Bangkok Post - November 4, 2000
Aphaluck Bhatiasevi

"Thailand has had one of the most successful approaches to HIV/Aids. "However, Aids in Thailand is evolving, moving from one population group to another. The country's response-and in particular the government's response-needs to be flexible to respond quickly to the changes in the epidemic and keep ahead of those changes," said the World Bank's country director J. Shivakumar, on the launch of the report yesterday.

The report said the government had invested only two baht per head per year on prevention, even though prevention was the best way to contain the epidemic.

Prevention now accounts for only 8% of the national Aids budget, said the bank's senior economist Martha Ainsworth.

Overall public expenditure on the national Aids programme had declined by 28% since 1997, she said, adding that despite effective condom campaigns among commercial sex workers, some 17% of brothel-based sex workers were thought to be infected with HIV.

"As Thailand recovers from the economic crisis, rising incomes are likely to lead to renewed demand for commercial sex.. any lapse in condom use could have an explosive impact on the epidemic, allowing it to regain its initial trajectory," she said.

Ms Ainsworth also raised concern over the lack of condom use among non-brothel based sex workers.

"Condom use has never been universal among indirect sex workers, and sex workers who have been trafficked to Thailand from neighbouring countries are a potential gap in the 100% condom programme," she said.

Ms Ainsworth said it was necessary to bring about behavioural change and condom use among other high-risk groups such as homosexuals, male sex workers, prisoners, fishermen and youth.

Another issue of concern was the increasing spread of HIV among drug users, their sex partners and children. The spread rate is estimated to be above 40% of new HIV infections.

If left unchecked, the high infection rate among drug users using the injection method would continue to be a reservoir for HIV transmission to the rest of the population, she said.

"The same pragmatic policy towards prevention of HIV among sex workers needs to be extended to drug injectors," she said.

Ms Ainsworth, however, raised concern that the transmission cycle among drug injectors is unlikely to be broken without a simultaneous serious effort to prevent HIV among prisoners.

An improved legal environment for behavioural change by making syringes available to drug users can curb the HIV spread, she said. Chris Beyrer, an academic from Johns Hopkins University, Maryland, said HIV-positive people in Thailand had poor access to basic health care and cheap drugs.
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