Gay Men in Thailand Face Steep HIV Rise

Health officials are struggling to stem alarming rates of HIV among men who have sex with men in Thailand.

"This is a real public health emergency," said Timothy Holtz, director of an HIV and sexually transmitted disease (STD) research program at the Silom Community Clinic, located near Bangkok's gay and bisexual entertainment district.

According to a new report released on 28 June by Thailand's Ministry of Public Health and the US Center for Disease Control and Prevention (CDC), HIV prevalence among gay men has risen sharply, from 17 percent in 2003 to 29 percent in 2011.

The study surveyed almost 4,800 clients who entered the clinic for testing from 2005 to 2011. It is estimated that Bangkok has a gay male population of 300,000 to 400,000. The Thai government has begun to redirect funds to control the epidemic within the often neglected group. In 2009, less than 1 percent of HIV prevention resources went to programs to protect men having sex with men. The next year, funding increased to more than 5 percent and then up to 8 percent in 2011, according to a UNAIDS report.

External donors still finance 90 percent of HIV prevention services for at-risk groups, which are carried out by NGOs and community-based groups, government officials said.

This year, Thailand's National AIDS Management Center has made male sex interventions the top priority, after finding that such contacts accounted for 41 percent of all new HIV infections in 2012.

Furthermore, the government is debating whether to distribute antiretroviral drugs (ARV), typically used to prolong the lives of people with HIV, for pre-exposure prophylaxis in at-risk groups, Holtz said. This method could prove valuable, especially for men aged 15 to 21, who have a 12 percent rate of new HIV infections per year, according to the Silom clinic study.

"You would be hard-pressed to find any population [in the world] that has an HIV incidence rate of over 10 percent," Holtz said.

Infected youth

The emergence of casual sex websites and competitive gay nightlife venues, both of which attract young men, have helped fan the epidemic, said Nikorn Chimkong, president of the HIV Foundation Thailand. Moreover, some local bars encourage risky behavior, with dark rooms and bathrooms tailored for sexual activity, he said.

"The gay business has changed so much," Chimkong said. "It's very easy to have sex inside these establishments."

And while outreach programs can pass out condoms and give safe sex advice to partygoers, advocates find it hard to reach their subjects online.

"It's very clear that there's a lot of sexual networking happening," said Alex Duke, program manager at Population Services International Thailand (PSI), an international NGO that provides HIV-related services. "The challenge is how to use that same medium to get out behavior-changing messages."

PSI and its partners are exploring ways to use social media and websites to complement peer-based outreach, he said.

Interviews and focus-group discussions with young men revealed potential risk factors for HIV, including group sex, inconsistent condom use, being introduced to multiple sex partners by older males, and experimental drug use that can result in "poor judgment" during sex, Holtz said.

At the same time, less than 43 percent of all gay men surveyed in the clinical study had a previous history of HIV testing.

HIV testing

One possible reason for the lack of HIV testing and awareness is the reluctance to teach sex education in public schools, advocates say.

"The government doesn't support it because they think young people will have more sex if they learn about it," Chimkong said.

Experts fear the HIV rate could be higher than projected due to the low numbers of people getting tested. To address this, PSI efforts have focused on a "test-and-treat" approach, with emphasis on HIV testing and ARV therapy (ART).

Siroat Jittjang, assistant program manager at PSI Thailand, explained that those who test positive for HIV should quickly receive ART to reduce their viral loads, which "greatly reduces the chance for them to transmit HIV to others."

Once people discover that they are infected, many suffer chronic depression and are afraid to seek treatment out of fear of social isolation or losing their jobs, advocates say.

"The first day I found out, I wanted to kill myself," said Tong Raksakul, a gay man with HIV. "I was in shock because I didn't have much sex."

Later, Raksakul began to use his personal experience to help others. He now works as the program manager for the Poz Home Center Foundation, which provides support and safe sex education to MSM living with HIV.

"We want them to have good lives and not spread HIV to others," he said.

(IRIN is a service of the UN Office for the Coordination of Humanitarian Affairs)