The following article was typed in from Issue 590 (November 19, 1991) of _The_Advocate_, a well-known gay and lesbian magazine in the United States (and without their permission). It's quite long, but worth the reading. I suggest that you save it (maybe make a printout) and read it when you have some time. The article bothers me; Thailand currently has the greatest potential among the nations of southeast Asia to be wiped out by AIDS. I hope that the people of Thailand do not fall into the same trap that has already ensnared several countries in Africa which may not exist in 50 years. Thailand's AIDS Battle ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Poverty, Superstition, and Uninformed Sex Workers Bring The Southeast Asian Nation to a Crisis Point by Deana Hodgin The bar was packed with Western men and their teenage go-go-boy prostitutes, despite the morning (_Nation_) paper's headline: `AIDS SCOURGE MAY INFECT 6.7 MILLION THAIS.' What up until recently were public health officials' whispered fears were now made concrete with the newspaper announcing, "Thailand is likely to have 6.7 million AIDS-infected people, and 400,000 of them will die from the deadly disease in the next ten years." According to the World Health Organization (WHO), 90% of the 20 million to 30 million people it projects will test positive for antibodies to HIV, the suspected AIDS virus, by the year 2000 will live in the Third World. Most of them will live in Asia. Researchers say the primary mode of infections will be through prostitution and intravenous drug use. Each month, thousands of people are being infected with HIV as cheap and abundant heroin, poverty, and a massive domestic and international sex industry are combining to ravage Thailand. "Oh, please," says Nigel, a British expatriate who came to Bangkok as a computer salesman 15 years ago. "You people in America are so full of fear, you don't know anything." After bouncing a smiling go-go boy on his knee, Nigel hands him a crumpled wad of money and pushes him off towards the stage, where 15 boys are dancing to vintage George Michael. The pins on their diaphanous jockstraps identify them by number. "C'mon, I'll show you why nothing here will change," says Nigel. Around the corner and through dim, rank alleys, the lights of Patpong - the biggest, swankiest bar district in Bangkok - waver in the wet heat. The neon and flashing lights herald two city blocks of bars full of girls, boys, and _katoeys_ - transvestites and transsexuals. "The personal pronouns in the Thai language don't have any gender," explains Nigel. "Gender's a bit more flexible here." In the downstairs bars, the lingerie-clad go-go goddesses dance topless along the length of the bars. "Come, we'll have a drink," says Nigel, indicating an upstairs bar. The backbeat of a Bruce Springsteen tune and the din of an enthusiastically cheering crowd drift out the door of one of the well-known sex shows. "Blow-dart lady missed!" jokes the sex show's doorman, alluding to one of the many performers who pop balloons by launching darts from their vaginas. "This way," says Nigel, opening a worn upstairs door. Inside, a few Thai women in bikinis shuffle listlessly to a fading eight-track tape of the Commodores. The old man sitting next to us shifts in his seat. His left hand is buried in the bathing-suit bottom of the bored young dancer sitting beside him; a young boy kneels before him and unzips his fly with his teeth. With his right hand, the old man lifts his beer. "Cheers," says Nigel. "Hell, it beats Texas," says the old man, his belt buckle clapping time with Lionel Richie. "You see, everything's for sale here," explains Nigel. "Tourism is the top earner, and a lot of the tourists come for this," he says, shrugging toward the mesmerized Texan. "The police and the generals who run the government own a lot of these bars. There's tons of money involved." A group of Swiss conventioneers stumble in from the steamy street and consider the beckoning of the go-go dancers. "All of these scare tactics, these projections of plague and campaigns with smiling condoms, they're worse than naive," says Nigel, downing his beer and saluting the Texan. "Nothing will really happen here until a couple hundred thousand people die here and it becomes too expensive to ignore." The official numbers are optimistically low. Only a handful of people with AIDS are reported to have died in Thailand, and the Public Health Ministry says it has counted just over 100 people with symptomatic AIDS. The prime minister's office estimates that between 300,000 and 400,000 people are now HIV-positive and says that the number could double by next year. AIDS awareness in Thailand is eerily reminiscent of the