 Thailand’s sleaziest beach town, Pattaya, derives a large part of its income from prostitution and tourism |
Can Thailand meet new challenges in HIV prevention? Gus Cairns reports from Bangkok in the first of a two-part feature
Thailand is still one of the few countries worldwide to mount a really effective HIV prevention campaign. But it is struggling to adapt its safer-sex messages to meet changing behaviour. HIV stigma makes getting treatment problematic, and a violent ‘family values’ crackdown against drug users, sex workers, women seeking abortions and gay men has recently intensified this stigma. Touchy about its reputation, the government is belatedly promising a crash programme to get HIV drugs to at least half the people who need them by the end of 2004.
 The Bangkok branch of Cabbages and Condoms restaurant |
Thailand, of course, is also the venue for this year’s International Aids Conference in July.
The Mercy Centre is only a mile or so from the girly bars of Patpong, but it’s not where the tourists go. The largest Aids hospice in Thailand is down a dead-end street in Klong Toey, Bangkok’s largest slum, a warren of tiny shops and shacks squeezed between the port and the freeway. There are many children, much poverty and drug use.
 Father Joe Maier and assistant, Usanee |
“ If you’re worth your stuff, you can visit us again,” Father Joe Maier tells me on my recent visit. The punchy style is typical of the 64-year-old Catholic priest, who has worked in Thailand for 30 years and who set up his Human Development Foundation to work with the poorest of the poor.
“We started working with Aids because it was there. Suddenly, about 11 years ago, we became a dumping ground for the terminally ill. We set up a hospice; 60 people died here in the first 45 days, some simply due to rejection.
“
It compelled us to work with the families. Initially we tried to get them to
visit and we were zero per cent successful. Now, if they won’t visit,
we take the patients to visit them.”
Usanee Jangeon, Father Joe’s assistant, a Buddhist nurse who trained
at St Thomas’s Hospital in London, shows me round. Patients smile at
me and perform the Thai palms-together ‘wai’ or hello salute. A
huge-eyed little girl regards me gravely, peering through the railings from
the first-floor landing.
“She has a lung disease,” says Usanee, “KS, maybe - and won’t live long. She can’t walk far and just likes to watch everything from that perch.” There are 41 kids with Aids in the hospice currently, of which only three have living mothers; the rest are orphans.
Counselling and spiritual support are essential to combat the terrible isolation of Aids, in a country where family is central to everything. Even when people are treated and do well on antiretrovirals they are often rejected by their families and this can prompt the desperate reaction: “If my own family don’t want me what is the point of living?”
A recent survey also showed that the worst stigma people experienced was at the hands of the medical profession. Usanee worries: “How are the hospitals, who routinely turn people with HIV away, going to be involved in the new treatment campaign?”
 The open air gym in Lumphini Park, next to Bangkok’s biggest gay cruising area |
HIV and Aids are bubbling under the surface and even as a tourist you only have to know the clues to see them. Pattaya, Thailand’s sleaziest tourist beach town, derives a large proportion of its income from prostitution despite the efforts of local politicians to promote a family-resort image.
Of course, it is easy to blame tourists for the extraordinary Thai sex industry, which involves half a million prostitutes of both sexes and foreign exchange earnings of getting on for £1bn. Among those currently most in danger of HIV in Thailand are, ironically, the mia luang (official wives) of Thai men, who, traditionally placed on a pedestal or left to get on with their own lives in between producing heirs, are vulnerable to their husbands’ wanderings.
The HIV rate in monogamous married women is, as it is in other Asian countries like India, climbing fast. UNAID Deputy Director Kathleen Cravero recently noted: “In Thailand, 40 per cent of HIV infections occur between spouses, with 90 per cent of them from husband to wife”
Another concern is that the stigma against HIV means that it is almost universally
talked about in terms of the opportunistic infections it brings rather than the
virus itself, and no more than 25 per cent of Thailand’s million people
with HIV even suspect they have it.
The infection rate is as usual concentrated in the vulnerable groups. In Thailand,
fifty per cent of drug users have HIV. Officially, 13 per cent of female sex
workers, though the figure is likely to be higher. And 20 per cent of gay men.
Back in Bangkok, as you stroll across Lumphini Park, one of Bangkok’s few green spaces, you pass an open-air gym where bodybuilders get themselves into trim for a stint at the boy bar. Next-door is a tree called the White Witch Bush, which, as it gets dark, is the focal point of Bangkok’s biggest gay cruising area.
It is also where the Rainbow Sky Group hold their open air meetings, where they teach gay guys how to use condoms and how not to get arrested for carrying them.
 ‘Ohm’, Rainbow Sky Co-ordinator |
Across the other side of the park is a converted water tower. On its ground floor is The Anonymous Clinic, Bangkok’s first ever dedicated HIV clinic. And in a little office at the top of the tower I find Rapeepun ‘Ohm’ Jommaroeng.
