Former Model of Success, Thailand's AIDS Effort Falters, U.N. Reports

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http://www.nytimes.com/2004/07/09/international/asia/09aids.html?th

 

July 9, 2004

Former Model of Success, Thailand's AIDS Effort

Falters, U.N. Reports

By LAWRENCE K. ALTMAN

 

BANGKOK, July 8 - Thailand's AIDS program, widely

promoted as the world's most successful in preventing

the disease, is in serious danger of unraveling, the

United Nations said in a report issued here on

Thursday.

 

The United Nations called the report " a frank

assessment " of Thailand's situation and said that the

report should sound an alarm and spur discussion of

the issue at the 15th International AIDS Conference,

which opens here on Sunday. The meeting is expected to

draw at least 15,000 scientists, health workers,

political leaders and advocates. Health officials have

long praised Thailand for preventing millions from

becoming infected with H.I.V., the virus that causes

AIDS, by acting decisively early in the epidemic.

 

Strong support from top political leaders to provide

educational programs and adequate public financing and

to promote condom use as part of protected sex helped

reduce the number of new infections to about 20,000 in

2003, down from a peak of 143,000 in 1991.

 

That was " an achievement unrivaled by any other

country, " J. K. Robert England, of the United Nations

Development Program, said at a news conference here.

 

But Thailand has let its guard down, the United

Nations said, allowing a new phase of the epidemic to

become " a frightening reality. " Prevention has lapsed,

and the incidence of H.I.V. is on the rise among young

people, fishermen, construction workers and other

migrant workers, drug users and gay men.

 

Half of the new infections are occurring among men and

their wives or girlfriends.

 

" Thailand may be in for a nasty surprise " from a

resurgence of the epidemic that does not yet show up

in national statistics, said Hakan Björkman, the

deputy resident representative of the United Nations

Development Program in Thailand.

 

The Thai government has cut its AIDS prevention budget

by nearly two-thirds since 1997. Now adequate

prevention services are reaching fewer than 5 percent

of teenagers and adults too young to remember the

heyday of the AIDS epidemic, Mr. Björkman said. He

also said that condom use was falling among young,

sexually active Thais because they considered AIDS a

disease of the past and had little or no perception of

the risk of H.I.V. Public awareness campaigns have all

but faded from view.

 

" Thailand is in a danger zone, threatened by a new

wave of the epidemic, and if Thailand's success turns

into failure, the world will lose a guiding light and

that will have great implications for the global

response to H.I.V., " Mr. Björkman said. " Time is not

on our side. "

 

The report is being posted on a United Nations

Development Program Web site (www.undp.or.th). The

agency said it hoped that all countries would use the

report as a reference to learn from what Thailand did

right and what went wrong.

 

About 1.5 percent of adult Thais are infected with

H.I.V., down from 2.5 percent in the mid-1990's. But

since 2000, the prevalence of H.I.V. among pregnant

women has doubled to 2 percent in southern Thailand,

and has exceeded 3.5 percent in two provinces.

 

Since AIDS was first recognized in the United States

in 1981, more than 400,000 Thais have died of the

disease, 53,000 of them last year.

 

The United Nations and leading Thai authorities on

AIDS urged Thailand to put AIDS back on the political

radar screen. The authorities also urged Thailand to

consider revising its prevention messages because some

old approaches may no longer work among a new

generation.

 

Young Thai women appear more likely to engage in

extramarital sex than earlier generations. Yet studies

have found that only 20 percent of sexually active

young Thais and 15 percent of young gay men report

using condoms consistently.

 

From 1994 to 2003, H.I.V. prevalence has dropped to 7

percent to 12 percent from 30 percent. Condom use

among brothel-based sex workers has dropped to 50

percent in some locations from 96 percent at the

height of the education program in the mid-1990's.

 

Stigma and discrimination remain major problems. About

40 percent of infected people report breaches of

confidentiality in the health system and 25 percent

say they have been harassed.

 

Although nearly all young Thais know that H.I.V. can

be transmitted by unprotected sex, 20 percent also

believe they can become infected by hugging or kissing

an infected person. " Condoms need to be available

everywhere, " said Mechai Viravaidaya, a leader in Thai

AIDS prevention. In a new approach, he said, Bangkok

now has the first A.T.M. in the world that can

simultaneously dispense condoms with cash.

 

Dr. Werasit Sittitra, a Thai who works for the United

Nations AIDS program in Geneva, recalled what he said

a young woman told him as she was dying of AIDS early

in the epidemic, " Adults did not do enough to protect

me. "

 

On Thursday, he urged Thailand to better protect its

young.

 

Copyright 2004 The New York Times Company