Published on November 17, 2005

With virtually no support from the government, a cash-strapped group of volunteers is relying on word of mouth and the Internet to inform gay and bisexual men in Bangkok that the rate of HIV infection has surged by more than 50 per cent in their community over the past two years.

Note hides beneath his baseball cap in a dimly lit corner of Lumpini Park on a Thursday evening. He’s 24, works in sales, and visits the park “sometimes”.

He says it’s easier to meet men in saunas, but if he has no money he walks to Lumpini Park. Most of the time he’s just looking for someone to talk to, but there are darker areas where, if you look long enough, you can see silhouettes of men having sex, and he is no stranger to those places.

Note will not reveal what province he’s from or how long he’s been in Bangkok because he is afraid his family or colleagues might find out he is gay from this information. He answers questions through Don, an English-speaking outreach worker from Rainbow Sky who is distributing condoms and safe-sex information in the park.

But Note is more familiar with English than he lets on. After a while, he begins his answers before Don has even translated the questions, and soon he stops staring at the ground like a child being reprimanded, offering a brief glimpse of his handsome, youthful face, lit up by a classic Thai smile.

Don’s goal is to make sure everyone like Note has a condom before it gets dark. For many of the men and youths that meet here, a packet of condoms and a tube of lubricant are equivalent to a day’s wages. Don also spreads the news that between one and four and one in three of them are likely to be infected with the virus that causes Aids.

It’s a health crisis that Thailand’s media and government have virtually ignored. Note says he first learned about the epidemic from a website about a month ago. He wasn’t sure if the news was reliable because he hadn’t heard it on television or read about it in a newspaper.

Few people in Bangkok’s gay community know the HIV infection rate has risen from 17 per cent to 28 per cent in just two years, says Kamolsate Kang-kanrua, the secretary-general of Rainbow Sky. One of the reasons the figure has surged is that most of those who are infected don’t know they are, he explains.

The association’s volunteers are working seven days a week to try to contain the epidemic, but they face two – perhaps insurmountable – hurdles. They receive little funding at home and money from international donors, specifically those funded by Washington, is contingent on adherence to prevention strategies promoted by evangelical Christians – strategies that could prove fatal to a generation of young Thai men like Note.

Thailand’s national Aids education budget is just Bt50 million this year and Rainbow Sky – which has offices in Bangkok, Chiang Mai and Phuket – received less than 1 per cent of this, Kamolsate says.

One result of this is that Thailand’s first safe-sex poster for gay and bisexual men was left hanging in limbo for several months. US donors objected to the randy couple in the original design, but even after several modifications the final image – of a gay couple who seem to prefer hugging to sex – had to be erased. Now, there is nothing left but words and Rainbow Sky officials are wondering whether anyone will notice the poster they plan to place on the walls of gay venues throughout the city.

Thaksin’s memory loss?

Senator Mechai Viravaidya, the activist who led Thailand’s first response to Aids, sees the surge in infections among gay and bisexual men as part of a second epidemic. He warns that young Thais are paying the price for the government’s failure to invest in Aids education, arguing that rising rates of sexually transmitted diseases are a harbinger of another devastating wave of HIV infection.

“It’s tragic that with a proven answer in our hands, we are allowing this to happen. We know what works. We’ve already done this,” Mechai says, referring to the 100-per-cent condom campaign he pioneered in the early 1990s. The Kingdom’s response then slashed infection rates, saved hundreds of thousands of lives and became a model for the world.

What is lacking now is public education and political leadership, Mechai says. Thaksin’s speech at last year’s World Aids conference contained the blueprint for dealing with the crisis. “Every good thing imaginable was said by him, but he appears to have forgotten his promises,” Mechai says.

“I’m going to carve them on a stone and put it Lumpini Park,” he adds. “Not exactly the 10 Commandments, it will be more like Thaksin’s Six Promises.”

Pot, a counsellor with Rainbow Sky, has been handing out advice and condoms in Lumpini Park for five years. “You see a lot of teenagers now,” he says. But the outreach workers say they are having a hard time reaching this generation with a safe-sex message that stresses abstinence and monogamy.

The association is fearful of criticising its international donors, but Kamolsate could not help scratching his head when he tried to explain the so-called “ABC” approach to Aids prevention promoted by Washington. “The first one is something like ‘try not to have sex at all’, and the second one is ‘be faithful to your partner’ and the last one is ‘use condoms if you can’t do the first two’,” he explains.