“I’m Co-ordinator of Rainbow Sky, Thailand’s only registered gay non-governmental organization,” says the 25-year old ex-journalist, proudly.
Rainbow Sky runs a phone helpline, fun events like sports days and parties, and a series of extraordinary HIV Prevention and Life Skills workshops that whisks 35-70 gay men at a time out of town and puts them in a remote national park centre for a week.
Ohm explains there is a big divide between the Pink Pound culture of Bangkok barland, which runs things like the annual Gay Pride, and the gay life happening in parks and villages all round the country. He says: “Gay men are not valued here. Even with Aids, they’d just be patched up and let go. There is no real social network.
“ People are terrified of exposure. The police harass cruisers in the park for carrying condoms. They can’t do anything criminally - cruising is not a crime. What they do is threaten exposure.”
It is a weapon former Interior Minister Purachai Piemsombun used to devastating effect when in 2001-2 the police staged a series of raids on Bangkok saunas, parading the usually middle-class customers in their towels on national TV news for their families to see.
“ The police arrested all the customers, put them in a van and took them to the police hospital, where they forced them to do blood and urine tests. What for? It was purely done in order to frighten.”
Thailand’s epidemic of sexually-transmitted HIV could have been a lot worse. The fact that the incidence in young men was brought down from 2.5 per cent a year in 1991 to 0.5 per cent in 1993 is largely down to one man: Senator Mechai Viravaidya, who is also Community Co-chair of the Bangkok Aids Conference.
 Senator Mechai Viravaidya, mastermind of the ‘Cabbages and Condoms’ and ‘100% Condom’ campaigns |
Mechai, 63, has devoted his life to improving rural poverty in Thailand. In the 1960s he was already convinced that overpopulation was a main driver of poverty and set up his Population and Community Development Association. But the thing he’s best known for is popularising the condom, first as a family planning measure and latterly as the defence against Aids.
Mechai toured schools and villages, blowing up condoms as he went. ‘Senator Condom’ then set up a chain of restaurants and resorts called Cabbages and Condoms (the name meaning that it should be as normal to buy a condom in a village marketplace as a cabbage). Condoms in Thailand are still called ‘Mechais’. In 1989 he launched the 100% Condom Campaign, targeting the people most likely to respond to pressure: the owners of the brothels which 90 per cent of Thai men were visiting.
This hugely successful campaign reduced an annual incidence of 100,000 new HIV cases to16,000 at the lowest point. “I haven’t seen anything like it anywhere else in the world,” said one health expert at the time.
But things change, and incidence is now running at about 55,000 new cases a year.
And, crucially, the 100% Condom Campaign was never matched by a 100% Clean Needles Campaign among intravenous drug users, until last year the HIV prevalence in drug users climbed relentlessly upward, peaking at 50% in 2001. Mechai is facing the fact that he may have to start a whole new Aids campaign.
Prime Minister Thaksin has initiated some progressive social policies such as interest-free village development loans and the 30-baht health scheme, where you can pay the equivalent of 42p and get GP-style health care (HIV treatment was expressly excluded from this scheme till the activities of Aids activists - see next month - forced its inclusion).
But, though taking care not to be directly responsible for it, Thaskin also initiated the Social Order Campaign, an attempt to pull back on the country’s reputation for sleaze and to ‘restore Asian Values’.
In 2001-2 Interior Minister Purachai Piemsombun waged a one-man war against underage drinkers and closed down go-go bars featuring pubescent prostitutes. Bangkok used to swing all night, but Purachai imposed a countrywide closing time of 2am, which will be further pulled back to 1am or even 12 midnight this spring. He also had the gay saunas raided.
The next part of the campaign drew international condemnation. At the beginning of 2003, local police led by Purachai’s successor, Wan Muhamad Nor Matha, went on a semi-sanctioned rampage of ‘extra-judicial killings’ of drug users, killing 2,600. They denied it, saying most of the killings were one drug dealer killing another to avoid being exposed.
But press photos were taken of officers standing proudly next to ‘dealers’ corpses. A nine-year old boy whose parents were on the list of suspects was shot down in front of hundreds of people in central Bangkok.
The next phase of the social order campaign appears to be against abortion clinics and Senator Condom is already getting ready to wage war against the government’s regressive anti-abortion measures. “I’m not afraid of anyone,” he stresses, “I’m happy to become Mr Abortion as well as Mr Condom.”
Exactly how this all gained the attention of the one person in Thailand who can tell Thaksin what to do - the King - and helped put energy into the campaign for Aids Treatment is a subject we’ll cover next month.
Next month: treatment access in Thailand
11-16 July 2004 XV International Aids Conference Bangkok: www.aids2004.org
