Thailand has long been held up as a role model for other countries in the fight against HIV/AIDS. There are many explanations why the 'pandemic' has played out the way it has in Thailand.
One circumstance that makes the country so exemplary may be that it always seems to deliver whatever AIDS; Inc requires at the moment.. Be it a disease said to be introduced by Westerners but more prevalent in the Northern provinces, remotest from the tourist centers to the South, staggering rises in seropositivity in IV users from 1% to over 30% in 8 months, equal numbers of infected non-drug using prostitutes, or army recruits in whom drug use and homosexuality were insignificant factors compared with female to male transmission, and in whom HIV prevalence was 3 times higher than syphilis. You name it, Thailand has it.
Even when Thailand delivers too well to be credible there is an explanation at hand: The Thai 'E' super strain of HIV, up to 500 times as infectious as the ordinary strains was conjured up to support the claims of astronomically high levels of transmission through vaginal intercourse in Thailand (and Africa). And when it was no longer needed, too fit for survival as it were, it just as quickly disappeared down the memory hole, leaving behind the equally incredible success stories of well planned and executed prevention campaigns.
It is not necessary to crunch numbers here. The simple proposition is that the status of HIV/AIDS in Thailand reflects at any given time the state of union between international incentives/pressures, national "face saving" politics and national moral sensitivities. Generally the convergence of interests has been a happy one and Thailandhas delivered, even in its backsliding.
In this respect, the first two articles of a new series on HIV/AIDS featured in Bangkok Post , called AIDS Lingers Behind Bars and Prison HIV/AIDS Programme , offer new insight into the world politics of AIDS as they apply in Thailand.
The first article begins with this homage to the suspension of human rights:
“It was in the aftermath of Thailand's 1991 coup that the country staged its greatest battle in the war on Aids. Martial law blew in where bureaucracy could only tiptoe, rolling out the famously successful 100% condom campaign in brothels (where only protected sex was sold), in schools (where condom competitions were held), on the bodies of water buffalo (where family planning slogans were painted), and over sensitivities that until then had made the condom barely known, rarely used, and generally taboo in parts of Thailand.
With the candid, unabashed call for 100%, there were few places where the condom failed to creep. As a result, the nation's Aids rates were slashed and the spread of what appeared at the time to be one of the world's most worrisome national epidemics was halted."
Thus, the first paragraph in the first article in this series hails martial law or similar conditions as a sine qua non in winning the battle against AIDS in Thailand. The article itself is written in the aftermath of Thailand's latest coup and subsequent martial law. It resonates particularly well with certain political 'developments' in the US, and of course with the 'test everybody' policies soon to be implemented if AIDS Inc. has its way.
The article's headline has already identified the perfect test population in a place where nobody has to be ashamed to admit that "AIDS lingers", namely among the certifiably criminal.
“Yet, of those few places, one was prison, where some believeThailand's Aids problem truly began and where, 15 years and another coup later, sensitivities remain and perhaps some of the nation's greatest remaining Aids risks linger.”
The shifting prison population is probably the largest group after pregnant women who are at one point or another "available in health facilities", as one speaker, HIV positive Grace Sedio from Botswana, put it at this year's Toronto AIDS conference. There is, however, one small problem with actual reported numbers. The Corrections Department recently announced that there are 740 known HIV cases in Thai prisons.
“With a population of 160,000 prisoners in 136 prisons, the 740 cases translate to a prison infection rate of 0.5%, which is about a third of Thailand's national Aids rate ( 1.4%) and only a quarter of the 4,800 prison cases (given as a 1.61% prevalence rate) that the Bureau of Aids, TB, and STIs reported to exist among the population.
It is a rate 20x times lower than the bureau found in the sex worker population (11%) and over 80x lower than that found among Thailand's population of injecting drug users, or IDUs (42%). A study performed by independent researchers in 2000 found that an IDU was 11% more likely to become infected in prison than in the community; a non-IDU 5% more likely. “
Translated into English, this means that the different face saving and policy making instances are still not in synch, with each other and with the so called 'independent' researchers, regarding the official stance. In fact, the whole thing is little more than conjecture according to Patrick Brenny, UNAids country coordinator for Thailand:
“Because so little data exists, and because there are such disparities in what little data does exist, Brenny says it is hard to be conclusive. "What the real story is and its significance in terms of size and scope of problem, no one really knows. There is a good chance HIV transmission is happening in prisons, and there is a good chance more is coming out than is going in.”
Accordingly the real problem to be solved is that of human rights: the regrettable enemy of benevolent efficiency that make up the 'face' of any regime. With positive test comes all the problems associated with guilt, fear and social stigma. In connection with that, there will be pressure to take the HIV drugs. Refusal of drugs may even in our part of the world, lead to mothers having their children taken away from them, or prisoners being confined in special HIV prisons.
In the second article in the series this point is addressed by Nipa Ngamtrairai, public officer with the Corrections Department :
“Counselling is provided with testing, though Nipa says that staff are limited in their ability to provide health teams and especially the counselling services needed to accompany Aids testing. While the Corrections Department is working on ways to increase Aids testing among inmates without making tests mandatory, she says there is a great need for more funding to provide the added tests, ARV counselling and the psychiatric treatments that will come with the plans.“
But Dr. Sombat Thanprasertsuk of Thailand's Bureau of Aids is quick to point out the key difficulty:
“While drugs and treatments are accessible to patients, the problem comes in enrolling prisoners to receive them”, says Dr Sombat.
Once more Patrick Brenny is ready with the solution to the conundrum, and the real explanation for the sudden interest in the well being of Thai prisoners:
“The, UNAids country coordinator for Thailand, says enrollment for Aids testing is a challenge everywhere, and that recently health departments around the world have begun revamping policies so Aids testing is the standard procedure. While subjects still have to understand the situation and give consent to the test, the process is initiated for them; that is, rather than having to ask for a test, the subject must say no to it.”
Lest any country even think to challenge, Thailand is poised to re-assert Her rightful place as the example to follow in the War on AIDS.
Claus Jensen is a Dane living in Thailand where
he is able to eke out a meager but sustainable
existence as a martial arts instructor primarily because
he is much taller than the average Thai, and can overpower most
ordinarily accomplished Thai boxing teachers provided they are half his size and
twice his age.
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