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In 1984, the first few cases of AIDS in Thailand involved homosexual men and intravenous heroin users. This lead the general public to believe that they were not at risk if they did not fall into these two risk behaviours.
In July 1988, the first case of HIV infection in a commercial sex worker was detected in the Chiang Mai province in the north. Then in 1989 the first national epidemiological surveillance found that 44% of female commercial sex workers in the Chiang Mai province were infected with HIV.
It is therefore projected that HIV-transmission by heterosexual modes would be a problem in Thailand; from female commercial sex worker to male clients, from male clients to wives and from wives to intrauterine babies. That means that the whole families could be infected.
This problem stems from the sexual norms of Thai men. It is normal practice for them to have premarital or extramarital sex with sex workers. Female adolescents are strongly discouraged to be sexually active. Girls that are willing to have sex are seen to be worse than prostitutes. Therefore to satisfy their sexual urges, boys will engage the services of sex workers. Almost all young men by the age of 20 have had sexual experiences with female sex workers.
Another Thai sexual behaviour is when they visit any place, it is a norm for them to visit the local sex workers. Otherwise they will be teased by their friends that they have not been to that place yet.
In the corporate world, if when an employee hosts a superior, part of the hospitality includes a trip to a massage parlour, where sex is included.
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To prove one’s masculinity, one must have many girl friends and frequent sex. Even some married Thai men still enjoy drinking and eating out with their friends and ending up for the night with female sex workers. In addition sexual services are easily accessible.
It could be said that AIDS epidemic in Thailand has been fuelled by commercial sex and the spread to families is rapid. This epidemic is at a serious stage. The number of full blown cases was low in the first 5-6 years but they multiplied rapidly. As at December 2001 186,000 cases had been reported. The number of HIV infections without symptoms is estimated to be one million.
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From the 186,000 full blown AIDS cases reported, 80% are from the age groups of 20-39 years. 65% of these are from the low socio-economic group, labourers and farmers. 82% acquired HIV via heterosexual transmission. The male/female ratio used to be 10:1, now the ratio is 3:1 which means that increasingly wives are infected by their husbands. This also means that more infants are going to be born with HIV infection.
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The social, economic and health impact of AIDS is enormous. Patients with AIDS are laid off from work and have no income to support themselves and their families. The patients suffer from a series of superimposed severe opportunistic infections before dying. Children, who are born with HIV infection, also have to suffer from a series of severe opportunistic infection before they die. It is unfair to these children who know nothing about and were not involved in the acquisition of the infection. The cost of medication and hospitalization is very high. The patients cannot pay for it, therefore the government and patients’ relatives will have to pay for it. AIDS affects everyone.
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Children who are born not infected will be orphaned when their parents die from AIDS. In general the orphaned children will live with grandparents who are too old to earn an income and in some cases they have no relatives to live with. These children will not be able to survive or may survive without quality of life. They may become homeless, drug addicts or sex workers etc. This is because they do not have adequate education obtain a job. It is Government policy to provide free education at the primary school level. The fact is that tuition is free, but students still have to have money for related expenses such as school uniforms, shoes, socks, books, pens, school activities etc. These kids do not have money to buy lunch at school nor money to pay for transportation to and from school.
The number of these HIV-affected children will be increasing at an alarming rate if we do not try to slow down the HIV transmission promptly enough. It could be said that these HIV/AIDS affected children will be a problem to the village, community and society.
In the Thai culture, a married son or daughter will take care of their parents and their own children. But if they die from AIDS, the grandparent will live with their grandchildren which are often very young. As they belong in lower socioeconomic groups their own relatives are also poor and unable to give assistance. This is the situation in the northern provinces where HIV transmission first affected Thailand via the heterosexual mode. It is a very depressing scenario. These grandparents need some assistance to be able to survive too.
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In Chiang Mai and the upper northern provinces where the rate of HIV infections have been consistently high, a large number of HIV seropositive children have been born prior to either parents’ awareness of their own HIV status. These children will be affected directly or indirectly by the epidemic. The most unfortunate children are those who develop symptoms of AIDS and have to suffer from various opportunistic infections before they die. Almost all of these children are of very low socio-economic status and either or both parents are ill and awaiting death.
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