BANGKOK, July 8 (UPI) -- United Nations' officials warned Thursday that Thailand's internationally lauded program, which took control of its explosive AIDS epidemic of the 1980s and 1990s, is threatened by complacency, lack of government funding for key programs and worrisome increases in the disease outside the commercial sex trade.
"I think that saying Thailand has let its guard down against AIDS is a good way of putting it," said Robert England, the United Nations Development Program's resident representative in Thailand. "Other things have become more important. But this epidemic is generalized in the Thai population and it is very vulnerable to spinning out of control."
From a peak of more than 140,000 new infections a year in 1991, a concerted effort by Thai officials, from the top down, created a world model of how to control the deadly outbreak of disease. That figure dropped to less than 20,000 new infections a year by 2001 as Thai politicians and key opinion leaders rolled out a massive condom campaign aimed primarily at commercial sex workers, whose infection rates were estimated at 30 percent or higher.
"That was a reduction of more than 80 percent -- no country in the world can rival this success," said England at a news briefing in Bangkok to present the UNDP's new publication, "Thailand's Response to HIV/AIDS: Progress and Challenges."
The 86-page document highlights the nation's successes in combating infection with the human immunodeficiency virus -- the organism that causes AIDS -- and also frankly demonstrates how the decade of success could be unraveling.
"The epidemic is now evolving," said Hakan Bjorkman, leader of the team that developed the report for UNDP. "The past successes we have seen are under threat."
Evidence of that threat, he said, is the growth of HIV/AIDS among vulnerable Thai population groups:
-- About 50 percent of people involved in injecting drug use now carry the virus, Bjorkman said, compared to 30 percent in the 1990s.
-- About 17 percent of young men who have sex with other men are infected with HIV, compared to about 4 percent in the 1990s.
-- About 6 percent of migrant workers and 5-10 percent of deep-sea fishing boat crews are infected with the virus, for which there is no cure, no vaccination and, for the vast majority of people in Thailand, no access to effective treatment.
-- Infection rates actually are increasing in the general population in the southern part of the country, particularly in provinces that are new centers of tourism, such as Phuket.
-- The infection rate among pregnant women has doubled, from 1 percent to 2 percent, in southern Thailand and has reached 3.5 percent in Phuket and Nakhon Sri Thammarat provinces.
Bjorkman noted that in Thailand in 2004, an expected 53,000 people will die of AIDS, despite the government's previous confidence in having the disease "under control." He added that AIDS deaths will be double the deaths from automobile accidents in a country notorious for driving excesses.
"Young people are increasingly at risk of HIV infection," Bjorkman said, "but only about 20 percent of them use condoms regularly. They don't think they are at risk."
Bjorkman told United Press International part of the problem in dealing with the epidemic today is how to deal with sex between spouses or girlfriends. Before, when the action against AIDS was directed at commercial sex workers, the young girls and women in brothels and bars could insist that their customers wear condoms because it was government and establishment policy.
"That campaign empowered women to negotiate for condom use," Bjorkman said. In fact, at one point during the campaign, up to 96 percent of commercial sex workers were using condoms.
It is a different story in the home, he said.
"I'm pessimistic about how to handle that aspect of controlling the epidemic," Bjorkman said, noting half of new infections occur in the spouses or long-time girlfriends of infected men. "It's hard for a man to tell his wife: 'I have been unfaithful and may have HIV, so we should use a condom.' And it is equally difficult for a woman to tell her husband or partner, 'I think you might have been unfaithful to me so I want you to wear a condom.'"
Mechai Viravaidya, co-chairman of the community program committee for the International AIDS Conference that opens in Bangkok Saturday, and an outspoken advocate of distributing condoms on street corners, in schools and even in bank automated teller machines, said the government of Thailand has relaxed in its vigilance against fighting AIDS.
He said the government had placed the fight against the disease in the hands of the Ministry of Health, even though greater success was achieved when the prime minister's office handled the crisis, back in the "Days of Enlightenment, as the successful campaign against the disease is now called.
"Public education against AIDS has gone to sleep," Viravaidya said. "I have had some children ask me if AIDS still exists in Thailand."
The only bright note is care for AIDS patients is good, he noted. Thailand has begun to treat people infected with the disease with state-of-the-art combination therapy.
Still, Viravaidya said, "You can't get control of the epidemic without prevention. What are the youth of today will become the AIDS (patients) of tomorrow. It is sad to see us fall back again. We need to get out of this bog."
AIDS is not only a health problem, England said. "It is an attitudinal problem, a behavioral problem and a societal problem and it requires a coordinated policy if it is to be controlled."
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Ed Susman covers medical issues for UPI Science News. E-mail [email protected]
