DISEASES IN THAILAND
Major infectious diseases found in Thailand also include bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis. Schistosomiasis (bilharziasis) is present in Thailand but the chances of getting it are relatively low. High risk areas include the southern parts of the Mekong River and lakes in northeastern Thailand.
Liver Flukes occasionally infect people in Laos and northeastern Thailand. They are picked up primarily from eating raw or uncooked fish. Some people get them from eating uncooked paa daek (unpasteurized ferment fish used in many Thai foods). Japanese Encephalitis is found in Thailand, particularly in the rainy season. It is said the highest risk areas are around rice fields and places where pigs are raised since pigs and wild birds (that hang out in rice fields) serve as reservoirs for the disease.
Rabies carried by rodents and dogs has been reported in the countryside. In 2001 there was a report of a rabid dog biting 52 people in three-hour rampage Fifty people died from rabies in Thailand in 2000 and 29 died in the first nine months of 2001, according to the Public Health Ministry.
According to an article in Boston.com: “A rabid dog has gone on the rampage in Bangkok and bitten over 50 people in three hours. The Bangkok Municipal Administration immediately warned dog owners to put collars on their pets and sent out teams of catchers to round up strays which plague the capital. By piecing together information from people attacked, city officials had established that at least 52 were bitten in the dog's frenzy. It was eventually caught and beaten to death by city guards. Dr Boonlert Lamlertpreecha, a Thai Red Cross vet, appealed to anyone attacked by a dog around the city's Chatuchak Market on Sunday to take a medical test and a vaccine for rabies urgently. "I would also warn anyone who was bitten by a dog in nearby areas during the past five days to get the antibody test as soon as possible because your life is in danger," he said. Boonlert said tests on the corpse showed it was carrying rabies. City officials said rabid dogs would be destroyed but healthy strays would be sterilised and held in a shelter for adoption. If nobody wanted or claimed them, they would eventually be released on the street again. [Source: Boston.com September 25, 2001]
Cholera was present in Thailand in 1997. The first cases of Thais dying from swine flu—a 42-year-old man and a 40-year-old woman—were reported in June 2009.
Thailand suffers from the world’s third highest incidents of cancer (2000). Cervical, liver and lung cancer are the biggest killers. It is not know why these diseases are so prevalent. In Thailand and Sri Lanka only two to five of every 100,000 women die from breast cancer compared to 30 or 40 in the United States. Diet is considered a major reason for the difference.
Respiratory diseases are a serious problem. Some are believed to be to be linked with air pollution. The adult prevalence rate of obesity is 7.8 percent (2003). In some urban areas 20 to 24 percent of the Thai population is obese. Some have blamed an increase in Western food in the Thai diet for this trend.
Malaria and Mutating Mosquitos in Thailand
Malaria is found in rural areas, but there is generally not much of a risk if you stay close to Bangkok and the beach resorts. Dangerous chloroquine- and Fansidar-resistant strains of malaria are common, especially near the Cambodian and Myanmar borders. Mefloquine-resistant strains have also been reported. Chloroquine, Fansidar and Mefloquine are the preventative anti-malaria medicines people usually take in malaria areas. Be especially careful in swampy areas and during the monsoon season. Malaria has been “practically eliminated” from coastal areas of Thailand (it is still found on some islands near Cambodia).
The most virulent and drug resistant from of malaria (Falciparum malaria) is found along the Thai-Myanmar border. Untreated the disease is often fatal. The disease has largely been kept under control thanks to doctors, using modern diagnostic method and he Chinese herbal "wonder drug" artesunate in refugee camps in Thailand near the Burmese border. The malaria rate in the camps is 1 to 5 percent compared to 25 percent in border regions in Burma. Unfortunately some doctors have been attacked by Karen guerrillas.
Many of the antimalarial medicines sold in Southeast Asia are fake. A study by Lancet in 2001, found that a third of antimalarial drugs sold in Cambodia, Thailand, Vietnam, Laos and Burma contained no active ingredient.