“Even when we go to a sauna to do outreach we have to tell [patrons] that the first option is not to have sex, that this is the best way to protect yourself,” he says in disbelief. Some sauna owners do not allow his outreach workers access to their premises.

Abandoned generation

Some 23 per cent of the 16- to 21-year-olds who took part in an HIV-prevalence study in June and July were infected. The study was conducted at 21 gay venues in Bangkok by the US Centres for Disease Control, the Ministry of Public Health, the Thai Red Cross Society and Rainbow Sky.

What differentiates the epidemic among gay and bisexual men in Bangkok from those in Western cities is that it appears to have happened recently and men here are getting infected at a younger age, says Dr Frits van Griensven, the study’s chief researcher. In 2003, his team found an overall infection rate of 17.3 per cent.

The surge in infections is also reflected in data from an anonymous clinic run by the Red Cross. The infection rate among gay and bisexual men using the Bangkok clinic doubled from 11 to 22 per cent from 2001 to last year, says Dr Prapan Phanupak of the Red Cross Aids Research Centre.

Rapeepun Jommaroeng, assistant secretary-general of Rainbow Sky, says the Ministry of Public Health has “done nothing” to address the epidemic discovered by the 2003 study. This was partly because gay and bisexual men had not been listed as an at-risk group in the National Aids Strategy and, as a result, officials had a hard time justifying spending money on a group that did not officially exist, he says.

An official in the disease control department says the crisis goes far deeper: “It has become politically astute to affiliate yourself with issues like smoking, alcohol and aerobics [rather than Aids], if you want to advance your career.”

This attitude infuriates Mechai. “They [health officials] have insufficient guts, courage, decency and manliness,” he fumes. “It’s their job to remind politicians that Aids is still the No 1 health threat.”

Mechai recently began spending his salary on buying condoms to distribute to youths and he’s expanding his Cabbages and Condoms Restaurant to include an Internet cafe and indoor bar.

Rainbow Sky is having a difficult time obtaining reliable condoms. Most of those it receives from the Bangkok Metropolitan Administration cannot be used because they are nearing their expiry date. However, the drop-in centre it runs at its Patpong office with a Bt1,000 a month donation from the Family Health International is drawing more than 500 visitors a month.

Vincent MacIsaac

Special to The Nation

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Counsellor delivers the test results simply and carefully

“The way you tell someone they have been infected with the virus that causes Aids – your body language, facial expressions, tone of voice and the words you use – can determine whether or not the person takes responsibility for their health,” counsellor Supaporn Chaikummao explains.

It is vital to avoid frightening them or treating the message like it is trivial, says Supaporn, who has been delivering the message for 13 years. “Of course it’s still hard, but I’ve learned to cope with the stress,” says the manager of the gay-friendly Silom Community Clinic.

“Because you have to convey an important message you have to learn how to manage yourself,” she explains. “You have to know yourself and you have to know the world.”

When Supaporn says “your HIV test result is positive”, she lowers her voice slightly. She is straightforward and shows no pity.

“You have to be confident in what you say, non-judgmental and professional.”

Displaying sorrow or appearing hesitant can produce a feeling of hopelessness, but seeming aloof can make the person feel like they have no value, she explains.

After telling someone that they are infected she asks what they intend to do in the next few hours, where they will go, who they will speak to and where they will spend the night.

“This is not a suitable time to give lots of information. You work with feelings and emotions. You try to make sure they are not suicidal,” Supaporn explains. It’s essential to give hope while conveying precise, accurate and unvarnished information, she adds.

It is just as important to remain professional and self-assured when telling someone the test is negative. “A lot of people don’t believe it when you tell them they have tested negative,” Supaporn says. “They say, ‘Are you sure? Are you really sure?’”

Despite the good news, she’s careful not to appear delighted. “It’s ok to show a little smile, but you have to remind them that if they don’t change the behaviour that brought them to the clinic the next time the test may come back positive,” she says.

Well over 100 people have visited the Silom Community Clinic since it opened last month, and the number is rising every week. The clinic, a collaboration between the US Centres for Disease Control and the Ministry of Public Health, offers free and anonymous HIV testing. The results are given within 30 minutes. One reason for the rapid service is that many people who get tested at anonymous clinics are too afraid to return for the results, Supaporn says.

The clinic is on the third floor of Bangkok Christian Hospital. It is open Tuesdays to Saturdays from 4pm until 10pm.

For more information visit www.silomclinic.in.th

E-mail: silom@tuc.or.th Or call: 02 634-2917.

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