Shinichi Asabe Article Collection

The People of Southeast Asia

Thailand How can it check the spread of HIV?February 2006

People living with HIV and AIDS engage in volunteer activities.

At the meeting of the Network of People Living with HIV and AIDS. The Network consists of 20-odd men and women in their 20s to 60s, and all of them were infected with HIV. The members present are listening to the vice-chairperson Thawee. They also ask questions and exchange their opinions = in a village health center of Mae Rim District in Chiang Mai Province.

In Japan people infected with HIV has increased to two and a half times its number in the past 10 years. The Joint United Nations Programme on HIV and AIDS (UNAIDS) gave a warning that HIV infection might be spread rapidly in Japan because the Japanese people didn’t have enough knowledge of HIV and individuals infected with HIV were alienated from the society. In Thailand, meanwhile, the number of people newly infected with HIV began to decrease fifteen years ago after peaking at 140,000 and fell below 20,000 in 2004. I visited Thailand, where the spread of HIV infection had been successfully checked, to see how Thai people had fought with AIDS, which statistics never showed.

“When the first set of drugs becomes inefficacious, you have to take the second set. You cannot start the same drug regimen again. So you have to take the drugs exactly as prescribed. You had better not to drink alcohol because the drugs overtax your liver.” The meeting held at a village health center of Chiang Mai Province was attended by 21 members of the Network of People Living with HIV/ AIDS. All of them were infected with HIV. The vice-chairperson of the north branch of the network Thawee was telling how to maintain their health. When Thawee found that he was infected with HIV, he attempted suicide. But he is surviving even after symptoms of AIDS developed.

Thawee used to be a truck driver, collecting and delivering milk. When he was 20 years old, he found out that he had been infected with HIV, but he couldn’t tell it to anyone. Tortured by loneliness and anxiety, he attempted suicide. After he drank alcohol, he rode a motorcycle at breakneck speed, and then his motorcycle crashed into a concrete bumping post. His motorcycle was damaged so badly that a policeman asked where the driver’s body was. Luckily he injured only his left arm. However, he finally developed AIDS in 2001 and symptoms of AIDS appeared in his eyes. He was terrified of losing his eyesight and considered committing suicide again by taking an agricultural chemical. “But my mother and sister said, ‘Anybody can be struck by AIDS,’ and they nursed me with great care. I came to think AIDS problems would never be solved even if I killed myself. Soon or later people will die. So it will never be too late for me to die after I fight against HIV in my body and social discrimination.”

This network was formed in 1997 by NGOs from every corner of the country including a NGO “Rattascha”, which has introduced medical herbs that will relieve the symptoms of AIDS since early in the 1990s when there was no medicine for AIDS. Now the network has seven branch offices in the country, and about 70,000 people belong to the network including not only people infected with HIV but also their families and supporters.

There was discrimination even in Thailand

The meeting was so open that we were allowed to take pictures of people’s faces present. A man named Nare (51) started a conversation with me. He said, looking back over that time, “Four or five years ago, my friends and neighbors worried that they might contract HIV by touching the tableware I used. Not only individuals infected with HIV but also their families were treated harshly. For example, a woman lost her job because her husband died of AIDS; a child was shut out from school because his parent was infected with HIV; and so on. It was terrible.” About 50 villagers died of AIDS including the village headman in his village with a population of about 600 people for the space of seven years from 1993. In Thailand the number of people infected with HIV is now more than 1 million, that is, one out of 60 Thai citizens was infected with HIV.

Hospitals and the Network of People Living with HIV/AIDS in close cooperation

A total of 660 inpatients and outpatients are under treatment for AIDS at Sarapee Hospital in the suburbs of Chiang Mai. Amarin Nochaiwong (42), the chief of the infection control section, thinks highly of the activities of the network. The hospital treats the patients for AIDS, and outside the hospital the network helps them with indispensable prevention and in-home care and supports them physically and mentally. Amarin said, “They hold meetings at schools and industrial complexes. At the meetings they say, ‘We are ordinary persons. We’ve never done wrong. We have lived a normal life like you, but we were infected.’ As a result of their activities, individuals infected with HIV were discriminated as a homosexual or a drug addict before but now people understand that they just didn’t have any knowledge of HIV and they were defenseless, so people infected with HIV can come to hospital easily.

The members of the network also give sincere advice to a person who has just found out that he/she was infected with HIV, because they know how he/she feels from their own experience. A person in the state of shock by being informed that he was infected with HIV may not open his mind to his doctor or nurse because he thinks that nobody will understand how he is feeling. CD4 is a kind of lymphocytes that HIV destroys. A healthy person in good condition has more than 1,000 CD4 cells per cubic millimeter. If the number of CD4 cells declines, the immune system gets weak and then a person infected with HIV develops opportunistic infection diseases, or AIDS. If the patient’s CD4 count falls below 250, he/she can get free anti-retroviral (ARV) drugs in Thai hospitals.

However, once a patient starts this anti-retroviral drug treatment, he/she has to take combination drugs every 12 hours without fail and the combination of the drugs needs to change every four or five years to keep the drugs efficacious. Moreover, the issue of the patents on these drugs has become a burning question in negotiation with U.S.A on a free trade agreement (FTA) since last year and there is a possibility that a US-Thai FTA will not allow AIDS patients to receive free ARV treatment. Amarin said, “So our hospital will not give ARV drugs immediately even when a person’s CD4 count falls below 250, but we tries to keep a patient’s CD4 count from declining in cooperation with the network.” He explained how important the daily care at home was.