Drug-Resistant Malaria Spreads Rapidly to Thai-Myanmar Border
In April 2012, AFP reported: “Deadly malaria that is resistant to drug treatment has spread rapidly from Cambodia to the border between Thailand and Myanmar, raising concerns of an uncontrollable epidemic, scientists said. A pair of studies published in The Lancet and the journal Science showed how the disease is moving fast into new territory and identified a region of the parasite's genome that may be responsible for mutating in order to survive. [Source: AFP, April 5, 2012 **]
“Malaria that was resistant to treatment with the current standard therapy, artemisinin, was confirmed in Cambodia in 2006 and has since surged 800 kilometers (500 miles) westward to the Thailand-Myanmar border, the researchers said. By studying 3,202 patients along the northwestern border of Thailand near Myanmar from 2001 and 2010 and measuring the time it took them to clear malaria infections from their blood after treatment, scientists were able to show a steady increase in drug resistance. **
“The number of slow-clearing infections rose from 0.6 percent of cases treated in 2001 to 20 percent in 2010. In western Cambodia, 42 percent of malaria cases were resistant between 2007 and 2010, indicating that the Thailand-Myanmar region was swiftly catching up to Cambodia's rates. "Genetically determined artemisinin resistance in P. falciparum emerged along the Thailand-Myanmar border at least eight years ago and has since increased substantially," said The Lancet study. "At this rate of increase, resistance will reach rates reported in western Cambodia in two to six years." **
“The research in the journal Science focused on what was making these parasites different, and found that a region on chromosome 13 of the parasite was strongly associated with slow clearance of infection. They sequenced the genomes of 91 P. falciparum parasites from Cambodia and western Thailand and compared them to parasites from Laos, where resistance to the latest artemisinin-based drugs has not yet emerged. They found seven genes that may be responsible for making the parasite resistant to drugs, and which may explain up to 35 percent of the growing resistance in southeast Asia. **
"We have now seen the emergence of malaria resistant to our best drugs, and these resistant parasites are not confined to western Cambodia," said leader of the study Francois Nosten, director of the Shoklo Malaria Research Unit that studies and treats malaria in the Thai-Myanmar region. "This is very worrying indeed and suggests that we are in a race against time to control malaria in these regions before drug resistance worsens and develops and spreads further." **
Dengue fever is common in Southeast Asia. It is a nasty, viral disease transmitted by the Aedes mosquito, usually the Aedes aegypti , the same mosquito that often carries yellow fever. Sometimes called "breakbone fever" or "break-heart" because of the intense pain it can produce, the disease is characterized by sudden onset of fever; intense pounding, frontal headaches; aching bones and joints; nausea and vomiting; and a feeling of being too sick to eat anything. Other symptoms include severe sweats, symptoms: eye pain, rash, chills, and excruciating chest pains. Tests foe dengue rely on the presence of antibodies, which can take up to a week to develop.
Dengue fever is found in 100 countries and kills about 20,000 people annually. Nine out of 10 people who get dengue fever don’t even feel it or get a mild case in which they feel something akin to a slight flu. People who get full-blown dengue fever are sick for a week or more. Many patients have a rash, which appears 3 to 5 days after the onset of the disease, and experience severe emotional and mental depression during the recovery period. Most cases of the disease are benign and self-limiting although convalescence may take a long time.
A few people with dengue fever suffer gastrointestinal bleeding. Fewer still suffer brain hemorrhages. In about 1 percent of cases dengue fever can cause a severe and often fatal hemorrhagic disease called dengue hemorrhagic fever (DHF) that occurs when capillaries leak and the circulatory system collapses.. Those that die of dengue fever often get DHF hemorrhaging in the final stage of the sickness. Failing to realize they are infected, they go don’t get treatment soon enough and lose blood plasma and go into shock after the initial fever passes. Some victims die within 10 hours of developing serious symptoms if they don’t get appropriate treatment.
There are several strains of dengue fever (the four main one are immunologically related). Those who get the disease develop an immunity to the strain they were infected by but are more likely to get DHF and get seriously sick if they get infected with a second, different strain. Scientists are not sure why this happens but think it may be because the immune system reacts the second time as if the invader were the first strain, wasting precious energy and leaving the body vulnerable to an attack by the second strain. Many doctors believe that since so few people show symptoms the when get dengue those that do display symptoms probably have gotten the disease a second time from a second strain. Getting the disease twice for two different strains seems to provide immunity for life from all strains of dengue fever.
History of Dengue Fever
Dengue fever and yellow fever are so closely related they are regarded as sister diseases. Dengue was first identified about 300 years ago but remained an isolated problems until it was spread around Asia and Pacific by troops during World War II. Both dengue and yellow fever were thought to have been close to eradication in the 1940s but have since made comebacks. The disease took off in crowded conditions in Asia. By 1975 it was a leading cause of hospitalization and death among children in the region.
From Southeast Asia dengue fever made its way to India, Africa, the eastern Mediterranean and finally to the Americas where it emerged as a threat in the 1970s just as campaigns to stamp out yellow fever in Latin America were declared a success.
