THAI NEWS AIDS 2005

Thai AIDS Death Toll Down Sharply in 2005

From January through November 2005, Thailand recorded 1,478 deaths from AIDS, compared to 6,593 for the same period in 2004. "The sharp drop is because of widespread access to antiretroviral drugs which resulted in improvements to the lives of people living with AIDS and HIV," Disease Control Department Director Thawat Suntrajarn said Monday in a statement. Locally produced AIDS drugs are available under a plan that lets the poor receive hospital treatment for about 75 cents US per visit. In addition, health authorities are stocking some 24 million condoms in 4,575 vending machines nationwide. The ministry also hopes to reduce drastically the number of babies born HIV-positive, about 2,400 last year. The estimated 18,000 new HIV/AIDS cases reported last year occurred largely among homosexuals and teenagers, Thawat said.

Children in a desperate plight - December 17, 2005

Unicef on Wednesday released its most damning report to date on the state of the world's children. The annual study is strong stuff and does not sit well on an empty stomach or ease the pangs of a guilty conscience, which Unicef seems to believe most of us should be suffering from with varying degrees of culpability. It made it clear that despite all the pledges, promises and good works, there are still hundreds of millions of children who are suffering exploitation and abuse, invisible to the eyes of the rest of the world.

The UN organisation accused society of letting the better part of a future generation fall between the cracks and become trapped and ignored after having been traded and abused or discriminated against. Such children, the flagship report said, grow up outside the reach of development projects, public debate and legislation. It described those hardest to reach as living in the poorest countries and most deprived communities, facing discrimination on the basis of gender and ethnicity while others are caught up in armed conflict, the sex trade or affected by HIV/Aids.

Unicef has always been the most outspoken of UN agencies but in this year's report it has come out with guns blazing and outdone itself. There is a reason for this and the organisation's new executive director, Ann Veneman, made no secret of it in launching the report. She is convinced that meeting the millennium development goals set out by world leaders at a UN summit five years ago and renewed last September, is contingent on reaching vulnerable, poor, exploited and abused children throughout the developing world.

The primary millennium development goal is to reduce extreme poverty by half by 2015. Other major targets include reducing the mortality rate among children under five years of age by two-thirds, primary schooling for all boys and girls, and a halt to the spread of Aids and incidence of malaria. What makes some of these children so hard to reach is their lack of an identity because they were not registered at birth. We have instances of this happening right here in Thailand.

She is not wrong in thinking the 2015 targets are in jeopardy, hence the dramatic appeal to UN member governments to heed this warning. Even if they do take notice, they will have to act quickly if they are going to improve the lot of more than a billion children facing a harsh and brutal existence because of conditions not of their making. Specifically, they lack at least one of the seven basic commodities deemed essential: shelter, water, sanitation, schooling, information, health care and food. Many also face the scourge of internal conflict and war.

The UN agency believes in keeping up the pressure on governments and, in an earlier report, estimated that because certain nations fail to meet their moral and legal obligations to respect the rights of children, over 30,000 boys and girls under five die of mainly preventable causes. Even more children and young people fall victim to illnesses, neglect, accidents and assaults that should not have happened.

Far too many governments fail to spend the minimum amount necessary to support basic social services. Unicef frequently, and with justification, points to poverty as being the greatest obstacle to development because it opens the door to the stark horrors of the sale and trafficking of young boys and girls, of debt slavery, forced or compulsory labour and children being pressed into armed conflicts, prostitution, pornography or the production, trafficking and consumption of drugs. Children around the world do suffer appalling abuses. Even those within the care of the state, have been subjected to abuse and mistreatment. Desperate circumstances call for desperate measures. The 2006 Unicef report leaves us in no doubt that we are just blundering along and doing more to perpetuate the poverty trap than eliminate it. That has to change

Media urged to remain vigilant in Aids fight - December 15, 2005

Leading HIV/Aids advocate Mechai Viravaidya has urged the media to remain watchful against the spread of HIV/Aids as there are signs of increasing infections among teenagers.

Mr Mechai was speaking at a regional meeting on South Asian media leaders' initiatives on HIV/Aids, held in Bangkok last week by the UNAIDS and the Asia-Pacific Leadership Forum on HIV/Aids (APLF).

The meeting was joined by members of print and electronic media from Bangladesh, India, Nepal and Pakistan, who shared their experiences about HIV/Aids reporting and barriers to reporting.

Talking about the HIV/Aids situation in Thailand, Mr Mechai said the local media had become less vigilant in the past two years, believing that a series of government campaigns launched since 1991 had resulted in a sharp decline in the number of people living with HIV/Aids in the country.

The media was making less effort to make people aware of the fact that HIV/Aids remained a serious threat. People could not rely on the government alone in the fight against HIV/Aids, and the media should play a more active role.

Mr Mechai, president of the Population and Community Development Association, said the Thai government had spent excessively on disease prevention, but made little effort to disseminate information that would help build up public awareness of HIV/Aids risks.

FTA 'to bar cheap Aids drugs'  - December 13, 2005

Aids patients were unlikely to gain access to cheaper drugs after the free trade agreement between Thailand and the United States is signed, a human rights discussion was told yesterday. Supatra Nakaphew, director of the Aids-related Rights Protection Centre, yesterday told the discussion, which is part of the Dec 9-16 National Human Rights Week, that Aids patients would see their human rights violated as the planned Thai-US free trade agreement was likely to protect only American patented drugs.

If the agreement is in force, Thailand will not be able to freely produce anti-Aids drugs and patients will have to pay more for US-produced medicines. "In fact, this will apply to all US medicines, be they for Aids or not," she said.

Non-governmental organisations had repeatedly asked the government to exclude drug patent protection from the FTA but had received no response.

Ms Supatra also complained about human rights concerns in connection to the on-going human trials of the anti-Aids drug Tenofovir in Thailand.

She said the manufacturer and the Aids Vaccine Research Centre in Bangkok are testing the drug on 1,600 drug addicts who are under a rehabilitation programme at 17 rehabilitation centres in Bangkok.

She alleged that participants were not receiving clean syringes and there was no campaign to make them aware of the possible danger of HIV infection through used syringes.

Cambodia had opposed the trials not only because prostitutes in the country were being hired for just five dollars a month to test the vaccine, but also because they were being forbidden to use condoms to prove the effect of the tested drug, Ms Supatra said.

All you need is love: Thanks to the loving embrace of his family, Kamol Uppakarn learned how to survive infection with HIV  - December 1, 2005

It has been nine years since that day when Kamol Uppakarn locked himself up in a room, alone in the darkness. He sat in a corner, his eyes fixed on a piece of cloth hanging from the ceiling. The doctor's words echoed inside his head: "I'm sorry. You've tested positive for HIV." At first, he was speechless. Then came the tears. The then 21-year-old fell into an abyss of no hope. Crushed by guilt and fear, imagining only the ugliness of death, Kamol found it hard to catch his breath. For hours, he did not move. The only thought in his head: "Soon, I'm going to get sick and die. So why shouldn't I die right here, right now?"

Right before he wrapped the cloth around his neck to hang himself, the face of a woman flashed through his mind. It was that of his mother. In the reverie, she grabbed his hands, tightly, and extended her arms a little wider to lift him up.

At that moment, Kamol realised that he was not all alone in the world. The thought that there was always a pair of arms to embrace him became a genuine life force, a source of inspiration for Kamol to accept his new "status" with the virus inside his body.

"Love and care was truly the ultimate cure. It was my mum, with her warm and tender love, who gave me the second chance to withstand this fear and, once again, restart a happy normal life," said Kamol, now chairperson of the Thai Network of People Living with HIV/Aids (TNP+), the support and advocacy organisation coordinating activities of HIV-infected people across the country. Finding love and acceptance while being HIV-positive can be a daunting task. But, for Kamol, the deepest expression of love lies within his family.

"Never a dull moment, never an uncomfortable silence," Kamol said. "Fortunately, I never feel like an outsider in my own home. I never see guilt or disappointment written on the faces of my family members, either. My parents and little sister never ask me why or how I got infected, but always give me great courage to live," he said with a friendly smile on his face.

Now 30, Kamol, outwardly strong and lively, said HIV/Aids - once perceived as a death sentence - has become a part of his life, just like one of his best friends. Every 12 hours he treats his "buddy" with anti-retroviral drugs to help nurture their relationship and prolong his life.

For Kamol, however, the best nourishment that he feels can boost his immune system and account for his nine years of relative well being, is fairly simple - just living everyday life with love and hope even in the midst of his illness. A positive attitude, Kamol believes, is a powerful medicine.

"I think that living a good, meaningful life is more important than worrying about death. If you are able to shrug off the notion of fatality, you will live a healthy and happy life like ordinary people," he said. The shirt he wears carries the message: "Action equals life, silence equals death."

To a certain extent, having HIV helps bring his life into focus and make it more manageable, he said.

"Having HIV is hardly worth it, but it's actually worth it - it has taught me to be stronger and taught me to see things from different angles. And now I'm truly appreciative of my own life," Kamol said.

Before the disease became part of his life, in his teenage years, the former hydraulic technician spoiled himself with drugs and debauchery. He used a daily dose of amphetamines for an energy boost and made occasional visits to "working ladies".

Little did he know. Having had enough of such indulgences, Kamol applied for a job when he was 21. There, waiting for him was a medical test result that showed he had contracted HIV, presumably through unprotected, unsafe sex.

"Since I didn't sleep with professional sex workers who are regarded as members of the 'risk group', I never thought I was at risk," he recalled. "I overlooked the possibility of being infected through unprotected sex with indirect sex workers - those cafe singers, dancers or drink partners - who may also be infected with HIV."

Without information on HIV or access to health services, Kamol said it wasn't easy for him to handle the extra pressure alone, neither could he share his agony with anyone but his family and a few close friends. The first positive sign was when he joined an HIV/Aids support group of the Niranam clinic (Anonymous clinic) based in Nong Khai, his hometown, where he gained access to information, met new people of the same status, and eventually regained his confidence and self-esteem.

Kamol then started to come out to the public by working as a volunteer and campaigner for HIV/Aids awareness. His activities included sharing information about what people living with HIV/Aids are facing and running campaigns to increase opportunities for HIV-positive people.

A common problem among people living with HIV is stigma and discrimination, which have a negative effect on their quality of life and rights as members of society, Kamol said.

"People with HIV have been shamed. Many people I've met have lived lonely lives and died, not because of HIV itself but from discouragement from society. Once, I found a man with HIV who was locked up in a hut in a field and was treated as if he were the virus itself."

The prejudice is strongest in the workplace, he added.

"Far too many HIV-infected people have experienced job-threatening discrimination and are often left unemployed. Although many people with HIV have been responsible for taking care of themselves, and have remained well and healthy, they feel that there are no helping hands, no room for them in society," he said.

In his opinion, the workplace should provide support to HIV-positive people and raise awareness among employers and employees about the infection, including better understanding of and a positive attitude towards those infected.

"Just like other so-called 'normal' people, people with HIV need to have work opportunities, so that they can support themselves and their families."

Kamol pointed out that much of the information available since HIV/Aids was first identified made infected people despair. Most people believed that if they were infected with the disease, they could do nothing more than deal with the situation in silence while waiting to die within a few years from different Aids-related illnesses.

It is only in the last 10 years that anti-retroviral medicines have become available in Thailand. The Government Pharmaceutical Organisation (GPO) has developed cheaper generic drugs, and can now produce a range of medicines such as AZT, d4T and 3TC that have passed quality and efficiency tests.

"Now we have much more access to the relief of symptoms and the fortification of the immune system. With appropriate treatment, we have more opportunities to improve our well being and extend our lifespan," he said. "It seems that the impossible has become possible."

That possibility has given him the confidence to forge his own family, he said.

While other people in his position might refrain from romantic commitment, Kamol embraces relationship and family.

For eight years, Kamol said he has been blessed with a happy life with his wife, who lost her first husband to Aids-related illness and is herself HIV-positive. He is also a happy step-father to his wife's 12-year-old son. Last year, the couple had their own daughter.

Kamol said that though he and his wife conceived their daughter the conventional way - through unprotected sex - they were well aware of the risk. They consulted closely with their doctors and with HIV counsellors and took all the necessary precaution.

According to Kamol, the medicine cannot totally protect the baby from being infected with HIV, but it can reduce the rate of mother-to-child transmission by over 90 per cent. His wife had started taking AZT during her pregnancy. Their daughter also received AZT every four hours during her first week of life.

Fortunately, the girl was perfectly healthy.

Having HIV doesn't make it harder to be a father, he said. He has learned to be responsible and to take good care of his family, especially his new little darling.

"I cried when I first held her tight against my chest, and I felt right away that the greatest thing in life is to be a father," Kamol said, beaming while raising his hands as if holding a baby in his arms. He added that he loves to talk to his baby and to hear her cooing.

"I realised that being positive doesn't mean that I can't be a good father. I am ready to provide her all my love, care and security, and, hopefully, I can see her grow up to be a healthy, beautiful woman.

"I always believe that everyone - whether they are negative or positive of anything - needs passion for life, and it's love within the family that gives me the strength to live."

Inclusion vs exclusion: The HIV/Aids challenge and Thailand  - November 30, 2005

After a promising start, the fight against HIV/Aids seems to be on the slide, but renewed efforts and an all-inclusive policy could yield big dividends

The HIV/Aids epidemic continues to wreak havoc and poses a pervasive challenge for the world community. The latest Aids epidemic update from United Nations (UN) agencies indicates some 40.3 million people living with HIV in 2005, while the number of those newly infected with HIV is 4.9 million. Aids deaths in 2005 total some 3.1 million people globally. In Thailand, statistics for 2004 indicate some 570,000 of those with HIV/Aids, with some 58,000 Aids-related deaths in 2003.

Thailand has often been cited as a success story in tackling the epidemic, and there are valuable lessons to be learned - while inviting caution against complacency. In the early 1990s, the HIV infection rate was around 140,000, but effective policies helped to reduce this to some 21,000 in 2000.

Credit on this front was due to various factors. A comprehensive national plan was evolved from the beginning of the 1990s to address the issue in a humane manner. Not only were prevention programmes introduced extensively, such as on condom use and related education, but also the message was to counter discrimination and respect the rights of those living with HIV/Aids.

There was broad mobilisation of both the government and non-governmental sectors to cooperate in addressing the issue, aiming for openness rather than denial.

Currently the country is in the midst of the 3rd National Plan (2002 to 2006) that highlights the need to reduce infection rates among adults, the reinforcement of access to care, and the mobilisation of localities, including local administrations and civil society, in action to prevent and mitigate the problem.

There is also increasing emphasis on enabling those with HIV/Aids to have access to antiretroviral drugs to help attenuate the infection. There have been commendable lessons in regard to the country's priority in enabling pregnant women to access these drugs to prevent mother-to-child transmission.

