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About the HIV situation in
Thailand, written before the Bangkok World Aids Conference...
Trouble
in Paradise
(PNs 101 & 102, May & June 2004)
Can Thailand meet the new challenges of HIV? Gus Cairns reports from Bangkok.
In the first of a two-part piece, he looks at how HIV prevention is changing in
the land that hosts this year’s World Aids Conference
The first country in its region to be badly affected by HIV, Thailand was also
the first country – and is still one of the few worldwide - to mount a really
effective prevention campaign. But it is struggling to adapt its safer-sex
messages to meet changing behaviour. A violent ‘family values’ crackdown against
drug users, sex workers, women seeking abortions and gay men has recently
intensified this problem. Touchy about its reputation, the government is
belatedly promising a crash programme to get HIV drugs to at least half the
people who need it by the end of 2004.
The Face of AIDS
I’ve been visiting Thailand as a tourist for five years. But I hadn’t asked
about HIV, or seen much of the real Thailand.
I’m seeing it now. 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 Khlong 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 much heroin.
“If you’re worth your stuff, you can visit us again,” Father Joe Maier tells me.
The punchy style is typical of the 64-year old Catholic priest, who has worked
in Thailand for 30 years and set up his Human Development Foundation (HDF) to
work with the poorest of the poor.
“We set up our first day school for these kids who lived above a slaughterhouse.
Now we have 33 preschools catering for all denominations.
“We started working with Aids because it was there. Suddenly, about 11 years
ago, we started getting sick people coming to us. 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’s compelled us to work with the families. Initially we tried to get the
families 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 and a nurse who trained at St
Thomas’s Hospital in London, shows me round. The building, centred round a cool
courtyard containing an incongruous Christmas tree, houses three adult wards –
one a TB isolation ward - two children’s wards, a nursery, a craft room, and the
Outreach Team office which faces on to the street.
Stick-thin patients smile at me wanly and ‘wai’ (perform the Thai palms-together
‘hello’ salute). A nine-year old boy is the craft room is creating a beautiful
batik mural. 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 is essential to combat the terrible isolation
of Aids, in a country where family is central to everything.
“We had one guy who was picked up paralysed, on the brink of death,” said Usanee.
“We treated his TB, gave him antiretrovirals. He was in hospital for six months
and in our hospice for seven, doing so well. He wanted to visit his wife and
daughters. He was so alive in the car on the way there.
“We arrived and he was told his family had moved out. On the way back his face
was a terrible thing to see. He refused all food and medications. We said
‘You’ve had a year of treatment. Why give it up now?’ He said ‘If my own family
don’t want me what is the point of living?’”
Such stories still happen. Aids Patient’s Mum Threw Out Belongings, Banned her
from Home, reads a story in the New Year’s Day issue of the Bangkok Post.
Such incidents drove the HDF to become an education and outreach project,
something Usanee now sees as its most important task.
“We have 45 workers and 400 trained family members – many of them people with
HIV, because otherwise the people say, ‘How do you know what it’s like, you
don’t have Aids’. It’s basic level stuff because people still think you can get
it from touch, from drinking water, from mosquitoes. We go to schools, to
factories – in factories we might run a programme for six months because there’s
only a 30-minute lunch break in which to teach people. On World Aids Day we
invited 300 students from five different schools in for an all-day Aids
workshop.”
She is concerned about the government’s drive to get people on treatment. “They
can’t implement their own Aids programme now,” she says. “How are the hospitals,
who routinely turn people with HIV away, going to be involved in the new
campaign?”
Beach Interlude
HIV and Aids are bubbling under the surface and even as a tourist you only have
to know the clues to see them. In between interviews, I visit an old friend in
Pattaya. Blackpool crossed with Sodom, Pattaya is Thailand’s sleaziest tourist
dive, deriving a large proportion of its income from prostitution, despite the
efforts of local politicians to promote a family-resort image.
So I am not too surprised when minutes after I settle down on the beach with a
book, Jit, 19, wants to get to know me better. He says he’s never visited
Pattaya before, which I don’t believe for a second.