Several new strains of the dengue virus have emerged in Asia and Latin America since the mid-1970s. The disease was a problem in Latin America and the Caribbean in the 1980s and 90s. It first took hold in Central and South America and progressed into Caribbean and the southern United States. There were 116,000 infections in Latin America alone in 1990. Cases have been reported in Florida and Hawaii.
In recent years there have been severe outbreaks of nasty forms of dengue fever and of DHF in Southeast Asia.
One Person’s Experience with Dengue Fever
Dengue fever often begins with a headache and an achy feeling. The headaches seems to migrate towards the eyes behind the sockets as fever takes hold rises. If full-blown symptoms take hold the pain spreads throughout the entire body.
One suffer who was struck by dengue fever in Singapore wrote in the New York Times, “Not for nothing is dengue also known as breakbone fever...I, for one, felt as though someone had tied a Brink’s truck to my lower back. My skin was flushed, I could not eat, and I slept 12 to 14 hours at stretch. When I went to my doctor two days later, I could hardly open my blood-stained eyes...The doctor had little choice but to send me home with the painkiller Panadal and some muscle relaxants.”
“A week after my first feverish night, a doctor looked at the tiny pinpricks of blood under the skin on my shoulders, and sent me for a blood test, which confirmed that I had dengue...My first blood tests also revealed that my platelets---the cells that allow blood to clot and prevent hemorrhaging---had dropped to almost half of what doctors consider normal. They weren’t low enough for me to be hospitalized for transfusions, fortunately, but they were low enough to earn me daily blood tests to make sure.”
“The virus had inflamed my liver, as well, sending liver enzymes into my bloodstream, another mysterious symptom. For weeks after my fever subsided and my platelets returned to normal, I was still laid out, lethargic and giddy. My appetite returned slightly, but food and even water tasted strangely unpleasant...A month of afternoon naps later I was completely recovered.”
Dengue Fever Mosquitos
Where dengue fever is found in Africa, Asia and Oceania Aedes aegypti is a small, dark mosquito with white markings and banded legs. It originated in Africa and made its way around the globe centuries ago when it hitchhiked on transoceanic voyages.
Aedes aegypti mosquitos prefer to feed on humans during the daytime and are most frequently found in or near human habitations. They are most likely to bite during a period of several hours in the late afternoon before dark and for several hours after day break.
In 2007, scientists published the genome---a map of all the DNA---of the Aedes aegypti, the mosquito that carries yellow fever and dengue fever. It turns out the genetic make up of this mosquito is more complex than the one that carries malaria. Both Aedes aegypti and the mosquito that carries malaria have about 16,000 genes but the genome for Aedes aegypti is about five times larger.
Dengue Fever Treatment and Prevention
Dengue fever has no vaccine and no cure. Most victims that show symptoms recover on their own with rest and hospital care. The disease is treatable through rehydration or by blood transfusions in more severe cases. Dengue fever can be avoided by staying out of endemic areas (the Center of Disease Control can tell you where they are) and protecting oneself against mosquitos.
Dengue outbreaks often have followed unusually hot, rainy and humid conditions. The danger of dengue fever rises when there is a lot of stagnant water for mosquitos to breed in. In some places where it rains a lot people get infected every two or three years as their immunity from the previous illness lasts only a year and they get infected again..
Developing a vaccine against dengue fever is difficult because one a vaccine has to be developed that can work on all the strains.. Scientists are tinkering with the genetic material of 17D to come with a vaccination for dengue fever.
Scientist were able to wipe out mosquitos that carry Dengue fever in a village in northern Vietnam by using a one-eyed crustaceans that lives in ponds where mosquitos breed and has a large appetite for the larvae mosquitos that carry Dengue fever.
There are concerns dengue fever could spread northwards, even becoming common place in the United States, as result of global warming. Already species capable of carrying the disease have been found in 28 states in the U.S. and as far north as the Netherlands in Europe. Cases of dengue fever have been reported in all 50 U.S. states but people who had it contacted the disease abroad and brought it home.
Dengue Fever in Thailand
In the early 2000s, tens of thousands of people were infected with dengue fever. More than a hundred people died in 2001. Particularly hard hit were Bangkok and the central provinces of Chonburi and Nakhon Sawan. In some places outbreaks occur every two or three years as immunity after not getting the disease only lasts a year.
In 2007, the number of cases of dengue fever in Thailand rose 36 percent . As of mid-2007 the disease had killed 17 people and affected more than 21,000 people. The increases was blamed on the early arrival of the rainy season.
