Phuket Number One In HIV/AIDS Infections Nationwide

[webfact]

Phuket Number One in HIV/Aids nationwide: MoPH

Schoolchildren take part in an HIV/Aids awareness campaign

at an event at Big C Supercenter on December 1, World Aids Day.

PHUKET CITY: Phuket has the highest incidence of HIV/Aids infection of Thailand's 76 provinces, but the figures are skewed by the island's huge migrant population, the island's top government doctor says.

Dr Pongsawat Rattanasaeng, director of the Phuket Public Health office, said Phuket's emergence as a top tourist destination is largely responsible for the province's dubious distinction as Thailand's 'per capita' leader in HIV/Aids.

Migrant workers from all parts of the country make their way here to work in Phuket, but are never registered as residents of the province.

Those who contract HIV and test positive at government hospitals in the province are counted among Phuket's HIV/Aids cases, he explained.

Phuket's official population is listed at around 330,000, but government estimates put the number of Thai people living here at about double that amount.

The Ministry of Public Health (MoPH) calculates instance rates of 'cases per 100,000 members of the population' for comparative purposes. The problem comes when the number of cases derived from the actual population is divided by the much lower 'official' population.

Only HIV cases involving Thai nationals are included in the MoPH statistics, he explained.

The MoPH keeps separate records for cases involving migrant workers from neighboring states. Most of these return home, but there are currently about 20 being treated for HIV/Aids in Phuket, he said.

Legally-registered migrant workers from Burma, Laos and Cambodia are eligible for treatment under the government's universal health care program initiated by former Prime Minister Thaksin Shinawatra.

Dr Pongsawat said that to mark December 1, World AIDS Day, the provincial government launched a number of public awareness campaigns to better inform people about how to prevent contracting HIV – and what to do if they test positive. Many of the activities involve youths, as they are deemed at high risk.

Systematic government HIV/Aids tracking statistics in Thailand began 20 years ago, in 1989.

From then until October 2009, reports from hospitals and clinics in Phuket revealed 6,648 cases of HIV infection, with 1,767 fatalities, Dr Pongsawat said.

There are currently 3,813 people undergoing HIV/Aids treatment in the province. Of these, just 805 are symptomatic. The ratio of male-to-female cases is about 2:1, he said.

Most patients are in the 25-39 age bracket and those infected identified themselves as working in a variety of professions including 'workers for hire' and housekeepers – as well as the unemployed.

-- Phuket Gazette 2009/12/3

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[geriatrickid]

I commend the MoPH for being open.

Last year, when initial results were being studied and an indication of severity was provided by multiple sources, some of the positions were ridiculed by commentators in TV. It's hard for a country to admit to this problem and it is argued by some in the tourist trade that data should be massaged and hushed up because of the potential for negative impact. The MoPH leadership had to be strong to resist those that don't like seeing such information.

If you want to have a better idea of how serious the situation is, one word: Extrapolate.

Most people with HIV do not know they are sero positive because of the resistance to testing. That fact isn't particular to Thailand, but is typical of every country. Stigma, fear, mai pen rai, barriers to testing etc. are why people don't get tested. A cynic or pragmatist might say there is an incentive to be open, it's called the WHO surveillance system and the potential to access funding from the US government, and the Gates & Clinton foundations to help deal with the problem. Honourable mentions go to the public health officials in the UK, Germany, Sweden and Norway that put health first and spoke out when the number of nationals returning home with HIV started increasing. Whatever the reason, it took a heck of a lot of courage to be open on this. I'm sure that the spin cycle will now go in to high gear, but maybe just maybe some tourists will pay attention.

[dumball]

A few facts I picked up from a world map of HIV cases in 2007 , Thailand 30,000 USA 22,000 Canada 500 Australia less than 500 New-zealand zero South Africa 320,000 . Hiding facts helps no-one , least of all those affected .

Moral ? Keep it in your pants or in a condom , one never knows what one could be getting into , even explosives are sent in pretty packages .

[BusyBee123]

A few facts I picked up from a world map of HIV cases in 2007 , Thailand 30,000 USA 22,000 Canada 500 Australia less than 500 New-zealand zero South Africa 320,000 . Hiding facts helps no-one , least of all those affected .

Moral ? Keep it in your pants or in a condom , one never knows what one could be getting into , even explosives are sent in pretty packages .

I don't think junkies injecting are going to be wrapping their needles with a condom

[chiang mai]

Of course it is, "the figures are skewed by the island's huge migrant population", correct that problem and you'll likely find that Phuket is not even close to be the highest incident location.

[dumball]

'BusyBee123' date='2009-12-03 19:44:16' post='3181230'dumball' post='3181216' date='2009-12-03 12:39:07']A few facts I picked up from a world map of HIV cases in 2007 , Thailand 30,000 USA 22,000 Canada 500 Australia less than 500 New-zealand zero South Africa 320,000 . Hiding facts helps no-one , least of all those affected .

Moral ? Keep it in your pants or in a condom , one never knows what one could be getting into , even explosives are sent in pretty packages .

