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Published on July 4, 2007

Fifteen-year-old Piyada is caught in a dilemma.

Her boyfriend tries to take their relationship to another level but she tells him she isn't ready. Then her classmates keep talking about their wonderful experiences with their steadies. The curious Piyada has no problem with pre-marital sex, but carries a deep secret that she believes could make her boyfriend ditch her.

Piyada was born with HIV transmitted from her mother. She has been taking state-provided anti-retroviral drugs for six years and is as healthy as any girl of her age.

A counselling nurse insists that she has to be honest with her boyfriend so that both can practise safe sex.

"But how could I ask him to use a condom because I have HIV?" Piyada laments.

"In my counselling group, a girl my age told her boyfriend the truth. She said he didn't believe her because she looked healthy and pretty. She reluctantly let him get away with not using a condom. But then he gradually disappeared from her life.

"I love my boyfriend. I don't want to give him the virus and I can't afford to lose him."

Piyada is among tens of thousands of teenagers born of mothers with HIV/Aids from the late 1980s and early 1990s when the infection peaked in Thailand.

They were born before the Public Health Ministry introduced AZT drugs to infected pregnant women and their new-born babies. Before the drug reduced mother-to-child transmissions to a mere 1 per cent as it is now, more than 25 babies out of 100 would catch the virus from their mothers. The risk was higher if they were breastfed. Many died, but others were lucky enough to survive to receive the anti-retroviral drug when it was widely introduced in 2001 to state-run hospitals. "Now we have a generation of HIV-infected teenagers who grow up just like other kids," said Pimsiri Liewprasertsuk from the National Children Health Institute.

"Some under my care at the institute are approaching 20 and it's the age they get sexually attracted to other kids. I have to check with them now and then about their love life and changes in partners to make sure we give them proper preparation for safe sex."

At the three-day 11th National Aids Conference starting today, the problem of new infections among teenagers will be an emerging issue that health professionals and social workers consider a priority. Thailand was praised internationally as a success story for curbing Aids, but the situation is changing because of increasing infections in the past few years, chiefly among teenagers.

"What worries us is not every infected teenager participates in a counselling group because they don't want to reveal themselves in public," said Nipa Chompoopa from Raks Thai Foundation's Aids programme. "After so many years of Aids education campaigns, social discrimination is still a big problem many people with HIV have to face."

Social discrimination makes many parents or relatives choose to keep the truth from children with HIV for fear that they would be discriminated against at school and by neighbours, said Nipa, who has been working with people with HIV/Aids in Chiang Mai and other provinces in the North for over a decade. Worse, children with infected ethnic parents who do not have Thai citizenship are denied treatment.

"There are many teenagers walking around not knowing they are carriers of HIV or those having no access to treatment," Nipa said. "They may have unwittingly passed the disease to their partners."

HIV/Aids in Thailand is on the rise chiefly because of unsafe sex, said former senator and "Mister Condom" Meechai Viravaidya.

Thailand has for far too long lived with its old reputation of successful Aids control in the early 2000s. While the government is doing better on the treatment front with distribution of anti-retroviral drugs, it forgot the disease prevention that is equally, if not more, important, he said.

"The use of condoms in the country has fallen dramatically to less than 20 per cent from 90 per cent of people having sex five years ago," he said.

Kittiphan Kanjina of the Thai Youth Network on HIV/Aids confirmed that young people were not concerned about Aids because of the weak campaign on prevention.

"Many still have the perception that Aids is only dangerous among homosexuals and men who buy sex," the young activist said. "They think they don't need to use condoms because their sex partners from schools are clean."

Tawat Suntrajarn, director of the Disease Control Department, acknowledged the problem, saying the ratio of the government's Aids control budget between treatment and prevention is 75:25, and the share of prevention will likely get smaller in the future.

"We have done a lot to control Aids, and now we want to give treatment to as many people as we can with the limited budget that we have," he said.

"We expect people to also help themselves. I don't think condoms are too expensive for people to buy for themselves."

Nantiya Tangwisutijit

The Nation