SARS in Thailand
During the SARS outbreak, Thailand was struck by a few cases in the early stages of the epidemic but managed to avoid being hit with a lot of incidents as was the case in China, Hong Kong and Taiwan. As of late April 2003, Thailand had 8 cases of SARS and 2 deaths. During the SARS outbreak, visitors arriving from affected countries were required to get a mandatory health check and wear face masks during the duration of their stay.
SARS put a damper on the tourist industry in Thailand. During the peak of the SARS scare tourist arrivals were half of what they normally were. To waylay fears, the government announced it would give $100,000 to any tourist who catches SARS. Thai Airlines said it would pay $100,000 to anyone who caught SARS while flying with the airline.
Highly pathogenic H5N1 avian influenza (bird flu) has been found among birds in Thailand as well as surrounding areas. The government has pledged financial support for the prevention effort, which mainly focuses on changing poultry farming methods.
Sexually Transmitted Diseases in Thailand
According to Encyclopedia of Sexuality: Thailand: “Thailand reports high rates of sexually transmitted diseases (STDs). In the Partner Relations Survey (Sittitrai et al. 1992), the lifetime prevalence rates of STDs were 49 percent among urban men and 33 percent among rural men, or 38 percent overall. Much lower proportions of women reported a history of STDs: 11 percent in urban women and 9 percent in rural women, or 10 percent overall. Gonorrhea and non-gonococcal urethritis (NGU) were the most common STDs in male participants, whereas chlamydia and urethritis were the most common in female participants. Knowledge about STD prevention and treatment was inadequate, especially in the face of the HIV pandemic. Data from military conscripts have confirmed the linkage between STDs and HIV infection. In these young men from lower socio-economic backgrounds, HIV infection was strongly associated with a history of STDs (Nelson et al. 1996), particularly a positive serology for syphilis, a history of gonorrhea, syphilis, genital herpes, genital warts, and genital ulcers (Beyrer et al. 1995). [Source: Encyclopedia of Sexuality: Thailand (Muang Thai) by Kittiwut Jod Taywaditep, M.D., M.A., Eli Coleman, Ph.D. and Pacharin Dumronggittigule, M.Sc., late 1990s; www2.hu-berlin.de/sexology/IES/thailand ]
“Almost all STD cases in Thailand could be traced to commercial sex. In a 1989 report, 96 percent of male clients at government STD clinics attributed their infection to having had sex with a sex worker (cited in Rojanapithayakorn and Hanenberg 1996). The government STD clinics carry out the Ministry of Public Health's sentinel surveillance (previously described in Section 8B) and have notably provided STD-related services to the general population and medical examinations to sex workers for at least twenty years. Although sex workers are encouraged to have a weekly examination, records show that they visited government STD clinics only once every seven weeks in 1994. Male sex workers have been also included in sentinel surveillance since 1989 (Kunawararak et al. 1995). In addition, these clinics trace the partners of individuals with STD. The male clients are asked to name the establishments from which they might have contracted STD, and outreach workers are then dispatched for further tests or scheduling treatment for the sex workers. The government STD clinics also have good collaboration with the police offices, allowing enforcement against uncooperative establishments. [Ibid]
HIV-AIDS in Thailand
Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a serious problem in Thailand. HIV/AIDS - adult prevalence rate: 1.3 percent (2009 est.); country comparison to the world: 39. People living with HIV/AIDS: 530,000 (2009 est.), country comparison to the world: 15. HIV/AIDS - deaths: 28,000 (2009 est.); country comparison to the world: 13. [Source: CIA World Factbook]
The International AIDS-HIV charity Art reports: Thailand is an example of a country where a strong national commitment to tackling the HIV and AIDS epidemic has paid off, with an admirable history of HIV prevention efforts. However, some of these past prevention successes are starting to be undermined by a current lack of HIV prevention and rising STD rates. New infections are highest among Men Who Have Sex with Men (MSM) and women who have become infected by their husbands or sexual partners. Increases in HIV prevalence among MSM is particularly marked in Bangkok, where HIV prevalence among this group has risen from 17.3 percent in 2003 to 30.8 percent in 2007. An estimated 530,000 people are now living with HIV and AIDS in Thailand. [Source: Avert, International AIDS-HIV charity website]
Thailand has the highest number of confirmed AIDS cases in Southeast Asia. In the early 2000s about 2 percent of the adult Thai population between 15 and 45 (about 600,000 people) had AIDS or was infected with the HIV virus. At that time AIDS claimed 53,000 lives a year and was the leading cause of death among adults. A deadly form of AIDS (the type E subtype) is very common in Thailand.