Yet, the epidemic is posing additional challenges today. First, it must be recognised that the problem is mutating. In the early 1990s there was much emphasis on action to deal with the spread in the commercial sex sector, particularly through 100 per cent condom use in relation to brothels and "direct sex workers". Today, it is those involved indirectly who need to be targeted - such as services beyond traditional brothels. The infection rate has been rising in some parts of the country, a testament to weaker information and prevention campaigns.

Second, not enough has been done to tackle the spread of the disease in regard to those using drugs illegally, particularly intravenous drugs users - those using needles. UN statistics indicate some 35 to 50 per cent of this group are being affected - and the spread is also to their partners.

Globally it is interesting to note this worrying dichotomy: Many drug users who are customers of sex services avoid using condoms, while many drug users who provide sex services also shun condoms.

Countries are often in a quandary as to what harm reduction techniques are to be promoted. Thai authorities are reticent to adopt needle exchange programmes, since there is a tendency to classify the use of needles among drug users as illegal. The campaign on the part of the authorities a couple of years ago for "quick fixes" in eradicating drug users posed additional problems due to the myriad of alleged extra-judicial executions - which are still unresolved today.

Third, there is the issue of adolescents. Statistics indicate a rise of infections among this group. To what extent is there an effective prevention campaign such as condom use on this front? This is a persistent cultural challenge since the more conservative sector of society claims, with a tint of moralisation, that access to condoms may fuel more sexual activities among the young (catchword: "Promiscuity"). There is the still-prevalent cultural taboo against educating the young generation about safe sex techniques; one lobby advocates abstinence as the key to prevention. In this regard, there are recurrent stories of condom machines being pulled down by conservative forces.

Fourth, while in the 1990s the misleading classification that HIV/Aids was a "gay" phenomenon was debunked by both the national policy and reality that the disease affected all groups - heterosexuals and others, and was crossing over into families with dire consequences for women and children, the issue of the spread among men who have sex with men is emerging today, as the infection rate among this group is on the rise.

Fifth, there seems to be a decline in the national budget accorded to anti-HIV/Aids programmes, while prevention campaigns have become less sustained. Although the country has a national committee that deals with the issue, it seems to be less energetic than in the past, perhaps due to the tendency to see the HIV/Aids problem as lower priority. There is the crunch of how to translate the national policy into decentralised programmes involving local players, such as the Tambon (district) administrative organisations.

Those shortcomings are compounded by the exclusion of a number of those living with HIV/Aids from enjoying their human rights, particularly from the angle of equal treatment and non-discrimination. In a UN study on Thailand in 2004, it was noted that a quarter of these people complained that they had been stigmatised due to their HIV status, while some 40 per cent claimed that there had been breaches of confidentiality in their health status.

This had, and has implications particularly for the medical sector and the employment sector, where the issue of privacy and human rights was, and is at times raised.

The discrimination factor is also mutating. Today, various groups who are already marginalised are being doubly or multiply victimised by HIV/Aids-related discrimination. On the one hand, it is well known that a number of children living with HIV/Aids are bullied at school, are prevented from entering school, or are driven out of school due to stigmatisation. On another front, the issue of non-discrimination is tested to the limit in regard to minorities and ethnic groups, including hill tribes and migrant workers. A challenging area is the Muslim population in southern Thailand, and there is the question of whether prevention programmes reach out to such groups effectively in a culturally sensitive, and today violent environment.

To overcome the exclusion factor which is both a cause and consequence of discrimination, there is a need to improve access to services and a human rights mindset with various dimensions.

First, access to information. This implies the need for more outreach programmes aimed at preventing and mitigating the spread of the disease, including creative and participatory awareness campaigns, condom availability and accessibility, safe sex techniques and harm reduction measures. More should be done to address risk-prone behaviour and reach out to the various groups noted above, such as indirect commercial sex workers, drug users, adolescents, men who have sex with men and mobile populations such as migrant workers.

There is also a need to discard arbitrary anti-drugs programmes which lead to violence against drug suspects and to approach the situation more from a community-based, rehabilitative angle.

Second, access to education. This calls for guaranteed entry of all children into the educational system and protection from discrimination and stigmatisation. At school, there is the importance of teacher, student and parent activities and associations to nurture understanding of the HIV/Aids phenomenon and to counter misconceptions about the disease which lead to the exclusion of those with HIV/Aids from their right to education.

Those living with HIV/Aids have a key role to offer peer education to others so as to foster mutual understanding. On another front, there is the importance of ensuring access to at least primary education for all children, including stateless children and the children of refugees and migrant workers, as a basic right. There is also a need to work with religious and community leaders - especially their liberal wings - to act as a force for educating the public, particularly in culturally sensitive areas, about prevention of HIV/Aids and non-discrimination, eschewing a moralistic tone.

Third, access to medical care. Although Thailand is targetting increasingly many of those with HIV/Aids in their access to antiretroviral drugs, there is still a need to work towards universal coverage of all who are affected by HIV/Aids. Fortunately flexibility in the intellectual property regime and related patents has allowed the production of these drugs at more moderate prices, and this process needs to be maximised to ensure more extensive access to those with HIV/Aids, in addition to providing medical care free or at least at reasonable prices. Likewise, access to medical services as a whole should be promoted on a non-discriminatory basis. The medical profession has a key role to encourage its members to ensure confidentiality and the right to privacy, and to provide incentives for ethical conduct.

Fourth, access to equal opportunities. This implies opportunities in a variety of sectors, including employment, vocational training and economic channels. As an example, Thailand already has a business coalition on Aids which helps to promote good practices in the workplace, such as voluntary testing for HIV/Aids, related counselling and non-discrimination. There is the call to promote the understanding and practice that those with HIV/Aids can continue to work on a par with others, in keeping with their skills, capacities and capabilities.

Fifth, access to remedies. A most sensitive challenge is what to do when there are violations of the human rights of those living with HIV/Aids. Clearly, although the judicial system may provide some legal remedies, those affected are unlikely to resort to such system for fear of exposing their identity with the looming potential of more stigmatisation. There is thus the need to explore a various of remedies and related mechanisms - formal and non-formal. In regard to the latter, various non-governmental organisations, related centres and shelters play a key role in advocating protection and in seeking justice for those affected.

In effect, the issue is not only one of legal remedies but also socio-cultural and political pressures for accountability. When gauged from the perspective of more decentralisation in the country under the current national plan, there is an essential role to be played by local organisations and personnel - governmental and non-governmental - to exert pressure for responsible treatment of those with HIV/Aids. For instance, the Tambon administrative organisations offer an opportunity for the concretisation of local workplans on HIV/Aids and a catalytic window for HIV/Aids-related programming, with local resourcing.

Significantly, under the new child protection legislation in Thailand, every province is due to have a child protection committee, composed of both public officials and civil society, and this system offers monitoring and a mechanism, albeit nascent, to protect children living with HIV/Aids from discrimination.

Inclusive policies towards those with HIV/Aids ultimately depend upon the fostering of the knowledge base, attitude, skills and behaviour embodying non-discrimination. They are propelled by good examples, sustained political commitment and resourcing, and broad public participation, of all age groups and genders, including those living with HIV/Aids.

Vitit Muntarbhorn is a professor of law at Chulalongkorn University. This speech was prepared for the 60th anniversary celebrations of Unesco. He has helped the UN in a variety of capacities, including as expert, consultant and special rapporteur.

Network launches condom drive - November 26, 2005

"Let's have Oop, and you won't have HIV/Aids, you won't get pregnant, and there will be no need to go for an abortion," said the Youth Network on Aids yesterday.

That's the key message the group sent out at the launch of a campaign to promote the use of "Oop" brand condoms, on the last day of the People's Aids Forum.

The project originated from the group's finding that young people still have difficulty getting access to condoms, despite Thailand's claims in the "Condom 100%" campaign.

The Youth Network supported its campaign yesterday with results from an opinion survey carried out in 12 provinces which showed that a number of Thai people, both teenagers and adults, are giving much importance to the use of condoms, while viewing sex as a natural way to express love.

Kittiphan Kanjina, of the Youth Network, said the survey also indicated that youngsters constitute a risk group, and the campaign for safe and responsible sex is necessary for them and for the prevention of HIV/Aids.

About 1,500 packs of condoms were given out throughout the event at Sanam Luang yesterday.

Another batch of 800,000 packs will be put on sale across the country at a price of 15 baht per pack.

The proceeds will go towards the establishment of a condom cooperative, which is aimed at funding the group's activities including the Oop project.

The group plans to recruit around 1,000 youth volunteers to do the selling.

Another group leader, Wannakanok Pohitaedaoh, said "Oop" is a symbol of love and care from her group to teenagers. Under the slogan "talking condoms", the volunteers would not only sell the products to young customers, but also advise them on how to use condoms properly.

Forum ends with call for equal treatment: Govt reminded of its promises to sufferers  - November 26, 2005

Civic networks yesterday closed a public forum on Aids with a strong demand to the government and society - give people living with HIV/Aids equal treatment.

The three-day event, spearheaded by the Thai NGO Coalition on Aids, was aimed at disseminating information about the current Aids situation in Thailand, raising public awareness, and reminding the government of its promises to ensure access to treatment for HIV-infected people and prevention of the disease.

The Network of People Living with HIV/Aids urged society to think more of the nearly 600,000 HIV-positive people who remain unable to access treatment.

Each group at the forum came up with a demand that it hopes will help it achieve its goal in the fight against Aids.

The network of drug users highlighted "harm reduction" as the best strategy to solve Aids problems, and called on the government to end its "war on drugs" and stop labelling drug users as criminals, arguing that they have the potential and power to help society.

The religious networks wanted holders of different faiths to work together to help reduce new infections and create a friendly society for HIV-positive people.

The group of affected elderly people said HIV/Aids has left them in poverty and hardship as they could not deny the burden of looking after their HIV-positive children and orphaned grandchildren, amidst stigma from communities. It demanded adequate welfare payments as well as financial support for its activities.

The network of children affected by HIV/Aids wanted equal rights, similar to those enjoyed by other children's groups. They said they also have the right to a bright future, and a chance to grow up as ordinary teenagers.

The Youth Network on Aids said it was determined to promote condom use under a "sex with responsibility" campaign.

The network of migrant workers demanded equal access to public health and other services involving HIV/Aids, including antiretroviral treatment and basic information in their native languages.

Workers' groups called on employers to ensure that HIV-positive people were not discriminated against at workplaces. The compulsory HIV-testing of workers should be scrapped and HIV-positive workers should not be dismissed as long as they can do their work, they said.

The network of sex workers demanded that society accept commercial sex services as a job, and that they be given equal rights to social welfare just like other occupational groups.

The network of homosexuals appealed for more space and understanding in normal society, asking the public not to judge them simply because of their sexual preferences. "Once society can accept homosexuality as somthing normal, and we can get access to appropriate health services, that will be the right start for tackling HIV/Aids," the group said.

The women's network wanted medical outlets that are friendly and sensitive to their feelings, access to reliable information on women's health, and the right to have a say and make decisions.

All the groups reached a consensus on the trial of HIV/Aids vaccines and medicines, as long as the process is conducted with respect for community participation to the rights of volunteers.

German in Aids scare re-arrested - November 26, 2005

A blacklisted one-legged German at the centre of an HIV scare involving hundreds of Thai women was arrested for entering the country for the third time and will be expelled again, police said yesterday.

Hans-Otto Schiemann, 54, was detained on Thursday night in the northeastern province of Chaiyaphum and will be handed over to immigration police.

"He was arrested late last night at a bus terminal in response to a request by immigration police and we will hand him over to immigration today," said Col Boonlert Wongwatjana, Chaiyaphum police superintendent.

Immigration police in Bangkok confirmed they will expel Mr Schiemann as soon as possible but declined to say how and when he re-entered Thailand.

Mr Schiemann, 54, who claims to be infected with HIV and supposedly had unprotected sex with hundreds of Thais, was arrested for a second time in March after re-entering the country through Thailand's main international airport despite being blacklisted.

Mr Schiemann, a one-legged army veteran, had been deported earlier for overstaying his 30-day visa.

Neighbours in Chaiyaphum said last year he drove around the town offering large sums of money to students for sex and also frequented karaoke bars to pick up women. The allegations were first made by his ex-wife.

Health officials printed 2,000 flyers warning students to avoid him and posted banners throughout Chaiyaphum.

Officials said the scale of the problem was not clear, with many women reluctant to come forward for an AIDS test, but said Mr Schiemann could have had sex with up to 400 women and teenage girls.

Thailand has no law allowing action against people who knowingly infect someone with HIV

Elderly carers urge more support - November 25, 2005

Aging people affected by HIV/Aids are bemoaning the government's inadequate support and unclear policy which leave them to fend for themselves while having to care for HIV-positive children.

A group of elderly people mostly from Chiang Mai province took to the stage at the People's Aids Forum yesterday at Sanam Luang. They shared their experiences and discussed hardship after their children became infected with HIV/Aids.

A grandmother, Chanfong Phumphoey, 69, of Ban Huay Yang in San Sai district of Chiang Mai, is nursing her youngest son who has HIV/Aids. It was only five months ago that the deadly virus claimed the life of her eldest son, making the emotional pain all the more difficult to bear.

"Every parent shares a common wish for their children to look after them in their old age. As my son became ill, I can't help feeling sad for him and for myself, but I can't let him know," said Mrs Chanfong.

Instead, she encouraged her son to muster his strength and fight the disease. Her moral support keeps him going and watching him take care of his life prolongs her own.

In grief herself, she started to think of other families in the neighbourhood facing a similar ordeal. In her community, there are about 20 families with Aids patients under their roof.

Mrs Chanfong visited them and found some older folk had shut themselves in their houses after their children died.

"I had to console them. They're not suffering alone. I then persuaded them to get out of the house and socialise with others," she said.

Three years ago, she came up with an idea of finding jobs for the elderly as a way of spending their time more fruitfully.

A vocational group was formed, which taught those taking part to make artificial flowers and traditional hot compress. They also took up traditional massage training.

Today, there are 32 older folk and 23 young people with HIV/Aids in the group, which has 50,000 baht of savings. The money pays for medical and other necessary expenses for its aging and ill members.

"But the funds we have are not enough. Of course, we receive cash donations from temples and the tambon administration organisation. But that's not enough to pay our bills and ensure smooth operation," she said. "Many of our members still have to work full time to care for their ill children. People their age shouldn't have to work this hard."

Activists divided on condom promotion  - November 24, 2005

Yes or no? Youth affairs activists are divided whether condom use should be promoted among teenagers. The contentious issue came up during a hot debate at the People's Aids Forum at Sanam Luang yesterday.

Kittiphan Kanjina, of Youth Net, endorsed the condom use campaign. He said teenagers today are unknowingly at risk of being infected with HIV/Aids and other sexually transmitted diseases (STDs), and condoms are their best protection.

He cited statistics which indicated that one-fourth of new HIV infection cases in the country are young people between 14-25 years old.

Also, he said, a number of teenage girls had the problem of unwanted pregnancy and many ended up having abortions.

