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:
AVERT.org
USAID
Thailand’s rising AIDS threat
UNAIDS Evaluation of 100% Condom Programme
Mr. Condom
Brothel-based sex workers