Asia looks to Thailand's AIDS success story

In the global fight against the spread of HIV/AIDS, there are few happy stories to tell.

Thailand may be one. Its nationwide prevention campaign, launched in the early 1990s, has dramatically cut the spread of the disease. As a result, the number of people testing positive for HIV, the virus linked to AIDS, fell last year to 23,676, down 83 percent from a peak in 1991 of 142,819 according to the Thai government.

Thailand's success in averting an epidemic on the scale of the most afflicted African nations has won international praise - particularly its promotion of 100 percent condom use in its sex industry, and the involvement of Buddhist monks.

Keen to share its experience, Thailand is emerging as a learning center for developing countries in Asia, where AIDS is spreading rapidly. At Thailand's Chiang Mai University, training courses for AIDS prevention have attracted healthcare workers from around the region, including most recently from Afghanistan, East Timor, and Sri Lanka.

"We need condom promotion at a district level. Now we have zero percent condom use in our country," says Shiafiqullah Shahim, a member of Afghanistan's Ministry of Health. "We also have large numbers of drug users sharing needles."

Experts say countries at risk of an AIDS epidemic can adopt Thailand's lessons of early intervention and pragmatic policies for illicit activities. In Afghanistan's case, which has only recorded 15 cases of HIV this year, this would involve targeting intravenous drug users and refugees, and screening unsafe blood supplies.

What may prove harder to transplant is Thailand's other strength in battling AIDS: grass-roots community activism.

That factor was brought home to Chiang Mai's latest batch of students on a field trip to Phrao, a rural province that, since 1992, has recorded over 800 HIV/AIDS cases among its 50,000 population. Hospital officials in Phrao explained how their workload has eased as patients take on more responsibility for their own care and support. This has translated into better monitoring of drug regimes and fewer patients being hospitalized.

Another key to success has been removing prejudices about those afflicted by the epidemic - prejudices that fuel ignorance of the disease among people who think it only happens to others.

Chaiban Veeratsak, a former soldier who contracted HIV in the mid-1980s, recalls how the food he brought to local festivals would sit untouched as people avoided him. He says the stigma attached to the disease has fallen away over the past four years as HIV-positive residents have invited local leaders to come to meetings of their self-help group.

Group members support each other and gain local visibility through small businesses. Mr. Veeratsak and his wife, who is also HIV-positive, cook food and sell it from their home. Others in their self-help community, which now number 130, grow pesticide-free crops to sell at the hospital and on local markets. "Without community self-help groups like ours, we would still face discrimination," he says.

Such attitudes are an exception in most Asian countries, where AIDS sufferers are often shunned. Former US President Bill Clinton attracted attention in China at a recent AIDS conference when he embraced a young AIDS patient in front of television cameras - something that few Asian leaders are prepared to do publicly.

"Societies with lots of stigma don't lend themselves to an open dialogue about AIDS. It's not enough to give people information, there needs to be open discussion and people living with AIDS must participate," says Hakan Bjorkman, deputy representative to Thailand for the United Nations Development Program, which supports the Chiang Mai training courses.

For conflict-torn countries like East Timor, Afghanistan, and Sri Lanka, AIDS often takes a back seat to more pressing needs, including other infectious diseases like malaria and tuberculosis.

But experts warn that HIV/AIDS can breed fast and thrives on ignorance and social discrimination.

In East Timor, only a handful of people have tested positive for HIV, but healthcare workers say poor monitoring and the widespread stigma is probably masking the true picture.

"People don't know who is infected, but they are scared. Of course, if they hear that HIV-positive people are being treated at a clinic, they would run away from that clinic," says Rui Carvahlo, a HIV/AIDS field worker in East Timor.

As well as community networks, Thailand has also nurtured faith-based responses to HIV/AIDS that proponents say could also be applied elsewhere in Asia. Initial reluctance by clergy to take a stance on a disease seen as sinful has softened in recent years, prodded by high-profile monks who have opened hospices for abandoned AIDS patients.

In northern Thailand, Buddhist monks have begun running frank AIDS-education programs in local schools, as well as offering support and counseling to HIV-positive people. One of those is Somya Uthejan, whose husband died after passing the disease to her. She lauds the involvement of monks in her self-help collective.

"We live like an extended family in the community ... and now members of the family are able to understand and support us because monks are respected in the community," she tells her visitors.