BANGKOK – Bare-chested male models strutted through the glitzy ballroom in Bangkok to the beat of house music while dozens of young gay men waited anxiously, working up the nerve to have a blood test.
The mostly female health team taking samples seemed incongruous next to the shirtless models circling the party, but the health workers’ presence at the TestBKK event, Thailand’s first mass HIV testing for gays, was sending a powerful message.
Over the past decade, HIV has spread rapidly among gay men, transgender people and male sex workers in Bangkok to reach epidemic levels, fueled partly by greater use of illicit party drugs that make people less cautious about sex, experts said.
Once touted as an HIV success story, Thailand is now faced with infection rates in its gay population comparable to those in Africa’s AIDS hot spots.
Waking up to the scale of the problem, Thai authorities have embarked on a campaign to raise awareness about HIV and encourage testing among those most at risk: men who have sex with men and transgender people.
Frits van Griensven, an HIV researcher and adviser to the Thai Red Cross, said the initiative to focus on this key group was a positive step and long-awaited acknowledgement that Thailand – which successfully tackled HIV/AIDS in the 1990s – had failed to keep up with the spread of the virus into certain communities.
“For the government to take a stand in this epidemic and stand up for the rights of a minority population, I thought this was a big move,” van Griensven told the Thomson Reuters Foundation in an interview at his home in Bangkok.
He said it was only in the past year that Thai authorities had started to take this seriously and focus on HIV (human immunodeficiency virus) prevention in Thailand’s gay community.
Perhaps the biggest step in the campaign was in March last year with the release of guidelines on how to prevent the spread of HIV in men who have sex with men and transgender people. The guidelines came nearly 30 years after the first AIDS case was diagnosed in a gay Thai man.
“It’s a little late, but it’s better than never,” said van Griensven, welcoming moves to take testing to gay communities.
RISE OF HIV
This month Thailand’s Ministry of Public Health began offering free drugs to all HIV patients to expand treatment and put them under the state’s monitoring system.
Data from 2013 estimates Thailand has 450,000 people living with HIV/AIDS, but only 353,000 have access to life-saving antiretroviral drugs.
Thailand’s large gay community, which officially numbers about 560,000, or 3 percent of men aged 15 to 49, is now seen to be at risk of HIV. Van Griensven believes this figure underestimates the real number of gay men in the country, and 7.5 percent, or about 1 million of the 66 million population, would be closer.
In 2003, while working with the U.S. Centers for Disease Control and Prevention’s (CDC) unit in Thailand, van Griensven collected data showing 17.3 percent of 1,121 Thai men in Bangkok bars, saunas and pick-up spots tested positive for HIV.
The situation has worsened since with studies showing about 30 percent of all men who have sex with men in Bangkok are HIV positive. In 2013, gays, transgender people and male sex workers accounted for 41 percent of all new HIV infections in Thailand.
Timothy Holtz, director of an HIV-focused program run jointly by the CDC and Thai Ministry of Public Health, said the HIV epidemic among gay men “really is an emergency situation”.
“The only place you really see high rates like that are in the hardest hit areas among the generalized HIV epidemics in sub-Saharan Africa,” Holtz said in an interview at the CDC-run Silom Community Clinic at Mahidol University’s Hospital for Tropical Diseases.
“It’s not quite as high as it is in some really high-risk populations in southern Africa, such as in young women of child-bearing age in South Africa, but it’s still very alarming.”
According to UNAIDS, nearly one in five South Africans aged 15-49 are HIV positive.
IGNORANCE IS BLISS
Thailand was once considered to be in the vanguard of the fight against HIV.
After the country’s first AIDS cases were diagnosed among Thai and foreign gay and bisexual men in the mid-1980s, the epidemic took off, spreading through the country’s massive sex industry, their clients and then the men’s wives and babies.
In the 1990s, 35.5 percent of female sex workers across Thailand had HIV.
Then Thailand launched a condom use campaign targeting prostitutes and their clients, as well as antiretroviral treatment to prevent HIV transmission from pregnant women to their babies, which cut the estimated number of people infected each year to 8,100 in 2013 from 143,000 in 1991.
But over the past decade the numbers have started to rise again among certain groups, with many gay men unwilling to be tested, believing ignorance is HIV-free bliss.
At Silom Community Clinic, the CDC’s voluntary counseling and testing center for men who have sex with men founded by van Griensven, 46 percent of men who walk in have never been tested.
“That’s really high. When you’ve got roughly half of an at-risk population who’s never been tested, that needs to change,” Holtz said, adding that gay men in Thailand should get tested at least once a year, if not more often.
Somsak Akksilp, deputy director general of the department of disease control at the Thai health ministry, said spreading awareness through traditional media does not work with younger generations and outreach has to be clearly directed at gay men.
“They never watch television. They never read newspapers. So how can they get messages from government or public services?” Somsak said. “We should have more mobile clinics or outreach units to serve them in the places convenient for them.”
Testing is critical because awareness has failed to slow the epidemic, according to Piyathida Smutraprapoot, AIDS chief for the Bangkok Metropolitan Authority.
“If people know their status, they can learn how to prevent the spread to others,” she told the Thomson Reuters Foundation at the TestBKK event that attracted about 100 people.
The Asia Pacific Coalition on Male Sexual Health (Apcom), the Bangkok-based advocacy group behind TestBKK, later told Thomson Reuters Foundation that eight out of 76 men tested at the event were found to be HIV positive.
Van, a 24-year-old NGO staffer who asked to be identified only by his nickname, had his third HIV test at the event. His first test followed a casual hook-up. Van is now in a steady relationship but remains unsure if he is safe from the virus.
“With my boyfriend, I trust him to an extent – 99 percent. Even if he strays, I told him: ‘Please protect yourself’.”
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