By: Our Correspondent


mechaiA nervous teenage boy
sheepishly walks up to a convenience store counter and whispers
softly to the clerk: “Condoms, please.”

the woman says loudly, prompting everyone in the store to turn and
look at the youngster, who suddenly quivers with embarrassment. Then,
in a normal voice, she says, “Sir how many packs do you want?”

This television advertisement, part of a campaign called “Proud
to Carry Condoms,” is designed to make Thai teenagers
understand that it’s normal to practice safe sex. The message
sounds harmless enough, but it deeply angered conservative groups
here who said it encouraged teenagers to have sex.

On October 12,
the ad will stop airing — not because of the moral outrage,
organizers say, but simply because the grant from the Global Fund to
Fight AIDS, Tuberculosis and Malaria that was funding it is set to
expire. In fact, despite opposition from some self-styled moralists
and the lack of funds to keep this particular ad running, AIDS
activists say that Thailand has actually stepped up its efforts on
AIDS prevention in the past year after a big drop off.

Last year
the situation appeared much more dire.
At the time, Patrick Brenny, head of the UNAIDS office
in Thailand, said: “Public information, which was once
ubiquitous, has dropped off the radar screen. There is a strong
recognition that prevention programming needs to be ramped up.”


This year, Brenny says,
the Thai government has done that in a number of ways. First, it came
up with a new strategic plan that “talks about at-risk
populations in a way that’s more overt.” Second, the
National AIDS Committee created a subcommittee on prevention efforts
headed by none other than Mechai Viravaidya, widely known as “Mr.
Condom.” Third, it has taken the nearly $15 million saved from
issuing compulsory licensing on patented AIDS drugs this year and
re-invested it into prevention activities.


“My sense is that
we will actually see more and more ads this coming year,”
Brenny said. “Before, in the early 1990s, you couldn’t go
half an hour listening to the radio without hearing an ad about
condoms and HIV. I don’t know if it will reach that level
again, but people certainly know they cannot just check a box and say
we are done with AIDS prevention.”


Indeed, back in the
1990s Thailand became a case study for AIDS prevention. When Prime
Minister Anand Panyarachun took power after a 1991 coup, Thailand was
reeling from the incurable disease. About 143,000 new infections were
recorded in 1991 alone, and experts predicted that up to 10% of Thais
would die from AIDS over the following two decades.


The budget on AIDS
prevention activities quickly jumped from $2.6 million in 1991 to $46
million in 1993 to $462 million in 1994. Much of the money was spent
on a sweeping countrywide education and media campaign whose public
face quickly became Mechai and his condoms.


The results were
excellent. New infections fell by more than 80%, and experts
estimated that the massive campaign prevented about two million AIDS


But when Thaksin
Shinawatra became prime minister in 2001, the government’s
priorities shifted. Prevention budgets were slashed by about
two-thirds in favor of offering universal access to anti-retroviral
drugs for AIDS patients.


“The government
has spent about $100 million per year on fighting AIDS for roughly
the past six or seven years, but how they cut the pie has changed,”
Brenny said. “The new success is that 130,000 people are now
accessing treatment. That is a great success, but the pie didn’t


Indeed, the Public
Health Ministry rocked the pharmaceutical industry earlier this year
when it issued compulsory licenses on a number of first and
second-line anti-retrovirals. The government defended the program so
it could expand treatment for more HIV patients.


Crucial to Thailand’s
successful AIDS treatment program, ironically, was its prevention
efforts in the 1990s. A World Bank report in August 2006 found that
Thailand saved about $43 in treatment for every $1 spent on


“Officials have
realized that if they don’t turn off the tap [of new AIDS
patients], they will not make any headway against AIDS,” Brenny
said. “To ensure the sustainability of the treatment program,
they must work harder on prevention. Otherwise, they are not turning
off the tap.”


Although Thailand is
not at risk of another AIDS explosion, Brenny said “there is
very fertile ground for a second wave of infections if something is
not done.”


Particularly alarming
are increased prevalence rates among specific groups, including
teenagers, the spouses of men who visit sex workers, intravenous drug
users, men who have sex with men and migrants. The UN said earlier
this year that housewives comprise 40% of Thailand’s 18,000 new
annual cases, followed by gay men with 28% and sex workers with 10%.


A Thai government
survey earlier this year found that infection rates among sex workers
last year had risen to 35 per 1,000 from 23 per 1,000 a year before.
Another study found that about 70% of Thai 18-19 year olds don’t
use condoms. Mechai—Mr. Condom himself—has lamented that
condom use has fallen to about 20% from 90% at the turn of the


“Over the past
five years, the government has been asleep at the wheel,”
Mechai said. “During the Thaksin era prevention efforts


The current government,
he said, “has done a good job on prevention and they have
expanded treatment.”


Mechai said the
government plans to continue prevention efforts with an advertising
blitz and talks in schools. The groups who oppose condom ads for
teenagers are “crazy,” he said, adding that most of the
country supported safe-sex campaigns.


“We need people
to know that it’s fine to have condoms,” he said. “AIDS
is still the number one killer in Thailand. These prevention efforts
must continue.”


Though it may seem
obvious, experts see a direct correlation between prevention
campaigns and new infections, as could be seen in the steep drop
during the 1990s and the increases among certain key groups during
the past few years. Less spending on prevention in recent years has
boosted HIV prevalence among some groups.


“Over the last
two or three years there has been increasing concern among NGOs and
nurses and doctors who work with people with HIV about the little
that has been done in terms of working with teenagers,” said
Paul Cawthorne, the head of mission for Medicins Sans Frontieres in
Bangkok. “They see the results of that in the rising number of
sexually transmitted diseases and groups practicing unsafe sex. STDs
are usually a good indicator of HIV trends.”


“I’m not
saying just throw money at the problem and it will go away,” he
added. “But there is fairly strong evidence that if you have
reasonably well-defined prevention programs and senior politicians on
board, then the number of new infections can drop.”