situation in New York or San Francisco in the early '80s: The projections change daily, denial is rampant, and the government ministries are wasting precious time quarreling over who will get authority and money. Anonymous testing has only just begun, and HIV-positive prostitutes are being carted off to an isolated camp. RAMPANT DENIAL ~~~~~~~~~~~~~~ A gay Thai man who had lived for many years in the United States was the first person in Thailand to die of AIDS-related complications. That was in 1984. Epidemiologists say the disease has gone through three stages since then. "From 1984 to 1987, we thought it was a disease of gay men and some intravenous drug users," explains Dr. Ye Tun of the AIDS prevention bureau at Thailand's largest nongovernment health organization, the Population and Community Development Association. The nascent gay community began education efforts by word of mouth and through the gay magazines that began to appear at urban newsstands. "I wrote one of the first articles on AIDS in Thailand," says Khun Natee, founder of both the Fraternity for AIDS Cessation in Thailand (FACT) and the White Line AIDS education dance troupe. Khun Natee is Thailand's first grass-roots AIDS activist. "We tried to get information on AIDS from people in Europe and America, because no one knew anything here. People here have superstitious ideas, such as you get AIDS if you sinned in your last life. Some superstitious people believe that if you are gay, you were an unfaithful wife in your last life." Although the majority of lesbians and gays in Thailand are still closeted and there is no program for testing or tracking AIDS in the gay community, early education efforts appear to have paid off: A recent test of several thousand Thais showed fewer than 1% of those who identified themselves as gay to be seropositive. The exponential spread of AIDS among Bangkok's intravenous drug users -- whose seropositivity rates rocketed from 2% in 1988 to 50% in 1990 -- focused attention to the seriousness of the disease. AIDS is now in the papers, on television, on radio, and in magazines. The Thai government began working with WHO in earnest in 1988. More than 30 international relief organizations are working on AIDS education and to alleviate the conditions that lead to high-risk behavior. The current government, installed less than a year ago after a military coup, is more progressive and proactive in addressing AIDS than the former government. Prime Minister Anand Panyarachun heads the National AIDS Council, a policy-making body that includes representatives from both government and nongovernment relief organizations. "Of course, everyone is very worried now, because AIDS has quickly reached its third stage in Thailand," says Ye Tun. "The majority of people becoming infected now say they are heterosexual." SEX AND PROSTITUTION ~~~~~~~~~~~~~~~~~~~~ Although the numbers are still relatively small in Asia, Ye Tun says thousands of people are becoming infected with HIV each month. "In June 1990, we surveyed 1,300 sexually active men throughout Thailand," he says. "Of those, 26% said they had had multiple sex partners in the past six months, 59% said they never use condoms, and 85% said they don't think they are likely to contract the AIDS virus." Ye Tun says these attitudes and the Thai culture's acceptance of prostitution are helping to spread the AIDS virus. "Sex isn't limited to the tourist bars," he says. "We believe that 450,000 Thai men go to prostitutes each day. And most of them go to the less expensive brothels, or teahouses, where infection rates are the highest." Thailand's Ministry of Public Health estimates that there are 86,000 commercial sex workers, but independent relief agencies say that's a vast understatement. "We think there are 800,000 prostitutes in Thailand under the age of 18," says a spokesman for the Center for the Protection of Children's Rights. Ye Tun attributes the fast pace of infection to sanitary conditions in the developing country. "Sexually transmitted diseases (STDs) can make a person much more susceptible to infection with HIV," he says, "and especially away from the big cities [where 80% of Thailand's 56 million people live], many STDs are endemic." The AIDS epidemic's increase in Thailand may also be linked to chronic viral and parasitic infections that weaken the immune systems of poor and rural people. Although the blood supply in the regional capitals is relatively safe, it is thought to be less trustworthy in the countryside. Physicians say the medical overuse of transfusions and the use of unsterile needles are less common than they once were, but these practices are not unheard-of in isolated communities. Others say the massive