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 safe lives.

  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.