I don't think junkies injecting are going to be wrapping their needles with a condom

Your comment leads me to believe you are of the opinion only 'Junkies' can contract HIV !!!!!!!

[BusyBee123]

nope just dont think quoting statistics relevant to all manner of ways of contracting hiv can be fixed with a condom

[WinnieTheKhwai]

OMG ... where's the 'slams forehead' smiley when you need it....

Plain and simple: they don't understand statistics... Anyone bet it went like this:

1. Count number of positive HIV tests / people living with hiv/aids

2. Divide not by the total number of people present in Phuket but buy the official population number which for a place like Phuket is *MUCH* lower.

3. Multiply by 100%

Well waddayaknow, another botched statistic was born, in the country of ... something or another..

The problem is NOT migrants, the problem is NOT their HIV infection rate, the problem is 'the top government doctor' not knowing a percentage from a hole in the ground.

EVEN when counting migrants you can still arrive at a correct and reasonable statistic that's only marginally higher than when counting only relatively rich native Phuket people, but you have to divide by the right $(#*&$&(*# number!! Triple DUH.

Edited December 3, 2009 by WinnieTheKhwai

[WinnieTheKhwai]

Hey.. I missed an opportunity to blame the Nation for not having a brain of their own to check such things.. Oh well, next time.

[viorel]

So they are around 4,000 ppl infected with HIV from ~ 600,000?

This meens around 0.6 % (if i understand well).

I belive it is more plausible to die because of a bike accident than because of AIDS.

So, in the end, why you should be scared about something that can kill after 10 years, when you can die tomorrow?

[borracho]

The ratio of male-to-female cases is about 2:1

Unprotected gay sex might be a factor here. Though it would be "politically incorect" to say so.

[Valentine]

I read a few months ago the number of registered vehicles in Phuket was 700,000 plus the number of other province vehicles surely makes the population of Phuket at more than one million so yes the official incidence of HIV+ in Phuket is lower than stated. However, with the huge sex industry which flourishes in Patong & growing in many other places on the island there must be those who have HIV+ & getting treatment from outside Phuket,, those who have it & are not aware, it could still make the incidence in Phuket quite high.

[geriatrickid]

So they are around 4,000 ppl infected with HIV from ~ 600,000?

This meens around 0.6 % (if i understand well).

I belive it is more plausible to die because of a bike accident than because of AIDS.

So, in the end, why you should be scared about something that can kill after 10 years, when you can die tomorrow?

Uhhh, no.

First let's look at the big picture. The conservative politically correct rate from the WHO, ranges from a low of 0.9 to a high of 2.1% of the total Thai population living with HIV (using the 2007 data). The WHO relies on actual recorded cases (as reported by Thailand) and uses a conservative adjustment factor. There is a segment of researchers that will suggest that the rate is more along the lines of 2% to 5%. (This is attributable to under-reporting, both intentional and unintentional.)

Whatever measure you use, it's still a heck of a lot of disease reservoirs wandering about.

Now, look at the press report. Most patients are in the 25-39 age bracket and those infected identified themselves as working in a variety of professions including 'workers for hire' and housekeepers – as well as the unemployed. Actually what was said was that casual workers were the leading employment group. That line made us laugh. Workers for hire/casual workers is a polite term for sex trade workers. Ok, so what am I saying? Even if you discount for the foreign nationals, Phuket has a major HIV problem with it's sex workers. My personal belief is that the number of people with HIV that work in the sex trade is probably in the range of 30%-40%, and I'm being conservative. I'd venture that the rate in Patong is probably closer to 50%. That's a side issue, but it explains why public health officials in foreign countries crapped their pants when HIV infections atrributable to Thailand visits started appearing.

Look at the numbers that everyone can agree on; There is a large population that flies under the radar because they are not in Phuket "officially". In Thai bureaucratese, these non locals should be counted under their respective provincial counts not under Phuket's or should be excluded outright if they are not "Thai". That doesn't help contain the problem, because those non locals are still mixing with the local population. Unfortunately, health budgets are established based upon official population numbers. Keep one last stat in mind, if one accepts the PC "estimated" number of people living with HIV in Thailand is 610,000 people, the estimate of infected people receiving anti retrovirals is only 153,000. Do the math. When people do not receive preventative medication, they almost always develop AIDS. Now put yourself in the position of the provincial health authority. It's expensive to care for someone that has the complications of AIDS. It's expensive to dispense antiretrovirals. True, many will go home to be cared for, and others will just go off somewhere to die but that still leaves alot of people that will eventually flood the local "free" hospitals which in turn will put tremendous cost pressures on the local health delivery system. The provincial health authority has a ticking time bomb on its hands. It's asking for help before it has a problem where people with AIDS take up the wards and eat up the healthcare budget.

2007 data is here; http://www.searo.who.int/LinkFiles/Facts_a...08_Thailand.pdf

[WinnieTheKhwai]

50% even among sex workers is pretty ludicrous, I don't think I want to have that debate. Such a rate has never occurred anywhere in the world including Africa.

