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HEALTH: Discrimination Could Offset Thailand’s HIV/AIDS Gains

Marwaan Macan-Markar

BANGKOK, Jul 2 2004 (IPS) - The thousands of foreign delegates due to arrive here for this month’s world AIDS conference will not have to wait long to get the first lesson about their host’s healthy attitude towards safe sex.

They will be given condoms as welcome gifts at Bangkok’s airport or en route to their hotel.

Those who miss this initial give away may not have to despair, since hotels to be used for this international gathering between Jul. 11-16 are expected to have the prophylactics on offer for guests in their rooms.

The man behind this initiative is no stranger to high-profile safe sex campaigns. Mechai Viravaidya, a member of Thailand’s Senate, is better known as one of the country’s leading campaigners against the spread of HIV.

His condom distribution efforts since the early 1990s have even earned him a sobriquet that Mechai wears with pride. The senator is known as ‘Mr. Condom.’

And the annual HIV prevalence rate in Thailand proves that his open, liberal and, at times, humours approach towards safe sex is a potent antidote to the spread of the killer disease.

Since the current infection rate, according to the ministry of public health, is around 19,000 cases annually, which is a dramatic reduction from the 143,000 new HIV cases reported in 1991 – on record as Thailand’s worst year.

Such an impressive achievement, however, is not all that participants at the 15th International AIDS Conference (IAC) will learn about Thailand’s efforts to cope with the global pandemic.

The estimated 15,000 to 20,000 participants due to attend the Bangkok conference will also come into contact with other features that have placed this country ahead of its South-east Asian neighbours in caring for people with HIV.

Among the most significant, say HIV/AIDS activists, is Thailand’s drive to increase the supply of cheap, generic anti-AIDS drugs to its citizens.

”We are happy with the government’s effort to increase access to anti-retroviral drugs,” Kamol Uppakaew, chairman of the Thai Network of People Living With HIV/AIDS, explained to IPS on a recent afternoon in his small office on the eastern edge of Bangkok.

Under this programme, members of Kamol’s organisation work in tandem with hospital staff in 114 hospitals across the country to counsel patients when they come for their regular dose of a drug- cocktail that slows the spread of HIV.

However, according to Nimit Tienudom, director of the Bangkok- based AIDS Access Foundation, the anti-AIDS drugs programme is not without faults. It includes the government’s decision to place this medical care package for Thais with HIV beyond the scope of the country’s national health insurance programme.

”This means that the hospitals have to apply for a special budget every year, making the programme unsustainable,” he told IPS. ”It also creates a sense of discrimination.”

In October 2002, the government of Prime Minister Thaksin Shinawatra launched the Extended Access to Care Programme with the aim of supplying 50,000 HIV patients of anti-retroviral treatment through state hospitals by the end of 2004.

Six months away from that deadline, Nimit says that ”nearly 40,000 people are receiving the drugs.”

This achievement gains in significance when compared with the picture across Asia, where, in 2003, only 43,000 – or four percent – of the one million people with HIV across the continent who needed anti-retroviral drugs had access to them.

In Thailand, by contrast, 20 percent of the 200,000 people with HIV who need the life-prolonging drug have access to it.

”I think we will be able to reach the 50,000 target by the end of this year, or even go over it,” said Kamol, who has been living with HIV for eight years.

Thailand has over 600,000 people living with HIV/AIDS out of a population of 63 million. Since the pandemic was first detected in this country in the 1980s, over 450,000 people have died due to the disease.

What has enabled the country to help its citizens with the killer disease is another pillar that buttresses Thailand’s role as a leader in combating HIV/AIDS – namely its ability to produce cheap generic anti-AIDS drugs.

Currently, the anti-AIDS drugs supplied by the state’s pharmaceutical organisation are ranked among the most affordable in the world. A month’s cocktail supplied by the state agency costs 1,200 baht (30 U.S. dollars), as against 30,000 baht (750 U.S. dollars) per month for a dose of brand-name drugs from a pharmaceutical giant.

In addition, Thailand is also in the vanguard to search for an HIV vaccine.

Medical researchers here are working with U.S. counterparts in an effort to conduct the world’s biggest HIV vaccine trial for what is described as a ”third phase” test.

A phase three trial is considered paramount for two reasons – it being done in a real-life situation and its results being deemed pivotal for the vaccine to be approved as a potent barrier against the infection.

But for AIDS rights activists, this picture of achievement could be tarnished during the conference due to a blemish that Thailand has failed to overcome. Thai society still discriminates strongly against HIV/AIDS patients.

”This conference will be a huge reality check for the official image projected by Thailand that it is tolerant of people with HIV,” Anthony Pramualratana, executive director of the non- governmental Thai Business Coalition on AIDS, told IPS.

”We live in a society where we try not to discriminate outwardly, because it is considered the norm,” he added. ”Yet there are many instances where objections are raised against people with HIV.”

What happened in mid-June amplifies the vein of discrimination that runs through Thailand. A four-star hotel in Bangkok forced guests with HIV participating at a conference to stay on one floor and cordoned off a dinning area to keep them away from other guests.