The bits I do believe are that he’s from in the poverty-stricken Isaan area of
north-east Thailand, from Udon Thani, a town described by the Rough Guide as
‘charmless…a sprawl of grey cement’. And that he was earning 5,000 baht (£70.26)
a month in a shirt factory there (slightly more than the statutory minimum wage,
which is £62.50 a month). This puts into perspective his disappointment when I
decline his services, given that the tourist rate per trick is about 1,000 baht.
It is easy to blame tourists and their predecessors, GIs on leave from Vietnam,
for the extraordinary Thai sex industry, which involves half a million
prostitutes of both sexes and foreign exchange earnings of getting on for £1bn.
But prostitution, though technically illegal, is deeply entrenched in Thai
culture. Every small country town has brothels catering for Thai men and it is
culturally quite acceptable for men who aren’t rich enough to afford a mia noi
(a ‘minor wife’ or mistress) to visit them regularly. 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.
Jit also has a nasty dry cough. “You should take something for that,” I say.
“The doctor give me some pills for it….set…sep…”
”Septrin?”
“Yes, Septrin.”
Now this is a country where you can buy anything over the pharmacy counter from
Viagra to snake’s blood pills, but I still wonder why a doctor found it
necessary to prescribe medicine used to treat PCP for a chest cold.
Jit wouldn’t necessarily make the HIV connection himself. 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.
This 1.6 per cent infection rate is low by African standards but 7-15 times the
rate in Europe and the US. Furthermore it is, as usual, concentrated in the
vulnerable groups. 50 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.
Meet me by the White Witch Bush
Back in Bangkok, I stroll across Lumphini Park, one of Bangkok’s few green
spaces. On the way you pass an open-air gym where preening bodybuilders get
themselves into trim for their stint at the boy bar. Next door is a garden
featuring a tree called the White Witch Bush – which later, as it gets dark, is
the focal point of Bangkok’s biggest gay cruising area.
It’s also where the Rainbow Sky Group hold their open air meetings, where they
teach gay guys – local Thai guys very different from the westernised youth you
see in bars – how to use condoms. And how not to get arrested for carrying them.
Across the other side of the park is an extraordinary cylindrical building – 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
is Rapeepun ‘Ohm’ Jommaroeng, Co-ordinator of Rainbow Sky.
“We’re Thailand’s only registered gay non-governmental organization,” he says,
proudly. “That means you have to be approved by the Ministry of Culture – so gay
life is now officially a cultural activity!”
There is, he explains, 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.
“Outside Bangkok Katoey (ladyboy) culture is still strong. If you’re gay in the
villages, if you want real love with the guys, you have to change your sex.”
The young (25) journalist was all set for a career in Australia when, on a trip
back home, he went cruising by the White Witch Bush and came across members of
the Wednesday Friend’s Club, Bangkok’s oldest organization for people with HIV.
They started off with an ‘office’ there but now have a proper one that organises
a phone help line, 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,
“where they can’t escape!”
Ohm says: “Gay men are not valued and don’t value themselves here. Even with
HIV, they’d just be patched up and let go. There was no real social network, no
meeting place. We established Rainbow Sky simply as somewhere for them to return
to.”
It also recently did the first-ever survey of HIV prevalence among gay men.
There had been a presumption that men who had sex with men would pick up on the
same ‘100% condom’ message directed at the commercial sex industry. But what
researchers found was that unless you were a ‘money-boy’ or involved in the bar
scene, that knowledge did not transmit.
They approached men cruising in bars, parks and malls and took a saliva swab to
test for HIV. They gave them a card with an identifying bar code on it and said
“You’ll get 200 baht if you come to the clinic for your result and bring one
friend with you.”
They found that one in five of the Lumphini Park cruisers had HIV.
Astonishingly, there still isn’t a gay-specific HIV organisation in Thailand.
“TNP+ [the Thai Network of People Living with HIV, who we talk to next month]
want to set one up but are having difficulty in finding people who’ll identify
themselves,” says Ohm.
“Thailand has wonderful laws. For instance, we found that there’s nothing in law
which says two men can’t get a civil marriage! But people don’t know their
rights.”
