Thailand's Health and Social Disaster: One in 60 Thais Now has HIV Virus by Phairath Khampha 30 November 2001 AIDS leading cause of death in Thailand One in 60 Thais is infected with HIV, and AIDS has become the leading cause of death among the population of Thailand, a UNAIDS/WHO report says. The 2001 global summary of the AIDS/HIV epidemic said transmission between spouses could account for up to 50% of new infections wherein unfaithful husbands have become infected from prostitutes. The vast majority of Thai men are philanderers. This rate is so high as to be nearly as common in the population as the ordinary cold, meaning sex with a Thai gives a very high chance for infection, even with a condom, which is known to be effective only about 30% of the time. This will be a demographic and socio-economic timebomb for the country. Some Thais are known to now also be infected with a new, more virulent form of the virus that can be transmitted through mutual oral kissing. This was a reminder that targeting high-risk groups was inadequate. Countries should track patterns of HIV spread and adapt their responses, the report said. Sharing injecting equipment was also an efficient way of spreading HIV. More than 50% of injecting drug users had been found with the virus in Burma, Nepal, Thailand, China's Yunnan Province and Manipur in India. Prevention programmes among injecting drug users should be another priority, the report said. The report said Thailand's prevention programmes were well-funded, enjoyed political support and were comprehensive. They had trimmed annual new HIV infections to about 30,000, from a high of 140,000 in 1991. Countries where the HIV rate was low or which had large populations had a good opportunity to act. Gro Harlem Brundtland, WHO director-general, said low reported national prevalence rates can be misleading because the rate may be exceedingly high in certain sub-populations. "In many countries, we have to take these figures as warning signs of an impending epidemic, not as excuses for complacency," she said. This is particularly true where both infected people and medical personnel tend to under-report cases because of social stigma and other social issues, such as in Thailand. In Thailand cases are discovered mainly by accident, through typically infrequent medical checks, or when the infection becomes obviously full-blown. In countries with many people, a few percentage points could translate into millions of individuals infected, meaning a subsequently more rapid rate of infections. Worldwide, HIV/AIDS was the fourth-biggest killer, the report said. At the end of 2001, some 40 million people were living with HIV. In many parts of the developing world, the majority of new infections occurred in young adults, with young women especially vulnerable. About one-third of people living with HIV/AIDS are 15-24, the report says. Most do not know they carry the virus. Many millions more know nothing or too little about HIV to protect themselves against it and most are forced into having unprotected sex. In Thailand, large numbers of young women are forced into having sex as, in effect, unwilling partners in what is nothing more than a semi-instituionalised form of mass rape. In Asia and the Pacific, the epidemic claimed the lives of 435,000 people in 2001, while 1.07 million adults and children were newly infected with HIV, bringing the total number of people living with HIV/AIDS in this region to 7.1 million. In Asia and the Pacific unprotected sex between clients and sex workers, needle sharing and unprotected sex between men were the biggest causes. Large numbers of sex slaves, common in countries like Thailand, only exacerbate the problem because the women are "expendable" assets as more young girls can easily be kidnapped or otherwise forced into the trade. Commercial sex provides the virus with considerable scope for growth. Behavioural data collected in the region show that in the past decade, men who reported having visited a sex worker in a given year ranged from 5% in some countries to 20% in others, particularly Thailand. In India and Vietnam, levels of infection among clients and sex workers are rising. In Ho Chi Minh City, the percentage of sex workers with HIV has risen sharply since 1998, reaching more than 20% by 2000. To break the speed at which the epidemic is spreading, countries should act fast to put programmes in place, or expand access to treatment and care. Arresting the spread of HIV among young people was particularly important. Reverting to what traditionally had been more conservative sexual mores would help very much, too, instead of adopting an erroneously inflated idea of western sexual behaviour.