Sex, AIDS and Thailand

For years, international health experts have pointed to Thailand as a rare success story in the global battle to contain the AIDS epidemic. The situation looked grim for the country in the 1980s, when doctors reported that sex workers in Bangkok's famous red-light district were beginning to test HIV positive. There were dire predictions that the virus would spread rapidly through the population, infecting as many as 4 million of the country's 65 million people by 2000.

It didn't happen. Instead, the Thai government launched a comprehensive education and prevention campaign. Brothels started using condoms. Public-service messages were broadcast on radio and television every two hours. Anti-AIDS messages—often served with a healthy dose of sanuk, the Thai sense of playfulness—were spread in schools, hospitals, police stations and courthouses. After peaking at 143,000 in 1991, the annual number of new cases of HIV infection fell to 19,000 in 2003. That still leaves 604,000 Thais living with HIV or AIDS, but it could have been much, much worse.

Now, as scientists and activists from around the world gather this week in Bangkok for the 15th international AIDS conference, two new reports from the U.N. warn that Thailand's triumph may be in jeopardy. While Thai men are no longer visiting brothels in the numbers they once did, there has been an increase in extra-marital affairs and casual sex, and condom use has fallen dramatically. Meanwhile, HIV infection rates have spiked among young people, pregnant women and intravenous-drug users.

Several factors have contributed to the worsening trends. "We have become complacent," says Mechai Viravaidya, (a.k.a. Mr. Condom), a senator and the principle architect of Thailand's successful anti-AIDS program of the 1990s. "People think because they can't see HIV anymore that we have it kicked, and they are taking risks again." Following the Asia-wide economic crash of 1997, successive Thai governments have slashed budgets for prevention programs to less than half their 1997 levels. Condom funding is down, education programs in schools have ended, and the media campaign has all but disappeared. Meanwhile, other avenues of infection—such as drug users sharing needles and men having sex with other men—have been largely ignored.

And in an understandable but no less ironic twist of fate, the advent of effective anti-HIV drugs has lulled folks at all levels of society into dropping their guard against HIV—just as it did in the U.S. and other countries. "This government has done a good job on treatment and care," says Dr. Praphan Phanupak of Chulalongkorn University in Thailand. "But they have to get back into prevention. There needs to be a balance [between treatment and prevention] if you want to contain this virus."

Despite recent setbacks, Thailand is still probably the most successful country in the world in checking the spread of HIV. But AIDS flourish-es where attention lags, and attention is lagging not just in Thailand but in all of Asia, where 1 of every 4 new infections now occurs. HIV infection rates have hit new peaks in China, Indonesia and Vietnam. And in India, 5.1 million people are now thought to be HIV positive—making it second only to South Africa in number of cases. AIDS is not invincible, but it is relentless.