Ohm talks about the way the police harass the Lumphini Park cruisers and the
patrons of the many gay saunas.
“The police will use as evidence against cruisers in the park the fact that they
are carrying condoms. They can’t do anything criminally – cruising is not a
crime. What they do is threaten exposure. People are terrified of that.”
It’s 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 young and middle-class customers in their towels on
national TV news for their families to see them.
“It’s all politics,” says Ohm. “The owner of Pharos [Bangkok’s second biggest
sauna] was in the previous government.
“What the police did was 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? We have no idea. It was purely in order to frighten.
“A person in that group complained to the National Anti-Corruption commission so
the next time they kept people in custody and told them they’d hold them till
they signed consent forms for the blood tests.
“The really bad thing was that all the saunas stopped providing condoms because
the police said it was evidence of sex on the premises.”
Senator Condom
Even the pioneer of condom use in Thailand is having troubles. A few days later
I go to a cool white building off Sukhumvit Road, Bangkok’s busiest shopping
street, to talk to Senator Condom.
Thailand’s epidemic of sexually-transmitted HIV could have been a lot worse. The
fact that the rate among soldiers is now 2.5 rather than 10 per cent, and that
only one million rather than 1.5 million people in Thailand have HIV, is down to
one man – Senator Mechai Viravaidya, who is also Community Co-chair of the
Bangkok Aids Conference.
Mechai, 63, of mixed Scottish/Thai ancestry, 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 had set up a network of family
planning clinics, which later became his Population and Community Development
Association. The block next to his office (a floor of which he has turned over
to the Bangkok Aids Conference team) is emblazoned with a huge sign saying
NON-SURGICAL VASECTOMY CLINIC.
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. He got people
making condom flowers and condom tables and condom T-shirts. He 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 market place as a cabbage).
Condoms in Thailand are still called ’Mechais’.
So he was ideally placed to co-ordinate Thailand’s anti-Aids campaign when it
became clear that the culture of commercial sex threatened to plunge the country
into an Aids holocaust. In 1989 he launched what became the 100% Condom
Campaign, targeting the people most likely to respond to pressure – the owners
of the brothels which 95% of Thai men were visiting.
The police informally licensed brothels and ensured the sex workers had regular
health checks. So they could put pressure on the owners to ensure that clients
demanding unsafe sex would be banned, and that establishments that allowed it to
happen would be put out of business.
The campaign was stunningly successful, cutting off the chain of infection near
its source and reducing an annual incidence of 100,000 new cases to 16,000 at
the lowest point. The incidence in young men was brought down from 2.5 per cent
a year in 1991 to 0.5 per cent in 1993. “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. In some ways the 100% Condom Campaign was a victim of its own success:
Thai men stopped using brothels to get their sexual kicks and started having
regular on-the-side girlfriends. Western patterns of sexual behaviour also
caught on, ranging from serial monogamy in straight teenagers to the growth of a
westernised, non-prostitution-based gay scene in places like Bangkok and Phuket.
‘Thai Teenagers Shunning Condoms, Health Ministry Warns’ ran a news headline in
November, finding that only a quarter of Thai teens were using condoms with
girlfriends they knew.
And, crucially, the 100% Condom Campaign was never matched by a Clean Needles
Campaign among intravenous drug users – with the result that until last year the
HIV prevalence in drug users climbed relentlessly upward, peaking at 50% in
2001. Belatedly, a few methadone and needle exchange programmes have been
started.
Mechai is facing the fact that he may have to start a whole new Aids campaign.
“I’ve been a feather duster tidying up Aids the last few years,” he says. “The
feather duster will have to become a crowing rooster again.”
A man of boundless energy and humour, he is, as ever, full of new ideas. He’s
launching a scheme called Cops and Robbers where the police will hand out
condoms with traffic-violation tickets. Every school in the country will have
four afternoons of Aids activity pinned round the Bangkok Aids Conference. HIV
storylines are being levered into the country’s melodramatic soap operas. Mechai
is sponsoring a study to see if lemon juice can be used as a cheap microbicide.
He’s contemptuous of the current anti-condom feeling in the USA. “We don’t care
what USAID (the DfID equivalent) thinks. They can drown in their own stupidity.
