Inter Press Service - Monday, April 5, 1999
Prangtip Daorueng

Having lived with HIV since the illness began spreading in Thailand more than a decade ago, Ittirak is one of the closest witnesses to the development of Thailand's efforts to cope not only with the pandemic's health, but social, toll as well.

Discrimination is part of the hardship Ittirak has had to fight since getting HIV, the virus that causes AIDS, 13 years ago in his teens.

Although Thailand is known as a success case in curbing the spread of HIV and AIDS, he says discrimination against people with the virus has not improved. "Some hospitals still reject AIDS patients. Many companies require blood test from new employees," he said, speaking at a press conference at the Thai Red Cross Friday.

Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) who has just visited Indochina, added: "They say people live with AIDS die twice: the first time by the society, and second time by the virus." It was to fight discrimination and violation of the rights of people with HIV and AIDS that Piot last week signed a collaboration agreement with the Thai Red Cross Society.

Before coming to Thailand, Piot had gone to Cambodia and Vietnam to assess the AIDS situations there.

His trip underscored the continuing danger that the pandemic poses for Asia, where 7.2 million people are living with HIV/AIDS. One-fifth of this number were infected in the last year alone.

Asia's younger generation is particularly vulnerable to the spread of the illness. More than half of all new infections in Asia are taking place among those under 25 year of age.

Piot says openness to discussing the risks with the young is essential to stemming this trend. "Many countries share a culture of silence that makes people shy away from frank discussion of sex and drug use, when we have evidence that openness and sharing with adults help young people to adopt safer behaviour," he pointed out.

Thailand has shown that a persistent effort at education and information can change behaviour to curb HIV/AIDS. Piot cited a recent national survey by Mahidol University which shows evidence of increasing condom use and less sexual contact with sex workers among young Thai men aged below 24.

"In a very short period, Thailand is very successful in not only changing people's (sexual) behavior, but also their attitudes," Piot observed. But this is a lesson other Asian countries have yet to learn well enough, says Kul Gautam, chair of the Regional Interagency Commission for Asia-Pacific (RICAP) subcommittee on HIV/AIDS, speaking on HIV's spread in the Mekong region countries, India and China.

"The rapidity of the growth is alarming," Gautam pointed out. "'China now has 400,000 HIV-infected people, the number is estimated to be one million in one year."

Since Asia is where the concentration of the world population is, he says, the challenge will remain there.

The problem of lack of access to information among younger generation cannot be underestimated.

A survey of urban young Cambodians aged 11-20 shows extreme misunderstanding about HIV/AIDS. While 80 percent of them believe it is "impossible" for them to contract HIV, less than one in three have ever talked to anyone about AIDS. In India, studies show most young men received very little sexual health information. Those who do get information from the media and friends.

Asian countries, especially those in East and South-east Asia, now face added constraints from the regional financial crisis that has led to cuts in health budgets in the region.

Likewise, Piot says that there is a risk of young migrant workers who worked in the cities during the boom time and went back home, bringing HIV into their villages.

The crisis has also led to sharp declines in school enrollments and higher drop-out rates among girls in many Asian countries.

In Jakarta, for example, enrollments for girls in junior secondary schools dropped nearly 20 percent in 1998/1999. This also means less opportunities for this group of youngsters to have HIV/AIDS education, at a time when more girls may be forced into the sex industry.

UNAIDS says an estimated 20 percent of the 2 million sex workers in India are below 15 and nearly half are under 18.

The number of sex workers in Cambodia has risen from some 1,500 in Phnom Penh in 1990, to some 40,000 by the end of 1990s in Phnom Penh and Battambang, two of Cambodia's biggest cities. About 40 percent of these 40,000 sex workers are infected, says UNAIDS.

Piot says it is more important than ever for Asian governments to continue supporting health and education programmes.

"Government in Asia must compensate for lost revenue, but the great danger is that health and education programmes will be sacrificed. That would be a tragic mistake," he says.

Such cutbacks are not just figures on paper. Echoing the fear of others like him, Ittirak says Thais with HIV are afraid that the financial crisis will make the government reduce its support for health care and treatment for them, at a time when many of them have become unemployed.

"AIDS patients now know that they can stay alive and healthy with AZT, which needs monthly spending of around 20,000 to 30,000 baht (540 to 810 U.S. dollars," Ittirak explained.

"But now the financial crisis has driven many HIV-infected people, who were once able to support themselves and stay on medication, out of jobs. Now they are worried about how they can afford it," he said.

Added Ittirak: "The only hope is that the government can still subsidise them on health care and treatment." (END/IPS/ap-he-hd/pd/js/99)
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