Bangkok Post - April 24, 2001

We had to accept the fact that this epidemic had arrived in Thailand and was not going to go away.

To deal with the problem, I had to find out the exact situation by demanding facts and figures, and projections for the future.

HIV/Aids was threatening the entire country and had spread to all sections of Thai society. There were 143,000 new infections in 1991 alone. And it was predicted that over the next 20 years, up to 10% of Thais would die from Aids.

We had to accept that the traditional and punitive public health measures which had been practised to combat the epidemic had not worked.

Tough and bold decisions were needed if the spread of the disease was to be curbed.

Only governments and political leadership at the highest level could make a difference in the fight against HIV/Aids on a national scale.

We had to accept that this epidemic was being driven by socio-cultural practices, which no government wanted to admit existed. They included: commercial sex, intravenous drug use, and cultural practices such as the sale of children and young women into sex work.

The fact that all these activities are illegal makes people want to deny that they exist in our societies.

Not only did we have to accept the existence of these practices, we had to also accept that they occurred on a large scale in Thai society. For example, over 20% of Thai men were visiting sex workers every year. It was thus necessary to publicly acknowledge the scale of the problem and to state that we were going to take urgent action.

To address the situation, I had to demand compilation and analysis of information and data as a basis for policy and programme decision. I asked the concerned agencies to constantly update me on the situation.

Sentinel monitoring of infection levels in all provinces had indicated that HIV prevalence in Thailand had jumped five-fold within a two-year period. Prevalence was growing rapidly among young Thai men who were tested on conscription into the military at the age of 21.

Thailand was in the throes of an HIV epidemic. This was a new type of threat to our country and our people.

The epidemic demanded that there be an end to hypocrisy and denial which, we should note, still occurs in countries of the Asia-Pacific region.

I had to give clear directives to each government ministry to formulate individual plans and budgets. I also asked our governors and each province to develop provincial Aids plans.

We also invited the involvement of all sectors of Thai society, including NGOs, businesses, local leaders and people living with HIV/Aids. This was in recognition of the important role of civil society in mounting an expanded national response to the epidemic.

The HIV/Aids epidemic was clearly beyond the scope of the health sector alone. The impact of HIV/Aids on our country's economic and social development was potentially great.

The highest political leadership was needed to effectively combat Aids. I established and chaired the National Aids Prevention and Control Committee under the Office of the Prime Minister. This body became the co-ordinating body for national Aids planning and public education.

To mount a national-scale programme, we had to quickly and drastically increase the government budget for HIV/Aids, rather than wait for foreign donors to arrive.

The government Aids budget for prevention and control increased from $2.6 million in 1990 to $24 million in 1992. That represented over a 900% increase in a span of less than two years.

After I left office, the budgetary increases continued under new governments. In 1993, the government budget went up to $46 million and in 1994 to $461.8 million. These sums did not include aid from donors.

The Thai government also recognised the importance of allocating funds to NGOs and community-based organisations. In 1992, we allocated $480,000 to them. In 1996, the amount increased to $3.2 million.

We recognised the necessity of educating the whole of Thai society, not just those groups at highest risk. We were fighting for a radical change in perception and behaviourial response within Thai society.

It was thus essential to engage all sectors of Thai society in HIV/Aids prevention and control. We adopted a multi-level and multi-pronged strategy.

We mounted a nationwide education campaign, enlisting the co-operation of the media, including TV and newspapers.

We targetted parents and teachers, many of whom still had conservative attitudes. We initiated a national programme on HIV/Aids education in schools and mounted a large-scale peer education programme for young people in the workplace.

We also promoted prevention interventions among drug users, the majority of whom are youth. Two-thirds of intravenous drug users share needles. Thailand currently has a 5.3% HIV prevalence rate among intravenous drug users. Hence, further action to address this problem, particularly focussing on our youth, is critical.

We also targetted sex work and established the 100% Condom Programme. The programme enlisted the co-operation of agencies and individuals to distribute free condoms to clients of sexual services.

Very early on, we fought stigma and discrimination, to protect the rights of people living with HIV/Aids. When I became prime minister, there was a proposal to pass legislation that would have restricted the rights of people living with Aids. We did not pass the bill.

There were prevention campaigns that inadvertently reinforced the stigmatisation of people living with Aids. We stopped those campaigns. We also lifted the ban on entry to Thailand of foreign nationals known to have HIV/Aids.

Looking back, I am proud to have been part of Thailand's achievements as the first Asian country to recognise the severity of Aids and to place the issue high on the national agenda.

The most recent findings validate the approach we took in the early 1990s. They show that: behavioural change has reduced new HIV infections from almost 143,000 in 1991 to 29,000 this year; since 1993, an estimated two million fewer people are HIV-infected than would otherwise have been the case; and the percentage of adult men visiting sex workers has fallen and condom use has increased drastically. The national sentinel surveillance indicates that condom use in sex establishments now is over 90%.

Many people have said Thailand's route to success is not replicable, that it is unique. But today we see success in changing the course of the epidemic in Uganda, Senegal, the Philippines and Singapore.

We also see political leaders taking bold political decision. They include: Paolo Teixera-Ferraira, a Brazilian member of parliament, whose personal commitment made possible legislation for government funding for harm reduction programmes that reduced HIV infection among intravenous drug users in Sao Paolo state; Muslim imams in Uganda, whose leadership was significant in spearheading the implementation of Aids education and condom promotion in their communities; and the 3,000 sex workers in Calcutta, India, who formed co-operatives to bargain condom use with their clients.

Today, we have the benefit of the experiences of those who have gone further along the road-we see the devastation in the case of those who did not act soon enough-as in Africa where 70% of adults and 80% of children with Aids worldwide live. We also see what we can save when we take heed and act early, as in the case of Thailand.

Ladies and Gentlemen, you can shape the Asia-Pacific region's collective response to HIV/Aids.

I urge you to seize the moment. Act now to stem the spread of HIV/Aids-for the lives of our people, for the human security of our region.

010424
BP010412

Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2001. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .