HIV and AIDS and Sexually ??;?·??.-ed Infections in Thailand*

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Geographic area: Thailand Health condition: Between 1989 and 1990, the proportion of direct sex workers in Thailand infected with HIV tripled,

from 3.50/o to 9.3¾ and a year later reached 21.6%. Over the same period, the proportion of male conscripts already

infected with HIV when tested on entry to the army at age 21 rose sixfold, from O.S”lo in 1989 to 30/o in 1991.

Global importance of the health condition today: HIV/AIDS is one of the greatest threats to human health worldwide,

with an estimated 38.6 million people infected with the virus in 2005. The vast majority of people with HIV are in sub-Saharan Africa, where ltfe expectancy today is just 47 years; without AIDS, it is estimated that life expectancy

would be 15 years longer. The number of children who have lost a parent to AIDS is now estimated at 20 million.

Intervention or program: In 1991, the National AIDS Committee led by Thailand’s prime minister implemented the

ulOO”lo condom program,” in which all sex workers in sex establishments were required to use condoms with clients.

Health officials provided boxes of condoms free of charge, and local police held meetings with sex establishment

owners and sex workers, despite the illegality of prostitution. Men seeking treatment for sexually transmitted infec­

tions (STis) were asked to name the sex establishment they had used, and health officials would then visit the establishment to provide more information.

Cost and cost-effectiveness: Total government expenditure on the national AIDS program remained steady at

approximately $375 million from 1998 to 2001, with the majority spent on treatment and care {65%); this invest­

ment represents 1.9% of the nation’s overall health budget.

Impact: Condom use in sex work nationwide increased from 14% in early 1989 to more than 90% by June 1992. An

estimated 200,000 new infections were averted between 1993 and 2000. The number of new STI cases fell from

200,000 in 1989 to 15,000 in 2001; the rate of new HIV infections fell fivefold between 1991 and 1995.

Acquired immunodeficiency syndrome (AIDS), caused sub-Saharan Africa, the epidemic is becoming increas­ by the human immunodeficiency virus (HIV), is among ingly serious in Asian countries. Of an estimated the greatest threats to health worldwide. In 2005, an 8.3 million infected persons in Asia, more than two estimated 38.6 million people were living with HIV. thirds are in India. 1 Approximately 572,500 people During 2005 alone, about 4.1 million people became in Thailand are infected with the virus, with national infected and another 2.8 million lost their lives. 1 prevalence rates the second highest of aH countries in

Although the vast majority of people with HIV are in the Asia and Pacific region.2

Preventing HIV/AIDS and Sexually Transmitted Infections in Thailand

The negative social and economic impacts of HIV/ AIDS are profound. In Africa, the average life expectancy at birth is 47 years; without AIDS it would be 62 years. Household incomes in societies that lack social support mechanisms are declining dramatically, and the number of children orphaned by AIDS is now estimated at 20 million, with 75,000 of those

3orphans living in Thailand.1· Well-documented stories of large-scale success in HIV

prevention are f