Cautious optimism that Aids HIV is under control in Thailand with ongoing government campaign

There can be no doubting the success of the Thai government's successive campaigns aimed at defeating the threat of HIV/Aids since the global epidemic threatened the kingdom in 1991.

'I think when you compare Thailand to other countries and consider the threat that was being posed, it is a remarkable achievement for the country,' says James Morris, a commentator in Bangkok.

The country is in the middle of its current campaign but official figures suggest the rate of HIV/Aids infection in the country is still declining. Concerns have been expressed about an increase in sexual activity among younger people in Thailand and unscrupulous sex workers working outside establishments. A key part of the government's successful programme was to introduce HIV/Aids education and prevention regimes into the sprawling sex industry in Thailand which has always been illegal in the country.

One of the key successes of the Thai government has been to encourage sex workers to always use condoms with the result that the infection rate among Thai women working in the sex industry has reduced to 2.5%. The concern now is that there are growing numbers of outlying sex workers failing to keep to such measures especially among independent or immigrant sex workers. One source estimates that up to 40% of Thai prostitutes may be failing to abide by the strict guidance issued by government agencies and programmes although some commentators think this figure too high.

HIV/Aids in Thailand highest among gay men and drug users

While the growth or further spread of HIV Aids in recent years has come from heterosexual activity, the vast majority of HIV/ Aids cases in Thailand still relate to the gay community and drug users. the most recent figures show that:

62% of people infected with HIV/Aids in Thailand are male. The incidence of HIV/Aids infection is as high as 30% among the gay community or among men engaging in sex with other men.

The success of the government's campaign in this area has resulted in more funding for the treatment of HIV/Aids infection including the provision of antiretroviral drugs and tests conducted to show the effectiveness of such campaigns.

Foreigners visiting Thailand who are sexually active

Thailand, somewhat unfairly, has a reputation in western countries as being a centre of paid for sex. Actual figures show that prostitution and sex for sale activities in Thailand are below average in Asia but not so for Aids/HIV. Thailand is near the top of the table in the region but fares well when compared to infection rates in Africa with a rate of infection similar to Russia and some European countries.

'It think it's pretty unfair,' says James Jacobs, an Australian who operates a diving business in Phuket . 'I've lived here for nearly twenty years and while I am am aware HIV/Aids like most people, the government has done such a job of it that I'd think Thailand is just as safe as many parts of Europe or even Australia, to my mind at least, but there are guys that come here for fun with the ladies and I'd advise them the same as I would any young lad in Australia and that's don't get involved with unprotected sex with strangers, like use condoms.'

A recent survey among TLL users (ThaiLoveLines - Thailand's No. 1 dating Site) shows that 53% of men who visit Thailand engage in sexual activity on their trip to Kingdom. Key segments in this groups include:

Young western men coming to Thailand on 'sex and booze' holidays particularly western men from the UK and Australia. Middle aged European visitors who regularly meet up with short term girlfriends. The survey showed that 23% of German users had regularly girlfriends in Thailand.

Aids HIV in Thailand falsely overestimated

Because of it's reputation for being a sex for sale destination, Thailand has equally unfairly been labeled by some as a country that rates high on the list of HIV Aids infected countries. In fact Thailand ranks 39th in the world behind such countries as Haiti, Ghana and a host of African countries. South Africa, the country which hosted the 2010 World Cup had the 4th highest incidence of HIV/Aids in the world.

Thailand has an incidence of 1.3% although recent figures in Thailand suggest a lower figure of 1%. This can be compared to 17.8% for South Africa where the Kingdom of Swaziland is located. Swaziland in South Africa has a rate of nearly 26%. Taking a European country such as Ireland for example, the figure here show an incidence of 0.2%.

An indication of the tendency by the media to exaggerate and overestimate Aids HIV in Thailand can be seen from a newspaper report some years ago in Australia where a senior medical professional was perhaps incorrectly quoted or understood as saying Thailand was the 'Aids capital of the world' and attributed increases in the incidence of HIV/Aids in Queensland, Australia to younger Australians paying for sex in Thailand.

Dr. Richard Kidd, the president of the Queensland Medical Association said: 'I would want to get that message out again about safe sex - I don't know how much young men are aware that Thailand is the HIV capital of the world.'

Researchers in Australia are not sure what is causing the spike in HIV Aids that was reported. However it is not so clear that the problem originates in Thailand where HIV Aids has been in decline. However Dr. Kidd may not be entirely wrong.

