse at the Mercy Center for the last eleven years – but thanks to GPO-VIR, the anti-retroviral produced by the Government, we have been able to lower the cost of the monthly treatment for each person from almost 30.000 Bhats (around 1.000US$) to less than one thousand”. The production of generic drugs within governmental health programs increased dramatically the number of people accessing care and support, even though there are still some 280.000 people in need of ART who don’t know they can access it for free.

Thailand, though, is also a reminder that success can be relative. Data on the current status of the epidemic – there are still 480.000 people living with HIV today, mostly in Bangkok and urban areas – are giving a warning signal of a reverse to an increasing trend in some most at risk groups. In fact, even though the majority of new HIV infections in the country have occurred among injecting drug users for a long time, since Thailand has become a destination par excellence for sex tourism around the world things have changed for the worse and prevention programs have, more than ever, become crucial.

At Wat Phra Bat Nam Phu - a Buddhist Temple in Lopburi that runs a hospice for people dying of AIDS - there are organized tours where visitors can meet patients and hear their first-hand stories and, since 1992, there’s also a controversial AIDS museum where visitors can see the embalmed bodies of those who have donated them before dying of AIDS related causes. “Today the majority of new infections – says Nuengluetsai, a 24 years old staff nurse at Wat Phra Bat Nam Phu – occur because of risky sexual behaviors. Even though patients treated here are predominantly males, in Thailand the majority of HIV+ people are women. Mostly prostitutes, ex prostitutes or female partners of men who have contracted the virus having sex with a prostitute”. If, on one hand, according to a study on Thailand’s underground economy by the Chulalongkorn University in Bangkok, sex tourism contributes almost to 3% of the country GDP, on the other hand, domestic prostitution is a definitely bigger phenomenon. There are an estimated 450.000 Thai males that have sex with female prostitutes on a daily basis. Among sex workers there are many foreign migrants who have higher levels of HIV infections than their Thai counterparts.

Among their clients, many are as well migrant workers from lower-income neighboring countries such as Burma, Cambodia and Laos. Only a fifth of them are legally registered and “poverty, cultural differences, difficult working environment, language difficulties or fear of arrest and deportation often prevent them from accessing information about HIV and AIDS, as well as healthcare and other social services” says Jeab, a 28 years old volunteer at Raks Thai Foundation’s PHAMIT Project (Prevention of HIV/AIDS among Migrants Workers in Thailand). “In 2010 – she continues – 27.5% of migrant workers under the age of 25 years had more than one sex partner in the past 12 months and the use of condoms during sexual intercourse, especially among fishing boat crews, was very much inconsistent”.

In general, changes in Thai society in the midst of socio-economic challenges and lowered budgets on prevention have led to an 85% of Thai youth who don’t see HIV as something that they should be concerned about. The government's complacency during the first half of the last decade, its huge cuts on the HIV prevention budgets and the shortage of care and support programs has probably contributed to an always growing lack of awareness of HIV and AIDS. People living with HIV continue therefore to encounter high levels of stigma and discrimination and any time there is a misunderstanding about AIDS, the idea that HIV+ people have a different set of rights than the uninfected gets stronger.