AIDS in Thailand: a medical student's perspective

Abstract

Acquired Immunodeficiency Syndrome (AIDS) has become the biggest problem facing the health profession of Thailand today. The Ministry of Public Health reports that there are 400,000 individuals in Thailand already infected with the Human Immunodeficiency Virus (HIV) and is predicting that 4 million will be infected by the year 2000. This explosive epidemic first occurred among intravenous drug abusers (IVDAs) and subsequently spread to other high risk groups, especially prostitutes. The heterosexual population was next affected. The AIDS problem in Thailand was seen close-up by this writer, then a fourth year medical student, studying during an international health elective. At all three hospitals where I worked, I encountered large numbers of AIDS related admissions. Ten percent of medical beds at a Bangkok hospital were occupied by patients with AIDS related problems. In comparison, two hospitals located in the northern province of Chiang Mai had 15-20% and 30-40% of their beds occupied by patients with AIDS complications. Opportunistic infections were the primary reason for admissions. This paper describes the current AIDS epidemic in Thailand and the preventive measures being undertaken to combat it. Strategies to combat AIDS focus on preventive measures. The current program in Thailand emphasizes AIDS education and awareness, the promotion of condom usage, decreasing needle sharing, the screening of donated blood, and the development of the GP160 vaccine. The program, however, has been undermined by the country's well organized sex industry. Without a clear commitment from the Thai government, Thailand faces serious health and economic consequences from this epidemic in the coming decade.

PIP: Thailand's Ministry of Health estimates that 400,000 persons are infected with human immunodeficiency virus (HIV) and this statistic is projected to reach 4 million by the year 2000. From 10-40% of Thailand's hospital beds are occupied by patients with acquired immunodeficiency syndrome (AIDS)-related complications. HIV is believed to have been introduced by Thai homosexuals who had travelled abroad, and spread rapidly among intravenous drug users and prostitutes until establishing a hold in the heterosexual population. Among prostitutes in brothels, who serve a total of 450,000 clients each day, HIV seroprevalence is close to 25%. Current prevention strategies include AIDS education and awareness, promotion of condom use, decreases in needle sharing, and screening of donated blood. At present, 95% of rural and 98.8% of urban Thais are aware that AIDS is transmitted by sexual intercourse and that condom use can prevent its spread. Nonetheless, only 21.7% of urban and 23.3% of rural males routinely use condoms. Counseling programs have increased condom use among prostitutes to 38-54%, but client resistance (only 10% of men who have sex with prostitutes use condoms) remains an obstacle. The cost of caring for an AIDS patient, from diagnosis to death, is about US$40,000. Thailand has been selected as a site for trials of the GP160 vaccine, but given the length of time before the vaccine will be available to the general public, the emphasis must continue to be on other preventive measures.