Thailand seems to have the largest incidence of HIV Aids in Asia although it's recorded figures are similar to Russia, twice that of the USA and three times that of France and Switzerland. 'The current figures for Thailand are impressive when you consider the extent of the original problem in 1991,' says James Morris. 'It is a remarkable achievement by the Thai government.'

Jim Jacobs, the Australian expat thinks the comments by the medical professional in Australia were a little unfair. 'Yes maybe there is a bigger problem in Thailand but this relates to incidents that occurred in the past, I think that the increases in Australia may just as well have come from younger Australians paying for sex in Australia or other Asian countries as young men seem to do more often these days, regrettably. But then I'd say that it's always best to be careful and warn young people about the dangers out there.'

Mr Jacobs points out that in Thailand the health service was 'exceptionally well organised' and the Thai government has successfully removed the stigma associated with the disease. It should also be noted that while figures in Queensland and Western Australia showed spikes, this was not the case for other parts of Australia.

Australian doctor on Thailand's Aids status

The Australian doctor in Queensland may have meant to infer that Thailand along with Papua New Guinea had the highest rate of HIV Aids per head of population in Asia, with 1300 out of every 100,000 people diagnosed with the disease in Thailand. From official figures at least, Thailand does not appear to be the Aids HIV capital of the world with a rate of infection similar to that in Russia but over twice the rate in the United States.

The claim comes at a time when one of Thailand's leading campaigner against Aids and ex cabinet minister has suggested that the Thai government needs to launch a new condom and information programme to combat the disease. Successive governments in Thailand have been largely and fairly credited with leading a very successful campaign to minimise the effect of HIV Aids in the aftermath of the 1991 Aids crisis in Thailand.

In 2012, a former government minister and Aids campaigner associated with the programme, criticised the government of then Prime Minister Yingluck Shinawatra for failing to tackle the possibility of a reemergence of the threat.

'Thailand prior to the recent coup had a period of instability and perhaps the government may have taken its eye off the ball, the new government is operating a far more stable climate and I would expect that the successful campaign to combat Aids in Thailand will continue,' says James Morris, an international correspondent in Bangkok. 'But there is a concern about younger Thais and a more promiscuous culture, so that needs to be addressed. I would say that there is a heightened danger among Thai sex workers but the government's education campaign and programmes seems to have effectively brought this under a control, I don't agree with the figure of 40% of Thai sex workers engaging in unprotected sex. From what I have read and through interviews I'd be surprised if it was anything like 10%. Today in Thailand the highest incidences of Aids/HIV is still among the homosexual community and drug users.'

Thailand's HIV/Aids champion criticises former Thai government

The former Thai government minister, who has received numerous UN awards for his work on campaigns in conjunction with the Thai government which was credited with reducing by over 90% or nearly eliminating the threat posed to the HIV Aids virus to the population, has in recent times expressed concern that the issue may resurface as a problem in Thailand and called for another war on Aids HIV to be undertaken.

In a 2012 interview with the Australian Sydney Morning Herald newspaper in New South Wales, Australia, he warned that infection rates for HIV/Aids were still a problem in Thailand and may have begun to increase again. It has been suggested that currently in Thailand the trend is for new infections to be generated from among the heterosexual community. It is claimed that 80% of new cases are from this group which contrasts sharply with the trend in developed countries where the rate is as low as 10%.

The former minister, in his interview with Australian media, again advocated more advertising to the general public to use condoms. Such was the intensity of campaigns in the 1990's that the popular 73 year old became known in Thailand as 'Mr Condom'.

In an interview with Australia's Sydney Morning Herald the minister highlighted his concern about Aids in Thailand: 'I innocently thought I had done the job...but the government has fallen asleep at the wheel. There is a total indifference to a war we have to fight,' he said.

He was referring to evidence that the rate of Aids/HIV infection may again be growing with young Thai teens engaging in premarital sex. The comments came at a time when the crisis riven government of Yingluck Shinawatra was battling to survive. This was prior to the 2014 coup in Thailand which introduced calm into the country. 'Despite Thailand's reputation as a sex for sale centre, the people of Thailand are very private and old fashioned,' says James Morris, in Bangkok. 'There is evidence that this is changing and that younger Thais, even those at school, are experimenting with sex. The problem is that that there is still a marked reluctance in Thailand to openly discuss this.'

