San Francisco Chronicle - Thursday, December 19, 2002
Andrew Perrin, Chronicle Foreign Service

Through a highly successful public-education campaign and promotion of condom use, the government stemmed the rapid spread of HIV by targeting red- light districts. The nation's well-funded programs reduced annual new HIV infections from 143,000 in 1991 to 29,000 in 2001, according to UNAIDS, the United Nations' HIV-AIDS program. The World Bank credited the program with saving 395,000 people and billions of dollars in medical treatment and lost working hours.

But even that wasn't enough. Today, AIDS is the leading cause of death in Thailand, overtaking traffic accidents, heart disease and cancer.

BEYOND THE RED-LIGHT DISTRICTS

"The disease has moved out of the red-light districts and into the general community," said Usanee Janngeon, health coordinator at the Human Development Foundation in Bangkok. "It is all over Thailand now. It's in the lower class, the middle class and the upper class. It's in the womb. It's everywhere."

Critics contend that early success bred government complacency. They argue that drastic cuts in AIDS programs in the past six years because of the nation's economic crisis, coupled with a reluctance to confront the changing face of AIDS, has sparked the virus' resurgence.

"The Thai program was very successful with sex workers and their clients," said Tim Brown, director of the UNAIDS program at the East-West Center in Hawaii. "But now there are other issues that have to be addressed -- IDUs (intravenous drug users) and husband-to-wife transmissions. No part of the Thai program directly addresses those issues."

More than 1 million people, or 1 in 60 Thais, already are infected with the virus, giving Thailand the 15th largest population of HIV-infected people in the world. By 2006, more than 50,000 are expected to die annually in Thailand from AIDS-related causes, according to a World Bank study.

U.N. researchers say about 80 percent of AIDS cases involve heterosexual sexual transmission.

In a comprehensive report released in 2000, the World Bank warned that Thailand risked a resurgence of the AIDS epidemic because of a decline in condom use at home and in extramarital liaisons.

The first recorded AIDS case in Thailand occurred in 1984. The epidemic here began among homosexuals, the so-called first wave, then spread to drug users and prostitutes. The red-light customers inevitably became the fourth wave, followed by their wives and girlfriends. The sixth wave consists of mothers passing the virus to their children, health workers say.

Eight-month-old Gao is one of some 5,000 children born with HIV each year. "My husband told me there was a 50-50 chance" that Gao would be born with the virus, said the baby's 36-year-old mother, Dup. She contracted the virus from her husband, who died a month after their son's birth.

Now, with no means of support, mother and son are forced to live at the Human Development Foundation, a privately funded AIDS hospice run by a Roman Catholic priest. The doe-eyed Gao lives in a ward alongside 12 other infected children, most of whom will die before they reach puberty.

A MOTHER'S DEVOTION

"The life I have now is for him," said Dup. "It is my mission to stay healthy so that I can devote everything I have to him. The thought of him being sick and alone in this world will keep me alive."

Much of the government's early success is due to one man, Mechai Viravaidya. An economist who has long been involved in family planning, Mechai forced Thais to confront issues they had never faced before with a series of publicity stunts in the 1980s.

He handed out condoms in red-light districts, painted condom advertisements on water buffaloes and opened a restaurant -- now a well-known chain -- called Cabbages and Condoms, where diners are still served prophylactics before the main course. Some Thais call him "Mr. Condom" and refer to condoms as "Mechais. "

In 1991, Mechai headed the government's AIDS prevention agency and devised what the World Bank described as "one of the few international examples of an effective national AIDS prevention program."

The government enforced condom use in brothels, which increased from only 14 percent in 1989 to more than 90 percent by 1994. Infection rates plummeted. But Mechai's message never reached the countryside.

Chomnad Manopaiboon, a researcher with the Thai Ministry of Public Health, told delegates at an AIDS conference in Bangkok in March that prevalence rates in frontier areas were twice as high as in the rest of the country.

In Chiang Rai province, in the heart of the infamous Golden Triangle that borders Burma and Laos, 7 percent of the population has HIV, health officials say. Manopaiboon blames the high rates on an explosion of methamphetamine use and a steady flow of illegal immigrants from Burma, Laos and neighboring regions of China -- all places where little has been done to check HIV infection rates. Many immigrants wind up working in brothels.

20% OF SEX WORKERS INFECTED

In 1997, the World Health Organization said 20 percent of sex workers in rural Thai areas were HIV-positive, compared with only 7 percent in Bangkok. Studies show that only 50 percent of men who visit sex workers in rural areas consistently use condoms.

In the meantime, health officials are pessimistic that they will be able to rein in the killer virus anytime soon.

Many men now avoid brothels for fear of contracting AIDS and are having affairs with acquaintances or women at the office without using condoms, health experts say. And since the 1997-98 Asian financial crisis, schoolgirls and university students -- in a trend mirrored across the region -- are contracting HIV by trading sexual favors for gifts such as clothes and cell phones from well-off men and passing it on to their boyfriends.

"These are the children of once-affluent Thai families," said Lee-Nah Hsu, manager of the United Nations' Southeast Asia HIV and Development Project. "These girls are considered pure, so they continually fall outside the AIDS education programs."

What this adds up to, she said, is that "changing values and patterns of behavior in Thai society are playing a major part" in the increase of AIDS.
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