On AIDS And Thailand
This past academic semester I have had an excellent opportunity to explore one of the world’s most pressing issues. I took a class on the HIV/AIDS epidemic and its impact on society. The class was designed to help us hone our research writing skills,
so each pupil was asked to choose a topic. We would research our topics all semester long, write a term paper that was closer in length to a thesis, and then give a 20 minute presentation on our topic towards the end of the semester.
Having an interest in Thailand, and knowing that Thailand had battled with this beast, my mind naturally flipped over to Thailand. Originally, I planned to do my project on Thai commercial sex workers (CSWs). This was with the full blessing of my Professor- the most awesome feminist ever. She too had traveled to Thailand, part in the capacity of a Buddhist and part in the capacity of a package tour straight to Phuket- get me out of the cold- tourist. She was interested in Thai CSWs, and admitted that she admired them for their confidence in their decision. Not something you expect to hear from a feminist, but people can surprise you- if you ever want to know way too much about how genders interact, without all the sexist men are from Mars, women from Venus bullshit, this would be the lady to talk to. But I digress… It was with her encouragement and blessing that I chose this course of study.
I began my research sure that I would have no trouble finding resources to tap. After a few days of searching a considerable wealth of information, I was appalled at how little information was available. Remember, these days all those academic journals consolidated into online databases, with full texts available online. It takes as little 30 minutes these days to know about pieces written in the past 30-50 years on one topic. I had searched the ends of the (English speaking) earth and found next to nothing.
I sought the advice of my instructor and was met with a grin. “Now you understand…” She told me that next to nothing is known about how many people are living with AIDS, how they are catching it, how they are being treated, how long they will survive, and how education and new technology affects all of these rates. There is some work being done, but most of it is total garbage with ridiculous errors, biases, and flat out lies. Most of the “information” you read in even the most respectable publications is unproven at best, and a total fabrication at worst. You would think that with all of the money being poured into this fight that more reliable data would be available.
I was truly appalled- no one had bothered to study what proportion of prostitutes in Thailand are living with HIV/AIDS. As Stick demonstrated a couple of weeks ago, no one even knows how many prostitutes there are in Thailand- this would make it hard to obtain an accurate idea, but there are not even any small or medium sample studies. That is, in English at least. Perhaps the Thais have conducted such studies without bothering to publish them abroad- hard to imagine that one would shun international academic acclaim, but mai pen rai.
I decided to back up and research the types of people infected, their method of transmission, their attitudes on life after infection, and how it was being treated. I restarted my research process only to be disappointed again. There is very little known about the situation in Thailand. Plenty of studies have been done, but many are quite biased, and many are of very little value. As an example, someone has done a study on infection rates of Burmese factory workers in the Northwest of Thailand. It’s not that they are unimportant, it’s just that maybe that energy could be refocused on more basic investigations. It’s all good though- that particular study was total and complete garbage with no meaningful conclusion or data- it’s amazing that it was published.
So, I went to discuss my project with my professor once again. This was when she revealed the second truth to me. AIDS is a cash cow for researchers, scientists, private companies, and even governments. You do not know the meaning of corruption until you examine the situation in Africa. My favorite examples of the greed and disregard for human life are the ‘scientific’ studies- many subjects are participating in more than one test, and thus participating in more than one treatment regimen at once. In other studies, patients who die during the study are simply recorded as electing to be removed from the study, with no investigation as to how or why they died- it couldn’t possibly be the drugs. These are the studies that drug companies use, and these are the same studies that are used as proof when presenting a new drug or regimen to the FDA, the EU, and the media. No one gives a shit, though. The people conducting the experiment are outside contractors on tight budgets to maximize profit and working on tight deadlines. The drug companies need to get a product out as fast as possible. The regulatory organizations cannot be seen as keeping ‘a life saving drug‘ from the public, and the media has to print something that’ll sell.