90 per cent of our funding is Thai money anyway.”
But a bid to put condom machines in student lodgings was turned down by
university teachers (and the students’ union). Although Mechai claims “the
general public just laughs at this hypocrisy. We’ll just put condom machines
outside the fence”, this little skirmish is symbolic of a major barrier Aids
activists now have to climb; an attitude of New Puritanism brought in by the
government elected in 2001 and its charismatic Prime Minister, Thaksin
Shinawatra.
Prime Minister Thaksin and the Social Order Campaign
Thailand’s economy imploded when the baht’s value halved in 1997. It limped
through recession until January 2001 when the Democratic Party was ousted by a
brand new party, ThaiLoveThai, created by Thaksin, a billionaire businessman who
owned the country’s major telecom company but had no previous interest in
politics.
The Sylvio Berlusconi of SE Asia, Thaksin Shinawatra spent the first few months
of his government swatting away corruption scandals and has an autocratic image.
But he is now in a position of unassailable popularity, having delivered six per
cent growth for the last two years. Thais feel they could do a lot worse: this
is a country that was under military rule as recently as 1992.
Thaksin is a kind of right-wing populist. He 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 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 the
freewheeling club and sex culture. He personally attended police raids on clubs.
Alcohol licences had never previously been taken seriously, but Purachai chased
out 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.
As we saw above, he also had the gay saunas raided.
The next part of the campaign was much more dramatic, and drew international
condemnation. Purachai’s successor, Wan Muhamad Nor Matha, decided to wage war
on ‘drug dealers’ – which in practice meant drug users.
War meant just that. At the beginning of 2003, local police 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 ‘silencing killings’ –
one drug dealer killing another to avoid being exposed. But press photos were
taken of them 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.
Mechai is now having some problems of his own. The next phase of the social
order campaign appears to be against abortion clinics.
“The police raided my clinic next door,” he tells me, “like there were gangsters
in there.
“Somebody had ‘complained’ we were doing illegal abortions. The police said,
‘We’ve found no evidence of abortions but found seven women waiting for them’
“Well, I called them to my office and summoned someone from the Health Ministry
and said that section 30 of the Thai Criminal Code permitted a woman to have an
abortion for the sake of her health and that the WHO definition of health
includes mental health.
“I’m not afraid of anyone. I’m happy to become Mr Abortion as well as Mr Condom.
If institutions won’t do abortions the quacks will do them. As for condoms, I
now find I’m having to plead with the gay saunas to ignore the harassment and
start providing condoms for their customers again.”
“When Aids first came to this country some of the proposals put forward were
unbelievable – incarceration in leper colonies, and so on. We were under
military rule then.
“No one in this democracy is going to hold us to any standard that is
regressive.”
Paisan's Story
In his own way PM Thaksin wants to be progressive, too. That’s why he is
mounting his bold plan to get 70,000 people on HIV drugs by the end of the year.
But I discovered that without the courageous work of ordinary Thai people with
HIV, Thaksin’s treatment plan could never have got off the ground.
And an old enemy might yet stall the programme in its tracks, or lead to huge
complications as very sick people become resistant to the drugs. The old enemy,
of course, is the stigma of Aids.
One person who has never bowed to Aids stigma in Thailand is Paisan Tan-Ud. The
skinny, intense 37-year old was diagnosed 12 years ago at a recovery centre for
drug addicts. He was the first chair of the Thai Network of People Living with
HIV and Aids (TNP+) and now heads his own organisation, the Thai Drug Users
Network.
“I was part of the group that set up the Wednesday Friends Club at Chulalongkorn
hospital, Thailand’s first support group for people with HIV, in 1991.
“I was seeing so many of my friends dying or living in fear I felt we had to
become more active, to become a force for change instead of just for support. In
about 1999, shortly after TNP+ started, we saw what was happening in the west
and decided we had to focus on treatment. Without treatment, there is nothing
for us.”
Paisan says that one of the biggest barriers for people with HIV to overcome
was, and still is, the attitude of some of the medical profession.