Mental support by visiting home

Visiting the home of a member who cannot go to a meeting or see a doctor is one of the activities of the network. Wang Naper (right) is asking how Manatt feels and checking that she takes the drugs exactly as prescribed. = in Chiang Mai City

I accompanied a member of the network Wang Naper (48), who is in charge of the work of visiting homes. Chachai (33) and his wife Tonri (28) were both infected with HIV. At their house, they were at work on embroidery. The network fixed them up with that piecework of embroidery. They get 10 baht (1 baht is about 3.1 yen) by embroidering on three spots of a pair of pants. They work together and embroider on 20 pairs of pants per day. “We can’t find any other job, but I don’t think our illness is the reason. Our neighbors know we were infected with HIV, but they treat us as ordinary people.” Accepting their illness without being obstinate, Chachai and Tonri seem to live positively.

After having worked at a Japanese bar in Chiang Mai, Chachai moved to a town on the borders of Thailand and Malaysia and worked at a karaoke bar, where he met Tonri who was from the same province as he was. She was working there too. Then they got married. When she was pregnant, she had a medical examination. The result showed she had infected with HIV. And it also turned out that Chachai was infected with HIV as well. Tonri said, “I took the drugs and I didn’t feed this child on breast milk, but I’m still worried that she might be infected.” Wang Naper said to her, “Your child is three and a half years old now. I think she’ll be O.K.” She eased Tonri’s mind. Wang Naper’s first-born daughter died of AIDS at the age of two and a half.

According to Dr. Pradit of the Public Health Ministry, when a pregnant woman is untreated, the rate of mother to child transmission is about 30%, but when a mother in pregnancy receives drug treatment and her newborn baby is given drug treatment until the age of three months, the rate is reduced to 6%.

A pure heart (chai bourist) helps reduction in the number of patients with AIDS.

Wang Naper visits other members of the network who didn’t attend the meeting. Manatt (36), a dress designer, was lying under a mosquito net in a dimly-lit room in the daytime. She felt too tired to get up last April. She went to the hospital and found out that her CD4 count was down to eight and had developed AIDS. At that time she weighed only 22kg. Since then she has taken five different drugs twice a day. Now her CD4 count has risen to 79 and she weighs 40kg. After “combination chemotherapy” using a combination of drugs to suppress the emergence of drug-resistant virus was introduced in 1996, AIDS is no longer a deadly disease.

Manatt takes part in an activity of the network when she feels all right. Last December she gave a talk to about 100 students at Queens Nursing School in Mae Rim. She said, “What I wanted them to understand was that they needed thorough precautions because they could not tell by appearances who was infected with HIV. Also I told them that if doctors and nurses treat patients with a pure heart (chai bourist), the number of patients with AIDS would surely decrease.

A public campaign is essential

Surichai Wungaeo, an associate professor specializing in sociology at Chulalongkon University, said that activities by people infected with HIV had been very helpful in checking the spread of HIV infection. “People infected with HIV used to be ostracized and in the depth of despair, but they began to come out, look after themselves, help each other and hold meetings. Through their activities the accurate information on HIV infection was widely conveyed, and it has become common knowledge that anyone could have been infected or can be infected with HIV.”

Surichai also mentioned about the campaign of Mechai Viravaidya known as “Mr. Condom”, chairman of the Population and Community Development Association. In 1992 Mechai was appointed Minister of the Prime Minister’s Office, responsible for social works. He got Prime Minister Anand to chair the National AIDS Committee to make not only the Public Health Ministry but also the whole nation tackle the AIDS problems. The Thai government decided the free provision of medical examination and treatment for AIDS in 1996 and started to provide patients with 500 baht per month as a means of livelihood. The network also gets public aid of 22 million baht (the current year). “Discrimination hinders prevention and treatment, and the discrimination comes from ignorance. Not only the promotion of using a condom but also a social campaign is essential to check the spread of HIV infection,” Surichai said emphatically.  また、

A Japanese volunteer infected with HIV

There is a handicraft factory along the national road in the north of Thailand. They produce about 1,000 articles a month, including stuffed toys, bags and purses. The factory has 11workers including pieceworkers living in the vicinity. Five out of them were infected with HIV. The factory has been a going concern since their products displayed on a Sunday market caught the attention of a Japanese buyer.

Message from Thailand

Thawee is taking the wheel toward the next meeting. “A message for the Japanese people infected with HIV? Well, first of all they have to accept the fact that HIV lives in their bodies and then think how to change their present lives, leaving the fight against discrimination till later on. If they are afraid of what others may say all along, they may give themselves up to despair.” After a short silence, he started talking again, as if he was talking to himself. “Before I was infected, I had lived only in my own interests. My main preoccupation was making money to buy something. But now I work for others and society. I find fulfillment everyday. I realized that happiness wouldn’t be brought by money or goods, but it was inside me.” The words of Thawee, who narrowly missed death three times, seemed to come from the bottom of his heart.

(Story & Photo by Shinichi ASABE)

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