AIDS education campaign has fallen short; the colorful brochures and pamphlets distributed by relief workers and the government fail too bridge the illiteracy of the urban underclass, who have the highest rates of HIV infection. "The government throws the information," says AIDS activist Khun Mechai. "They have the attitude `If you catch it, good for you. If not, oh well.' They need to learn to target those who need to be educated." FOLK REMEDIES ~~~~~~~~~~~~~ A wrinkle specific to AIDS education in Asia is the role of folk remedies and superstition. In nearby Singapore, vendors of cobra blood do a booming business in the cheap brothel districts. It is believed that drinking the snake's blood can prevent or cure AIDS. "Also here there are some folk remedies, some roots and hers to take against catching AIDS," says a go-go boy at Bangkok's My Way bar. "My sister makes these herbs to keep me strong." Clinic workers say the biggest obstacle they face is convincing the prostitutes and their customers that prevention can save lives. "If I am meant to get sick, then that is OK, I accept," says the go-go boy, whose back is caressed by a German pharmaceutical salesman. "No one can see the future, so why cry about it?" Although the people most at risk for AIDS may not be ready or able to hear about it, many others are listening. When they act, it is sometimes the result of AIDS phobia. Several employees at a major Australian airline have been warned by their employer to stay away from prostitutes. Many multinational companies looking to hire new employees discreetly list "good health" as a requirement for the job and require a physical -- and blood test -- as a condition of employment. The Thai government has no antidiscrimination laws concerning AIDS. Newspaper accounts of mistreatment by hospital workers of those who have tested HIV-positive are common. Although there is a newly build AIDS ward at one Bangkok hospital, there are no penalties for hospitals that turn away or mistreat AIDS patients. "I worry about the day when people begin to get sick," says Khun Mechai. "We have only 9,000 hospital beds in Thailand." Thai employers mistreatment of employees with AIDS is unregulated. The few people with AIDS who have given interviews say they were fired from their positions as soon as their employers found out about their health status. In August the Thai government opened anonymous testing centers in four cities as a part of its $1.72 million anti-AIDS program. This promising development is offset by recent AIDS legislation proposed by the Ministry of Public Health that would mandate the development of a list of HIV-positive people. "I have seen the clause stipulating that AIDS patients must report to officials who would be able to summon them round-the-clock, whenever they want to," says Mechai Viravaidya, a minister in the prime minister's office and an outspoken family-planning and AIDS activist. "I think that this clause violates the individual's rights," he said at a news conference. Increased awareness and fear of AIDS have trickled down to the syndicates that procure young prostitutes. These businesses send agents to rural villages to recruit young brothel workers. The agent will pay the parents $200 to $800 for their child, and stories of trading a television for a daughter or son are old hat. The syndicates tell the family that their child will be employed in a factory. Once the agent pays the parents, the child must pay back the employer through half of the wages earned in the brothel. Most of those working in the local brothels receive 60 baht (slightly more than $2) per transaction and see between ten and 20 customers per day. Those who are beautiful enough to work as go-go dancers or in private sex clubs make a great deal more, frequently three times the average salary of a factory worker. "The boys come to the gay bar scene when they are 12 or 13 years old, thinking they'll make enough money to do something else eventually," says Pisamai Tantrakul, who runs a translation business. Translators cater mostly to bar boys and girls who write to their foreign beaux. "They write, `I love you, please come back soon, and send money.'" she says, adding that both boys and girls who work the streets and the bars are getting younger: "They're starting younger, and they're writing more letters, looking for a foreign man to support them so they can get out of prostitution. They are afraid of AIDS." The boys who stand outside the Dairy Queen at night with eyelids red from sniffing paint thinner look young enough to be in grammar school, but their whispered offers are not the words of children. "We're seeing a big increase in child prostitution," says a spokesman for the