"With all these risks, I think condoms are very necessary for teenagers today as they are basic prevention tools. Condoms can prevent Aids and pregnancy, which would save many youngsters from being dropped out of school," Mr Kittiphan said.

Opponents, however, argued that promoting condom use is not the right solution.

Kittisak Wongtrakul, of Pure Love Project, raised concern that the condom campaign would create wrong attitudes about the value of sex.

"Many youths today are getting addicted to sex, regarding it as something irresistible. But they do not realise the true value of sexual relationship as a means to build up a warm family and bring about a new life," he said.

In his opinion, not every youth needs condoms. His Pure Love Project has divided young people into three categories - pure group, risk group, and sexually addicted group.

Only those in the sexually addicted group need condoms, he said. The other groups simply need moral teachings to enable them to live and love properly.

"Instead of giving them condoms, we need to advise them when is the best time for them to have valued sex," Mr Kittisak said.

Just being an adult does not mean someone is ready for sex, he said. More importantly, not every sex partner can become a parent. He cited a 1993-2003 survey among married couples which showed the number of divorces had almost doubled from 46,952 couples in 1993 to 77,735 in 2003. This implied the condom campaign could not help improve people's sexual behaviour, he said.

Condoms could only block problems but they could not help young people to achieve maturity and sense of responsibility, he said.

Another condom campaign supporter Saengsunee Julachao, of V-Teen Group, said nothing is wrong for girls to carry condoms with them. It's up to them to choose whether to get into a sexual relationship or not.

Mr Kittiphan said that he, as a condom use campaigner, would like teenagers to view the condom as a close friend they can always turn to in time of need.

Society more united in fight against Aids: Better access to health care, less social stigma  - November 24, 2005

Society has learnt valuable lessons since HIV/Aids first came to light 20 years ago through the strengthening of public participation in the fight against the disease, said renowned Aids campaigner Senator Jon Ungphakorn yesterday. "People have learnt they can share their lives with people infected with the Aids virus, unlike the situation 20 years ago. This is thanks to the hard work of networks of people living with HIV/Aids, who have been striving to educate society with accurate information on the matter," he said at the People's Aids Forum at Sanam Luang.

"We can't say Thailand has achieved success in the prevention of HIV/Aids since there has recently been a rise in new infections. However, we can ensure society understands HIV/Aids properly, remove the stigma and the idea that people with the virus need to be isolated from mainstream society," he said.

Mr Jon said such networks had managed to make progress on several issues related to HIV/Aids. This included ensuring that people living with HIV/Aids got access to medication under the 30 baht healthcare scheme, as well as receiving equal access to medical treatment.

Several hospitals across the country provide counselling units for people with HIV/Aids. Several counsellors themselves live with HIV/Aids, which ensures there is no discrimination when patients seek out these services.

Thailand's first case of HIV/Aids was recorded in 1984 and a few years later the virus had quickly spread, affecting several thousand people. Poor medical treatment meant that many people died from the disease.

Mr Jon said the government chose to try and use scare tactics to prevent the spread of HIV/Aids. However, these tactics failed and the number of people with the virus continued to rise. People testing positive at that time faced enormous social stigma.

Buareian Buddiken, the leader of a group of people with Aids from Isan, said she felt she had no future on learning she and her husband were HIV-positive in 1992. The couple resigned from their jobs as they feared the negative reaction they might receive from their colleagues.

Mrs Buareian's husband died soon after, so she returned to her hometown to start working with the network of people with HIV/Aids. She said she managed to start a new life and met her current husband, who is also HIV-positive. The couple have a one-year-old baby.

"I used to live in fear because nobody provided me with accurate information about the disease.

"But now there are many groups providing facts and figures. Now I can live with the disease because my family understands and is supportive.

"They are willing to take care of our child should I die. However, I'm confident I won't die anytime soon," she said.

Civic groups to give a more human angle  - November 23, 2005

The People's Aids Forum, organised by the Thai NGO Coalition on Aids and 18 other advocacy groups, kicks off today to address the successes and failures of the two-decade battle with the disease. Under the theme "For Life, Dignity and People's Participation", the three-day forum at Sanam Luang is aimed at providing information about HIV/Aids, as well as raising public awareness about the disease in Thailand.

Senator Jon Ungphakorn, chairman of the organising committee, said this year's Aids forum is the first in which civic groups have been the key actors.

"This is unlike previous events co-hosted by the government which had more academic content and less of the human angle," Mr Jon said.

"The People's Aids Forum will reflect clearly what problems each group is facing and how they can be tackled."

A key message the organisers hope to deliver is that Thailand is still far from being an HIV/Aids success story and that new problems continue to emerge despite an overall decline in HIV infection.

Visitors are encouraged to attend debates on various topics, including one on the measures elderly northern people are taking to tackle Aids problems.

Sawang Kaewkanta, director of Foundation for Older Persons' Development, said elderly people are seriously affected by HIV/Aids because they are often the only ones looking after patients.

A foundation survey showed 77% of HIV-infected people are being looked after by the elderly, he said.

"The survey also found that of 206 HIV-positive people in Chiang Mai, a half-dozen are elderly.

"The oldest is 74 years old. It's not known how they were infected, but it's likely they caught it while caring for their children," said Mr Sawang.

A youth group will host a debate about the necessity of using condoms, or if young people should focus on abstinence rather than safe sex.

Controversial discussion topics will include the ethics of research papers on HIV/Aids and how sufferers would be affected by a Thai-US free trade agreement.

A group of intravenous drug users will share their experiences before and after being infected by HIV.

A network of groups representing diverse sexual orientations is inviting all genders to a discussion on gays and Aids. The topic will focus on the inclusion of same-sex relationships in sex education curriculum.

People with doubts about coverage under the government's 30-baht healthcare scheme can obtain information from a booth operated by a women's group.

A network of human rights groups will also provide information about laws to protect the rights of HIV carriers.

Legal experts from the Centre to Protect the Rights of People Living with HIV/Aids, the Law Society, the Attorney General's Office, and the National Human Rights Commission will provide legal advice for visitors throughout the forum.

Civic groups: Thailand no Aids success story  - November 10, 2005

Despite an overall decline in the number of HIV infections, Thailand is still a far cry from being a success story in the fight against HIV/Aids, civic groups said. The groups, which are working under the Thai NGO Coalition on Aids (TNCA) and colleagues from 18 Aids NGO networks said new problems continue to emerge, including an increase in new infections among young people and men who have sex with men; a high rate of infections among intravenous drug users; the overlooking of certain risk groups, especially foreign migrant workers, prisoners and minority groups in HIV/Aids awareness campaigns.

The problems will be addressed at the People's Aids Forum to be held at Sanam Luang on Nov 23-25 under two major themes entitled "Know the facts of HIV/Aids" and "Keep your promise".

"Thailand has been unable to tackle its Aids problems, contrary to appearances, despite the HIV infection rate falling in certain groups,"said Senator Jon Ungphakorn, organising committee chairman.

He expressed concern that the government and society have paid less attention to HIV/Aids issues despite the fact that the problems still exist.

"It may be true that Thailand has already passed the most critical HIV/Aids period, but many problems remain,"said Mr Jon.

The government, he said, also lacked clear policies to address discrimination against people living with HIV/Aids, while society viewed them as people waiting to die despite the fact Aids can be treated.

"This government has shown little interest in HIV/Aids problems. The issue was never mentioned in its platform policies in the latest election campaign. Prime Minister Thaksin Shinawatra has never attended the meeting of the National Aids Committee and normally sends some of his deputies instead. And so far it appears that nobody in the administration specialises in the issue," said Mr Jon.

He said Thailand also lacks a sustainable mechanism to prevent HIV/Aids, and he saw sex education and life-skills training in schools as being key to achieving this.

With all these issues being addressed, organisers are hopeful the forum will raise public awareness about the real Aids situation in Thailand.

Nimit Tien-udom of Aids Access Foundation said the forum is the first of its kind organised by civic groups, and will truly show the plight of grassroots people.

"This forum won't ask the government to do this and that for us. But we'll show them the existing problems and the model projects to cope with them,"said Mr Nimit.

The event will include an exhibition about HIV/Aids, academic forums, live performances, consulting services from 18 Aids-related networks, such as the networks of drug users, HIV carriers and service workers.

Staying Alive  - November 9, 2005

MTV is once again staging its free Staying Alive 2005 concert, which aims to raise awareness about HIV and Aids on Saturday November 26 at the main auditorium, Thammasat University, Tha Phra Chan campus.

Thai artists to join the mission include singers and bands such as BodySlam, Endorphine, 4 Gotten, Crescendo, Ben Chalatit, Thaitanium and Ruengsak "James" Loychusak.

In its third year, the concert aims to boost understanding about the global epidemic, and promote living in harmony with infected patients. The campaign, "Staying Alive", is geared toward raising awareness about the epidemic.

Despite ongoing attempts to educate people about HIV/Aids, the rate of new infections is still soaring. According to Unicef (Thailand), there are currently over 600,000 people living with HIV/Aids and up to 500,000 children affected by the disease. Over 289,000 children in Thailand have been orphaned and thousands have been born to HIV-positive mothers. But the major concern today is young people. Half of the infected people around the world are those between 15 and 24 years old, with most of the individuals acquiring the disease through unprotected sex due to a pervasive lack of understanding about how the disease is transmitted.

"The problems are getting more complex, and the risk group is younger people, especially female teenagers," said Andrew Morris, programme officer at Unicef (Thailand).

To get the preventive message across to youth, a number of organisations including Unicef, UN Aids and the Ministry of Health are launching the campaign with MTV.

"As the entertainment channel for teenagers, our programmes reflect their lifestyle and tastes," said Hunsa Thanomsing, general manager for MTV and VH1 Thailand.

Hunsa said she hopes "Staying Alive" will empower and educate all people, not just those affected by or infected with the disease.

MTV veejays will visit 12 provinces in the country - Chiang Mai, Chiang Rai, Nakhon Sawan, Yala, Surat Thani, Nakhon Ratchasima, Ubon Ratchathani, Khon Kaen, Pattaya, Rayong, Kanchanaburi and Ayutthaya - to spread the message of the campaign, she added.

For more information and tickets to the concert, contact MTV Thailand on 02-681-4646 or visit www.mtvthailand.com. Outlook will also be giving away two tickets each to five lucky readers who can answer the following question: When is World Aids Day? Fax your answer to Outlook on 02-240-3668 before noon on November 18. The winners will be announced in Outlook on November 23.

Haven for transgenders: Population Services International's branch "Sisters" launched in Pattaya  - November 1, 2005

"Sisters," the first counselling centre for transgenders in Thailand, was launched in Pattaya yesterday. Located on Soi Yensabai in South Pattaya, the non-profit centre is a branch of the Washington-based Population Services International (PSI). Its objective is to provide information and activities that benefit members both in their daily life as well as in HIV prevention.

PSI deputy country representative Olivier Le Touze said transgenders in Thailand are both highly vulnerable and underserved. "There are other programmes targeting men who have sex with men (MSM), but none ever targeting transgenders. Besides, transgenders have very specific issues relating to stigma, discrimination, their own behaviours, and self-esteem that could put them at risk of HIV infection."

PSI chose Pattaya as its first branch in Thailand because of its large population of transgenders - about 700-1,000 and rising to 1,300 during peak tourist season. Despite their high number, there were no particular aid services for them before.

All staff members are transgenders themselves, and the centre's name "Sisters" is meant to give the impression that once they step inside, they are all like sisters.

"Here I can dress the way I like, be who I am, and I know everyone will understand me,"said Jumpol "King" Sritala, 22, a peer educator at the centre.

King is a veterinary graduate from Chiang Mai's Mae Jo University. She had applied for work at a few private companies before but they all rejected her, saying her hair was too long or that they didn't think she was fit for the job.

King eventually landed a job at a pharmacy in Pattaya but the office dress code made her feel uneasy.

"I had to wear a shirt and slacks, pull my hair back, and was not allowed to put on a makeup. Of course, I could follow the dress code, but that's not me. When I heard about the centre, I thought it's interesting and it's also a chance to help others," said King, in a white T-shirt and jeans and with her long hair streaming down her back. "I want society to accept that transgenders can also work like others, men and women. We don't like discrimination and always wish to be part of society," she said.

Sitthiphan Boonyapisomparn, Sisters operation supervisor, said the centre provides counselling for drop-in visitors as well as an outreach programme for those at workplaces and young people wandering around Pattaya.

Four staff members are assigned for the drop-in service and 15 others for outreach activities. They give advice about sex-change surgery, tips for hormone taking, safe sex practices, as well as stress relief tips for those facing social stigma and discrimination."Use of condoms is one of the major problems among transgenders. Although most of them know well about HIV/Aids and how to prevent it, it happens that they rarely put it into practice. Most often we find they don't use condoms with their regular partners,"said Sitthiphan.

The centre's services also include mental and health counselling, and recreational activities such as cooking and makeup classes, reading, chatting, as well as necessary medical services. HIV testing will soon be available.

Korakoch Singmuang, Sisters drop-in supervisor, said the centre currently has 113 registered members. There is only one rule - they are not allowed to bring along their male partners.

"We want to keep it the safest place for transgenders, so they will feel safe, relaxed and comfortable whenever they come here," said Korakoch.

Aids activists want deal on drug licence: Patients may become resistant to medicine  - October 30, 2005

Aids activists yesterday urged the government to negotiate for a compulsory licence on Effavirenz to help patients who are resistant to GPO-VIR, which is produced locally.

Nimitre Thienudom, director of the Aids Access Foundation, considers the Aids situation in the country to be at a crisis point due to an insufficient supply of GPO-VIR, an anti-retroviral drug manufactured by the Government Pharmaceutical Organisation (GPO), a firm under the Public Health Ministry.

Patients who are becoming resistant to GPO-VIR require Effavirenz, a stronger drug which is still expensive, costing a patient about 20,000 baht a month. Those using GPO-VIR currently pay just 1,200 baht per month for it.

Mr Nimitre said Effavirenz was difficult to buy on the market and so the government should resort to compulsory licensing in a bid to prevent a shortage.

Chuchai Somchumni, a senior official at the National Health Security Office, attempted to allay the concerns of Aids patients, insisting that the GPO was in talks with a pharmaceutical company producing Effavirenz, claiming the outcome was likely to be positive.

If it can be produced in India or Thailand, the price would drop to about 6,000 baht for a month's supply, said Dr Chuchai, whose agency provides health services to the public. He did not name the drug firm taking part in the discussions.

About 2,000 people are facing the problem of GPO-VIR resistance and the number is likely to increase year on year.

Deputy Public Health Minister Anuthin Charnveerakul played down the concerns of Aids groups, saying the government had sufficient budget to take care of those who are resistant to GPO-VIR.

But he admitted that compulsory licensing was a sensitive issue because it could ruin the atmosphere of trade and investment in the country.

"We have to think about it very carefully. The best way is to negotiate with the company," he said.

