That was only a few months after she had returned to her home in Chaiyaphum's Nong Bua Rawe district from Bangkok because her HIV-positive husband had fallen ill and was unable to work.

Lacking a job, stigmatised by the community and ill, Charuwan suddenly found herself facing the biggest challenges she had ever confronted. She considered herself lucky to be able to at least access medical services at Nong Bua Rawe Hospital. Many other HIV-infected people are not so lucky.

Of the roughly 200 HIV-positive people registered with the hospital, Charuwan was one of only three people who had bothered to come back for medical assistance. The others simply disappeared.

Nurse Urarak Yuangthong, the head of the hospital's HIV/Aids section, told Charuwan about the absences in the hope of finding out why the others had not shown up for help. That was when Charuwan decided to tell her own story. Upon hearing it, the nurse decided to work with Charuwan and two other HIV patients to identify the problems that other HIV patients faced.

"I couldn't believe what I saw. One of our friends was left to live alone in a cowshed outside the house out of fear he would infect other people," said the nurse. "Another was forced to leave a public bus while travelling to see doctors when the other passengers refused to take the same bus.

Charuwan had also heard of other tragic stories.

"Some didn't have even Bt20 to pay for the bus to the hospital ... and finally died at home, despite the fact that people can live longer with proper treatment," she said.

The stigma and discrimination continue to surround people with HIV, even after their deaths. The community demanded that the bodies of HIV patients be disposed of at a separate crematorium, far from where they had lived.

"They dreaded going to the cremation of HIV patients. Some even panicked because they were afraid the smoke from the cremation would deposit the HIV virus on the roofs of their houses, and the virus would drip onto them when it rained," said Urarak.

Children whose parents were known to have HIV were forced out of school, irrespective of whether the children had HIV or not, said Charuwan.

At the beginning, Urarak and Charuwan's work was to identify HIV-positive patients who were trying to avoid receiving life-saving treatment. Then they began building up a network of openly HIV-positive people to do what was not easy - educating the community so people would gradually change their attitudes about HIV/Aids.

"No one, including me, ever wanted to let other people know we had the disease. But I had to. I had to let them judge me," said Charuwan. "At first, I was thought to be promiscuous simply because I had HIV. I wasn't. I have only one partner."

Having HIV-positive volunteers reach out to infected people who were in hiding helped, said Urarak. Because of their efforts, more HIV-positive persons decided to come out of the shadows and receive proper assistance. Many also offered to help other infected people they knew.

As a result, the mortality rate of HIV-infected people in Nong Bua Rawe has decreased dramatically from about 40 per cent to less than 1 per cent, said Charuwan.

"Well, it's really something to be proud of. Around the time we began, all of the patients we took to hospital died, one after another," said Charuwan.

What's more, thanks to the group's efforts to reach out not only to HIV patients, but also to the community, the HIV-infection rate in Nong Bua Rawe has dropped to about 21 per cent, compared to about 40 per cent in 2001.

The district yesterday was one of seven communities to win a Best Practice Award in the field of HIV/Aids prevention and resolution at the community level, given for the first time by the Disease Control Department

Urarak said the key to the group's success was the involvement of local administration officials. It took four full years to get the district's local administrations fully involved in fighting HIV/Aids.

Now, people living with HIV/Aids in Nong Bua Rawe are protected by their own community. They're given travelling costs to cover trips to see the doctor, and those who are unable to make a living get a Bt500 allowance.

"It has been a gruelling struggle over the past five years, but it has been worth it," said Urarak.

Arthit Khwankhom

The Nation