Since 1984, when the first AIDS case was discovered in Thailand, more than 1 million people have contacted the HIV virus. When the infection rate was at its peak in the 1990s, over 143,000 people became infected each year. At this time there were reports of discrimination directed at people with HIV-AIDS: families disowning members with the HIV virus; parents not accepting children that carry the virus. Shots were fired and grenades were tossed at Bangkok AIDS clinics.
For a while the incidence of HIV-AIDS was particularly high in northern Thailand, where half of the prostitutes became infected there in a very short time. Cambodia also has an HIV adult infection rate of around 2 percent. India, Bhutan and Malaysia have rates between 0.5 and 2 percent. In contrast the HIV infection rate is around 0.5 percent in the United States and 26 percent in Zimbabwe (the highest rate in the world). [Source: United Nations]
Early History of AIDS in Thailand
HIV was first detected in Thailand in 1984. The first reported case was a gay Thai man who studied in the United States. In the late 1980s, the HIV virus spread among intravenous drug users through syringe use and then spread by sexual contact among heterosexuals. AIDS and HIV spread rapidly in the late 1980s and early 1990s. In the late 1980s, Thailand experienced the first H.I.V. epidemic in Asia, and one of the most severe. By 1991, 10.4 percent of military conscripts from northern Thailand were infected by the virus, the highest level ever reported among a general population of young men outside Africa.
The Thai government was slow to respond to HIV-AIDS and its entry into Thailand. Economic pressures created by the need for tourist dollars and the early low numbers of actual AIDS cases slowed the government's response to the pandemic in the 1980s. At this stage the government did little. It worried that making too much of a big deal about AIDS might scare tourist away and hurt the economy. Government officials were banned from discussing AIDS in the media. A health minister who broached the subject in a speech had his effigy burned at meeting of travel industry workers. A serious campaign was not mounted until 1991. By that time it was already too late for some people.
According to the Encyclopedia of Sex: Thailand: “This slow response caught Thai governmental officials and health care providers unprepared for the rapid explosion of new cases of HIV infection and AIDS. Infection rates remained quite low through 1987, mostly affecting men who had sex with men. Then, there was a rapid increase in seroprevalence among injecting drug users (IDUs). In 1988, 86 percent of known seropositive cases were among IDUs, 4 percent were men who had sex with men, and 2 percent were heterosexual women. By 1990, another shift had occurred and shortly thereafter female sex workers showed extremely high seroprevalence rates. This phase of the pandemic was first detected in northern Thailand in 1989. As injecting drug use was shown to be very rare among sex workers, heterosexual intercourse was then identified as a potentially effective mode of HIV transmission in Thailand. In 1991, the HIV seroprevalence among urban brothel sex workers in a northern province rose to 49 percent. Because many Thai men have unprotected sex inside and outside of their marriage, high rates of HIV infection were soon detected not only in sex workers, but also in their clients, pregnant women, and newborns. The 1994 national median prevalence rates of HIV infection were 8.5 percent among men attending STD clinics, and 1.8 percent among women attending prenatal clinics [Source: Encyclopedia of Sexuality: Thailand (Muang Thai) by Kittiwut Jod Taywaditep, M.D., M.A., Eli Coleman, Ph.D. and Pacharin Dumronggittigule, M.Sc., late 1990s; www2.hu-berlin.de/sexology/IES/thailand
“A series of studies have focused on the men newly conscripted to the military in order to infer the extent of HIV infection among Thai men at large. Prior to 1993, the HIV-seroprevalence rates in these northern conscripts ranged between 10 percent and 13 percent, considerably higher than the rates among conscripts from other parts of the country. Some unique sexual patterns of the young men in northern Thailand have been linked to their greater risk of HIV infection. When compared to men from other provinces, upper-northern young men were more likely to have initiated sexual activity at a younger age - before age of 16 - to have had their first experience with a female sex worker, to have had more frequent sexual contacts with sex workers, and to have reported a history of STDs. [Ibid]
“Vithayasai and Vithayasai (1990) provided the first evidence that by 1988 HIV was already spreading among female sex workers and their customers in northern Thailand. Many other studies have consistently shown that female sex workers in the north have disproportionately higher rates of HIV infection than those in other parts of Thailand; brothel-based female sex workers were found to have an HIV incidence of 20 seroconversions per 100 person-years of follow-up. In 1994, the national median prevalence of HIV infection was 27 percent among brothel-based commercial sex workers.
