Thailand Builds Successful Program

Last July, in Goa, India, the state government justified the eviction of commercial sex workers from a red light area as a move to curb the spread of AIDS.

Sahara House, a drug rehabilitation center in New Delhi, is overcrowded due to discriminatory practices in clinics and hospitals which refuse to admit drug patients.

In Cambodia, brothels were ordered closed in a bid to stop the spread of AIDS but it had the opposite effect. New brothels sprang in places less accessible to healthcare systems and AIDS volunteer workers, putting people at greater risk.

In December 1995, Malaysia's Minister for Islamic Affairs announced that beginning in January 1997, all Muslim couples intending to marry would have to undergo HIV testing to protect future generations.

These measures are among the responses which have proved ineffective in curbing the spread of the pandemic in the region.

In 1996, one million of the 2.7 million estimated new HIV infections in the world were in southeast Asia, particularly rapid spread of HIV in Thailand, India, Cambodia, and Myanmar.

Cohen said that in many countries in the region, "There is an absence of good governance, of the principles that you hoped would be present in governments, which is a true partnership between government and civil society and between the government and the private sector."

In upper northern Thailand, which accounted for 40 percent of total reported HIV/AIDS cases in that country, a policy of decentralization of funds, consultation with NGOs and HIV victims, and less red tape were adopted in the mid-1990s.

In 1994, Thai authorities set up a committee with 32 members from government and NGOs. The committee strengthened the monitoring systems, coordinated programs with all sectors involved with HIV/AIDS, promoted AIDS education, reduced discrimination against victims, and developed a support network for people living with HIV/AIDS.

A year later, $1.7 million was directly allocated to the program and was used solely by the committee, which then allocated the money to communities in the region.

"That was the first time in the history of the Thai budgetary system that a budget was provided for a program not belonging to any ministry of the government," said Dr. Wiwat Rojanapithayakorn of the Thai Ministry of Public Health.

He said previous funds from the government were "inadequate, restricted to government agencies, and delivered in a context of maximum bureaucratic procedures and minimal flexibility." There was also little consultation with local communities, NGOs, and AIDS victims.

As shown in the upper northern Thai case, Cohen said, an effective response requires that government "begin to share authority and power with other civil society organizations, because governments would otherwise be overwhelmed by the problems and would not be able to cope with the consequences when large numbers of people become sick and are dying from AIDS."

It is unfortunate, he added, that Thai authorities did not act earlier. The HIV problem has worsened and there are now an estimated 850,000 HIV infections. "The Thai experience tells us that the best time for an effective prevention is when HIV rates are still low. If you wait until problems get worse, it could be too late."