More kids fall prey to Aids: Unicef calls for shift in awareness, action  - October 25, 2005

Children in East Asia and the Pacific are increasingly bearing the brunt of the HIV/Aids pandemic, with an estimated 120,700 children living with the disease, the regional director of Unicef said yesterday. "The face of HIV/Aids in East Asia and the Pacific is becoming younger," Anupama Rao Singh said.

In Thailand, about 60% of new infections each year were now found in people under 24. In Vietnam, 63% of the people infected were under 30.

Studies indicated children in the region had limited understanding of how the virus was transmitted and what they could do to protect themselves.

In a survey of rural schools in China, over half of the students believed they could prevent HIV by exercising.

Ms Singh was speaking at the Bangkok launch of a global campaign to alert the world to the enormous impact of HIV/Aids on children. She called for a shift in awareness and action on the problems.

The Unite for Children, Unite for Aids campaign aims to raise global awareness of the fact that HIV/Aids is robbing tens of millions of children of their childhood and threatening their future prospects.

Because of HIV/Aids, children and young people were missing out education, medical care and support, while suffering great emotional pain. Statistics showed that an estimated 15 million children worldwide have lost at least one parent because of Aids, and less than 10% of children orphaned or made vulnerable by Aids receive public support or services.

Bai Bagasao, of UNAids Asia Pacific regional office, said young people play a vital role in building sustainable HIV prevention efforts - for themselves, their peers and as a role model for younger children. "So we must engage the voice of youth in the long-term fight against Aids," she said.

Few children infected with HIV were receiving life-prolonging medicines. In Asia and the Pacific, 34,500 children needed anti-retroviral treatment last year but less than 1% of them were receiving it. Only a small number currently receive Cotrimoxazole, a powerful antibiotic which nearly halves child deaths from HIV/Aids and costs just a few cents a day.

Bangkok Senator Jon Ungphakorn said new anti-retroviral drugs must be developed, specially for small children.

"Today, small children infected with HIV/Aids have to take tablets for adults instead of syrup which is more suitable for them. I have heard many carers say they have to break up the tablets so kids can take them, and yet it was not clear how much was the right dose," he said.

Youth group to give out free Oop! condoms to teenagers  - October 8, 2005

In a bid to reduce embarassment and strengthen the fight against the disease, the National Youth Network on HIV/Aids will distribute Oop! brand condoms, which it recently designed and developed, among youths. Sarinya Singthongwan of the Condoms Project Society said the Oop! condom initiative was partly inspired by a campaign promoting the use of condoms among sex workers. However the campaign, which has won high praise, has been effective in cutting down HIV/Aids infections only among focus groups.

Aids infection rates, abortions and unwanted pregnancies are reportedly on the rise among teenagers, said Ms Sarinya.

"Teenagers feel uncomfortable buying condoms at convenience or drug stores. They also feel too embarrassed to ask for free condoms, afraid they'd be branded as being obsessed with sex," she said.

Ms Sarinya has defended the scheme, which she says might also be seen as encouraging teenagers to have sex.

"It is in fact to raise awareness about safe and responsible sex among teenagers. The core of this campaign is friendly service. This project is to give them access to safe sex. And the youth networks will also provide additional information to educate them about the dangers of HIV/Aids, and about good health," she said.

A roadshow is being planned with the cooperation of MTV Thailand in 12 towns across the country to promote the scheme.

Oop! condoms, however, will not be available over the counter. They will be sold to youths via around 200 youth groups and will cost 10 baht per pair.

The network is seeking a permit from the Food and Drug Administration and expects to begin marketing the products in December.

The scheme is being funded by several agencies including Unicef, Thai NGOs Coalition on Aids, Global Fund, and Path.

The Public Health Ministry, meanwhile, has opened a clinic to treat teenagers with sexually-transmitted diseases (STDs). This follows the findings of a study that 50% of teenagers contracting sexually-transmitted diseases now opt for self-medication and treat themselves with over-the-counter drugs.

The first so-called Modern STD Clinic is at Bang Rak Hospital. From fiscal 2006, the ministry also plans to double the anti-Aids budget to 3.3 billion baht.

In another development, the Education Ministry has incorporated HIV/Aids and STDs in sex education at both private and public schools. The new sex education curriculum starts in the second semester of this academic year. This follows findings that the gonorrhoea infection rate had risen to 11% among students last year, from 3% in 2000.

Chiang Rai Tries New Approach to Teaching Teens About Safe Sex - October 05, 2005

A survey of teenage behavior conducted in Chiang Rai province this year raised concerns about the risk of HIV infection among youth. Only about 30 percent of respondents said they used condoms. The survey also found that teens are beginning to have sex at younger ages and that they do not tend to practice safe sex or have knowledge about HIV/AIDS.

In response to the findings, Chiang Rai has conceived the idea of a peer-to-peer club to promote safe sex. The club, to be located in the province's most popular teen hangout area, will offer inducements such as free Internet to attract youth. Regular visitors will be exposed to information on HIV/AIDS and sexual relations, with counseling on other teen problems possibly to be added later.

Teenagers who work as counselors at the club will receive in- service training and report what they learn from clients to public health authorities.

The club's establishment is part of a Thai-US cooperative effort on HIV/AIDS-related problems in the country's northern region. Like many provincial Thai cities, Chiang Rai has a lot of students from outlying district who come to live in dormitories while they go to school. The provincial health office met with dormitory operators to seek their cooperation, including installing condom machines for the young residents. The province's deputy chief medical officer, Dr. Surin Sumanapun, said few dormitory owners were receptive to the idea.

Thailand Expands Access to Critical AIDS Medicine - October 03, 2005

As of October 1, the Thai government will give an additional 10,000 patients access to GPO-VIR, a locally produced generic AIDS drug. Previously, some 50,000 Thais were receiving the medicine under a quota system. Thailand's universal health care program, established in 2001, allows patients hospital visits for 30 baht (approximately 75 cents US) each, regardless of the ailment.

The government's action places Thailand ahead of other Asian countries in caring for patients with HIV/AIDS. The World Health Organization and UNAIDS' "3 by 5" goal of giving 3 million people access to affordable antiretroviral drugs by the end of this year has fallen short in Asia and Africa, according to WHO. WHO reported that coverage has increased from 50,000 people on treatment in June 2004 to nearly 155,000 patients receiving ARVs in June 2005 in Asian countries with a high incidence of HIV.

Close to 800 government hospitals will be involved with the program, according to Paul Cawthorne, country coordinator of Doctors Without Borders. He noted that hospitals in northern Thailand will have a greater burden because of more HIV cases in that region.

"We campaigned for this [GPO-VIR program] for four years. The pressure on the government has worked," said Nimit Tienudom, director of the AIDS Access Foundation advocacy group. Nimit intends to lobby the government to produce a new line of inexpensive generic ARVs that will be necessary in 3-5 years, when many people on the current GPO-VIR regimen will likely have developed drug resistance.

'Mr. Condom' Says Thailand Has Returned to Ignorance: AIDS Is Back - October 03, 2005

Mechai Viravaidya, dubbed "Mr. Condom" for his pubic-education and condom-distribution campaign, said new HIV infections are rising because Thais, especially youth, are having unprotected sex. Mechai, a senator and chairperson of a private population association, claims the country had 25,000 new infections last year, more than the official figure of 19,000.

"We've gone back to days of ignorance," the activist said. "There's no reason why next year it won't be 100,000 new cases."

Due to its thriving sex industry, Thailand was believed to be on the verge of an HIV/AIDS epidemic when its first AIDS case was recorded in 1984. In 1991, the government counted 143,000 cases in the country. Officials estimate 1 million Thais have contracted HIV and 500,000 have died. Mechai put the number at 2 million infections and 800,000 HIV/AIDS deaths. In the 1990s, after Mechai persuaded the prime minister to head the National AIDS Committee, the budget to fight the disease increased 50-fold, and the government required radio and television stations to broadcast HIV/AIDS education announcements. The current prime minister, Thaksin Shinawatra, has neither attended NAC meetings nor addressed HIV/AIDS in Parliament.

In July 2004, the UN Development Program warned of an HIV/AIDS resurgence. Funding of HIV/AIDS programs dropped from $82 million in 1997 to $25 million in 2003.

Government spokesperson Suraphong Suebwonglee denied the government was neglecting HIV/AIDS and said Thaksin shares Mechai's concern about its spread among youth. Recently, Thaksin announced a policy to prevent youth delinquency, including inappropriate sexual behavior.

In 2004, STDs in youth increased at least 30 percent. Mechai thinks HIV/AIDS is on a similar track and noted that only 20- 30 percent of Thai youth use condoms.

New global standard picked for Thai drugs - September 20, 2005

Thailand is planning to introduce a new international standard to ensure medicinal products from the Government Pharmaceutical Organisation (GPO) and private manufacturers will be in line with international drug market requirements. Prapol Ungtrakul, a senior official of the Food and Drug Administration, said the Pharmaceutical Inspection Cooperation Scheme (PIC/S) has been picked as a new standard, replacing the one endorsed by the World Health Organisation's Good Manufacturing Practices.

PIC/S is the only international standard that provides a team of inspectors to check a candidate's procedure before approving its membership, Mr Prapol said.

Now, there are only three outstanding pharmaceutical standards applied worldwide - the WHO standard, PIC/S, and the one introduced by the United States Food and Drug Administration.

The European Free Trade Association founded the Pharmaceutical Inspection Convention for EU members in 1970 and PIC/S was established for non-EU members in 1995.

The EU allows drugs from overseas to enter its market if they pass the PIC/S requirements. Currently, 40% of major pharmaceutical markets are in the US and about 30% in EU countries.

The US is also expected to apply for PIC/S membership. If that happens, it means PIC/S is going to play an important role in the world drug market.Currently, PIC/S has 27 member countries.

"If we are approved for PIC/S membership, it will enhance the image of our pharmaceutical industry. We will be able to sell our medicinal products more widely in the world market. Many countries have shown their interest in our products but they require the PIC/S standard, which we don't have yet," Mr Prapol said.

He said Thailand should speed up its standard upgrading as Asean plans to allow free trading in health care products in 2010. Asean is likely to require all its 10 member countries to adopt the PIC/S standard. Currently, only Singapore and Malaysia are PIC/S members. Thailand plans to apply for PIC/S membership early next year, expecting to be endorsed in 2008. The Philippines, Vietnam and Indonesia are likely to do the same soon.

Acting GPO director Wanchai Subhachaturus said Thailand's membership in PIC/S would bring many benefits as it would open new markets for Thai pharmaceutical products, especially Aids drugs.

GPO now has the capacity to produce around 80 million tablets of Aids drugs per year with a total trade value of about one billion baht. It plans to double its capacity in the next few years, which will enable it to export to African countries.

Currently, Thailand exports some seven million baht worth of Aids drugs per year to Burma, Cambodia and Nigeria.

Decadent society behind premature teen sex: Promotion of condom use an essential step - September 18, 2005

The Education Ministry blames a decadent society for the problem of premature sex among teenagers and urges parents, teachers and the government to instil moral values into youngsters. "Children are what society is," said Charuayporn Thoranin, deputy education permanent secretary.

At a seminar on sex education yesterday, Mrs Charuayporn said premature sex is associated with pornographic movies, obsession with brand name goods and other luxuries, a carefree attitude, uncaring families and several other social ills. She admitted past efforts to stop moral standards from declining had failed but said the Education Ministry alone could not be blamed.

The ministry had already done its best, she said. "But if a massage parlour is right across the street from a school, what can we do?"

She said the ministry would no longer deal with teen problems alone but would ask society, parents and teachers to get involved in efforts to modify teen behaviour and promote morality.

The ministry would spend the next three months telling people what they could do to get wayward youngsters back on the right path, Mrs Charuayporn said.

Parents and teachers at the seminar agreed teenagers liked to imitate the ways actors dressed and live their lives, and that promotion of condom use among teenagers was necessary.

They also called for HIV-infected children to study with other students and said it is teachers rather than parents who should be responsible for teaching sex education.

 HIV Alarm Sounded - September 12, 2005

Around 20 percent of female sex workers in the Sanam Luang area recently tested positive for HIV, Dr. Parnrudee Manomaipiboon of the Bangkok health department said Friday. The 115 women had volunteered to get tested during an annual check-up conducted from May 1 to June 15, said Parnrudee, director of the Bangkok Metropolitan Administration's Health Center No. 9. Other area residents considered at high risk - including male sex workers, drug addicts, and the homeless - have not yet been tested. Earlier, Bangkok Deputy Gov. Samart Ratchapolsitte called on men not to patronize sex workers in Sanam Luang, which has been closed off at night since Aug. 25 after the city reinstated a ban on loitering.

Children with HIV Still Facing Rejection - August 29, 2005

Two cases of discrimination against children living with HIV recently surfaced in Thailand's Kaset Sombun district. An 11- year-old girl was forced to leave a school under intense pressure from parents who worried that the girl could pass the virus on to their children. A six-year-old girl in the same district was forced to stop attending a kindergarten for the same reason.

According to Jinda Khemthong, the leader of a network of people living with HIV/AIDS, the older girl has been living with a relative since her parents died of AIDS-related causes six years ago. She started antiretroviral therapy three months ago and was eager to attend school after being rejected by her former school. Jinda said her group has encouraged the community to learn about the disease in a bid to ease prejudice against the girl. "Unfortunately, they don't even let the poor girl drink water from the same container," said Jinda.

The six-year-old is also suffering mentally after being forced out from her kindergarten, said Jinda. Her parents died some years ago and she is being cared for by grandparents in their 60s.

Fake drugs, poor quality foods in South - August 29, 2005

The Public Health Ministry says there has been an increase in the availability of counterfeit medicines and substandard foods, as well as a rise in communicable diseases, including HIV infections, in the southern border provinces.

Concerns were raised after Suwaj Thienthong, the ministry's inspector-general, surveyed towns near the Thai-Malaysian border in Narathiwat, Satun, Songkhla and Yala. He found dysentery, malaria and HIV to be common and on the rise. Counterfeit drugs and substandard foods, including two makes of bird's nest beverage and an instant tea powder, mostly imported from neighbouring Malaysia, were also being sold.

Sirichai Pattharanuthapron, Narathiwat public health officer, said eight of 21 food samples collected from grocery stores in Sungai Kolok did not meet the required standard.

Thai and Malaysian public health authorities will set up a joint panel to enforce strict controls on food and drugs. The first meeting is set for December.

Addicts oppose Tenofovir trial - August 26, 2005

More than 100 drug users protested at city hall yesterday against an ongoing human trial in Bangkok of Tenofovir, an Aids prevention drug.

They raised questions about its safety and the willingness of the volunteers and demanded a halt to the trial.

The three-year trial, which began in June, is sponsored by the Bangkok Metropolitan Administration and the US Centers for Disease Control and Prevention, with pharmaceutical support from drug company Gilead Sciences.

Aiming to recruit 1,600 intravenous drug users treated at 17 rehabilitation centres in Bangkok, the trial has so far been joined by more than 100 volunteers.

