Thailand - which is hosting the 15th International AIDS conference in Bangkok - has been considered a success story in the fight against the deadly virus. Its massive HIV/AIDS education campaign in the 1990s drastically reduced infection rates. But now, experts are warning those gains may be slipping - especially among the young.
In 1990, Thailand's HIV/AIDS rate was soaring. In 1991, 140,000 new infections were reported. The government responded with a massive public education campaign, which by the end of 2003, dropped the new infection rate to just 17,000.
Thailand was particularly successful in prevention in the country's infamous sex trade - with its condom education and promotion. Nimit Tienudom, director of the AIDS Access Foundation, says the program uses a "carrot and stick" approach. Brothels have to enforce condom use between commercial sex workers and their clients or be shut down. In exchange, the government provides free condoms, counseling, and health care.
"We have more experience about AIDS, it's true," he says. "And some countries can learn from our experience. But we still have a problem, we still have to create a new [way] for give information for the public."
Infection rates are still declining among prostitutes. But that is not the case in the male homosexual community or among young people.
Hakan Bjorkman, the U.N. deputy resident for HIV/AIDS programs in Thailand, says part of the problem is economic - as the 1997 Asian financial crisis forced the government to spend less on such awareness programs. "The reason is that AIDS education programs are not reaching young people as they used to," he says. "They should revive their large-scale media campaigns. And they should target young people with information and life skills and condom availability."
International health organizations say out of a population of more than 63 million, 670,000 Thais live with HIV/AIDS. It is one of the leading causes of death in the country.
Senator and respected AIDS campaigner, Mechai Virivaidhya, known locally as the "condom king of Thailand," says HIV/AIDS treatment is now the government's goal. "As far as treatment is concerned, every Thai citizen who needs drugs will get the antiretroviral drugs," he says. "And we've also gone beyond that by adding and providing loan funds for HIV positive people."
The Thai Health Ministry distributes antiretroviral drugs to approximately 70,000 HIV-positive people through state hospitals. It hopes to increase drug production in 2005 to treat approximately 200,000 people.
Thailand produces its own medicines and has been able to reduce the cost of the life-prolonging antiretroviral drugs from at least $500 a month to about $30 - by filing a health emergency with the World Trade Organization. This allows a country to produce generic drugs without paying any royalties or fees, on patents held by the pharmaceutical companies.
The country now has an oversupply of these medications and Senator Mechai says Thailand is the first nation to distribute free antiretroviral drugs to other countries. "HIV/AIDS has no national boundaries, so stop talking about it, help your neighbors," he says. "We will provide drugs that are being produced because we have excess capacity, to give to poorer countries."
One of Thailand's major concerns now is to educate sexually active young people about the risks of unprotected sex. Studies done by the Department of Health show the infection rate among sexually active teens rose to 17 percent in 2002 compared to 11 percent in 2001.
Twenty-seven-year-old Sujima Virivaidhya, daughter of the senator and an AIDS campaigner, is following in her father's footsteps. Organizing the youth portion of the 15th annual World AIDS Conference, Ms. Sujima says the country must target the whole community to deal with the problem.
"Not only the children that you have to educate, but also the parents, the teachers as well. You also have to educate them at the same time as they educate their children," she says. "If the teachers say something, if the parents say something they believe it, they understand it."
Mr. Bjorkman from the U.N. HIV/AIDS programs says young people are now at risk because they were too young to learn from the government's education campaign in the 1990s. "Young people, the really young people, they come on the scene, so to speak, become sexually active - they weren't around in the early '90's when this big campaign was going on. So they come out, they don't use condoms, they experiment with drugs, some of them," he says. "They're very vulnerable."
Health experts agree the Thai government needs to target the nation's youth in a new and comprehensive HIV/AIDS awareness campaign to prevent a further rise in infection rates.