AIDS first hit drug users, then prostitutes and their clients, then women and finally babies. The HIV infection rate among women rose sharply in the mid-1990s. By 1995, 800,000 people and one in three prostitutes had HIV-AIDS. In the late 1990s the when the disease reached its peak there were about 1 million with HIV and AIDS.
The HIV-AIDS problem was particularly acute in the sex industry. Studies in the early and mid 1990s found that In 4 out 10 prostitutes in northern Thailand and one third of the child prostitutes in Southeast Asia tested positive for HIV. At the same time 58 percent of all 21-year-old males reported visiting a "sex-worker" and 39 percent said they did not use a condom. Health officials said they believed that corruption exacerbated the AIDS problem. Brothels with HIV prostitutes that would otherwise closed down stayed open with police payoffs.
Combating HIV/AIDS in Thailand in the 1990s
Thailand's AIDS preventing program is considered a model for the developing world and is regarded as so successful because it effectively use community resources to raise public awareness and reduce the number of HIV infections. The program began in earnest in 1991. Among its attributes are wide distribution of free condoms, widespread testing, and vast public education programs that included radio and television announcements made very two hours. More than $50 million spent on AIDS education in 1996 alone. [Source: Library of Congress]
In the early stages the campaign focused on monitoring brothels and rasing awareness among men used the,. In the province of Ratchaburi, where HIV and AIDS rates were particularly high, a leading health officials met with all the known prostitutes and convinced them to adopt a “no condom, no sex” policy. Those that refused to wear condoms were denied service. Later the same program and policy was adopted for the whole country. In 1991, the number of 21-year-old males who paid for sex dropped to 24 percent and only 7 percent did not use a condom.
According to the Encyclopedia of Sex: Thailand: “By the mid-1990s, there has been some good news of behavioral change and decreasing new cases of HIV infection. Paralleling the success of the mass advertising campaign and the 100 Percent Condom Program, condom use in commercial sex increased from 14 percent of the sex acts in 1989 to 90 percent of the sex acts in 1994 (Rojanapithayakorn and Hanenberg 1996). As the government distributed massive amounts of condoms to commercial sex establishments all over the country, the incidence of STDs correspondingly decreased by over 85 percent. Meanwhile, the HIV seroprevalence among the military conscripts from northern Thailand declined from 10.4 percent in 1991 to 6.7 percent in 1995 (Nelson et al. 1996). New conscripts have greater proportions of men who never had sex with sex workers, and greater proportions of men who never had STDs. [Source: Encyclopedia of Sexuality: Thailand (Muang Thai) by Kittiwut Jod Taywaditep, M.D., M.A., Eli Coleman, Ph.D. and Pacharin Dumronggittigule, M.Sc., late 1990s; www2.hu-berlin.de/sexology/IES/thailand
“Initiated in 1989 on a small-scale basis, the widely successful 100 Percent Condom Program was later adopted nationwide, with participation from every province in Thailand by April 1992 (Rojanapithayakorn and Hanenberg 1996). The program promotes condom use by sex workers and their clients without exception. Sex workers are instructed to withhold service and refund the fee upon the client's refusal to use a condom. The program utilizes the preexisting structures of the police and the Ministry of Public Health's STD surveillance system to enforce compliance from commercial sex establishments. STDs, monitored by the hundreds of government STD clinics around the country, are used as a marker of non-compliance with the program. When the source of STD is traced to a non-compliant establishment, temporary or indefinite closure of the business by the police is warranted. With the cooperation from every sex establishment, customers quickly learn that they cannot go elsewhere to find a sex worker who would allow unprotected sex, and the commercial sex establishments understand that they are not losing clients to competitors.
Reduction in AIDS Cases in Thailand
The United Nations Programme on HIV/AIDS (UNAIDS) reported in November 2004 that the Thai government had launched a well-funded, politically supported, and pragmatic response to the epidemic. As a result, national adult HIV prevalence has decreased to an estimated 1.5 percent of all persons aged 15 to 49 years (or about 1.8 percent of the total population). It was also reported that 58,000 adults and children had died from AIDS since the first case was reported in 1984. The government has begun to improve its support to persons with HIV/AIDS and has provided funds to HIV/AIDS support groups. Public programs have begun to alter unsafe behavior, but discrimination against those infected continues. The government has funded an antiretroviral drug program and, as of September 2006, more than 80,000 HIV/AIDS patients had received such drugs. [Source: Library of Congress, 2007]
The spread AIDS-HIV peaked in 1991 with 143,000 new cases and then steadily decreased to only 19,000 new cases in 2003, and a total of 600,000 with HIV or AIDS. This was far less than 4 million cases that were originally predicted The drops were attributed to increased condom use, programs directed at sex workers, and decline prostitute patronage. The effort too push condom use is credited with reducing the the incidence of new infections by 85 percent.