The scientific community has failed the people it is meant to serve. One can even suggest that all of these stupid, little studies were done not for the insight it would provide the scientific community, but for that grant money. There is plenty of money to go around, and there are plenty of opportunities to gain a publishing credit, not to mention the title of ‘AIDS researcher.’
Yes, I am cynical, and no I do not have any respect for the scientific community at this point. I you feel that I am mistaken, please let me entertain your point of view.
A bigger cynic would use this knowledge to twist an even larger lie. Many have chosen to believe that AIDS is just a figment of the media and drug companies and governmental organizations and Martians. I’ve seen these ‘ideas’ presented on this very site. The fact of the matter is this- there are millions of people all over the world suffering from AIDS with a very bleak future, and no one is really doing anything to help them. There is lots of talk and shuffling of feet, but it’s not happening on the prevention and treatment front. One notable exception is the study of what causes HIV/AIDS- scientists have made pretty decent progress in understanding how it develops and works. Once this mystery is solved, the real work can begin, and all of this squawking can end… hopefully.
Until that time, I ask those who choose to delude themselves to leave the comfortable life in the west or even in Thailand, and to confront a kid from Soweto who lost both of parents to AIDS and who is currently looking at a life expectancy topping out at 20 because he can’t get the drugs that would prolong his misery another 10 years.
Wait, did I say Thailand? You had better believe I did! This is where the miserable topics end, and the positive discussion begins. Thailand’s leadership may not be the best, but they have been as close to perfect as possible in controlling the outbreak of HIV/AIDS. In fact, the nation of Thailand is widely regarded as running the most successful prevention and treatment program.
Here are some of those ugly numbers for you. It is estimated that there are about 600,000 people living with HIV/AIDS in Thailand right now. I believe this data to be reasonably accurate, even though it is really just the number of reported cases with plenty of room for those who did not report their infection. That’s 1% of the population- you can add a few decimal points to that if it makes you feel better. Let’s compare this to other countries. In the USA, 0.6% of the population is expected to be infected- but this is also a country it is much, much more advantageous to keep infection to yourself. How about Africa? The closest nation to Thailand in economic terms is South Africa. It’s not a perfect comparison, but it’s not too bad. In the early 1990’s the two nations both had infection rates hovering around 1%. Today, Thailand still has that 1% rate. South Africa, according to the most conservative estimates derived from UN AIDS studies show some appalling figures. 11-13% of the entire population is infected. Some estimate that 25% of the ‘adult’ population is infected. UN AIDS also indicated that 25-30% of pregnant mothers are infected. Shocking figures, so shocking that I cannot vouch for their veracity just because I find them so hard to digest. I recently read that South Africans are spending a lot of time at funerals- so much so that it has become a common day to day activity.
Either way, even if you overestimate Thailand’s infection rate, and underestimate South Africa’s infection rate, the two do not even come close. These two nations started off with similar rates of infection. What caused the disparity seen today? Obviously, there are plenty of factors unique to both nations, but the overwhelming majority of this difference is caused by on thing, public awareness campaigns.
Thailand has run the world’s most successful public awareness campaign in the world. Hands down. I challenge anyone to find a single country more successful in fighting HIV/AIDS. Now take into consideration the astronomical levels of drug and CSW use in Thailand. It’s absolutely amazing to me that Thailand still exists in any meaningful manner today.
To give you a short history of the situation in Thailand, the problem began up north in Chiang Mai. In 1988, studies done by NGOs showed that CSWs and Injection Drug Users (IDUs) had a collective 1% infection rate. The very next year, it was revealed the 40% of Chiang Mai CSWs were infected. The next year showed that 40% of IDUs were infected. Personally, I think this data is bogus, but that doesn’t matter- it scared the living bejesus out of the government and NGOs. The government started off by doing things thought unthinkable. Instead of approaching the issue in an unrealistic matter, they admitted that people would use CSWs, and to a lesser extent, admitted that IDU would keep on keeping on. They started with the 100% condom campaign- the idea of making sure that condoms were used 100% of the time in sex establishments. They used a variety of tactics including intimidation of brothel owners. The proof of this campaign’s effectiveness were seen almost immediately- many health clinics reported a 90% drop in STD cases. They kept up with this promotion of condoms (Yes- Mechai was more than influential in this cause, and still is today- has anyone heard of his mandatory condom bill that introduced into the Senate recently?)
