An End to ‘Business as Usual’ : Thai Companies Join the Fight Against a Snowballing Epidemic Spurred by Rampant Prostitution

As an up-and-coming young Thai professional during the mid-1980s, K. Surapong regularly ended long workdays with a few drinks with his buddies and sex with prostitutes--sometimes protected, often not.

Surapong, now with full-blown AIDS, has spent the last few years as one of the country’s leading “guinea pigs,” testing an array of drugs that temporarily arrest the symptoms of the virus.

“I promised my doctor I would help him to the last day of my life,” said Surapong, the first Thai to test a variety of antiviral drugs, including AZT. At 38, he is physically a shell of his former self, and does not expect to see his 40th birthday.

The tragedy for Thailand is that Surapong’s former lifestyle is still fairly common among Thai men, most of whom have their first sexual encounter with a prostitute working in the nation’s thousands of brothels, coffee shops, massage parlors and other fronts for the sex trade.

Sex for cash here is not just recreation, but an integral part of the business culture. Thailand’s prospering economy has created a boom in expensive executive clubs for business entertainment. Sex is prominent among the offerings.

Realizing the threat AIDS poses to one of the world’s fastest-growing economies, Thailand’s business community has begun to implement AIDS prevention programs in the workplace and is contributing to government AIDS programs.

“It’s a very, very scary situation,” said Chanin Donavanik, executive director of the Dusit Thani Hotel Group, Thailand’s largest chain. Two years ago, the company launched an AIDS awareness campaign among its 6,000 employees, requiring attendance at three-day seminars and AIDS briefings as part of new employee orientation.

Although government statistics show only about 2,000 people actually sick with AIDS, estimates are that about 600,000 of some 57 million Thais are infected with the HIV virus. (Some officials believe more Thais are sick, but are not counted because they have left urban areas to die quietly in remote villages.) By comparison, the United States has more than four times the population, but an estimated 1.1 million people who are HIV-positive.

According to several studies, from 2 million to 6 million Thais--3% to 10% of the population--are expected to be infected by the year 2000. About half a million Thais are expected to have died of AIDS by then.

All told, Thailand is looking at about a $9-billion cost to deal with the epidemic by the year 2000, including lost wages, declining productivity and the skyrocketing cost of health care.

The visible force of AIDS here so far may be just the first, small sign of a looming disaster not only for Thailand but also for much of Asia.

World health officials say the epidemic has peaked in Africa and that the destructive fury of the virus has shifted to Asia, threatening the region’s miraculous economic growth. By the turn of the century, experts predict, more than 1 million Asian adults will become infected each year, accounting for about 40% of the new cases expected annually worldwide.

“The familiar epidemic snowball is taking shape before our very eyes,” Dr. H. M. Merson, director of the World Health Organization’s global program on AIDS, told an assembly of Asia health professionals in New Dehli last fall. And it “may ultimately be more massive in scope and overwhelming in impact than anywhere else in the world.”

After long denying its problem, Thailand is now perhaps the most forthcoming of all Asian nations about the extent of the disease among its population. Its new candor however, comes late, and many other Asian countries appear set to repeat the mistake.

Experts say Thailand’s public and private initiative to combat AIDS is worth emulating.

“In AIDS prevention, a businessman is more useful than a hospital,” said Chookiat Prateetong, human resources manager for Robinsons department stores, a large Thai chain. “A business can prevent, say, 100 deaths, which a hospital cannot do.”

Thai Farmers Banks donated $200,000 to a program to hire HIV-positive AIDS educators, who teach the bank’s staff and 200 of its top corporate clients about AIDS prevention. The money also provides economic opportunities for women in poor villages in north Thailand as an alternative to prostitution.

For the last several years, Avon’s Thailand unit has devoted its yearly “Day of Commitment” to educating various groups about AIDS, and it is now assessing how it can distribute AIDS prevention information through its network of 40,000 Avon saleswomen.

“It is an issue for women because we have to protect ourselves, even from our husbands or lovers--we cannot rely on them,” a human resources manager at Avon said.