I think it's an error in using statistics plain and simple; there's no reason why Phuket's rate would be higher than Mae Hong Son, Pattaya, Bangkok, etc, etc.

One thing did occur to me last night.. There is a possibility that the 'Top government doctor' isn't stupid, but corrupt and this is a ploy to get some cool aids budget down South, and channel it away from places like Mae Hong Son where there truly is a problem. I would almost prefer that to be the case.. I have a much higher tolerance for corruption than for stupidity.

[Scott]

Thank you Geriatrickid for an informative and insightful analysis of the situation.

HIV/AIDS is a complicated problem. This is especially true when it gets mixed with morals, sexual preferences, racism, nationalism and xenophobia.

The figure of sex workers being infected at 50% is a posters upper end guestimate. I tend to think that's high, but not out of the realm of possiblility. Lots of factors such as the length of time in the trade and how active in the trade they are would affect it. The point is pretty close to 100% of sex workers are in the category of being exposed to the virus.

[geriatrickid]

50% even among sex workers is pretty ludicrous, I don't think I want to have that debate. Such a rate has never occurred anywhere in the world including Africa.

I think it's an error in using statistics plain and simple; there's no reason why Phuket's rate would be higher than Mae Hong Son, Pattaya, Bangkok, etc, etc.

One thing did occur to me last night.. There is a possibility that the 'Top government doctor' isn't stupid, but corrupt and this is a ploy to get some cool aids budget down South, and channel it away from places like Mae Hong Son where there truly is a problem. I would almost prefer that to be the case.. I have a much higher tolerance for corruption than for stupidity.

It's not ludicrous and it is common to find a rate of infection of 75%++ in certain areas of Africa. Along the truck routes through Uganda and in South Africa there are places that exist solely to provide "services". This leads to a concentration of people specific to those services. It doesn't mean that the whole continent is at that rate, just that small little hectare of space. Please note that I said Patong, I did not say Phuket and I also said these people were specific to the trade. Let me reinforce to you that my observation applies to one specific demographic segment and not to the general population. I hold that opinion because;

1. The surveillance system that previously existed in Patong isn't there anymore. When's the last time there was a mandatory testing procedure? Was it in the past year? Was it last year? I cannot recall one swoop in the past 18 months and I think I'd be safe to say 24 months.

2. Prevention and education efforts in Patong bars are not there anymore. If so, please tell me when the last time such an activity occurred.

3. Pattaya health authorities still make the effort. Chiang Mai authorities still make the effort. Where is the budget for it in Patong?

4. Where do you think people that work in the trade and are turned out by their Pattaya employers now go? I believe it to be Patong. Obviously, if the infected workers were prevented from working in places where they still had surveillance migrated to an area where it wasn't deemed to be an obstacle, there would be a concentration of such people. It's no big mystery and all it means is that the concentration of such people will be reduced elsewhere.

5. I do believe that there are many foreign migrant workers concentrated on Phuket, simply because of the building boom.

The distribution of population with defining characteristics really isn't that extraordinary. Consider it from a different perspective. Some areas attract people. I can pick up a map of any major city and can map out population characteristics using postal codes. For example, in New York there are certain areas where one will find a high concentration of the elderly In London, I can find specific hotzones for drug addicts. In Madrid, I can find a location favoured by people that have low incomes. All of these people will be attracted by certain local characteristics such as cheap rent or whatever. in the case of Patong, my personal view is that it is favoured by a certain segment of the population, because the environment is conducive to the population. It's not rocket science. All that is happening is that peas on the plate are pushed into one section.

I also stated that it was my personal opinion. I think that if you make the effort you will find conservative estimates of 30% for Patong. Even if you don't believe me, the WHO numbers give a national rate. You can bet that while there are sero positive people found all over the place, it is normal to find high concentrations of such people in certain locations, particularly if they are associated with the hospitality trade. They will be found where there are tourists. And if they can't work in some tourist places they will go where they can work. Those people are sure as heck not going to be hanging out on the main street of Suratthani plying their trade.

What's ludicrous is insinuating that the MoPH official releasing the information is corrupt. Far from it. All he's saying is that he's stuck with other communities' problems and that they need help. Is it any different than the major cities asking suburbs to contribute to their upkeep since those suburbs are using the city's services?

I gave the link to the WHO report. Look at the numbers and do the math.

Edited December 4, 2009 by geriatrickid

[DaraRai]

i wonder if there will be an AIDS resurgence...it seemed to have decreased in the '90s or so, but now it seems to be back in full-blast numbers...

[Spee]

First let's look at the big picture.

A part of the "big picture" not often mentioned is all of the ticking time bombs flying back to various parts of the world, after engaging in physical activities with infected people still working in the trade, in some cases unwittingly propating the disease further.

One of my girl's friends from the village went to work in Pattaya several years ago, got involved in the trade, and now has a full-blown case. I wish people would be more careful. These are almost entirely preventable situations.