Thai AIDS "success story" scares Asia

By dpa Asia correspondents


Bangkok (dpa) - Thailand, repeatedly cited by international agencies
as a success story in the fight against HIV/AIDS, is offering a new
lesson these days.

"If Thailand is a success story imagine what failure is like," said
Senator Mechai Viravaidya, whose family planning and anti- AIDS
campaigning has made his name synonymous with condoms in Thailand.

Thailand, a country notorious for its commercial sex industry, was
one of the first Asian nations to acknowledge it had a serious
HIV/AIDS problem in the early 1990's and to do something about it.

In 1991 and 1992, HIV/AIDS education programmes were initiated on
radio, public television and in schools; government-funded free
condoms were handed out to brothels nationwide; non-governmental
organizations received public funding to fight AIDS; and the prime
minister was made chairman of the National AIDS Committee.

The World Bank, in a recent study, estimated that the campaign
prevented 6.6 million Thais from contracting the virus and saved the
country 18.6 billion dollars in health care.

But over the past five years, the anti-HIV/AIDS battle has been
sidelined by other national concerns. AIDS education, for instance,
was taken away from the prime minister's office and passed on to the
health ministry, where it was abandoned. The free condoms programme,
for example, was discontinued.

While the government has been good in providing health care for AIDS
sufferers, recently including AIDS patients in its subsidized health
programme, its record on prevention has taken a hit in recent years.

Consequently, the number of new cases of HIV infection has jumped 30
per cent over the past two years, reaching 18,000 in 2005. Nearly 24
per cent of the new cases are teenagers.

"Young people ask me if AIDS is still around as if they're talking
about the Korean War," said Mechai. "If there is no information,
people think there is no AIDS."

India, which has 5.1 million HIV/AIDS patients - the world's second
largest number - is another tragic example of the consequences of
lack of awareness.

Indian leaders, including Health Minister A. Ramadoss, have only
lately displayed an interest in programmes to combat the scourge,
key ingredients in Thailand's once successful anti-HIV/AIDS drive.

An upfront approach could translate into major results for India,
reckoned UNAIDS country coordinator, Dr. Denis Broun.

"The effort should be to convey the message effectively.
Communication should not be general messages like AIDS is a danger
or AIDS kills...it should lead to altering people's behaviour and
make sure that condoms are glamorous to use."

The government's Targeted Intervention programme has only reached 20
per cent of people considered high-risk - sex workers, intravenous
drug users, migrants and gay men.

Another stumbling block is the apathetic attitude of provincial
governments tasked to implement the anti-HIV/AIDS programmes.

"States such as Nagaland, Mizoram, Uttar Pradesh and Bihar, where
the virus is spreading, are indifferent to the threat of the
epidemic. This approach could be disastrous," a voluntary worker
associated with the federal government's AIDS control programme
said.

Further, the quality of surveillance of HIV/AIDS in the country has
raised concerns. New infections dramatically fell to 28,000 in 2004
from 520,000 in 2003 causing UNAIDS executive director Peter Piot to
surmise sampling was done in rural areas when most of the affected
population are living in cities.

UNAIDS has helped China to develop similar methodology to other
countries for estimating HIV cases, including calculating the
prevalence among high-risk groups such as blood sellers, intravenous
drug uses and sex workers.

"We've seen some progress in the last two years," said Joel
Rehnstrom, UNAIDS country coordinator for China "It's an ongoing
effort to get a better understanding of the epidemic."

The official estimate of 840,000 HIV infections was expected to be
revised on or around this year's World AIDS Day. The estimate is
based on a cumulative total of 126,808 HIV infections, including
28,789 AIDS cases, according to the most recent health ministry
statistics.

Though the number of recorded HIV cases has tripled in the last two
years, experts say this does not necessarily reflect a rapidly
growing number of infections.

A campaign to test hundreds of thousands of rural residents who sold
their blood in the 1990s was believed to be the major factor behind
the sharp rise in recorded infections.

"We don't have the impression that there is an overall increase in
infections," WHO China spokeswoman Aphaluck Bhatiasevi told Deutsche
Presse-Agentur dpa recently. Recent random surveys seemed to "show
little increase" in the number of HIV infections in China,
Bhatiasevi said.

Still the level of HIV/AIDS infection in China appears to be low
compared with most Asian nations, which experts believe is due to
most HIV-infected people going undiagnosed because of ignorance,
fear, poverty and other factors.

Chinese health officials began talking about HIV/AIDS in individual
provinces last year and now discuss prevalence at the prefectural
level, Rehnstrom said.

That along with Chinese leaders making high-profile, televised
visits to AIDS patients are "really only the starting point". China
now needs to do more to encourage a commitment to HIV/AIDS awareness
and prevention at the local level, Rehnstrom said.

"There are indications of a spread of the epidemic to the general
population and that's what the government is worried about," he
said.

Singapore is seeing a similar trend in the spread of the disease,
with Health Ministry figures showing that of the women infected with
the disease, seven in 10 are married.

Men are having casual sex and going to see sex workers, said Melissa
Kwee, president of the National Committee for UNIFEM Singapore. "If
you put that together with the finding that over 60 per cent do not
disagree with that practise, you have risky behaviour on the part of
men, and you have trusting or ignorant behaviour on the part of
women."

Singapore is now offering free health screenings for women at
designated facilities.

The Indian government will be scaling-up treatment programmes,
efforts to sensitize the medical community and campaigns to change
people's attitudes and encourage them to practise safe sex.

Still, only 16,000 of the 500,000 Indians with HIV/AIDS receive anti-
retroviral treatment, another reason behind the spread of the
epidemic.

"Since people are not treated, many who suspect they have HIV/AIDS
do not go for testing. This contributes to the silent epidemic,"
Manisha Misra, UNAIDS programme officer for India said.

Making the HIV/AIDS epidemic as public as possible is what benefited
Thailand in the past.

"You should get a retired head of Coca-Cola to run your AIDS
prevention programme because he would know you can never stop the
promotion," said Mechai.

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