Thai Aids "success Story" Scares Asia

[george]

Thai AIDS "success story" scares Asia

BANGKOK: -- 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.

--Bangkok Post/DPA 2005-11-29