Center for the Protection of Children's Rights, who requests anonymity. "Brothels are waking up to the trend in younger children from northern Thailand's hill tribes and from Burma and southern China," continues the spokesman. "Volume has dipped a bit because of the fear of AIDS, so they can ask a higher price if it's a child and exotic." Because the foreign young prostitutes don't speak Thai, they are also easier to control; as illegal immigrants to Thailand, they have no health benefits. "When they get sick, they are frequently sent home with nothing," he says. THE GAY COMMUNITY ~~~~~~~~~~~~~~~~~ Increased awareness of AIDS has also meant a heightened awareness of gay people and an emerging gay community. "People confuse what is gay - is it the transvestite in the clubs, is it the man who likes small boys, is it the girl who likes girls?" explains Khun Natee. "It's hard to develop, in this very conservative society, a positive idea of what is gay." The popularity of gay bars has rocketed, tripling in number in three years. The majority are found in Pattaya, a beach resort town in southern Thailand. Business is off this season. "So many boys, but nobody takes," frets the _mamasan_ at Big and Long Boys bar. The _mamasan_ -- a sort of personal shopper in drag on amphetamines -- chips the glitter off his press-on nails into his drink. "Why you no take boy? Take two, you videotape, only 400 baht, very cheap. Good for you." The boys are bold salesmen in their own right. "I good with ladies, I show you," says one whose shorn head shows that he's only recently returned from a Buddhist monastery. Asking him if he's gay will get you a standard go-go Zen answer: "What is anybody? I'll be whatever you want me to be." Bangkok is one of the most wide-open cities in the world, a town of sewage and temples, the easiest place on earth to make a friend, a city where bargain assassins charge a mere $30. "Of course, there's no gay community here, who needs one?" says Jacques, a retired French army sergeant. "You want a guy, you buy one, it's a free market." In a gorgeous teak home above a canal, a dapper gentleman in a seersucker suit rearranges a set of antique opium weights on his desk. "You see, so many of us left home and came here so that we could live outside of rigid categories," he says. "Not all of us are eager to join up in some other community." The fear of AIDS is leading some to seek the safety of community. "In the former time, everyone was closeted," says Khun Natee, "but gayness is becoming more open now. We now have six gay magazines. Our organization meets twice each month to discuss gay topics: We show films about gay issues, and we go on trips together so that people can meet other gay men." The newsletter from FACT goes to 200 people and details films, plays, and events as well as updates on AIDS. Khun Natee's dance troupe performs at local brothels, gay bars, and tourist bars to educate commercial sex workers about the dangers of AIDS. "Many people do not read, and many don't want to hear about AIDS," he says. "But with the music and the costumes and dance, people are drawn in. We do plays that pose the question the brothel worker has to answer every day: Is it worth it to use a condom? Is my life worth it?" Convincing sex workers to use condoms is tough, says Khun Natee. "Especially for the women in the brothel, the condom is her enemy," he says. "I talk to them, they tell me, `I have to see as many men as I can each day. Arguing over the condom takes time. Then if he puts on the condom, he takes twice as long, and I make less money.'" Khun Natee says it's hard to convince people to choose safety over cash. "A lot of go-go kids say, `I'm more afraid of hunger than AIDS.' But I remind them of the Buddhist saying we have in Thailand, _`Tai_di_dai_di.'_ It means `Do good things and good things will come back to you.' "I believe in education, and I think that when society sees us working too teach and support people, they will have a better idea of gay people," Khun Natee continues. "I want to set an example that _gay_ doesn't necessarily mean AIDS or transvestites or promiscuity. I want them to see that I am proud to be a good gay man. For you, this is simple," he says, fingering his signature rainbow suspenders. "In Thailand it is a revolutionary thought." Outside of the urban centers, the dazzle of dance education and choreographed 30-second television commercials gets less mileage. Those who travel throughout the rural northwest of Thailand say that the current campaign against AIDS is not calibrated for the realities of the countryside. "They don't want to see dancing condoms," says a jaded health worker. "They want to know when the government is going to