The government stepped up the pace and began bombarding the public with public service announcements. They worked, apparently, as rates continued to fall throughout the mid 90’s. They continued with these public service announcements until the Asian financial crisis.
Instead of using the crisis as an excuse to drop a very un-sanuk topic and secretly hope for the best, the government took their now smaller budget and re-organized their efforts. Now they focused on developing means to care for those who were infected already. They refocused their prevention methods to target children at a young age- to put the fear of God in the soon to be horny bastards. It’s still effective. Rates are still falling.
How is it known that this is effective? In 1991, 140,000 people reported infection and in 2003, 23,000 people reported infection- additionally, it should be noted that there is much more incentive to report your condition so that you can become eligible for the excellent treatment Thailand provides.
We all know that Thailand is a nation of piracy experts, quite excellent at what they do. But did you know that they are also adept at pirating drugs? Thailand was the first nation to start counterfeiting anti-retroviral drugs to patients. They are now exporting this technology to countries who cannot afford drugs from the pharmaceutical companies. Thailand has gone from needing NGO support to providing it for less advanced nations.
From what I understand, these drugs are not available to all Thais who wish to take them under the 30 baht healthcare scheme. I have read it from a number of sources, but have been unable to confirm this. If you can confirm this, please let me know!
Please do not mistake Thailand’s success in preventing HIV/AIDS as an indication that there is no threat. There is great danger, just as there is anywhere. Furthermore, Thailand’s rate of infection is still high compared to the “developed world” even though it is so low compared to the rates of the “developing world.” Many can provide anecdotes that they have evaded the bug for so many years and so many women- that’s great. But ask yourself, is your luck the same? Think of all the punters who have not been so lucky? Is this how you want to die? Do you honestly want to trust that technology will develop fast enough to save your sorry ass? Do you delude yourself into thinking that the current medications are anywhere near adequate? Do you think you would even have a snowball’s chance in hell of affording them?
So, in short, all of those AIDS deniers on this site, and those who proudly provide anecdotal evidence as proof that AIDS is a big farce and that nothing bad will come from shagging ladyboys with no condoms are only able to so thanks to almost 20 years of hard work on the part of the Thai government and countless NGOs. I will not tell anyone how to run their life, and I will not judge someone until they become reckless. You can enjoy all the women you want without a condom, but you had better make damn sure that you’re getting yourself checked and you better make damn sure that you do not infect anyone else. No, it’s not ok to infect someone because they didn’t make you wear a condom. This kind of behavior is socially irresponsible, and in my opinion, absolutely disgusting. You may have no reason to stay alive, and you may want to die a painful death, or you may choose to believe that all of this is a bunch of lies. This doesn’t mean you have the right to let some one suffer for their rest of their life just because they were dumb enough to sleep with you.
I hope that I have made you think today. HIV/AIDS is a scary topic. It is difficult to approach, difficult to discuss objectively, and difficult to comprehend. It is even more difficult to approach if one knows that they have done risky things in the
past. I hope that in the future you will consider the implications of your actions, and that you will show more sensitivity to a dire situation. Most importantly, do not ever believe what you read.
CAVEAT LECTOR: This piece is, at best, a poor summary of my work. You will notice that I included no citations- the material referenced in my original work largely comes from resources not available to those outside of education institutions with the funds to purchase access to these vast online databases. Understanding this, I have tried to present the most balanced picture possible. I have not presented any material that I deem to be easily disputed, aside from my obvious editorials and value judgments.
An interesting article. It is a shame that more accurate data about actual numbers is not available.