In myriad other ways, Thai companies have joined the campaign. Krating Daeng, bottler of a wildly popular “energy” beverage--which some Thais believe increases men’s sexual endurance--now distributes AIDS information.

Some gas stations distribute condoms with the purchase of a full tank of gasoline, and one bank’s automatic teller machines flash the number for an AIDS hot line. Radio and TV spots, produced by Saatchi & Saatchi Advertising (Thailand), run free on state and private networks for at least one minute every hour.

All this complements a highly lauded Thai government program that includes funding for AIDS education in the budgets of all major government ministries and requires each province to develop similar plans.

The government is spending $48 million a year on AIDS education--including instruction for primary school students, while the private sector contributes mostly in-kind services of equal value.

“Thailand is leading the pack in Asia in AIDS prevention and control,” said Steve Krause, a World Health Organization technical officer in Bangkok.

Still, “nobody is doing enough, that’s the bottom line,” said John P. Baker, an American who works with the nonprofit Population and Community Development Assn., founded by Mechai Viravaidya, a noted family planning expert who is credited with spearheading the government’s anti-AIDS programs. (The former government minister is so closely identified with family planning and AIDS prevention here that condoms are often called “Mechais.”)

Many companies’ AIDS education programs are cursory, Baker said. Too often companies will bring in a “guy in a white jacket that tells them about AIDS and then they will think, ‘We are immunized and let’s get back to what we do,’ ” he said.

“Very few companies have really thought out how they are going to deal with the AIDS situation,” said John Ungpakorn, who runs an organization that provides counseling to HIV-positive people, including many who have lost their jobs.

Mandatory testing of employees and dismissals of those found infected are widespread, both in the private sector and in public service, Ungpakorn said. One textile worker learned she was HIV-positive only when she was fired. The hospital where she gave birth tested her without her permission and also disclosed the results without informing her.

Such practices violate government policy and serve to deprive infected people of wages just when they need financial assistance most, AIDS activists say.

Surapong is lucky. He is from a relatively affluent family, has had a good education and can still work--as a marketing consultant and as a military defense system designer--though his salary pays mostly for medication.

Ironically, it is the military--not generally considered the most enlightened institution in Thailand--that has the country’s most progressive workplace policies to date.

New conscripts for two-year national duty are accepted into the armed services even if they test positive for the virus. But only career officers can expect any long-term treatment at military expense.

Even foreign firms here are just beginning to focus on the potential fallout from the epidemic, including the management problems inherent when large numbers of workers become infected.

A recent survey taken by the American Chamber of Commerce indicated that the issue was beginning to appear on the screens of American managers. Some are working to adapt for their Thai operations a U.S.-developed training manual on how to cope with AIDS in the workplace.

“You either pay now or you pay more later,” said James P. Reinnoldt, Northwest Airlines’ regional managing director, one of the most active U.S. executives on the AIDS issue.

AIDS in Thailand

The number of Thais diagnosed with AIDS or AIDS-related complex is growing rapidly each year. 1988: 25 1989: 123 1990: 281 1991: 763 1992: 908 *

Unlike in the United States, heterosexual men account for the vast majority of reported AIDS cases. Heterosexual men: 62.9% Heterosexual women: 10.3% Injecting drug users: 12.8% Homosexual/Bisexual men: 3.4% Children infected at birth: 7.6% Blood recipients: 3.4% Other: 2.3% Some people counted in 2 categories; e.g. drug-using homosexual men.

*

Thailand’s Population and Community Development Assn. has calculated that the AIDS epidemic will cost the Thai economy millions in dollars a year in addition to the direct cost of providing medical care. The estimates are based on the lowest and highest estimates of the number of people who will become infected.

Best-case scenario (Dollars in millions) 1992: $154 1993: $230 1994: $349 1995: $493 1996: $678 Worst-case scenario 1992: $154 1993: $235 1994: $370 1995: $542 1996: $768 Source: Thailand Ministry of Health Population and Community Development Assn.