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Pillow Talk

I’ve been given the opportunity of writing this month’s Pillow Talk. Most of you will know me through the monthly motorcycle column I have been writing for years. I suppose because the home office knows I am single they felt that the subject matter would be better served being written by yours truly. This subject we’re about to take a look at is almost considered taboo to talk about in Pattaya and Thailand in general. HIV and AIDS is usually only discussed when one seeks advice because they are concerned about a high risk act they took after a night out on the town or when one who is actually infected needs to inform an intimate partner of the unpleasant news. Perhaps due to the close association between Tourism and vigorous sexual activity in a place like Pattaya any issue that could tend to affect the economics of the scene whether it be crime or HIV is better avoided. Ironically, the statistics seem to indicate a profound decrease in the rate of transmission of HIV almost in every category except man to man in Thailand. I say seem, as these statistics indicate those people who have gone for treatment not those who may be infected and don’t know they are and who may be still transmitting the virus to someone else. If there is any silver lining to this horrible cloud that has plagued our generation and that of the young, it would be that World Health Organization projections made in the early 80’s were far off the mark. The following is what AVERT has to say about Thailand and HIV. I found the historical references particularly interesting. Statistics can only be found at this point up till 2005.

There are very few developing countries in the world where public policy has been effective in preventing the spread of HIV/AIDS on a national scale, but Thailand is an exception. A massive programme to control HIV has reduced visits to commercial sex workers by half, raised condom usage, decreased the prevalence of STIs (Sexually Transmitted Infections) dramatically, and achieved substantial reductions in new HIV infections.

Thailand, though, is also a reminder that success can be relative. Its well funded, politically supported and comprehensive prevention programmes have saved millions of lives, reducing the number of new HIV infections from 143,000 in 1991 to 19,000 in 2003. Nonetheless, more than one-in-100 adults in this country of 65 million people is infected with HIV, and AIDS has become a leading cause of death.

Unless past efforts are sustained and new sources of infection are addressed, the striking achievements made in controlling the epidemic could now be put at risk. Factors such as an increase in risky sexual behaviour and a rising number of STI cases have led to concerns that Thailand could face a resurgence of HIV and AIDS in coming years. The government has decreased funding for AIDS prevention programmes significantly, and there are signs that public awareness is waning. Complacency - among both the government and the public – poses a real threat to the fight against AIDS in Thailand.

The History of HIV and AIDS in Thailand

Early responses

The first case of AIDS in Thailand occurred in 1984. For the next few years, gay men, sex workers, injecting drug users and tourists were more commonly affected than other groups. The government took some basic measures to deal with the issue, but an epidemic was not yet apparent. Most of these measures were aimed at high-risk groups, as the government believed that there was not yet sufficient reason to carry out prevention campaigns among the general public.

At the same time, public awareness of the issue was increasing. The case of Cha-on Suesom, a factory worker who became infected with HIV following a blood transfusion, was widely broadcast through the media after he agreed to allow his story and identity to be publicised in 1987. He became well known after appearing on TV shows and in national newspapers, allowing the public to appreciate the human side of the epidemic. Cha-on and his wife had both been fired from their jobs as a result of his HIV-positive status, and the injustice of this situation helped to increase public sympathy for people living with HIV.

Between 1988 and 1989, the HIV prevalence among injecting drug users rose dramatically, from virtually zero to 40%. The prevalence among sex workers also increased, with studies in Chang Mai, northern Thailand, suggesting that 44% of sex workers were infected with HIV. The rising level of infection among sex workers led to subsequent waves of the epidemic among the male clients of sex workers, their wives and partners, and their children.

The prevailing view was still that HIV and AIDS had come from abroad and were mostly confined to a few individuals in high-risk groups. It was still not generally recognised that the epidemic would spread more widely. One government official insisted that the situation was under control, and stated that: “The general public need not be alarmed. Thai-to-Thai transmission is not in evidence.”

Some members of Thailand’s parliament proposed that all foreigners should be required to pass an HIV test before being admitted to the country. In keeping with the view that the threat was limited, the government only spent $180,000 on HIV prevention in 1988.

The 1990s

It was not until 1991, when a new Prime Minister, Anand Panyarachun, came to power, that AIDS prevention and control became a national priority at the highest level. The new prime minister took several important steps that have since been credited with helping to slow the epidemic. Firstly, the AIDS control program was moved from the Ministry of Public Health to the Office of the Prime Minister, increasing its political influence, and the budget was increased almost 20-fold to $44 million in 1993.

Secondly, a massive public information campaign on AIDS was launched under the leadership of cabinet member Mechai Viravaidya, a well-known Thai AIDS activist and politician. Anti-AIDS messages aired every hour on the country's 488 radio stations and six television networks, and every school was required to teach AIDS education classes.

