Thailand: Getting to zero?

"Getting to Zero" is the United Nations' continuing theme for this year's World AIDS Day. It refers to zero new HIV infections, zero deaths from AIDS-related illness and zero discrimination.

I don't know exactly how achievable the declared targets and commitments are in Thailand. I certainly would like to hope they are, but although access to treatment and mother-to-child transmission prevention has seen much success in recent years and likely continues to improve, the country's approach is still, or has become, lagging in many important areas.

Much has been said of Thailand's success in combatting the first wave of the HIV epidemic. Education campaigns during the early 1990s effectively raised awareness of the disease and its risk factors, resulting in significant positive behavioural changes in the population. Condom use by sex workers became almost uniform. New infections dropped from almost 143,000 in 1991 to 29,000 in 2000.

This success, however, has seemingly led to complacence, if not by the government then in visible continued education efforts reaching the public. As the population has aged, today's youth have grown up without a media telling them of the dangers of unprotected sex. Indeed, with advances in anti-retroviral treatment, HIV today seems to have become just another disease to some. Combined with increasing trends in adolescent sexual activity, the youth sense of invulnerability and an unimproved sex education—Thailand's having the second-highest adolescent pregnancy rate was widely reported earlier this year—these factors could spell a resurgence of the epidemic in the subgroup, if not a recipe for disaster.

That resurgence has yet to occur. And I still hope that the combined magnitude of the HIV risk and unwanted pregnancy issues will have pressured society and the government to reconsider their stances on sex and education before then. An overhaul of current attitudes—the unmentionability of premarital sex in particular—is critical, though insistence on the part of various international and non-governmental organisations have so far resulted in little visible change.

Yet sexual transmission of HIV isn't the only remaining major issue. Though various campaigns and government efforts have been made, stigmatisation and discrimination is ever still present in Thai society. Limited public education has allowed misconceptions about the disease to continue, especially since what little many people know about AIDS came from the death scares of the 1990s. Although the issue seems most serious in rural areas, where in some places individuals remain shunned by entire communities and children barred from attending school, the extent of human rights violations is much farther. It is still the norm for workplaces to discriminate—illegally—against people living with HIV, whether they be manual labour or white-collar workers. And in a culture where status and labels guide social interaction, being HIV-positive often results in quick, condescending judgment. This is the case even in the medical setting, where many healthcare providers abandon professionalism and treat such patients with seeming contempt, all the worse if they also happen to fall into a stereotypical at-risk or low-socioeconomic group.

Clearly, lack of education isn't the only factor perpetuating such stigma and discrimination; social values and cultural norms also contribute. Apart from being a rights issue in itself, such discrimination also forms a barrier to accessing preventive measures and treatment. If left unchecked, this could develop into a vicious cycle in which some isolated groups become increasingly cut off.

Successive governments have reaffirmed their commitment to HIV/AIDS prevention, and cooperation with NGOs and other civil and private parties remains strong. However, society as a whole must also be willing to change certain attitudes. Whereas the 1990s' campaigns dared to defy taboos and brought sex to public attention, similar actions are needed now. The same campaigns from the past will do little to stop the increasing youth risk or achieve non-discrimination, unless the underlying social and cultural issues are confronted and dealt with.

And therein lies the real challenge.