Bangkok hosted the 15th International AIDS Conference in July, 2004. It was a far cry from the first meeting in 1985, which was attended by 2,100 scientists and was comprised mainly of dry meetings and paper presentations, The 2004 conference was attended by 17,000 delegates and included speeches by celebrities and world leaders, elephants depicting the conference logo, pretty girls giving out brightly-colored condoms, lobbying by drug companies, and meetings among politician to figure out the best ways to make available treatments available.
Condoms in Thailand
In the 2001 Time sex survey 76 percent of males and 59 percent of females said they used a condom and 18 percent of males and 24 percent of females said they had never used a contraceptive. Despite this, Thailand is one of the of the world’s largest condom makers, Several of the largest condom makers in the United States use factories located in Thailand.
According to the Encyclopedia of Sex: Thailand: In the Partner Relations Survey, the research participants reported that condoms were readily available. Considerable proportions of the participants reported having used them some time in their lifetimes: “52 percent of the men, 22 percent of the women, or 35 percent overall. Attitudes toward condoms were not especially surprising. Most men feared a lack of pleasure or diminished sexual performance with the use of the condom, and couples found using condoms threatening to the trust in their relationship. [Source: Encyclopedia of Sexuality: Thailand (Muang Thai) by Kittiwut Jod Taywaditep, M.D., M.A., Eli Coleman, Ph.D. and Pacharin Dumronggittigule, M.Sc., late 1990s; www2.hu-berlin.de/sexology/IES/thailand
“The heightened HIV awareness and the government-sanctioned 100 Percent Condom Program have significantly increased the use of condoms, especially in the context of commercial sex. Although the government received condoms from foreign donors before 1990, all condoms provided to sex workers since 1990 have been bought by the country's own funds. In 1990, the government distributed about 6.5 million condoms; in 1992, they spent U.S. $2.2 million to buy and distribute 55.9 million condoms. Commercial sex workers receive as many free condoms as they require from government STD clinics and outreach workers. On the national level, the recent increase in condom use has been documented to relate in time and magnitude with the overall decline of STDs and HIV incidence.
Mr. Condom and Cabbages and Condoms
Thailand most famous anti-AIDS crusader is Mechai Viravaidya, better known as "Mr. Condom." So successful is his family planning and safe sex program that condoms are sometimes referred in Thailand as "meachais." Since beginning his crusade in 1984, he has met with thousands of schoolteachers and promoted festivals featuring condom relay races, condom inflation contests, and given out free key rings with a condom encased in plastic and a label that says "In emergency break glass."
Mechai’s public appearances are often like comedy routines. He tells women, “Condoms are a girl’s best friend” and tells men they all need the large size. "We wanted to desensitize the talk of contraception," he told National Geographic, "and put education about family planning and AIDS preventing in the hands of people."
Mechai opened a restaurant in Bangkok called Cabbages and Condoms, where waiters sometimes serve food with inflated condoms on their heads. Other outlets were opened. The one in Chiang Rai has condoms and sex toys hanging from the ceiling. It serves northern and central Thai food. Dinner costs $10 to $15 a person. Money goes to a charity whose goal is to prevent AIDS by encouraging safe sex.
Thai police have participated in a program in which they have given out condoms to motorists in traffic. The program was called cops and rubbers. In another program youngsters have been sent into shopping centers dressed as condoms to distribute condoms to teenagers.
100 Percent Condom Campaign
Chris Beyrer and Voravit Suwanvanichkij wrote in the New York Times: “It became clear early on that the commercial sex industry — illegal but popular among Thai men — was at the core of the virus’s explosive spread. The Thai response was the 100 Percent Condom Campaign. As part of the campaign, public health officials aggressively focused on bars, brothels, nightclubs and massage parlors for condom education, promotion and distribution. Sex workers were likewise offered counseling, testing and treatment. The openness of sex venues there and health officials’ access to the women in them made this a relatively simple intervention. [Source: Chris Beyrer and Voravit Suwanvanichkij, New York Times. August 12, 2006]
Venues that did not agree to require condom use were shut down. Signs appeared over bar doors saying, “No condom, no sex, no refund!” And the government put resources behind the effort, distributing some 60 million free condoms a year. A wider national effort was also under way. Condoms appeared in village shops and urban supermarkets, and frank H.I.V. education was introduced in schools, hospitals, workplaces, the military and the mass media. Thais worked hard to reduce fear and stigma and to support those living with H.I.V.