“Doctors had no ability to treat and a terrible attitude towards us. The
prevailing idea was that we were bad people for having done this thing to
ourselves. Even now, many doctors think: ‘They’re going to die anyway’.
“We responded with ‘We will die if we have no information’. We started training
people to train their doctors. Now things are moving fast. The government wants
to set up an HIV Comprehensive Care Centre in every one of the 800 public
hospitals in the country. Every centre will include two people living with HIV
as part of their staff. They have already set up 100 centres.”
So he’s optimistic, then?
There is a long pause.
“Hmm. It’s going to be very complex getting people on to antiretrovirals. I
haven’t heard much about how they are going to encourage people to come forward
for treatment.
“Also, 75 per cent of the drugs dispensed are intended to be GPOvir, the
3TC/d4T/nevirapine combination made by the Government Pharmaceutical
Organisation [currently priced at 1,250 baht or £17.58 a month].
“Second line regimes – efavirenz for people who can’t tolerate nevirapine,
boosted indinavir for people with NNRTI resistance - will be much more
expensive.
“Also, the government can only afford to pay for a CD4 count every six months
and a viral load test every two years. How will we know if people fail?
“We will really fuck this up if we don’t plan it properly.”
The junkies and the King
Paisan is also finding that the recent crackdown on drug users has made it much
more difficult for patients to come forward.
“The treatment centres are empty. Drug users do not want to identify
themselves.”
He has never been afraid to do this, however. The Thai Drug Users Network was
born at the Chiang Mai 14th International Harm Reduction Conference in April
2003. At the height of the government-sanctioned murders of drug users, a group
of them stood continuously outside the conference, silent witnesses to the
terror around.
“We mounted the only public demo against the Prime Minister during the drug war.
Other organisations said we should call ourselves the Former Drug Users Network.
We said ‘No, not at all. We are who we are’.”
They didn’t stop there, either. On 4 December 2003 the Thai Drug Users Network
held a demonstration outside the royal palace in Bangkok, during the
celebrations of the King’s birthday. They wanted to make sure the Prime Minister
kept his word, and there was only one person who could make him do it. His
Majesty King Bhumibol Adulyadej, the world’s longest serving monarch.
You can only understand exactly how revolutionary a bunch of druggies
petitioning the monarch is if you’ve been to Thailand. The King is revered. No
King, no Thailand, is the feeling.
The King, of course, never makes his feelings public. But what he says goes. And
the word is that he told Prime Minster Thaksin to curb his addiction for killing
drug users, and to concentrate on treating them instead.
Suing for Cheap Drugs
Paisan is not the only activist to have been instrumental in securing treatment.
Kamon Uppakaew is the current chair of TNP+. The former engineer caught HIV, he
thinks, from a visit to a sex worker in 1994 and was diagnosed in 1996 when he
applied to work at a truck factory in Taiwan. He turned activist instead.
He was part of the group that broke the back of drug company monopolies by
winning a case against the pharmaco Bristol-Myers Squibb and the Thai
government, and forcing BMS to drop enforcement of their patent right for the
drug ddI (didanosine).
Kamon says: “According to section 51 of the Public Health Act there is room for
the government to issue a compulsory licence to manufacture a patented drug in
‘emergency conditions’.
“The Government Pharmaceutical Organisation was going to manufacture ddI but BMS
threatened to sue them. So they made it as a powder, since the patent BMS was
enforcing was for the buffered tablets, but the powder was very difficult to
tolerate.
“We asked the government why they didn’t invoke section 51 and it was clear they
were afraid of being shut out of the World Trade Organisation.
“So we decided we couldn’t rely on the government and formed our own team of
people with HIV. We talked to a US academic who said that BMS developed ddI with
grants from the US National Institute of Health and didn’t have the right to
enforce the patent.” (This argument is now being used in the US itself against
another pharmaco, Abbott, to get it to reverse the price rise of its drug
ritonavir).
Kamon and Paisan both helped organize the first ever public demonstration by
people with HIV in December 2000, when 500 people stood for three days outside
the health ministry to demand an end to the ddI patent.
In December 2001 the crowd came back, doubled in size, to demand that HIV
treatment be included in the 30-baht health scheme Prime Minister Thaksin had
instituted as Thailand’s first move towards free primary healthcare – but from
which he specifically excluded HIV drugs.
