Background
Thailand lies between the Andaman Sea and the Gulf of Thailand just south of Myanmar and Laos and north/northwest of Cambodia. Since unified as the kingdom of Siam in the mid-14th century, Thailand remains the only Southeast Asian country never ruled by a European power. After a bloodless revolution in 1932, Thailand became a constitutional monarchy guided by a written constitution that outlines the monarch’s responsibilities and duties. In September 2006, a military coup removed Prime Minister Thaksin Shinawatra and his government from power. Thailand is currently being ruled by an interim government, which has promised to deliver a new constitution by October 2007.
The economy is heavily driven by tourism, with the services industry accounting for 46 percent of Thailand’s gross domestic product. Although most visitors come to see the natural beauty of the fertile lands and beaches, a small portion visit Thailand as “sex tourists” who frequent the brothels in Bangkok, Chiang Mai and other major cities. Said Sudarat Sereewat, director of the Coalition to Fight Against Child Exploitation: “A lot of people want to come for the weather, the culture, the cheap prices. … But the big problem is that there are many factors that made Thailand a paradise for these sex tourists: weak law enforcement, technology and things like that.”
The face of HIV
The sex industry played a major role in the spread of the HIV/AIDS epidemic in Thailand, which recorded its first case of AIDS in 1984. Men who have sex with men (MSM), sex workers and intravenous drug users fueled the epidemic, which peaked at 143,000 new cases in 1991. In 1988 the government spent only the equivalent of $180,000 on prevention because of a belief that it was a foreigner’s disease. In 1991, Anand Panyarachun became prime minister and made AIDS prevention and control a national priority. Thailand spent $44 million in 1993 on efforts to curb the spread.
Alongside this new government policy, a massive media campaign was launched by cabinet member Mechai Viravaidya in which AIDS awareness messages were aired on the hour on all radio stations and the six television stations. A “100 percent condom” program was also initiated, enforcing correct and consistent condom use and providing free condoms for all commercial sex workers and their clients. The combination of programs produced the necessary results, with the annual number of new cases falling dramatically to about 19,000 by 2003.
Challenges to fighting the HIV epidemic
Thailand’s government received accolades from governments and nongovernmental agencies (NGOs) around the world for its quick response and early containment of the disease. However, several NGOs and activists warn that Thailand needs to reevaluate the communities it has targeted and recognize that the face of AIDS is changing in the country. Thailand’s prevention efforts and campaigns have dwindled noticeably in the past decade, and some fear that high-risk groups, which now include young people, are going to suffer the consequences.
Rapeepun Jommaroeng of Rainbow Sky Association, an NGO working with MSM in Thailand, said that because of tradition and custom, sex is still a taboo subject, leaving the younger population in the dark about the consequences of unsafe sex. “If you can’t bring sex to the table, you can’t talk about a prevention campaign.”
Overall prevention campaigns are less prominent than they were in the 1990s, and as the United Nations Development Program HIV report on Thailand found, prevention services for young people are adequately reaching only 5 percent of the population. According to the report, only 20 to 30 percent of youth who are engaging in sexual activity are consistently using a condom. Youth today are too young to remember the messages that were so prevalent nearly a decade ago, and without an adequate reinforcement of the message, they are at risk of giving rise to a new wave of the disease, the report warns.
Thai government response
After the coup d’etat in Thailand in September 2006, an interim government has been set in place. In an effort to deal with a marked deficit and overspending by the former government, the budget was substantially changed and Thailand is struggling to keep funding for prevention efforts.It is likely that the new government will try to make positive changes to the HIV/AIDS programs, although it remains unknown at this time.
One of Thailand’s major accomplishments in HIV/AIDS treatment is being able to supply 20,000 HIV-positive people with free antiretroviral drugs, which have been credited with transforming HIV/AIDS from a fatal condition to a manageable illness. Thailand produces generic drugs that cost only $300 annually per patient, which is far less than the $8,000 that the Kaiser Family Foundation says that brand-name drugs would cost in the U.S. and European countries. The government announced in June 2006 that it hopes to continue reaching out in this way to more HIV-positive people this year. In collaboration with the Joint United Nations Program on HIV/AIDS and the World Health Organization, the Thai government has come up with a National Plan for HIV/AID Vaccine Development, a program designed to foster research and development of a safe and affordable vaccine for HIV through strategic planning, research and clinical trials.
U.S. government response
Although Thailand is not among the 15 “focus countries” receiving special emphasis from the President’s Emergency Plan for AIDS Relief, it has received $22.4 million under PEPFAR, the five-year, $15 billion U.S. initiative to combat HIV/AIDS. A program PEPFAR sponsors is the Human Development Foundation’s Mercy Center located in Bangkok. People who are HIV-positive can obtain antiretroviral treatment from the center, as well as hospice care and outreach education. The facility reaches out to people living in the slums surrounding Bangkok.
Under the Global AIDS Program, two U.S. agencies, the Department of Health and Human Services and the Centers for Disease Control and Prevention, also work in Thailand; they provided $5.7 million in 2004. Their work there has provided help in coordinating and educating volunteer staff in counseling services. The program also funded technical services to implement a monitoring system for prevention of mother-to-child transmission of HIV.