The protesters asked to meet Deputy Bangkok Governor Pensri Pichaisanit and deputy city clerk Pitinan Natrujiroj, who are in charge of the project.

Dr Pensri promised to consult the project's researchers and let the protesters know the outcome in one week

Teenagers 'at greater risk of HIV infection' - August 19, 2005

The government should pay more attention to preventing the spread of HIV/Aids among teenagers, said Prof Daniel Tarantola, an expert on the disease at the World Health Organisation (WHO).

He said there were signs that the HIV epidemic was threatening to rebound, especially among teenagers, drug users and housewives. And he urged the government not to lower its guard in combatting the disease.

"Thailand has done a good job fighting against HIV/Aids. I hope to see more cooperation, especially in terms of financial support, between the government and independent networks working closely to minimise the epidemic's spread," he said. He was speaking at a press conference at the Public Health Ministry.

The WHO says it has found many indicators showing a possible rebound in the disease, although Thailand has cut the number of new patients living with HIV from 17,000 people last year to 15,000 this year. One third of new HIV infections are among women who have regular sex with their spouses. There were also signs of an increased risk of infection among men who have sex with men.

Dr Sombat Thanprasertsook, an expert on HIV/Aids, said rates of sexually transmitted diseases (STDs) were increasing among teenagers.

In 2003, 1,398 teenagers were infected with STDs, and this figure rose to 2,286 the following year.

The increase indicated the higher risk of HIV infection among teenagers, he said. He also pointed out that teenagers aged between 16 and 17 had an increasing tendency to change partners, which was very dangerous.

"We campaigned hard to reduce Aids transmission almost 20 years ago. So teenagers now don't know about our strong campaign against the epidemic," said the deputy permanent secretary of the Public Health Ministry, Dr Narongsak Ungkaauwapla. "It is likely that they have already ignored its danger. Therefore, from now on, we will switch the campaign directly to teenagers to reduce the risk of HIV infections."

Risks in HIV-men baby plan: Expert says safety can't be totally guaranteed - August 16, 2005

Safety cannot be fully guaranteed in a plan to help HIV-infected husbands to have a baby through intra-uterine insemination of their wives, the former chief of the Medical Council Pramuan Virutamasen said yesterday.

Dr Pramuan said unexpected mistakes could occur through human or lab errors, resulting in the mother being infected with the deadly virus which causes Aids.

In theory, a woman would still risk being infected with the virus during the process of intra-uterine insemination, he told a seminar entitled: "Is Thai society ready for the HIV family to have a baby?" held by the Thai Red Cross Society.

The seminar was held to discuss the issue as the Thai Red Cross and Chulalongkorn University's medicine faculty will set up a clinic to "clean sperm" in a few months for the first time in Thailand.

The sperm from HIV-infected husbands will be cleaned and via intra-uterine insemination will be injected into the woman when the woman is ovulating.

The clinic's procedure will be available for a stable and well-off family in which the husband living with HIV has a strong desire to have his own baby with his HIV-negative wife.

Usually, the HIV virus is not found in sperm, but in white blood cells and seminal fluid. The sperm will be separated from the fluid and made free of HIV before being injected into the woman's uterus.

The technique has been widely used for 10 years in many countries such as Italy, Britain, Spain, the United States and Australia.

"The sperm cleaning procedure is not as easy as expected. The technique is very complicated. Several tests must be taken to make sure that no sperm is found attached with HIV," he said.

But Prapan Panupak, director of the Aids Research Center of the Thai Red Cross, said that the idea of sperm cleaning could create great benefits to a family living with HIV. They could enjoy the basic right of breeding, he said.

He said that advanced technology could now reduce the HIV infection rate between mother to baby from 25% to less than 1% so the chance of HIV infection during intra-uterine insemination was very slim at only "0.0001%".

But Dr Pramuan said a couple where the husband is infected with HIV should think about the future of their child instead of focusing only on their desire to have a baby. They will have to consider how the baby will be brought up if their parents die of Aids, he said..

Kamol Upakaew, chairman of the People Living With HIV Network, believed that medical developments could prolong HIV/Aids people's life so they can enjoy life just as normal people can.

"People living with HIV can die at an old age. So they can enjoy everything ordinary people have, including a baby," said Mr Kamol, who has an 11-month-old girl with his HIV-positive wife.

AIDS MUM, CHILDREN SEPARATED: As her condition worsens, they cannot be together this Mother's Day - August 12, 2005 

Today is the first time in years that Noi, who is terminally ill with HIV/Aids, has been away from her children on Mother's Day.

Due to her illness Noi has had to leave her nine-year-old daughter, Kaew, and her five-year-old son, who is HIV-positive, in the care of social workers at a state-run emergency home for children on Rama VI Road.

The children were taken from their house in Samut Prakan last Sunday when Noi and her husband, who also has Aids and is in a critical condition, were admitted to a local hospital and there was nobody to take care of them.

Noi was released from hospital yesterday but her husband has to stay on. Yet she has no wish to take her children back, and says staying at the home appears to be the best option for them.

"I do miss them dearly, but it should be better for them to stay there and have someone to care for them. What will happen to them if they stay with me and I die one day?" said the 24-year-old, who is unemployed.

Usually, her daughter took care of Noi and her husband, who became blind two months ago. Kaew did all the household chores and her responsibilities caused her to miss school often.

Kaew said she had to feed her parents, clean their bodies in the morning and evening, and also clean the house and wash clothes and dishes.

"Since my father can't see, I have to stay around and help him. Sometimes my mother, who cannot help herself, has bowel movements on the bed and I have to clean it up," she said.

Life was hard and sometimes the family went without food. Fortunately, they had kind-hearted neighbours who took turns helping them.

"Some days people brought me food. Some days I had to share a packet of instant noodles with my brother," Kaew said.

The burden she shouldered had stolen precious time from her childhood. Kaew said she rarely had time to play with other children, and when she was not at school she dedicated most of her time to her bed-ridden parents.

Neighbour Samarn Bunrod, 51, praised the girl for her unselfish behaviour, saying she did everything to take care of her parents, whose condition had deteriorated over the past few months.

"The couple had to go to hospital often. At first we didn't know the truth [that they had Aids]. We knew that only after they developed the symptoms," said Mr Samarn.

Kaew is too young to know that her parents suffer from HIV/Aids, a disease that could take them away from her forever.

She said life is better at the emergency children's home. `It's more fun here, with many toys and friends to play with," she said.

She had no idea when she would see her parents again, and nobody knows if she will have that chance.

Ratanawalee Kowapradit, chief of the home, said the centre would look after Kaew and her brother for the time being. They have to miss school for a while. The boy is at risk of related infections and needs to have further blood tests.

"We need to gather more information about their family and relatives. If they eventually lose their parents, we'll see if their relatives could look after them. If not, we'll find them an appropriate place, which could be a state welfare centre, to take care of them and their education,"said Ms Ratanawalee.

Noi has to suppress the urge to see her children again, saying she wouldn't know what to do if they asked to follow her back home. "It's best for us all not to see each other, at least for now," she said. "They are secure and happy. Their lives are better there."

Ministry to Target TB During HIV Treatment - August 09, 2005

A new TB treatment program conducted by Thailand's Public Health Ministry will target people living with HIV/AIDS. The dual-treatment program is aimed at curing TB in addition to treating HIV/AIDS, said Anutin Charnvirakul, deputy public health minister.

Under the new initiative, people with TB will be tested for HIV and evaluated for antiretroviral treatment, and people with HIV who test positive for TB will be signed up for TB treatment.

"The more tuberculosis patients who are cured, the less chance there is that the disease will spread to the rest of the population," Anutin said. Approximately one-third of those with HIV/AIDS are also found to have TB, he said. This TB infection rate is about 12 times that of the general population.

Thailand records about 10,000 new TB infections and 6,000 TB- related deaths annually. Most TB patients are low-income working-class people. About 55,000 people are enrolled in the six- to eight-month TB treatment program.

The nation's rate of successful TB treatment - 76 percent - is considerably lower than the World Health Organization's standard of 85 percent, said Dr. Somchai Phinyopornpanitch, deputy director-general of Thailand's Disease Control Department.

Among people co-infected with TB and HIV, TB drug resistance is higher, 5-7 percent, than the general population's rate of about 1 percent. Because of this, the ministry is monitoring drug resistance on a four-month basis in every province.

Dare to CARE - August 8, 2005

Yutthachai Preeyamas feels comfortable with his sexual orientation, and is accepted by his family and friends as one of those Men Who Have Sex with Men, or MSM. But when the 27-year-old went to see a doctor with a rectal problem, he was surprised by the doctor's reaction.

"Instead of treating me professionally, the physician told me to quit being homosexual. He asked me why I couldn't love a woman. He also preached to me that anal sex was a channel for the HIV/Aids epidemic and recommended that I change my abnormal sexuality," he recalls.

Another MSM, Pornsak (not his real name), said he was frustrated when he went to the Red Cross to donate blood. On the application form, he was requested to state his sexual activities for safety purposes. "I felt uneasy when the nurse asked me if I was an MSM. I understood that the question was meant to check whether I was engaging in risky behaviour or not, but after all, isn't it mandatory to test all donated blood from everyone, whether straight or homosexual?"

A transgendered man, Nisarat (not her real name), also suffers from the same bias against homosexuality; she was not allowed to apply for private health insurance. "An insurance company rejected my application right away when they saw me. They said that, being a transgendered man, I have a high risk of HIV/Aids infection. But heterosexuals are as susceptible to HIV/Aids as homosexuals, aren't they?"

It can be even more troublesome for women who love women.

"Many avoid seeing doctors when it comes to problems with private parts because they feel uneasy being asked about their sexual behaviour. They usually end up finding pills at a drugstore, rather than seeking professional advice," says Nattaya Boonpakdee of the Women's Health Advocacy Foundation (WHAF).

Problems such as these were addressed at the 1st International Conference of Asian Queer Studies, held recently in Bangkok. Some 500 scholars, human rights activists, artists and film-makers convened to discuss, research and document Asian lesbian, gay, bisexual and transgendered (LGBT) cultures.

The conference examined how the quality of life for people with same-sex partners is affected by limited physical and psychosocial health care, a significant issue in the age of the HIV/Aids epidemic, widespread sexual transmitted diseases (STDs) and transgender operations.

"The attitude of health care providers is a critical factor in determining whether people with same-sex relationships can have access to quality health care," said Assoc Prof Peter Jackson, from the Australian National University in Canberra, a key organiser of the conference.

The growth of LGBT groups in Thailand, such as the Fa Si Roong (Rainbow Sky Association of Thailand, or RSA), the Bangkok Rainbow Group and M-Plus for gay men, plus Anjaree and Lesla for lesbians, has helped provide services to homosexuals in difficult situations by reducing the sense of isolation and providing support.

"The [health] services are much needed but still inadequate. Mainstream social programmes and public attitudes toward queers as deviants and pitiful people still loom large," said Viroj Tangvanich, president of RSA, the first and only gay organisation registered with the Office of the National Culture Commission in Thailand.

Participants at the conference emphasised differences amongst the three main groups of LGBTs when it comes to health issues:

MSM (Men Who Have Sex with Men)

Risky sexual behaviour is a major concern among MSM groups. But in the on-going battle with HIV/Aids, STDs, hepatitis, rectal cancers and, increasingly, anal warts (anal condyloma acuminate), MSMs in Thailand still have to fight sexual bias caused by the limited availability of professional services, equipment and well-trained public health personnel, says Rapepun Jommaroeng from RSA.

"There was a case in which a doctor asked a patient, 'Why does it hurt when I insert the probe? Isn't anal sex more painful?' He lacks the sensitivity needed for MSM treatment," Rapepun says.

He adds that many times the focus is on sex-related diseases only, with basic health issues overlooked "Heavy alcohol consumption and smoking are rarely mentioned as health threats among MSM. Insomnia and restlessness have also become prevalent among the group. But few studies pay attention to these issues," he says.

Besides, the group also suffers psychological problems, mainly stress, in family, school and work situations. There is also the problem of self-acceptance.

"While struggling to understand themselves, some homosexuals can't function well at school - they're afraid their peers and teachers will not accept their sexual preference. In some conservative families, gay teens can be kicked out of the house and become homeless or even criminal," he says.

"Most gay men do not have role models that would help them develop their identity more confidently. And general meeting spaces are also limited to gay areas, such as Silom sois 2 and 4, public parks and saunas, which is not the best way to learn about oneself," he adds.

Another problem lies in the inter-ministerial conflict of government policy towards gay health and lifestyles. "While the Ministry of Health promotes the use of condoms in saunas, the Ministry of the Interior raids saunas and regards used condoms found there as evidence of prostitution."

Transgendered/Transsexual/Transvestite (TGs)

TGs, or katoey in Thai, are increasingly common in Thailand, but their growing numbers have not led to an increase in the sort of information and specialist health services that they require.

"Many TGs believe that they are women trapped in the bodies of men, and to be able to find true love, mostly with straight men, they have to transform themselves into women. That's why sex change surgery tends to become their ultimate goal," says Pornthep Prae-kao, a PhD candidate at Khon Kaen University's Nursing School.

Sex change surgery comes at a cost: many trade their physical health for psychological happiness and self-esteem.

"After the removal of the testicles, the body cannot produce male hormones, so patients have to rely heavily on hormone tablets to maintain an equilibrium in their body chemicals for the rest of their lives."

But such drugs are not without side effects, which include nausea, dizziness and premature ageing. Some have to change hormones constantly to find ones that will work properly, a process that causes both physical pain and psychological frustration.

"If they stop taking hormone pills, the skin can become rough and start ageing faster, making them look older than they really are. Many stop seeking their doctors' advice because of the expense and instead rely on advice from friends about new treatments."

Without continuous professional care, many will also experience other health problems such as permanent fatigue, constant pain in their new sexual organs, incontinence and loss of sexual desire.

"One 21-year-old TG man said she had no idea why she did it [the operation] in the first place. She felt it was normal for TG men to have a sex-change operation, but later she questioned herself as to why she had to make herself a sick woman, when she could have been physically healthy as a man," Pornthep says.

To have a female voice, many undergo laser operations on the vocal cords, or a paring down of the Adam's apple, which carries a 50 percent risk of causing muteness.

"But many take the risk to become real women," Pornthep adds.

Some TGs will never gain acceptance from their families and communities, especially as they grow older.

Without public acceptance of their individual choices, many become the subject of constant mockery. Some even attempt suicide.

"I know one TG who decided to remove her artificial breasts while she was in her early forties. She didn't want her younger relatives to regard her as a weirdo. It was a traumatic decision for her but she wanted to be normal in their eyes," he recalls.

While many TGs work as cabaret performers, female impersonators and make-up artists, some, especially those who have poor education and have run away from home, end up as sex workers. Without proper health services, they fall victim to STDs and HIV/Aids.