Key figures about HIV/Aids in Thailand

Thailand's government has been very successful in its campaigns since 1991 and is currently engaged a new campaign aimed at reducing HIV/Aids transmission. The figures for the incidence of HIV/Aids in Thailand is as follows:

• About 1% of sexually active Thais have HIV infection.
• It is estimated that over 20,000 Thais still die each year from HIV/Aids and related illnesses.
• About 0.3% of Thai women have HIV Aids infection
• It is estimated that about 2.5% of female sex workers in venue based sexual establishments may have HIV/Aids

The investigations in Australia into an alarming rise of STD and HIV infections among young Australian men in Queensland and Western Australia has certainly led one leading doctor to suggest that the spike in infection may be linked to younger Australian men traveling to Thailand to spend money on prostitutes.

'I think this may be a bit unfair to Thailand but it would be wrong for anyone to suggest that Thailand was Aids free or it was ok not to use a condom when visiting Thai sex workers or even by visiting sex workers at all in Thailand.' says Jim Jacobs. 'What has happened in Thailand is that infection rates have been controlled by effective government campaigns and the use of condoms. I often joke with some of the boys coming out here and ask them out straight if they have brought condoms with them but I'm really not half joking, when you think about it, it's really serious.' Mr Jacobs business relies on many young westerners particularly Australians visiting Thailand.

Thailand continues to be a key getaway location for young Australian men seeking cheap sex and beer according to the Australian expat. Jacobs runs his business in Thailand and has lived in the country for nearly twenty years. His advice to young Australians and other foreigner coming to Thailand is the same as that offered by the legendary Thai former government minister and Aids campaigner: use condoms and avoid unprotected sex.

'I don't want to frighten or put off anyone here, I don't agree for a moment that there is anything to be afraid about but any sensible person anywhere in the world would not have sex with a stranger without a condom and this is true also in Thailand as in the USA or any western country where there also still risks.' says Mr. Jacobs. 'I say to anyone visiting Thailand to find condoms if they are going to get involved in sexual activity,' he states. The Australian points out that there are still many Australians who visit the country for the amenities and the scenery and who are not interested in the sex trade. 'I'd say it's a 50/50 thing really and everyone is just here for a holiday, right, no point talking like that to a guy who has brought his girlfriend.'

Concerns that Aids/HIV may reemerge as a problem in Thailand

While the government is aiming to wipe out the problem by 2016, concerns are being raised particularly regarding the issue younger Thais engaging in unprotected sex with multiple partners and those procuring the services of sex workers for unprotected sex. 'It is clear that foreigners visiting Thailand should not engage in unprotected sex,' says James Morris but the message has got to get out there, that's the issue.'

It has been suggested that there is growth in sex workers engaging in unprotected sex which is a cause for concern. 'There are no official figures yet on this so its speculation but I have seen research showing that up to 30% of expats living in Thailand have used the services of sex workers and I know of at least one well known expat who has recently died from complications associated with the disease, so yes it's no time to let the guard down and HIV/Aids is not something that has gone away,' says James Morris.

Key facts about HIV/Aids in Thailand

• Thailand has the same rate of infection for HIV/Aids as Russia with 1% of the adult population being infected. This is an official figure to 2011 and the rate has been decreasing with a very effective government campaign. Compare this figure to nearly 18% for South Africa. The rate of infection is twice that of the United States.
• The rate among female sex workers in Thailand is estimated to be 2.5% with the key danger posed being unregulated sex workers offering unprotected sex.

Reports suggesting that new incidences of HIV/Aids infection in Thailand are originating in the heterosexual community are of concern. There is also heightened concern about young Thai teenagers increasingly engaging in premarital sex often unprotected and men availing of unprotected sex with sex workers. Transmission of the HIV/Aids virus is achieved through anal or vaginal sex not through oral sex which poses little or no risk.

Thailand is not the Aids/HIV capital of the world and the claim is unfair in the light of official figures showing a continuous decline in infection rates, However Thailand has the one of the highest infection rates in Asia and there are concerns about groups posing increased risk of infection.

Thailand is country which has effectively contained the HIV/Aids epidemic which posed a severe threat to the country in the early nineties. The rates of infection have now been brought to levels to within a range of some European countries and half those of the United States well below rates in Africa. However because of the reputation of the Thai sex industry and the continuing numbers of tourist who engage in sexual activities often with sex workers in Thailand, the issue should be a cause of concern to those involved. 'It is clear that there are scare mongers out there but the message is clear, unprotected sex in Thailand with strangers or sex workers is like playing Russian roulette with your life,' says James Morris. 'That said the same is true in the United States or Europe or wherever you will go.'