This national mobilization was classically Thai — funny, nonthreatening and sex-positive. When we briefed the Thai surgeon general on an H.I.V. prevention program for soldiers, he said, “Please be sure the program maintains sexual pleasure, otherwise the men won’t like it and won’t use it.” It worked. By 2001, fewer than 1 percent of army recruits were H.I.V. positive, infection rates had fallen among pregnant women, and several million infections had been averted. The 100 Percent Condom Campaign proves that H.I.V. prevention efforts can succeed by focusing on at-risk populations, providing tangible services and making healthy behavior, like condom use, social norms. Cambodia, the Dominican Republic and other countries have successfully adopted the Thai model.
Thailand has been a leader in HIV and AIDS treatment, in developing cheap drug treatments and making them available to all who need them. In March 2002, the Thai Government Pharmaceutical Organization started producing a one-pill generic drug, called GPO-VIR, forcing down the monthly treatment for one person from between $500 and $750 to $30. GPO-VIR contains the drugs stavudine, lamivudine and nevirapone—a combination recommended by the World Health Organization.
In the 1990s, only about 15,000 of the 150,000 AIDS and HIV sufferers that needed anti-viral drugs had access them to them. Some got the drugs from Access, a nonprofit group The government provided some assistance but even among the people who received the assistance the drugs were expensive. At that time the cost of anti-AIDS cocktail with AZT and ddl was about $200 a month, a lot of money in a developing country. Locally-made AZT wasn’t that expensive but ddl was. Much of ddl was produced by Bristol-Myers, Protest were held to ease up on U.S. licensing laws allow local companies to produce ddl.
In the 1990s hospitals don't have the facilities to take care of the large numbers of AIDS patients. Sometimes people with AIDS and HIV waited in long line for quack medicines and pills that promised miracle cures but delivered dubious results. Buddhist temples and organizations were active in the treatment of AIDS patients. Many AIDS patients who had been rejected by their families ended up monasteries, like Wat Phrabat Namp in Lopburi, where they lived in small one-room apartments and did chores like gardening, cooking and making crafts while they are still able. When the died the were cremated. Some monasteries had piles of bags with ashes unclaimed family members.
In July 2005, the Thai government announced that it would offer anti-retro viral drugs at almost no cost to the 500,000 people nationwide that had the AIDS virus. After that policy was initiated the number of deaths in Thailand from AIDS fell sharply. The number of people who died between January and November in 2005 was 1,478 compared to 6,593 for the same period in 2004.
An experimental AIDS vaccine failed in a test in Thailand to prevents AIDS. It was given to 2,500 drugs users, some of whom contacted HIV.
Resurgence of AIDS
A report released in 2004, indicated that the AIDS-HIV was on the rise again. This time the problem was not in the sex industry but rather was among young people, pregnant women, people having affairs and intravenous drug users. The rise was attributed to increased drug use, complacency and less money spent on prevention and more people engaged in risky sex. By that time AIDS funding had fallen from $53 million a year to $36 million and only 8 percent was earmarked for prevention, with much of that spent on supplying those with disease already with drugs while young people generally didn’t receive meanful AIDS education.
Thaksin Shinawatra did little to tackle the AIDS problem in Thailand when he was prime minister in the early 2000s. A Thai study released in 2004, found that men where visiting brothels less but extramarital affairs and casual sex were on the rise, and condom use was declining. The infection rate among intravenous drug users had risen to as high as 50 percent and a crackdown on drugs had driven many of them underground. Rates were rising among homosexuals. Young people were engaging is risky sex. One study found that only 20 percent of sexually active young people and15 percent of active young gay men used condoms consistently
A study in 2004, found that 12 percent of prostitutes were infected with HIV and 17 percent of gay men in Bangkok who were tested were positive. Particularly worrisome was the spread of HIV and AIDS to the general population in southern Thailand, especially among pregnant women.
A 56-year-old one-legged German man was accused of trying to infect nearly 1000 teenage girls with HIV through unprotected sex. When caught he launched into a tirade calling Thai women “witches” and “monkeys.” In some places posters were put up warning Thai girls not have sex with him. Because there are no laws to deal with people who purposely infect others he was only charged with immigration offenses.
Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Tourist Authority of Thailand, Thailand Foreign Office, The Government Public Relations Department, CIA World Factbook, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.
© 2008 Jeffrey Hays
Last updated May 2014