"Some clients avoid using condoms with TGs as they assume that TGs are not really prostitutes, and many TGs consent in order to please their clients. Many are under the influence of drugs and alcohol when they have unprotected sex," says Sitthiphan Boonyapisompan, supervisor of the Outreach programme at Population Services International (PSI) Asia, which was established to provide support to TGs in Pattaya.

When they are arrested for lewd conduct, the legal procedures - such as whether to treat them as men, women or TGs - are not always clear-cut and transparent, Sitthiphan says. This also applies to charges of rape. Male-to-female TGs can only file an indecency charge (anacharn in Thai) but not a criminal charge, as they are not recognised as women either physically or legally.

"For TGs, there should be a referral system to fair, legal and effective health care services," he suggests.

Women Who Love Women

Perhaps most marginalised in terms of health care services are women who love women. According to Nattaya Boonpakdee from WHAF, many find it difficult to obtain information about safe sex, which is heavily skewed toward gays and TGs. The general public mostly regard sex between women as safe, since it is assumed that no penetration is involved.

"But there are other practices that can lead to STDs or HIV/Aids infection, and many women still haven't learned about safe sex. Only few have access to sex education, which is mostly in English on web sites," she points out.

She adds that the incidence of HIV infection among the group is steadily increasing because some women have been infected by former partners - male or female - and unknowingly transfer the infection to new partners. Many have no idea that oral sex and sex toys can be risky, too.

"To avoid discrimination by physicians, many lie to their doctor about their sexual behaviour or rely on the advice of friends. The chances of permanent healing and well-being are not guaranteed," Nattaya notes.

Prof Dr Suporn Koedsawang, who wrote a book about MSM health, adds that like many single women, lesbians are susceptible to a range of physical problems, including endometriosis, breast cancer and ovarian cancer.

"But only few researchers address these health problems among this group. With more knowledge made available to the group, we could help them learn how to take good care of themselves before it's too late," he says.

A ccording to experts in the field, the health of homosexuals can be improved in four major areas: Better understanding and more informed attitudes toward homosexuals within the medical profession; better health services and schemes for the group; an adequate and accessible body of knowledge on health issues and social adjustment; and fair policy and planning from the government.

"Medical professionals need more than knowledge and skill for treatment. They must understand people's rights and overcome their biases and ignorance about the LGBT group," says Krittiya Archawanitkul, a human rights expert from Mahidol University.

But changing perceptions takes a long time. "We can view LGBTs as a sexual minority group. But that should not rule out their right to standard services and professional treatment. With some sensitivity, their rights would be less easily violated," she says.

To tackle the high rate of new HIV infections and other STDs, Bang Rak Hospital on Sathon Road has opened a special clinic for MSM and male sex workers. But they can only accommodate 20 patients a day.

"We need more venues for treatment and more specially-trained personnel who understand the LGBT lifestyles and won't blame the patients' sexuality or gender for their problems. These experts can address both the physical and psychological aspects of their patients," adds Nattaya.

"But to label the clinic as LGBT, MSM, TG or Women Who Love Women is also a sensitive issue. Many gay men and women might still be in the closet and are not comfortable walking into such a clinic for fear of public ostracism," adds Rapepun.

More studies should explore the medical and psychosocial problems of queers. This includes work on the consequences of sex changes, individuals' sexual/gender identity, and public reaction towards homosexuals in Thai society. And it is important to make the resulting information more easily accessible to the group.

"Currently we rely on material from the Internet, which is mostly written in English. Some Thais find it hard to understand the technical language. But most crucially, one should be very careful about information found online, as it is often full of inaccuracies, misconceptions and myths about LGBT health," warns Nattaya.

Most significantly, public health policy should acknowledge the need for health services among the LGBT group.

"For example, the Public Health Ministry's 30 baht universal health care scheme does not have a package for TG men. Shouldn't they be tested under women's yearly check-up?" asks Pornthep.

"Everyone in this country is entitled to good health, and the LGBT group deserves better health services than they are receiving. After all, they are taxpayers too," says Krittiya.

Lack of awareness hurting HIV vaccine trial project: Programme shy of 3,000 volunteers - July 24, 2005

The world's largest human trial project for a potential vaccine against HIV/Aids is running behind schedule due to a failure in raising awareness among health staff and potential volunteers, a study has shown.

The joint survey by the College of Population Studies at Chulalongkorn University and the Bureau of Aids, Tuberculosis and Sexually-Transmitted Infections found researchers on the project were not able to deliver information properly regarding the trial process and the vaccine to health staff and potential volunteers.

As a result, the trial had not gained public attention, despite a campaign having been run for more than two years, the study said. The study was unveiled at the recent national conference on Aids.

The study was undertaken among Aids advocates, non-governmental organisations (NGOs), people living with the HIV virus and residents at the trial sites of Chon Buri and Rayong.

Respondents felt a lack of accurate information on the trial had also discouraged target groups from participating. Public health officials had not clearly understood the process of the human trial and had a negative attitude towards people living with HIV/Aids, the study said.

A team of professionals is to be set up to design a national communication plan for the targeted volunteers in a bid to raise their understanding and help monitor possible moral and rights violations among the volunteers, it said.

The US-funded project aimed to recruit 16,000 volunteers in Chon Buri and Rayong within six months of screening starting in September 2003. The project is 3,000 people short of its target, and its extended two-year recruitment period has passed.

All volunteers, aged between 20 and 30, must live in the two eastern provinces. Half were given a potential vaccine against the virus, while the other half received a placebo during a one-year period. Follow ups would take place every three years to monitor volunteers and check on their condition. Those in the vaccine group have been receiving shots of two combination vaccines _ canary pox vaccine Alvac and a synthesised combination of the B and E subtypes of the Aids virus AidsVax. The two subtypes are prevalent in Thailand.

Disease Control Department director-general Thawat Sundaracharn agreed with the study results, saying the poor campaign leading to problems in finding volunteers had played a part in the delay. The programme's main investigator, Supachai Rerks-ngarm, is still confident, saying there would be enough volunteers by year-end.

Men's Clinic Fills Sexual Health Niche - July 22, 2005

Last year, a clinic focusing on homosexuals, bisexuals, and straight male prostitutes with a gay clientele opened at Bang Rak Hospital in Bangkok. Initially called the Chai Rak Chai (Men Love Men Clinic), the clinic offered medical services to male prostitutes working in nearby red-light districts. Through word of mouth and cooperation among gay activist groups, the clinic, which now operates as a Men's Health Clinic,has expanded its services and now provides medical services, counseling, and a place to socialize and to plan outreach activities such as campaigns to promote condom use and peer sex education for gay youths.

A survey conducted a few years ago by Thailand's Disease Control Department and a team from the US CDC found a 17 percent HIV/AIDS rate among prostitutes and gay men at a number of Bangkok cruising parks. Based on that survey, DCD opened the clinic to ensure male sex workers free access to proper health care, said Dr. Sombat Thaenprasertsuk, director of DCD's HIV/AIDS division.

The clinic is open Monday-Friday and can serve only about 20 patients per day. Clinic doctors take extra time to question clients about sexual history, diagnose, and counsel on safe sex, according to Dr. Ungkhana Charoenwatanachokechai, the clinic's director. Besides diagnosing and treating STDs, the clinic will treat patients for any kind of diseases.

Clinic doctors are specially trained to serve men who have sex with men to catch diagnostic nuances non-specialists might miss. DCD plans to open similar clinics in cities around the country and to expand the Bangkok clinic's hours and days of operation.

Second-line drug copies cannot be made here  - July 18, 2005

Thailand is not a position to produce a second line of anti-retroviral drugs for patients who have developed a resistance to the locally-made GPO-VIR, dashing hopes of thousands of HIV/Aids sufferers who are seeking a more effective and cheaper medication.

Chief of the Disease Control Department Thawat Sundarachan said the country could not exercise compulsory licensing to produce copies of patented drugs for HIV/Aids patients to fight drug resistance.

"Despite reports of drug resistance among patients using GPO-VIR, the situation does not allow the government to produce more effective drugs at lower prices for them," he said at the end of the three-day national conference on Aids on Friday.

According to a department study, around 3,000 of the 50,000 HIV-positive people taking GPO-VIR have developed a resistance against the drug, and stronger anti-retroviral drugs were needed for them. About 500,000 Thais are known to carry the virus.

Although the figure was worrying, it was not seen as high enough to warrant low-cost, generic versions of a patented drug, because of the high royalty fees involved.

"The problem is the patent holders can demand high royalty fees under the principle of compulsory licensing," he said.

At the moment it costs the Government Pharmaceutical Organisation 1,200 baht to produce a monthly dose of the generic drug for just one patient, which is supposed to be cheap. But those who are resistant to GPO-VIR have to pay up to 24,000 baht per month for taking the two patented drugs Efavirenz and Kaletra.

Dr Thawat said the rate of drug-resistance was expected to increase because the Public Health Ministry planned to distribute the generic drug to 80,000 more HIV/Aids-positive people through the 30-baht universal health care scheme by the end of October, the beginning of the new fiscal year.

A budget shortfall also hindered the production of alternative anti-Aids drugs. The budget the government had endorsed can, at the most, ease the misery of 500 patients dependent on the highly expensive anti-retroviral therapy, he said.

Another problem was the facilities of the GPO factory did not meet the internationally acceptable production standards," he added.

But Jiraporn Limpananont, a lecturer at Chulalongkorn University's pharmaceutical science department, said the Public Health Ministry should immediately exercise compulsory licensing to help patients resistant to generic drugs gain access to brand-name drugs at lower prices.

"The government should not only base its decision by looking at the figures as that would only worsen the HIV/Aids situation in the country," she said. In Brazil, prices of brand-name drugs decreased sharply after the government passed a law on compulsory licensing.

Kamol Uppakaew, chairman of the Thai Network on People Living with HIV/Aids, urged the government to stick to its promise it made during the International Aids Conference last year to widen access to treatment for HIV/Aids patients including those who could no longer take GPO-VIR.

HIV drugs losing their power - July 15, 2005

The rate of drug resistance among HIV/Aids patients using the locally made GPO-vir anti-retroviral treatment has increased dramatically over the past couple of years and is expected to get even worse.The development, in which the drugs lose their effectiveness against pathogens that have become immune, was revealed yesterday at the 10th National Seminar on Aids in Bangkok.

The government recently announced that it would provide the GPO-vir cocktail of three anti-retroviral drugs virtually free of charge to about 60,000 HIV/Aids sufferers needing the life-saving treatment.

Yesterday’s seminar called on the government to make sure an effective infrastructure was in place to facilitate such a mass treatment programme.

However, it heard that a study of about 300 patients receiving the GPO-vir drugs at Mahidol University’s faculty of medicine at Ramathibodi Hospital had discovered increasing resistance to the efficacy of the treatment.

Assistant Professor Dr Wasun Chantrtita, of Ramathibodi, referring to the three ingredients of GPO-vir, said 49 per cent of the patients were resistant to Lamivudine, 39.6 per cent to Stavudine and 58 per cent to Nevirapine.

As a consequence, they had been forced to move to a more powerful drug regime that cost each patient at least Bt10,000 per month. This compared with the actual cost of Bt1,000 per month for GPO-vir, which was developed by the Government Pharmaceutical Organisation using the generic version of the three ingredient drugs.

Wasun said that most worrying was the fact that the high rate of drug-resistant HIV meant the spread of new infections that were already resistant to common anti-retroviral drugs.

These new patients with primary drug resistant HIV would be forced to begin with expensive anti-retroviral treatments, other than GPO-vir. They would also be prone to a wider drug resistance because resistance to Nevirapine usually meant resistance to many other anti-retroviral drugs as well.

Dr Ploenchan Chetchotisakd, an HIV/Aids drug resistance researcher at Khon Kaen University, said that although Nevirapine was vital to the prevention of HIV/Aids transmission from mothers to babies, the drug had the effect of causing unavoidable drug resistance in the mother within just 10 days of beginning its use.

Such resistance to Nevirapine cut the chances of the mother using a large group of anti-retroviral drugs that accounted for 90 per cent of those used by people living with HIV/Aids in Thailand, she said.

Associate Professor Dr Kiat Ruxungtham, an HIV/Aids expert from Chulalongkorn University, warned of a new form of HIV that was resistant to many existing drug treatments. It was called 3-DCR HIV.

He said the lethal drug resistance had been reported in Taiwan and Hong Kong where anti-viral drugs had been highly accessible over recent years.

Recent reports from New York also spoke of the increasing incidence of a form of HIV resistant to many drugs and capable of killing people within six months of infection.

Thailand Offers Antiretroviral Drugs to All Thais with HIV/AIDS for Almost No Cost  -  July 15, 2005

On Wednesday, Thailand's Ministry of Public Health announced its plan to offer low-cost AIDS drugs to the country's estimated 500,000 HIV/AIDS patients. "We will be the first country in the world to give every person living with AIDS access to antiretroviral drugs," said a ministry statement. The Thai-produced antiretroviral (ARV) drugs will be included in a government health care program that provides basic care to all Thais for 30 baht (72 US cents).

In March 2002, Thailand's Government Pharmaceutical Organization began producing a one-pill generic drug, GPO-VIR, that contains stavudine, lamivudine, and nevirapine - a combination recommended by the World Health Organization. GPO- VIR lowered the cost of monthly treatment for one person from US$500-$750 to US$30. Thailand has exported its medicine to neighboring countries and the technology for it to nations in Africa.

The country expanded its free ARV program from 3,000 people to 10,000 in 2002. Last year, it distributed ARVs to 50,000 patients. In 1991, when a record 142,819 infections were reported, Thailand launched a nationwide program to raise awareness and promote condom use. Still, the country sees about 20,000 new infections each year, 30 percent among teenagers and young adults, according to the health ministry. Since Thailand's first patient was reported in 1984, about 1 million Thais are believed to have been infected; close to half have died.

Young Muslims facing high risk of being infected with HIV - July 14, 2005

Aids is spreading among young women in the southern provinces because condom use contravenes religious beliefs and there is little sex education, which puts young Muslims at high-risk of infection, an HIV/Aids prevention worker in the South said.

Wannakanok Pohedaedao, representing a network of youths against HIV/Aids, said in her village in Yala's Krongpinang district there were about 200 young people who are sexually active but lacked the appropriate knowledge about safe sex.

"Muslim youngsters like me are curious to learn more about sex but we have to suppress it mainly due to religious beliefs about abstinence and birth control," she said during the opening of the three-day national conference on Aids. "However, lack of appropriate knowledge about protected sex could put us at high risk of virus infection."

The 25-year-old campaigner for HIV/Aids prevention said her village and nearby Muslim communities still disapproved of condom use and some male and female teenagers were embarrassed to buy condoms at convenience stores and would instead ask her to seek free condoms and birth-control pills for them.

She asked health authorities to build up a network for HIV/Aids education and help both Muslim adults and teenagers to be open-minded about the issue.

Without a change in attitude towards condom use and safe sex, HIV/Aids could cause social problems in the southern communities in the long run, Ms Wannakanok said.

