Condom is mainstay of fight

The condom has been the mainstay of the fight against HIV/AIDS and widespread distribution of free condoms by local family planning clinics has succeeded in a massive reduction in the spread of the virus.

Thailand in particular, has set an example to the rest of the developing world for the effectiveness of its HIV prevention work, which started in 1984 when the first case of AIDS was reported.

A"100 % condom campaign" targeting behaviour change in men has achieved exceptional results with rates of sexually transmitted infections falling by more than 90% between 1989 and 1997.

Eight years ago, with rates of HIV/AIDS running at about 3% among conscripts, the Planned Parenthood Association of Thailand persuaded the Royal Thai Air Force to take on an HIV prevention programme. They argued that the strength of the country was at stake and encouraged instructors to give out free condoms and use games and straight talking to help airmen understand the dangers of AIDS. Conscripts now pass on what they've learnt to at least three other people.

While the air force's programme ensures many of the male population are reached, at risk groups such as fishermen, intravenous drug users and sex workers have also been targeted.

Protecting themselves

On a boat moored in the harbour at Pattani in southern Thailand, a PPAT worker tells the fishermen about the dangers of AIDS and describes some of the prevention methods available. One of the men strikes up on guitar and sings a song he's composed about AIDS. Then follows a demonstration of how to put on a condom, using a wooden model.

Lek, 28, from Ubonrajatani, north east of Bangkok, has been a fisherman for eight years and lives on board. "We go out for 15 to 20 days and come home to port for a couple of days. When I come back, I go out drinking, partying and flirting with girls," he said. "It's good for the crew to know how to protect themselves - it's useful."

Lek, right, 28, a fisherman, from Ubonrajatani, north east of Bangkok, on board the boat in Pattani, believes PPAT's sessions are useful for the crew.

The Planned Parenthood Association of Thailand has been working with the fishermen for some years but also targets commercial sex workers in the town. Throughout the country there is now virtually 100% condom use among sex establishments. Weekly check ups, free condoms and health promotion campaigns have clearly paid off.

Linda*, 25, from northern Thailand, works to pay for her two sisters' education as well as supporting her parents. She earns about 400 dollars a month and sees roughly three clients a day. She says she won't have sex without using a condom.

But while the condom campaign has been successful in the brothels and massage parlours, sex workers tend not to use condoms with regular clients, partners and friends.

The Government is also concerned that the programme has not reached what they call indirect sex workers, those who work in restaurants where sex is offered clandestinely and may be denied by the owner.

Learning lessons

In other countries in the region, the prevalence of HIV is rising alarmingly. Cambodia had the highest prevalence rate in Asia with 4.04 per cent of the sexually active population estimated to be HIV positive, according to a UNAIDS report at the end of 1999. The epidemic is mostly among the heterosexual population whereas in Vietnam, China and Malaysia, the HIV transmission is mainly among intravenous drug users, although heterosexual transmission is also rising.

In Myanmar, HIV infection among sex workers rose from 4 per cent in 1992 to over 20 per cent in 1996, while close to two thirds of injecting drug users are infected. In India there are now 3.5m people living with HIV, the largest number in the world after South Africa.

Learning lessons from Thailand's success is now becoming essential for other countries around the world. Recently a twenty-strong delegation from six family planning associations in Africa, South and South East Asia took part in an HIV advocacy workshop organised by the Planned Parenthood Association of Thailand and funded by the Japanese Government Trust Fund.

Key lessons learned included adopting clear objectives, being prepared with up-to-date information and adopting a pro-active approach to key leaders and the media. Using existing networks as well as a multi-sectoral approach, ensuring sustainability by involving the community, and last but not least perseverance!

As Steven Kraus, programme and external relations advisor with UNAIDS in Thailand put it, "HIV/AIDS rates in South East Asia are what they were in Africa ten years ago. The big question is - will Asia get on top of the epidemic or not?"

* Name changed to protect identity