Bangkok Post - November 30, 2000

A recent report from the World Bank estimated that about one million Thais have contracted the HIV virus that eventually leads to Aids. Unfortunately, the majority of those seem to be unaware of the risk, and may even now be spreading the disease to those near and dear to them. This would partly account for the sharp rise in transmission among people outside the sex trade, from eight percent of the total number of new cases a decade ago, to 56 percent this year.

Nimit Thian-udom of Access, a non-governmental organisation that has been working with HIV-infected people, argues the past campaign's focus on commercial sex workers as the main source of Aids has inadvertently delivered a distorted message to the general public. Blood testing has become a stigma. Quite a few wrongly believe they are not in the high-risk group, only to discover otherwise when it is too late.

For example, despite a drop in the number of military conscripts who visit brothels, many continue their reckless behaviour patterns. Among those having sex with their partners, only 12 percent took the precaution of using a condom. Among those in the army who reported having had sex with other men, only 29 percent use protection. In addition, the Thai government has scaled back on budget funds for preventive measures, from 11 percent of total spending on Aids in 1997, to eight percent now. In concrete terms, only two baht is being allocated to educate each Thai adult concerning the virulent virus. Government complacency from its success in the promotion of condoms has also resulted in a severe cut in the distribution of free condoms from 53 million pieces in 1996 to 20 million in 1997. Usasinee Rewthong of the Programme for Appropriate Technology in Health (Path), pointed out that the number of condoms may have been boosted back to 31.5 million pieces this year, but that was still far from adequate.

Paisal Tan-ud, chairman of the Thai Network for People Living with HIV/Aids, believes prevention and care should go hand in hand. He cited examples from Western countries where antiviral therapies are readily provided when a patient tests positive for HIV.

However, in Thailand, those afflicted by the virus often find themselves facing ignorance and discrimination, especially among medical personnel.

"Surprisingly, many hospital staff members have not been sufficiently trained on how to treat the disease. "Worse, they seem to hold the misconception that every HIV person will die shortly, and thus it's a waste of time and resources to care for them. Others lump the images of gravely sick Aids patients with those infected by HIV. "However, with proper information on how to take care of themselves and to prevent opportunistic infections, people with HIV can live a sound and healthy life and keep their medical costs to a minimum," said Paisal, who contracted the virus almost a decade ago.

For example, a World Bank report points out that drugs cost only 404 baht per year to prevent Pneumocystis Carinii Pneumonia (PCP), much cheaper than treating PCP after a patient has become infected. Likewise, instead of paying up to 400,000 baht to treat tuberculosis (TB), the government could prevent TB among HIV patients by providing a constant supply of drugs at the cost of 90 baht per patient for a period of nine months.

In comparison, the government last year spent 290 million baht to provide antiviral drugs for 2,100 patients, covering just two percent of the country's total number of people with HIV. In fiscal terms, that translates into 140,000 baht per person per year.

Paisal and Nimit both say they are working on devising strategies to enable people living with HIV to have access to drugs at affordable prices. Free from worry over their health, those affected by HIV could play a crucial role in Aids awareness campaigns.

"We have a very dynamic network of people with HIV, consisting of 464 groups nationwide, who could contribute a lot to prevention programmes," said Paisal.

"Those with HIV could be good educators. However, we don't want superficial publicity. They could do something more substantial, such as urging communities to be aware that the disease is something that can happen to anyone, anywhere.

"On the other hand, Paisal admits disclosure of one's health status is still a sensitive matter in many areas. Nimit added that while encouraging different sectors in a community to join hands in order to care for Aids patients was a step in the right direction, one should first realistically assess the resources and the abilities of local residents to handle the situation. "Relevant state agencies should strive to ensure that each family is ready to take care of the patient, and not to promote the concept just because it sounds good," Nimit said.

"Home treatment is definitely better than hospital care, but there should be supportive mechanisms, such as good follow-up and referral systems for the community to rely on. "The key message to remember is that the HIV virus is treatable and treatment is never too expensive when the patient's health is considered. Contracting HIV does not mean one can no longer live with others in a community."

- To celebrate World Aids Day, which is tomorrow, Channel 9 will host a special programme jointly produced by Access and the Ministry of the Prime Minister's Office, offering information on how men and women can help combat HIV/Aids. The programme will be aired from 11 pm to 12:30 am. Access is also running the "My Positive Life" exhibition on the 7th floor of Mahboonkrong. For details on both programmes, call 372-2113-5.

Did you know?

As of the end of this year, there are an estimated 36.1 million men, women and children living with HIV or Aids worldwide, and 21.8 million have already died from the disease.

- This year alone, there have been 5.3 million new infections worldwide, of which 3.8 million were in sub-Saharan Africa, and 780,000 in South and Southeast Asia. Children constitute over 10 percent of the global figure.

- By the end of this year, it is estimated that Asia will have 5.8 million people living with HIV/Aids.

- China and India between them account for about 36 percent of the world's population. In India, with a low HIV prevalence rate of only seven of every 1,000 adults, there were 3.7 million people living with HIV/ Aids at the beginning of this year-more than in any other country in the world except South Africa.

- In South Africa, the epidemic is projected to reduce the economic growth rate by 0.3-0.4 percent annually, resulting by 2010 in a gross domestic product 17 percent lower than it would have been without Aids and wiping out $22 billion (968 billion baht) of the country's economy.

- By some estimates, 90 percent of HIV-positive individuals worldwide do not know they are infected. The HIV epidemic is driven by sex between an infected individual and a partner who is uninfected. Where the infection status of both partners is not known, the only safe options are sex without penetration or sexual intercourse protected by condom use.

- This year's theme of the World Aids Campaign is "Men Make a Difference". Men make up the majority of those infected with HIV, have more sexual partners than women, and are more likely to inject drugs. Focusing on men does not mean ignoring women, however. Men are encouraged to change their attitudes-especially with regard to masculinity-and behaviour in a way that will benefit women.

Sources: Unaids, Unesco
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