"The government should not just only talk but it has to prove that it would like to solve the problem of HIV/Aids infection among young people by listening to our calls and working with us," she said.

Up to 80,000 young people in Thailand have been infected with HIV/Aids with at least 600 new cases found each year, prompting health officials to try to control the virus spreading among major groups with high-risk behaviour.

Public Health Minister Suchai Charoenratanakul yesterday said that he was particularly concerned that teenagers' change of attitude towards having sexual relationships at an early age had recently caused a drastic increase in the level of HIV/Aids infection among this specific group.

According to the latest survey by the Bureau of Aids and Sexually Transmitted Diseases, many students aged below the age of 17 have experienced sexual relationships, usually one night stands, with their partners despite lacking appropriate knowledge and understanding of safe sex.

In Thailand, half a million people are living with HIV/Aids. An estimated 20,000 people are infected with the virus each year.

The Public Health Ministry aims to reduce the number of new infections to 18,000 this year.

Katherine Bond, associate director of the Rockefeller Foundation, said that the national budget on Aids has so far been spent on medical treatment rather than on educating young people.

The Disease Control Department spent almost one billion baht on medical care alone while only 50 million baht was used for prevention programmes.

She said the government as well as educational institutions should develop more programmes and activities to create close relationship between teenagers and parents, peers and teachers at home and at school because this would be an effective way to combat HIV/Aids.

"If adults want to work well with teenagers on HIV/Aids prevention, they have to let go of the power, learn to listen and ask them questions. This is so that they can truly participate and help someone with one of the most important social problems at the present," Ms Bond said.

7th International Congress on AIDS in Asia and the Pacific, Kobe (Japan) - july 1-5, 2005

There's good news and bad news

“BOOM!” That, in a word, is how one epidemiologist describes the spread of AIDS in Vietnam. Infection rates may be higher in Africa, but AIDS is growing faster in South-East Asia than in any other part of the world. What is more, in populous countries like Vietnam and Indonesia, even small increases in the proportion infected means millions of new cases.

Until recently, South-East Asia was considered a beacon of hope in the fight against AIDS. Thailand and Cambodia, where the epidemic took hold in the 1990s, have managed to reduce the incidence of the disease through vigorous and well-funded public-health campaigns. In Cambodia, the proportion of adults infected by HIV, the virus that causes AIDS, fell from 3% in 1997 to a still high 1.9% in 2003. In Thailand, the number of new cases has fallen each year for the past decade.

Even as Thailand and Cambodia get to grips with AIDS, however, the disease has been taking hold in other countries in the region. Myanmar and Papua

New Guinea, with estimated infection rates of 1.2% and 1.7% respectively, face what the United Nations AIDS programme calls generalised epidemics. Several others, including Indonesia and Vietnam, are witnessing sky-rocketing infection rates among drug users, from whom the disease might soon start spreading to the wider population. In East Asia as a whole, the number of people living with HIV rose by 24% in 2004 alone, according to a UNAIDS report, to be released on July 1st at a regional AIDS conference in Kobe, Japan.

AIDS is spreading so quickly because those most in danger are still taking risks. A recent survey of injecting drug users in three Indonesian cities found that 88% had used unsterilised needles in the previous week. No wonder, then, that half of all drug users in Jakarta and Bali have HIV. By the same token, repeated surveys find that relatively few prostitutes use condoms in Indonesia. Infection rates among them have risen as high as 17% in some parts of the country. In Ho Chi Minh City, in Vietnam, over a third of prostitutes inject drugs, and half of those are HIV positive.

People in the region remain worryingly ignorant about AIDS. Last year, the World Health Organisation reported that prevention programmes had reached only 19% of prostitutes in Asia and the Pacific, 5% of drug users and 1% of gay men. People in risky situations use condoms only 8% of the time, it reckoned. Only 1% of Indonesian women have ever been tested for HIV.

Most governments are responding pragmatically. After years in which AIDS was denounced as a social evil, Vietnam's communist rulers have begun to attend AIDS-awareness functions and promote AIDS-prevention schemes. In neighbouring Laos, soldiers are taught about AIDS as part of their training. Indonesia is running needle exchanges and handing out methadone to heroin users, although only at a handful of clinics.

But when Malaysian authorities announced that they would start similar programmes earlier this year, religious leaders reacted with horror. The government of the state of Perak said it would distribute condoms only to married men. In 2003, the Philippines' Catholic bishops succeeded in blocking a proposal to spend government money on condom distribution. The military regime in Myanmar has not yet allowed any prevention campaigns on radio or television. Even Thailand, which mounted a much-imitated “100% condom” campaign in the 1990s, is uncomfortable with any policies that imply forbearance in the face of drug use.

Even when governments are willing to tackle the problem, funds are often in short supply. UNAIDS reckons that AIDS prevention and treatment programmes in the region will get less than half the money they need this year, and less than a third of what they require in 2007 (see article). The Philippines has slashed its AIDS budget by more than three-quarters since the Asian financial crisis in 1997.

One of the hardest hit places in the region is New Guinea. Both the Indonesian portion of the island in the west, and the independent country of Papua New Guinea in the east have infection rates of over 1%. This seems to be linked to Papuans' relative promiscuity: the majority of Papuan men report multiple sexual partners. Yet New Guinea's awkward geography, poor infrastructure and myriad ethnic divisions make it difficult to mount an effective prevention campaign.

Myanmar presents even more daunting challenges. There too, AIDS has already spread beyond the most susceptible groups to the general public. In the city of Hpa-an, for example, 7.5% of pregnant women test positive for HIV. High rates of drug abuse (Myanmar is the world's second biggest producer of heroin) help spread the disease. So does the civil war that rages in much of the country, displacing many people and making others difficult to reach. There is no independent media, so a frank discussion of the country's problems is impossible. The junta is suspicious of NGOs and activists, while donors and aid agencies are leery of it. The generals are not good administrators at the best of times, and the health system is a shambles. Indeed, as bad as things sound, no one really knows how bad: the government conducted only 28,000 HIV tests last year, in a country of more than 50 milions.

Progress being made in battle against Aids - July 4, 2005

The global toll of HIV/Aids is three million lives a year, 10 times that of the Asian tsunami disaster. In many parts of the world, an entire generation of workers, educators and parents has been lost, with devastating impact on entire societies. Yet most of these three million lives annually lost could be saved by doing what was considered revolutionary just a short time ago - providing treatment to affected people in the developing world.

For years, the world stared at the unfolding Aids disaster and debated whether effective Aids care could ever be practical in poor countries. Many experts said Aids drugs were too costly or too difficult to deliver where they are needed most. Providing care in Africa would lead to massive drug resistance. Prevention efforts would receive less funding if we invested time and resources in providing therapy.

A new report from the World Health Organisation and UNAids shows that these concerns have been greatly overstated. Aids treatment works in the developing world. One million people are now receiving anti-retroviral drugs in the poorest and worst-affected nations. HIV treatment access in Africa and Asia has more than tripled in the past year.

Partnership between donors, international agencies and governments is beginning to pay off. National governments in countries such as Mozambique, Zambia and Cambodia, working with the support of programmes sponsored by the UN, United States and faith-based groups are building clinics and training health workers. In many countries, people with HIV/Aids are standing in long lines to get the treatment that - it has now been proved beyond any doubt - is just as effective in Lesotho as it is in New York.

Some say one million people on treatment is too little, too late, and I agree. More than six million people in the developing world need treatment today. This week's progress report makes recommendations for speeding efforts to dramatically increase the number of people on HIV treatment in low and middle-income counties. This can only be accomplished with greater support from political leaders in several of the most affected countries and the adoption of standardised, simplified, quality treatment approaches.

What does treatment mean for the million who now receive it? Since almost everyone with HIV in the developing world is young - under 30 - it means renewed hope for the future and extra years to support their families and educate their children. HIV treatment strengthens the pillars that keep societies from disintegrating into chaos.

At the same time, treatment also strengthens efforts to prevent HIV infection in the first place. The fact that effective treatment for HIV/Aids is available is driving people at risk to show up in unprecedented numbers for testing and counselling, during which they also receive information on how to protect themselves from HIV. In one district in Uganda, the availability of treatment has led to a 27-fold increase in demand for testing and counselling services.

Much remains to be done to ensure that health care in the developing world is both affordable and sustainable. Yet responses to HIV have already begun to create what may truly be revolutionary changes in global public health. The brand-name pharmaceutical industry has cut Aids drug prices for the developing world. The low-cost generic drug industry is expanding access to many formerly unaffordable therapies. And quality medical services are being offered for the first time in countries in which spending on health has hovered around 40 baht a person a year. The potential impact of these changes on efforts to treat other diseases, such as malaria and tuberculosis, as well as chronic diseases such as diabetes, heart disease and stroke, is enormous.

And yet, one million on treatment means that we are just beginning. Now that we have the tools and technology to slow this massive epidemic, universal access to Aids care is the only acceptable response.

Moving forward, greater financial resources are needed. These must be pledged not on a year-by-year basis, but as a long-term commitment that encourages poor countries to match donor support by investing their health-care funding, knowing that Aids treatment will not disappear when the international community takes up other priorities. All agencies, including WHO, must do a better job of coordinating the support for health worker training, drug procurement and the building of robust health systems that can support treatment not just for HIV, but for other diseases as well.

In reaching the one million mark, we have learned a tremendous amount about what works. But we have also missed great opportunities. More than five million more people need treatment now.

We are beginning to respond, but we can and must do better.

Jim Yong Kim is director of the Department of HIV/Aids, World Health Organisation

Anti-HIV Drug Trial  -  June 27, 2005

The Bangkok Metropolitan Administration will join the Public Health Ministry and CDC in conducting trials of the AIDS drug tenofovir to determine if it can prevent drug users from contracting HIV, said Pitinant Natrujirot, deputy city clerk. The three-year program will be conducted at 17 BMA drug rehabilitation clinics where 1,600 IV drug users who are HIV- negative and in good health will receive tenofovir, which is considered safe to use with a low resistance rate. To date, only 10 volunteers have been given tenofovir since early June, said program head Khachit Chupanya. Drug users ages 20-60 can register for the program at BMA clinics and will receive a daily transport allowance of 50 Baht ($1.22 US).

Activists want drugs off agenda  - June 16, 2005

Thai human right groups and HIV/Aids-related organisations are doing their best to get the government not to agree to free trade agreement (FTA) proposals with the US that will end up making HIV/Aids patients buy expensive patented drugs.

The organisations, led by FTA Watch, have sent a letter to Paul Hunt, the Geneva-based special rapporteur to the United Nations Commission on Human Rights on the right to health, asking him to use his influence with the Thai government, which will hold its fourth round of FTA talks with the US in Montana on July 11.

The groups want the Thai government to protect the right of HIV/Aids patients and other patients in general to continue to receive cheap medicines by not including the pharmaceutical industry in intellectual property protection under the planned Thai-US FTA deal.

According to the letter, if drugs for HIV/Aids patients and the pharmaceutical industry are included, many Thai patients will be severely affected.

Of about 700,000 HIV-infected people in Thailand, only about 50,000 receive non-patented drugs from the Government Pharmaceutical Organisation while there are 25,000 new infections every year.

If strict protections on the sale of non-patented drugs are enforced, the patients will be forced to pay for the expensive medicines, according to the letter.

Singapore gay party to be held in Phuket: Ban forces festival to switch venues - June 8, 2005

One of Asia's most popular international gay and lesbian festivals will be moved from Singapore to Phuket this year after the Singapore police turned down an application for a permit to stage the party, organisers said yesterday.

A gay website which had organised the festival in Singapore since 2001, <Fridae.com>, said the police earlier this month rejected its application for a permit because it would be "contrary to public interest".

The event will now be held from Nov 4-6 on Phuket, which is still struggling to bring back tourists in the wake of the devastation of the Dec 26 Indian Ocean tsunami.

Held on Singapore's Sentosa island yearly to coincide with Singapore's National Day in August, the party had been increasingly attracting thousands of participants from around the world since it was first staged.

It attracted 8,000 revellers in 2004 of which 40% were international visitors, Fridae.com said in a statement.

"We are disappointed that the authorities have deemed a National Day celebration by Singapore's gay citizens as being 'contrary to public interest,' when it had previously been approved four years without incident," said Fridae.com chief executive Stuart Koe.

"This is a direct contradiction to previous calls for embracing of diversity," he said.

The police ban came three months after Senior Minister of State for Health Balaji Sadasivan said the festival may be behind a sharp rise in the number of new HIV infections in Singapore.

Mr Balaji told parliament in March he based his statement on the opinion of an unnamed medical expert.

"An epidemiologist has suggested that this may be linked to the annual predominantly gay party in Sentosa, the Nation party, which allows gays from high prevalence societies to fraternise with local gay men, seeding the infection in the local community.

"However, this is an hypothesis and more research needs to be done by the experts," the minister said.

A record 311 people in Singapore had contracted HIV - the virus that causes Aids last year - up 28% from 2003.

Mr Balaji said 90% of the people who contracted the virus last year were men, with a third of them gay.

There are now more than 2,000 HIV or Aids confirmed patients in Singapore.

Fridae.com, which bills itself as Asia's largest website for gays, angrily rejected Balaji's comments.

Tourism operators in Phuket welcome the planned change of venue.

Phanu Maswongsa, vice chairman of Phuket Tourism Business Association, said the gay festival would be good for Phuket tourism.

"We should not look at them as gays.

They are tourists just like any other tourist," Mr Phanu said.

" If we limit their right, soon nobody would want to visit Phuket.

"The festival should help boost room occupancy, which has fallen to only 15%, he said.

Phuket faces AIDS crisis  - May 9

PHUKET, Thailand's southern  tourist resort island of Phuket is home to a worryingly high rate of new HIV cases, being one of the nation's top 10 provinces for AIDS infection, according to the province's chief medical official.

Dr. Wanchai Satyawutiphong told reporters,  however, that the government's provision of anti retroviral drugs had led to more people with HIV coming out into the open about their conditions, which would help prevent future infection.

Stressing that AIDS is a preventable disease, he ,nonetheless, pointed to a worryingly high new incident rate of HIV infection on the resort island.

Thailand's 'War on Drugs' Had Unexpected Consequences, New Study Says - March 30, 2005

A new study of Thailand's February-April 2003 crackdown on drugs found that although 70 percent of injection drug users (IDUs) reported ceasing heroin use in the campaign's wake, nearly a third of the quitters had switched to smoking methamphetamine or opium. "The multiple unintentional outcomes of such a government policy" could include an elevated risk of HIV infection among former IDUs, the study noted.

At the time of the crackdown, Thailand's government claimed that methamphetamine use was so rampant it was a national security threat. Prime Minister Thaksin Shinawatra's campaign against users and dealers of illegal drugs included widespread arrests, surrenders, and 2,300 killings. The government said the killings were the work of drug dealers seeking to silence potential witnesses. However, numerous public and media critics contend the killings were extra-judicial murders carried out by the police and other security officials.