"We converted the equivalent of 'Jingle Bells' into a safe-sex song." The high-profile campaign was initially unpopular with the influential tourism industry, and tourism indeed temporarily declined. However, once AIDS had a prominent place on the national agenda, opposition to the measures gradually faded and support increased.

Thirdly, and perhaps most importantly, the '100 percent condom program' was initiated. This program aimed to enforce consistent condom use in all commercial sex establishments. Condoms were distributed free to brothels and massage parlours, and sex workers and their clients were required to use them. Brothels that failed to comply could be closed. Without this programme, it is estimated that Thailand’s national HIV prevalence would be ten times higher than it currently is.

“When a team of reporters decided to test the 100% condom program by visiting Chang Mai with the aim of buying sex without a condom, they failed.”

A number of repressive policies, such as mandatory reporting of the names and addresses of people living with HIV who attended hospitals, were also repealed.

From 1992 to 1996, the National AIDS program received dramatic increases in funding. The government provided it with more than $80 million annually by 1996, and:

"Every segment of Thai society played a role in AIDS prevention. Everyone was involved - from the medical community to teachers, to monks, to prostitutes and to drug addicts. The government committed funds for research and backed private organisations that attempted to spread the word about how to stop AIDS. Even the powerful Thai military pitched in, running voluntary blood tests for soldiers."

Over 3.5% of military recruits aged 21 were reported to be HIV-infected in many parts of the country following a 1992 round of surveys, with a prevalence rate to 20% in Chiang Mai, northern Thailand.

The second ‘National Plan for Prevention and Alleviation of the AIDS Problem’, which covered the period from 1997 to 2001, maintained the previous effective programs, whilst adopting a more holistic approach, which included mobilizing the efforts of communities and people living with HIV/AIDS.

Iin the late 1990s, the Asian Financial Crisis resulted in a significant reduction and reorientation in the 1998 budget for AIDS prevention and control. Funding for medical interventions (including antiretroviral drug and treatment of opportunistic infections) was scaled back significantly. Support for condom distribution was also reduced. By 2000, domestic funding for HIV and AIDS prevention was roughly one quarter less than it had been in 1997.

2000 onwards

In 2000, combinations of antiretroviral drugs (ARVs) started to be used to treat people living with HIV in Thailand. This therapy, known as HAART (Highly Active Antiretroviral Therapy), can prolong the lives of people living with HIV and prevent the virus from progressing to AIDS. In subsequent years the number of people accessing ARVs increased dramatically, significantly reducing the number of people dying from AIDS. In 2000 the government also started a national system to monitor its mother-to-child transmission of HIV programme. 29

In 2003 the government made an official commitment to ensuring adequate treatment for all people living with HIV, and set targets to improve treatment access. As these plans have been carried out, the third "National Plan for the Prevention and Alleviation of HIV/AIDS in Thailand" (which runs between 2002 and the end of 2006), has worked towards the target of reducing HIV prevalence to less than 1% and providing access to care and support for at least 80% of the people living with HIV and other affected individuals.

By the end of 2005, national HIV prevalence was 1.4%, down from 1.8% in 2003 and more than 2% a decade earlier.

Thailand’s ‘Condom King’, Mechai Viravaidya – so-called due to his extensive work promoting accessible contraceptives over the past 30 years - is promoting a new campaign aimed at Thailand’s teenage population, which has a rising HIV infection rate. With slogans such as ‘if you still want to fly before your time, have a parachute’, Viravaidya hopes to target those who may have missed out on the extensive HIV/AIDS awareness campaign in the 1990s.

The current situation

• The majority of Thailand’s HIV infections (around 80%) occur through heterosexual sex.
• HIV affects more men than women in Thailand; the male-female ratio is nearly 3:1.
• HIV prevalence among pregnant women, which reached a peak of 2.35% in 1995, had fallen to 1.18% by 2003.
• The distribution of antiretroviral drugs has coincided with a dramatic drop in the number of officially reported AIDS-deaths – from 5,020 in 2004 to 1,640 in 2005.

So there it is. Good news and bad news. Decreases are good and complacency is bad. Until there is a vaccine available, all of us, single or married, heterosexual or gay will need to be responsible in this area. Some guys I know, opt to narrow down their odds by finding a regular girl rather than playing the field all the time. If I could only find one that doesn’t mind cooking, cleaning and taking care of my snakes then I would rather do the same. Until that time, I will practice the policy of always wearing a raincoat. Or better put and used in the Motorcycle Story, Ride Safe and Enjoy.

Regarding testing:

Dr. Oliver’s Clinic, (advertising in this book) does good fast all aspect testing and in a very discreet manner. He is also a Farang (Foreigner) who speaks perfect English and will tell you what you need to know straight. If you plan on spending considerable time with a woman having both you and her tested is a great idea and not very expensive.