Thailand’s response to AIDS has been widely applauded as one of the world’s greatest success stories. The HIV-infection rate in the country has fallen from 24,000 patients in 2001 to 8,000 in 2012, and more of them are receiving treatment. Thailand’s case is highly significant, as it is one of the first countries in introducing free antiretroviral treatments. While these medicines are unable to cure the disease, they make a crucial difference for the patients, as they allow them to live a much healthier life, thus enhancing their well-being for a longer period of time.
HIV-positive patients enjoy access to these medicines, without having to pay unaffordable medical fees. However, and despite this progress, the eradication of the social stigma still associated with the disease is one of the most important challenges they have to face. People diagnosed with AIDS are still denied the job opportunities they need to return to a normal life. In many cases, they are abandoned by their families and rejected by their immediate environment. On top of that, the disease figures in their medical tests, making difficult for them to take part in the labor market.
According to UNAIDS, there are 440,000 HIV patients in Thailand, from a population of 67 million, and there are many more unregistered carriers of the virus who are afraid of undergoing a test.
A negative perception of the disease and its patients permeates Thai society and makes much more difficult to eradicate it. Many Thais associate it with commercial sex or the use of injected drugs, illegal activities that are as frown upon in this country as in many others. As a result, many carriers of the disease are afraid of discovering in a test that they carry the virus, and therefore enter late into the healthcare system and their treatment is delayed. The consequences might be extremely dire: when a person infected with HIV is taking medication, the risk of becoming AIDS, the name of the disease, is much lessened.
Successive Thai governments have organised a series of campaigns aimed at reducing both the HIV prevalence and social stigma in the country. However, those campaigns did not exist only a few decades ago. When AIDS arrived in Thailand in 1984, the policy response was muted. At that time, the prevailing view was that AIDS was an epidemic brought from abroad, which was merely confined to a few individuals belonging to high-risk groups like gay men and injecting drug users. It was believed that it would not spread more widely.
This idea had to be dismissed promptly when, in the lately eighties, a major epidemic engulfed the country. HIV infection among injecting drug users rose from almost nil to 40% in a single year. On top of that, the rising infection levels among sex workers skyrocketed to a 31% at the national level by 1994, spreading subsequently waves of the epidemic in to those sex workers’ male clients, their partners and even their children, as was reported by the World Bank. It was then when the government came to be acutely aware that AIDS was a widespread problem that it could not avoid any longer.
In the early nineties, the Thai Government launched a public information campaign to reduce HIV transmission, and a program to promote universal and consistent condom use in commercial sex. After that, the annual figures of new HIV infections, which had peaked in the early nineties, declined by more than 80 percent.
But those initiatives are long gone and currently most teenagers and young adults may not remember the prevention campaigns that were carried out years ago and may be unaware of the risk entailed by unsafe sexual behaviours. For example, in 2010 it was discovered that, among venue-based sex workers, only 50 percent had undergone a HIV test during the last year, and that the HIV prevention programs only reached 57 percent of them, as was reported during the United Nations General Assembly Special Session in 2012. According to an UNAIDS report released in 2012, only 71 percent of Thais in need of treatment were receiving it.
The Thai government is urgently compelled to confront head-on several challenges. “Thailand has a universal health care system fully funded by the government, but getting newer HIV medicines and access to free Hepatitis C drugs is still a problem,” says Shiba Phurallatpam, regional coordinator of the Asia Pacific Network of People Living with HIV/AIDS. It is also noteworthy that HIV and AIDS prevention programs have gone into hibernation. Currently, around 80 percent of the national budget to fight against the virus comes from domestic sources and most of it is spent on treatment rather than prevention, according to HIV charity Avert.
Nevertheless, there have been some advances. Thirty years after the epidemic began, the silence on men who have sex with men was finally broken in 2011 when they were included as one of the key affected populations, along with drug users and sex workers. Although sex between men is not illegal in Thailand since 1956, prostitution is and a condom can be used as a piece of evidence in an accusation. Stigma and discrimination are still prevailing, and it remains the challenge of changing people’s attitudes. This is bound to be a long process, all the more challenging when the virus is widely perceived as closely linked with socially disapproved behaviours.
On the other hand, HIV also affects up to five million migrant workers living in Thailand. Although antiretroviral drugs are available irrespective of nationality, the difficulties that they have to face –like language barriers, exploitative conditions and frequent movements back and forth to their countries of origin–, make much more difficult for them to get access to the information about the AIDS and HIV they need. “This in turn can have negative consequences on their well-being and that of their communities, as well as undermine the realisation of global health goals, including HIV prevention, care and support.” says Andy Bruce, Regional Director of the International Organisation for Migration.
During a conference hosted by UNDESCAP on last January, the lead-up to discuss the Post-2015 Development Agenda, there was a call to the governments to insure that all the people, regardless of their social status, gets access to health services and HIV programs, including HIV education, testing, treatment and support services. It is crucial to ensure that nobody is left behind to put an end to an epidemic that has already claimed thousands of lives.