Thailand has a rich and colorful history, but perhaps its most interesting success is its effective response to the HIV/AIDS epidemic over the past 20 years. Thailand effectively mobilized an appropriate response to the growing HIV/AIDS epidemic of the early 1990′s, with significant political support and financial backing committed by the government. Advocates launched a successful public awareness and behavior change campaign to inform and enhance public knowledge about the spread of the HIV virus and how to protect themselves.
Spearheaded by one of the most famous AIDS activists in the world and a national hero in Thailand, Mechai Viravaidya (also known as “the Condom King”), thorough his organization the Population and Community Development Association (PDA) initiated a nationwide community-driven response, involving government officials and health ministers, schoolteachers, street vendors, religious leaders and taxi drivers to promote condoms as a lifesaving vehicle to prevent the spread of HIV infections in Thailand. A series of radio and television ads about using condoms aired every hour and comprehensive sexual education about HIV/AIDS was launched in schools to help spread the message.
Safe and responsible sex was the message of the day, and the campaign
worked. HIV infection rates dropped significantly, sexually
transmitted infections (STI) prevalence rates decreased and education
about condoms and use of condoms rose. New infections dropped from
140,000 in 1991 to 21,000 in 2003 (PDF).
But success can sometimes be its own demise. In Thailand’s case, such a
successful campaign in behavior change may have allowed the government
officials to slip into complacency instead of maintaining the
significant efforts the country had previously taken on HIV/AIDS
prevention. With the financial impact of the Asian Financial Crisis in
the late 90′s and changing political leaders with different priorities,
funding for HIV/AIDS prevention programs began to slide downwards and
condom distribution programs were scaled back.
UNAIDS reports that the Thai government has reduced HIV prevention budgets by two-thirds in recent years (PDF).
Now there is data that suggests that infection rates are beginning to
rise and increase in risky behavior has led to an increase in STI
rates, due in part to a new generation of young people who are unaware
of the importance of condom use and healthy behaviors when engaging in
sex — both for HIV prevention purposes but for family planning
purposes as well.
As part of the Asia Pacific Alliance
(APA) Conference, the participants went on a series of site visits to
meet with people in the field who are working to promote healthy and
Our first stop of the day was to a nongovernmental
organization (NGO), called the Empower Foundation
(which stands for “education means protection of women engaged in
recreation”), that does outreach and empowerment to sex workers. The
group was created as a response to the growing needs of sex workers,
many of whom are actually migrants, refugees or internally displaced
persons (IDPs), either internally from inside Thailand or externally
from places like Burma and Cambodia and other countries.
The Empower Foundation works to provide counseling, assistance, sexual
and reproductive health information, translation services and overall
support. Volunteers at Empower work actively to reach out to other sex
workers in a collaborative effort to provide a community support system
to inform women of their legal status and rights, teach sex workers how
to use condoms with clients in a “take it or leave it” approach
(refusing to perform services with clients without condoms), and build
life skills training such as language and teaching classes. Empower
has grown primarily through word of mouth, from sex worker to sex
worker, to spread gender equity, human rights and women’s social
empowerment. Sex workers are a vulnerable population, who oftentimes
engage in risky behavior, who are scared of arrest and who may have to
overcome language barriers; and it is Empower which stands as an strong
and important organization with a secure base of knowledge.
Our second stop was to visit a clinic of people living with HIV/AIDS
(PLWHA), located in a small village atop one of the surrounding hills
of Chiang Mai. The clinic, called the “New Hope for Life Center”, is
supported by the Planned Parenthood Association of Thailand
(PPAT). This support system for PLWHA is composed of members from both
communities: teachers and students in the school system and women
living with HIV/AIDS. The center provides a mobile health unit,
teaches peer education classes in high schools, teaches handicraft
classes to garner income for women living with HIV/AIDS, encourages
condom use (including teaching parents appropriate roles with their
adolescents), and attempts to create a transparent and open society to
reduce stigma and discrimination towards HIV positive people. By
working together, they are leading a community-wide effort to prevent
HIV infection, promote reproductive health needs and educate the
community about the benefits of a strong social network system.
Both of these groups, in different ways, have shown the importance of
shaping community based advocacy efforts through women-led community
leaders and decision-makers to further increase women’s rights and
gender empowerment. These women are leaders in steering Thailand in
the right direction, since the country is at a critical crossroads
facing declining funding and attention to both gender and reproductive
health needs. What is needed is a mix of the pragmatism of the past
and hope for the future — including education, opportunities for
growth, access to services, increased funding and a supportive
political system. It will take all these things in order to promote
healthier lives for a new generation of women in Thailand.