In 1991, Thailand had a rapidly growing HIV epidemic

Thailand and Cambodia

In 1991, Thailand had a rapidly growing HIV epidemic, fuelled by an illegal yet thriving sex industry. In the same year a change of government heralded a new, pragmatic response to the problem. At its core was the world’s first “100 per cent condom use” programme. Instead of trying to eliminate commercial sex, the government chose to distribute tens of millions of free condoms to brothels and massage parlours, and to clamp down on those that failed to insist on condom use. Men were discouraged from visiting sex workers, and the rights of women were promoted. At the same time, anti-AIDS messages were broadcast hourly on all radio and television stations, encouraging open debate about HIV and sexual issues. As in Uganda and Senegal, many diverse sectors of society became active partners in fighting HIV, including sex workers, community groups, schools, religious leaders, businesses and the military.⁴³

Following the start of this campaign, the number of Thai men paying for sex fell substantially, and reported condom use in brothels rose from 14% in 1989 to over 90% in 1994. The effect on the HIV epidemic was spectacular, with annual diagnoses plummeting from 143,000 in 1991 to around 19,000 in 2003, and Thailand has rightly been praised for this success. Nevertheless, Thailand’s record is not perfect. In recent years, funding for HIV prevention has fallen by two thirds and public concern has dwindled. The virus is widespread among injecting drug users and men who have sex with men, who have been largely neglected by prevention campaigns. Condom use has declined again among sex workers, who are increasingly working in non-brothel settings, where they are largely unaffected by the 100 per cent condom use programme.⁴⁴

Cambodia has also seen a drop in new infections after introducing a 100 per cent condom use programme. However, as in Thailand, HIV remains a major problem for Cambodia, and an increasing number of infections are among the partners of men who acquired the virus during commercial sex. Unless they revamp their prevention programmes, both countries face the risk of HIV becoming widespread among the general population.⁴⁵

India and China

India harbours two quite separate HIV epidemics. In the south, where heterosexual sex is the main transmission route, prevention projects have largely focussed on sex workers and their clients. This approach is credited with reducing HIV prevalence among all young women in southern states from 1.7% in 2000 to 1.1% in 2004.⁴⁶ By contrast, the main driver of HIV in the northeast is injecting drug use, and responses there have been lacking. As in many parts of Asia, men who have sex with men have also been neglected.

Neighbouring China has a much lower HIV prevalence than India, but some parts of the country are much worse affected than others. In central China, tens of thousands of people became infected during the 1990s when they sold their blood to commercial agencies. Authorities eventually reacted by enforcing tighter regulations, and the blood donation system causes far fewer new infections than before. In 2005, around 94.5% of blood came from volunteer donors, compared to just 22% in 1998. Today, most HIV transmission takes place during drug use or unprotected sex.⁴⁷

China has traditionally taken a zero tolerance approach to drugs; the police are used to arresting drug users and sending them to compulsory rehabilitation centres. Recently, however, that attitude has started to change, and schemes providing methadone treatment and clean needles have been set up in several provinces. Some regions have also altered their approach to sex workers by introducing a 100 per cent condom use programme, peer education and treatment for sexually transmitted infections.⁴⁸ On a national scale, the government has introduced routine HIV testing of people thought to be at high risk of infection, including drug users, sex workers, former blood donors and patients at sexual health clinics. This has led to many more people being diagnosed, though some experts have voiced concern that some people may be pressured not to refuse testing.⁴⁹ Overall, China’s response to HIV is improving, but coverage is still too patchy to have a substantial impact.