build a dam, pave a road, or bring clean water to their village. They want to know when all the money in the cities and this tremendous gross national product is going to benefit them." FOREIGN PHARMACEUTICALS ~~~~~~~~~~~~~~~~~~~~~~~ There is a growing air of resentment among Thais who believe that a type of scientific whoring is going on, that the industrialized countries are just using Thailand as an AIDS research laboratory without considering the plight of the Thai people. The past few years have witnessed international health organizations, foreign governments, and large pharmaceutical companies pouring billions of dollars into researching, defining, and delineating AIDS in Thailand. Some patient-care activists are tiring of the plethora of studies that don't benefit the Thais who are just starting to die. "Nothing changes," says Chantawipa Apisook, director of Empower, a support organization for prostitutes. "Westerners come here, they do more studies, more testing to produce more figures and more statistics. But the people's living conditions don't change. People don't change their behavior because of statistics -- those are only used to pin the blame on one group or another." Chantawipa Apisook and others say industrialized countries should use their power to influence the Thai government to enact laws protecting people with AIDS. "The Thai-language newspapers only talk about building a place of confinement for people with AIDS," says Chantawipa Apisook. An experimental "education facility" for HIV-positive prostitutes has already begun operation in an isolated northeast town; prostitutes who test positive are taken to the center for a two-month training period, during which time they are not allowed to leave the facility. Classes in nutrition, exercise, and AIDS prevention are offered for the two-month period, after which the prostitutes are returned to their homes. Of special concern to Empower are the research experiments being conducted by drug companies and foreign researchers. In mid October, WHO announced that testing of a possible AIDS vaccine would begin soon in Thailand, Brazil, Rwanda, and Uganda. "It's important that the side effects and the possible results of any drug testing be explained to the people here," says Chumpon Apisook, the project coordinator at Empower. "In Thai culture, we don't question the doctor because we respect him." One of several drug companies that is involved in drug trials in Thailand says it discloses all risks to trial participants. "We are testing AZT in Thailand," says Katherine Pattishall, head of Burroughs Wellcome's anti-infective section in its department of infectious diseases. "We are looking at two [dosages] to study whether Thais' size and body weight will allow them to handle the drugs as well." Pattishall says the company does not "expect anything unusual in toxicity." Empower's Chantawipa Apisook questions the companies' motivations. "Do they really expect this country can afford to buy AZT for everyone who gets sick?" she asks. When asked the same question, Pattishall says Burroughs Wellcome doesn't expect to sell much AZT in Thailand. "That would be difficult," she says, "when the median per capita spending on health care is about $5." Chantawipa Apisook says the drug companies should give something back to the communities they are researching. "All research should respect the human rights of the individual, and all companies that do research from which they would benefit should pass on some of that benefit to the people who live here." She also says American investors in bars and clubs, of which there has been a growing number in the past few years -- should think twice. "Poor people have very little education and few skills that can be exploited easily," she says. "Consider what it is you're investing in." Khun Natee says gay men who come to Thailand's 45 gay bars should use their influence to encourage safe sex. "If the manager doesn't make the boys use a condom in the sex show, tell him he should, and if he won't leave," he says. "Tell the boys at the sauna about safe sex, make them use condoms. Share your knowledge with us. Teach the men you meet what you know about positive life-styles by sharing books, tapes, any information you have. Pass on the love." Khun Natee's dancers are calling him into rehearsal, his phone is ringing, and another guest has arrived at the door of his studio. "I wonder sometimes about limiting our work to education, but I know we must conserve our strength for the big battle that is coming," he says. His newly built studio has an unfinished room that will be a switchboard, where he hopes to open an AIDS information line. "It's a strange feeling right now in Thailand."