The Toll of Stigma
Another activist, Paul Cawthorne of Médecins sans Frontières, takes up the
story. Paul, 49, originally a nurse from Lancashire, has worked for MSF for 12
years and in Bangkok for seven.
“The Minister of Health, Dr Sudarat, finally said after the 2001 demo that she
would include ARVs in the 30-baht health scheme if the price of combination
therapy fell below 2000 baht – at that time an inconceivable price.
“Drugs were produced for less than 2,000 baht within three months of her
announcement!”
Now, he says, the Prime Minister wants to show Thailand in the best light at the
international Aids conference.
“Thaksin wants Thailand to become Brazil number two, to be the second developing
country to treat all its citizens with HIV, and to do it better.
“Brazil is slightly richer than Thailand, and we have something like three times
Brazil’s HIV prevalence. But now, things are moving fast, and there’s only one
barrier to getting the drugs to the people. Stigma.”
Kamon talks about the stigma.
“Your typical new person with HIV in Thailand is now a young married woman who
has caught it from her husband. And she is the kind of person who will still be
shunned by her family, will still be ostracized from her village, if she
presents herself for treatment.
“TNP+ has a team of 30 people who go to all the 600 support groups round the
country educating people on how to use antiretrovirals.
“But we are still finding that people do not come forward till they are very
ill, and then you find you are trying to treat someone who turns out to need
treatment for MDR-TB, for meninigitis, for KS – it’s going to be very
complicated over the next few years.
“There’s no CD4 criterion for getting antiretrovirals because people won’t test.
It’s all based on symptoms. We are thinking about a campaign to encourage
testing but we’re honestly not sure if the public would support it. A campaign
to get tested would be seen as a campaign to expose people. So the most we can
do is to raise awareness in people who suspect they might have HIV.”
Partnerships for Positive People
Sujima ‘Luknoo’ Viravaidya agrees. She is the daughter of Senator Mechai, and is
running the youth activities at the Bangkok Aids conference.
She says: “Everyone thinks ‘Thailand has won the right to generic drugs. They
are sick, we cared for them, now we have drugs, they’re well, end of problem’.
Everyone wants to think it’s over.
“But people still don’t come for treatment till they’re very sick. There is no
culture of voluntary counselling and testing. Testing is seen as part of the
process of becoming a Victim with Aids. It is not seen as an empowering thing.
“On the contrary, it is seen as a tool of the government – something they want
you to do in order to keep tabs on you.”
However Luknoo and her dad have already started thinking about the onward
survival of people with HIV. “There will be a whole group of people who will be
trying to make a living and doing so often in the face of stigma.”
The solution they came up with was a very simple way of empowering people with
HIV – by giving them the money to set up businesses.
“It’s called the Positive Partners Programme. What we are basically doing is
bribing HIV negative people by giving outcast positive people money. The
positive person then chooses an HIV negative person to have as a business
partner. Explicitly, it’s got to be one pos, one neg – but the pos person has
the cash.
“I’ll give you an example of how it can work. This HIV positive lady wanted to
set up a laundry service in her village. At first the washing machines and the
irons were in her house and people wouldn’t come.
“Then they put them in the negative partner’s house and they started coming.
Once it was established they moved the laundry back into the positive lady’s
house, and they still came. In fact she got even more customers.
“And so the village was educated that you can’t catch HIV from clean clothes.”
So far, Positive Partners is low-key, with 10 projects set up in 18 months (“and
only one business failure”). But it seems a very Thai solution: a pragmatic way
of empowering people with HIV in a country that has never had a social security
safety net, but where everyone is a business person.
In many other ways, Thailand isn’t such a repressed place, and could teach some
of us about attitudes to sex. Luknoo is also helping set up the Global Village
area at the Conference, which will include a bar run by sex workers. The bar
girls will hand out condoms along with drinks “and will teach customers useful
things. Like how to striptease.”
I shall be interested to see what the Americans think of that, I say.
“I don’t care!” says Looknoo. “It’s our way of doing things.”
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