Of 165 participants surveyed, 98 (70 percent) claimed they quit using heroin during the crackdown. The benefit of weaning IV drug users off injection drugs should not be taken for granted, said researchers. Their report noted "methamphetamine use is known to be associated with HIV risk taking, such as unsafe sex and multiple partners." The study cited findings that heroin users who switched to alcohol and then returned to IV drug use "may be at higher risk for HIV infection, as alcohol abuse plays an important role in needle sharing."

In addition, fear and intimidation from the war on drugs are likely to discourage drug users from accessing HIV testing and other medical services, the report said.

Yngve Danling, a law enforcement advisor for the UN Office of Drugs and Crime, agreed. "If 70 percent are not using needles, that is certainly a good effect," he said. "But on the other hand, using other drugs like methamphetamine and alcohol is certainly a risk factor. People get careless."

Multi media anti-AIDS drive launched in south - March 20

BANGKOK,  – The Southern Centre for Non-Formal Education is launching a multi-media project aimed at helping prevent the spread of HIV in the southern region, the director of the Songkhla-based centre announced today.

Describing AIDS as a problem which was having a severe impact on the nation’s economic wellbeing, Mr. Areefen Abdullader said that this year the Non Formal Education Office had signed an agreement with UNESCO to publish multi media materials for the use of both urban residents and members of remote rural communities.

The southern centre is now training officials and teachers from the 14 southern provinces in how to use the materials, which they will then be able to use to inform local residents on how to prevent HIV transmission.

Mr. Areefen expressed hope that the campaign would prove effective, particularly among the target group of working-age public.

Thais Protest Anti-AIDS Drug Trial -  March 11, 2005

On Thursday in Bangkok, activists protested plans, proposed by the US CDC and approved by Thailand's Public Health Ministry, to test the efficacy of Tenofovir on hundreds of volunteers. The Thai trial of the AIDS drug, also known as Viread D, will involve 1,600 intravenous drug users in Bangkok.

The drug is also to be tested at sites in the United States and Africa. In some countries, planned trials of Tenofovir have been cancelled amid allegations that its manufacturer, Gilead Sciences Inc., failed to take steps to prevent subjects from being infected and did not offer continuing care for those who might contract HIV. In August, Cambodia's premier halted a Tenofovir trial that would have involved hundreds of sex workers. A planned trial in Cameroon was cancelled this year.

The Thai Drug Users' Network and other AIDS groups issued a statement Thursday opposing Thailand's approval of the tests because of alleged ethical violations and the failure to consult the entire HIV community. Paisan Suwannawong, director of the Thai AIDS Treatment Action Group, alleged that Gilead has failed to provide subjects with injecting equipment. Seree Jintakanon, chairperson of the Thai Drug Users' Network, said there has been no promise of treatment for volunteers diagnosed with HIV when seeking to join the trial or for those who might become infected during the three-year test.

Last year, Gilead responded to such concerns by saying all participants receive extensive counseling. The company said it is not compelled to provide lifetime health coverage for participants because they are being given prevention information that will make them less likely to contract HIV.

Teenage sexual behaviour in crisis, say AIDS experts . Feb 15

BANGKOK, - Nine construction companies have registered their interest in bidding for a Bt950-million contract to build a pharmaceutical plant to produce anti-AIDS medicines, the Acting Managing Director of the Government Pharmaceutical Organization (GPO), Wanchai Subhachaturus, told TNA on Thursday.

The companies are planning to bid to build the plant to manufacture the anti-AIDS medicines.

The contract would require the construction to be completed within 480 days of the official signing, he said.

An auction to choose the bidder will be held on 22 March.

The companies will be given details of the bidding process through a website that is due to be available from 18 March.

Details of the project requirements will be released on 2 March, Mr. Wanchai said.

Thailand to launch ‘clean teen' campaign to mark Valentine's Day - Feb 11

BANGKOK  - With last year's cases of venereal diseases up 30 per cent, and half of them students, Thai authorities are planning a 'clean teen' campaign to mark Valentine's Day this year, health ministry officials said on Thursday.

According to health ministry data, venereal diseases (VDs) such as gonorrhoea and syphilis are on the rise in Thailand after years of a declining rate of incidence.

In 2004, the number of Thais treated for venereal diseases reached 13,130, up 30 per cent from 10,000 the previous year. And 50 per cent of the VD cases were students, a ministry statement said.

The ministry estimates that 5 per cent of all VD cases get HIV/AIDS, as the presence of open sores facilitates transmission of the deadly virus.

Health officials have also warned of a rise in the number of new HIV/AIDS cases among Thai teenagers, a trend they attribute to increased sexual activity among Thai youth in love.

"Teenagers are at an age when they are just beginning to understand what love is," said Health Minister Sudarat Keyuraphan. "We want them to learn that love should be constructive, safe and warm."

THAILAND: UN Warns of HIV/AIDS in Thailand's Tsunami-Hit Provinces -  January 26,

Today in Bangkok, UNAIDS officials warned that Thailand's tsunami-devastated provinces could see a rise in HIV/AIDS due to condom shortages, unemployment, and trauma. The December 26 tsunami claimed the lives of some 5,300 people in Thailand's six southwestern-most provinces lining the Indian Ocean; 3,000 more people are still missing. "The problem is that many livelihoods have been destroyed so people may engage in behavior they wouldn't have normally done because they are dislocated or in trauma," said Patrick Benny, UNAIDS country coordinator.

Officials are concerned that tsunami survivors could turn to prostitution - already highly prevalent in some well-known beach resort towns like Patong - or to drug use. "There may be a higher level of vulnerability because people are traumatized or don't have their social fallback," explained Benny. "But we're not saying this is going to happen, we're saying this is a risk."

UNAIDS personnel who recently traveled to the south also found evidence of condom shortages, particularly among refugee populations in Phuket, Phang Nga and Krabi provinces. "There is a critical need for prevention programs and sexual health information among this population, not to mention getting people back to work and restoring their livelihoods," Benny said.

A recent UN Development Program surveillance report on HIV/AIDS in Thailand found an infection rate of almost 5 percent among migrant women in Phuket, while fisherman tested in the coastal province had an infection rate of about 9.5 percent.

B30 scheme delays adding anti-Aids drugs  - January 17, 2005

The government will delay providing locally made anti-Aids drugs under the 30-baht health-care scheme, saying it was not ready for such a long-term commitment.

After discussing the issue with the national committee on Aids prevention and solution, Disease Control Department director-general Thawat Sundarachan said that health authorities needed more time to ensure enough drugs were available.

"Once HIV-positive people use anti-Aids drugs, they depend on it forever, with even stronger doses. That's why the state has to prepare so it can guarantee it will be able to continuously provide the medicine," he said.

Dr Thawat said the ministry has been stockpiling medicine and training staff at each community health centre since it previously aimed to provide the drug under the universal health-care system by fiscal 2006 which starts this October. But the issue has not been finalised, he added.

Deputy Public Health Minister Suchai Charoenratanakul, who chairs the national committee, said 1.6 billion baht has been allocated for Aids prevention and treatment this year.

Most of the money would be used to increase GPO-VIR production. Another 400 million baht would be set aside for prevention campaigns among people with high-risk behaviour such as teenage girls and prisoners.

Nimit Tienudom, director of the Aids Access Foundation, however, believes including GPO-VIR in the universal health-care system is the best way for patients to gain access to anti-retroviral treatment promised by the government at the International Aids Conference last year.

"However, the national committee's lack of a clear commitment to the promise will affect Aids patients' access to low-cost generic drugs and their chance to live longer," he said.

The positive side of HIV infection - January 15, 2005

At one point in Riyo Naoi's affecting documentary Yesterday Today Tomorrow, an HIV-positive father in northern Thailand is trying to console his bed-bound, HIV-positive 11-year-old son and explain to the boy why he shouldn't feel so sorry that he's going to die.

"You've seen enough of the world," he says. "You've been to Bangkok. You've been on a plane. You've eaten enough good food. You've played enough games," he continues. "A lot of people die without having a chance to do those things."

It's tough, for both father and son. But is there any other way to say it? Is the father being cruel talking to his dying son about his own death?

To us, perhaps yes, because to us HIV is a frightening three-letter acronym that can immediately switch on our sympathy; but to them, as this quiet, observant documentary shows, HIV infection is a fact of life, a condition that they have no time to think how to deal with because they have to live with it every minute. The father's matter-of-fact remarks are not cruel but heartbreaking, because he's making them not only to his son but also to himself.

"You're going to die," he says. "And soon your mother and I are going to die too."

Riyo, a Japanese journalist who's been living in Thailand since 1999, spent three years documenting the lives to two HIV-positive families in a northern province, and the result is this small, simple and at times innocent and moving documentary.

Riyo knows that there's no need to hammer home any point, and there's no need to portray HIV/Aids as a global disaster. By simply showing us the everyday lives and stories of her subjects, Riyo's movie tells us a great deal about the effects of the disease on human feelings and lives.

The first family we meet comprises Anna and Pon. Both are farmers and HIV-positive. Anna lost her first husband in 1998 to HIV-related illness and a few years later re-married to Pon, who had lost his first wife, who was also HIV positive. The second family is the household made up of father Achun, mother Supani, and their 11-year-old son called Boy. All of them are infected with the virus, though they continue farming unperturbed, even when Supani becomes visibly ill and Boy is hospitalised.

Without forcing any comparisons, the film shows the contrasting fates of the two families.

The section about Anna and Pon has an air of objectivity as we appreciate the couple's attempts to move on in life, although with the conscious knowledge of their condition. Meanwhile dark clouds seem to loom over Achun's family, especially when we witness the progress of Boy, a sunny lad who happily helps his father pick giant jackfruits from their orchards during the first half of the movie, as he becomes emaciated and bed-ridden. What leaves a lasting impression, however, is not particularly Boy's sickness but the serene, sensible reactions of his parents.

In all, it would be a big mistake to think of Yesterday Today Tomorrow as a tear-jerking portrait of a life-altering tragedy, as many Aids-related movies are (which doesn't detract from their worth as films). Neither family is very poor or desperate; they just continue to live their lives in a society that's ready to support them, and the film wisely alternates its style of distant observation with a few moments of intimate probing. If you cry - and you're likely to - it's not because you feel sorry for these characters but because you know everything they do and say makes perfect sense, and that it's just too painful to realise that they really have no other choices.

Based in Bangkok, Riyo shot and edited the film almost entirely by herself, and the patient, thoughtful pacing of Yesterday Today Tomorrow reflects her dedication. Truly independent, Riyo says her grandmother and parents lent her the money to finish the film - and they should be proud to have done that.

'Yesterday Today Tomorrow' will be screened this Sunday at House theatre, RCA, as part of the Bangkok International Film Festival 2005. Achun and Riyo will be at the screening to meet the audience. Call Thai Ticketmaster on 02-262-3456 for tickets.

The government will pour Bt1.6 billion into programmes to prevent the spread of HIV and provide medication for AIDS patients over the coming year, Deputy Public Health Minister Suchai Charoenrattanakun announced yesterday.

“Last year we provide anti retroviral drugs to 50,000 patients with CD4 counts of less than 200”, said Prof. Suchai, who yesterday chaired a national AIDS meeting.

“Next year we will increase this number to 80,000 to maximize access to these drugs”.

He also confirmed that the Bt1.6 billion cash injection would be used to help prevent the spread of HIV among risk groups, including teenagers, young people doing national service and pregnant women.

“We will publicize this through the media in order to broaden knowledge of the virus”, he said.

The latest government figures indicate that Thailand is home to 348,605 HIV patients, of whom around 8-10 percent suffer from complications such as tuberculosis.

Around 32 percent of HIV patients are aged 25-35, with 84 percent having contracted the virus through unsafe sex.

Over the past year the Ministry of Public Health has been preparing hospitals for the inclusion of anti retroviral drugs in the Bt30 healthcare scheme in 2006.

AIDS vaccine trials are currently being conducted in the country's eastern Chonburi and Rayong Provinces, and Dr. Thawat Suntrajarn, Director-General of the Department of Disease Control, revealed that of the 8,500 volunteers who had received the first dose of the vaccine this month, none had to date suffered from any side effects.

The vaccine trials will end in 2010.

Immunitor Announces Placebo-Controlled Trial of Its Therapeutic AIDS Vaccine - January 5, 2005

College Park, MD -- Immunitor USA Inc., announces that its licensed vaccine candidate V-1 Immunitor (V1) has shown promising results in Phase II, placebo-controlled, clinical trial involving 47 HIV-infected individuals (http://www.emediawire.com/releases/2004/12/emw186195.htm)
The study was published in the special December issue of the Journal of Clinical Virology – the official journal of The Pan American Society for Clinical Virology and The European Society for Clinical Virology. The abstract of the paper is now available on PubMed - the website of the National Library of Medicine.
At the end of 6-month study volunteers who were treated with V1 had statistically significant increase in CD4-positive T-cell numbers (p=0.01). However, in the placebo group that has received sham pills, the changes in T-cell counts failed to reach the significance threshold (p=0.33). The clinical potential of V1 was further supported by an elevation in CD4/CD8 ratio among V1 recipients and decline in CD4/CD8 ratio in patients on placebo. The average weight gain among patients on V1 was 1.8 kg while placebo group lost 0.5 kg. These results indicate that V1 can delay or reverse the HIV disease progression without any concurrent toxicity.
"Our published data supports earlier published, Phase I studies of V1 demonstrating increase in T-lymphocyte numbers, decrease in viral load, body weight gain, and improved survival of end-stage AIDS patients,” said Vichai Jirathitikal, the inventor of the oral vaccine technology. "The study provides additional evidence that this type of vaccine might ultimately be effective as a safe and effective treatment for AIDS and potentially other autoimmune diseases as well."
"The very first clinical study of V1 was published in 2002. In just two years we were able to achieve the major milestone in drug development process, which is the pivotal Phase II trial. We have accomplished this despite major and obvious difficulties and we are looking forward to confirm such results in Phase III clinical trial," said Dr. Aldar S. Bourinbaiar, CEO.
Due to toxicity and drug resistance problems associated with conventional antiviral chemotherapy, the therapeutic use of AIDS vaccines is receiving increased attention in the medical community. There has been considerable experience with this type of approach, with several dozen clinical trials reported over the last twenty years. While the immune response appeared to change as a result of therapeutic vaccination in most, if not all studies, there was no demonstrable clinical benefit. Despite this setback many clinical studies of various therapeutic vaccines are in progress, which may eventually help to identify an effective strategy.
V-1 Immunitor is an experimental AIDS vaccine made as an ordinary pill and comprises heat- and chemically-inactivated viral antigens derived from the pooled blood of HIV-positive donors. V1, which is taken orally on a daily basis, is thought to function by modulating the mucosal immune response. This innovative method of vaccine administration places the emphasis on oral tolerization of alloantigens delivered through the gut. V1 is the first therapeutic AIDS vaccine

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