‘Mr. Condom’ Takes On an Old Foe

After a three-year retirement from walking the seediest neighborhoods here, Thai Sen. Mechai Viravaidya is back, greeting passersby with a firm handshake and a packet of brilliantly colored condoms. “Take it, don’t be shy,” he says. “It can save your life.”

Mechai was once the public face of HIV prevention in Thailand, the driving force behind a campaign that brought condom use among prostitutes to nearly 100% in the early 1990s and is widely credited with making this prosperous Asian kingdom a model of how to fight an incipient AIDS epidemic.

Now 63, Mechai has come out of retirement to face a new threat, a wave of indifference and ignorance that threatens to overwhelm Thailand’s earlier successes.

“The new generation hasn’t heard much about HIV,” said Mechai, who goes by the nickname Mr. Condom. “They think it is gone.... I thought I had done my job and I became an ordinary citizen, but nobody continued the momentum as strong as I had hoped.”

Thailand, where 600,000 people live with the infection and 400,000 have died of it, is in danger of a resurgence of the disease, according to a report issued by the United Nations Development Program in conjunction with the 15th International AIDS Conference convened here in July.

In the face of a global economic slowdown, government spending on HIV/AIDS programs dropped from $82 million in 1997 to $25 million last year.

Despite Mechai’s efforts, condom use is falling. Among prostitutes, the rate that was once 96% is now closer to 50% in some areas, according to the UNDP.

“Many men don’t want to use them,” said a young girl at the Sexy Bar in Bangkok who identified herself as Joy. “What can I do? I need money.”

In the 1980s, experts predicted that Thailand’s sex industry made for a disaster waiting to happen. The U.N. predicted that the number of AIDS deaths in this country of 63 million people would reach 4 million by 2002. New infections climbed to 143,000 in 1991.

An aggressive condom promotion program headed by Mechai -- who had led an earlier condom-promotion campaign that successfully lowered the country’s spiraling birthrate -- sharply reduced the spread of HIV among sex workers. The human immunodeficiency virus causes AIDS.

The Thai government also began producing anti-HIV drugs and accelerated efforts to reduce mother-to-child transmission. As a consequence, new infections dropped to 19,000 in 2003.

Thailand’s was “an achievement unrivaled by any other country,” Robert England, an official with the UNDP, said at a news conference announcing the agency’s report.

The lessons of the past, however, have not taken root with a new generation of Thais. The epidemic “has matured” and is spreading to more diverse population groups, making detection and prevention of new infections more difficult, the UNDP said.

“Thailand may very well be in for a nasty surprise,” said Hakan Bjorkman, a local representative of the UNDP.

Of particular concern is the growing rate of promiscuity and casual sex, especially among youth. Only 20% of sexually active young Thais are using condoms consistently. Half of all new infections are occurring among young men and their spouses and girlfriends, the report said.

Only 15% of gay men use condoms consistently. As many as 17% of men who have sex with men are HIV-positive, up from 4% in the mid-1990s.

But the most severe problem, many believe, is among intravenous drug abusers, where the HIV prevalence rate is 50%, up from 30% in 1994.

Paisan Suwannawong of the Thai Drug Users Network notes that there are no needle-exchange programs to limit the spread of HIV among users and only limited access to methadone treatment programs. And because of a recent crackdown on drug dealers, he added, many are reluctant to seek treatment or prevention programs.

“The crackdowns on alleged drug dealers ... could be priming an ideal climate for a more extensive spread of the virus,” the UNDP report said. “A pragmatic approach, like that adopted toward sex work in the 1990s, is much more likely to bring success.”

Other critics are more blunt. “Thailand’s drug policy is tarnishing its reputation for HIV prevention,” said Jonathan Cohen, a researcher for New York-based Human Rights Watch. “It’s a scandal that Thailand is hosting the International AIDS Conference while it persecutes people at high risk of HIV.”

The lack of programs for drug abusers in part reflects the stigma associated with both drug abuse and being HIV-positive.

One effort to overcome that stigma is being headed by Mechai, who has created a program of small-business loans to help the infected. To qualify for the loans -- which average about $300 and have a six- to 12-month repayment period -- each HIV-positive person must pair up with a healthy individual. Mechai thinks having a successful business might reduce the stigma associated with acquired immune deficiency syndrome.

The country is also expanding its production of HIV drugs. A spokesman for the Government Pharmaceutical Organization, which manufactures a combination pill containing copies of three widely used AIDS drugs, said the company was in the process of submitting clinical data to the U.S. Food and Drug Administration. Thailand is the first of the 27 countries that make copies of brand-name AIDS drugs to submit data to the FDA for approval.

The copies cost about $30 a month, compared with about $5,000 a year for the brand-name drugs. If the drug, called GPO-Vir, wins FDA approval, it could be purchased with U.S. funds available in the President’s Emergency Plan for AIDS Relief and shipped to other countries.

The spokesman said the company had the capacity to make drugs for 37,000 people, in addition to the 50,000 Thais who are expected to receive them free this year. Making larger quantities for sale abroad could reduce the cost of drugs destined for Thais.