Friday, March 27, 2009

The Case for Thai MSM and MSW

The prevalence of HIV/AIDS in certain high risk groups is on the rise today as government funding for prevention campaigns nears an all-time low in Thailand, a country once touted the ‘poster-child’ for HIV/AIDS prevention efforts. Hello, I am Devynn Birx-Raybuck and this is The AIDS Pandemic, a podcast hosted by Dr. Dave Wessner, associate professor of biology, and his students at Davidson College.

Though Thailand’s initial response to the AIDS epidemic was weak in its early years, in 1991, the new Prime Minister made HIV prevention and treatment a national priority. However, the country’s grip on the disease seems to be slipping recently, as evidenced by decreased funding in important sectors, increases in infection rates among MSM (men who have sex with men) and injection drug users, inconsistent condom use by sex workers, and increasing risky sexual behavior, especially by young people.

Thailand is notorious for its sex industry. Brothels, go-go bars, massage parlors, and other venues cater to native Thais as well as Western tourists, who travel to the country on “sex tours.” Unfortunately, commercial sex is not only omnipresent; it is often backed and funded by corrupt government officials. Thankfully, with initiatives such as the 100% Condom Program and Mechai Viravaidya’s (a.k.a. Mr. Condom) tireless public outreach, HIV prevalence among female brothel-based sex workers decreased significantly after the early 1990’s, when as many as four out of five of prostitutes were infected. The 100% Condom Program began in 1991, along with a substantial public education campaign. The goal of the Program was to encourage and enforce constant condom use by female sex workers in commercial sex establishments. However, male sex workers have been neglected during such efforts to protect their female counterparts and clients.

A famous street in Pattaya where many commercial sex extablishments are located (left). Kathoeys (tansgender males) outside a go-go bar (right).

By the turn of the century, these enormous gaps in focus and funding were revealed. In a comprehensive review of the situation written in 2000, authors McCamish, Storer, and Carl, made a case for the inclusion of MSM in the country’s prevention efforts. Indeed, male sex workers (MSW) and MSM are at high risk for HIV infection, according to several studies which identified infection rates as high as 30% in these groups. Education and prevention programs aimed at MSW have been infrequent, limited to tourist areas, and generally unsuccessful in the past. The authors advocated for bar-based interventions and peer-support groups, which they believed would impact both the freelance and employed MSW.

Finally, in February 2006, “Sex Alert,” a safe-sex information campaign directed at MSM, was founded, with the hope of reaching this community that has been largely neglected by other efforts. According to the regional director, Dr. Somchai, the organization uses several media to advertise and educate, including the Internet and text messages. They also provide counseling, free condoms, and information regarding other health issues. This new outreach effort, along with others, will hopefully curb the rising rates of infection among MSM. However, programs such as these cannot act in isolation. They require the support of the Thai government, people, and most importantly, those affected most by the epidemic. Perhaps, despite recent concerns over rising HIV/AIDS infection rates and risky sexual behaviors, Thailand will prevail once again in the fight against the AIDS pandemic.

Free clininc in Bangkok that a sex worker might visit for counseling or treatment. This particular building is a collaborative center run by the Thai Red Cross and Armed Forces Research Institute of Medical Sciences.

On behalf of Dr. Wessner and his students, I thank you for listening.

For more information, please visit:
Thailand’s rising AIDS threat
UNAIDS Evaluation of 100% Condom Programme
Mr. Condom
Brothel-based sex workers

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