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 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.
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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'."
(Reporting by Alisa Tang, Editing by Belinda Goldsmith.)
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