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Thailand: One Person Made a Difference

Living with HIV (2005)*: 580,000 (1.4% pop.)
Receiving Drugs (2005): 72,000-91,000 (60% of those who need them)
Est. AIDS Deaths (2005): 21,000

'Condom King' Mechai Viravaidya distributing condoms
chinese condom distribution

Part One: Chapter Six The Power of Leadership

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The relatively few success stories about HIV/AIDS seem to have one thing in common: a dynamic individual who rose to the challenge. For Thailand, that person was Mechai Viravaidya, known as "The Condom King." In Thailand's battle against AIDS, where Mechai appeared, success followed.

Thailand's first cases of AIDS surfaced in the mid-1980s among sex workers. Mechai quickly understood the challenge Thailand confronted; he had been working in family planning since the 1970s and had become famous for his frank approach to sex education. "You can't be embarrassed about a piece of rubber," he says. Many Thai dishes contain cabbage, so Mechai opened a restaurant called "Cabbages and Condoms" with the goal to make the condom as common as the cabbage. The word "Mechai" eventually became slang for condom in Thailand.

But when Mechai tried to mobilize the government to combat AIDS he met resistance. Many believed HIV was a disease of foreigners and it wouldn't become a national problem. However, in 1989, 44 percent of sex workers in the northern town of Chiang Mai were found to be infected with HIV. The virus spread from sex workers to their clients, and from there into the general population.

Mechai took matters into his own hands and went to the military. He found an ally in General Chavalit Yongchaiyudh who controlled 126 military-run radio stations and two of the country's five television networks. Chavalit agreed to make military stations available for an anti-AIDS campaign. He also agreed to help Mechai spearhead a three-year blitz to halt the spread of the disease.

Political commitment

In 1991, Mechai's old friend Anand Panyarachun was appointed prime minister following a coup. Over the years, during golf games and social gatherings, the two friends had discussed Mechai's worries about AIDS. Anand asked Mechai to join his cabinet as the minister of tourism. Although many fellow cabinet members and Thai businessman worried that acknowledging a problem with AIDS would hurt tourism, Mechai argued that dealing frankly with the epidemic would be good for the industry. He conducted a survey of tourists and found that 77 percent would be more comfortable traveling to Thailand if they knew that the government was working on tackling the AIDS epidemic.

Mechai also encouraged Anand to move the AIDS office to the prime minister's office and insisted Anand himself chair the country's national AIDS committee. From 1992 to 1996, the national AIDS program received dramatic increases in funding, with the government providing more than $80 million annually by 1996.

Together Mechai and Anand began what became known as the"100 Percent Condom Campaign." Brothels around Bangkok posted signs reading "No condom, no sex, no refund." Mechai's "Miss Condom" travelled the country holding condom-blowing competitions, and his "Condom Brigade" passed out condoms at every possible location. Police officers were involved in a "Cops and Rubbers" campaign, and sex education infiltrated every level of Thai society in a fun and informative way.

Combating Stigma

The condom campaign was extremely successful in lowering the rates of new infections through the urban sex industry. But in rural areas, stigma was still a huge problem. The government developed a second "National Plan for Prevention and Alleviation of the AIDS Problem," which covered the period from 1997 to 2001. It maintained the previous effective programs, while adopting a more holistic approach, including mobilizing and involving people living with HIV/AIDS. Mechai traveled the country appearing at schools and village halls with HIV-positive people. He would stand on stage and deliberately drink from the same spot on a glass as his HIV-positive colleagues, dispelling myths about transmission through casual contact.

Mechai also encouraged parents and teachers to allow children to receive AIDS education. He would tell them:"In your life there will come a fork in the road and both forks lead to flowers. One event for flowers is graduation. The other is the funeral of your child. You decide which road you want to take. If you want to take the first road then you'd better listen to me about HIV/AIDS, educate your staff, educate your kids and let it be done in school."

The overlooked population

While Mechai was focusing on his area of expertise, another burgeoning part of the epidemic was virtually ignored -- the spread of HIV among injecting drug users. HIV prevalence in this group ranges as high as 51 percent in Bangkok and the central region.

Drug use is generally socially unacceptable, but in Thailand drug users are not only ostracized. In 2003, nearly 3,000 people were reportedly killed by police when Prime Minister Thaksin Shinawtra launched a war on drugs. A report by Human Rights Watch claims that thousands more were arrested and that the highest levels of government endorsed extreme violence. The report states:"In the process, Thailand's fight against HIV/AIDS, for which it has received international praise, has been severely undermined by a climate of fear that has driven injection drug users, in particular, underground."

Flagging Efforts

Over recent years, Thailand's AIDS treatment and prevention budgets have shrunk. In 2000, the total amount dedicated to HIV/AIDS programs from all sources was just $65 million. According to the Health Ministry, in 2002 the HIV infection rate among teenagers rose from 11 percent to 17 percent.

"Some people wondered whether the success that occurred in some countries, including Thailand, would last," Mechai tells FRONTLINE. "And I would say that's a very relevant question because champions can always get knocked out." He has criticized the new Thai government for becoming complacent, and he is stepping back into the fight.

In 2005, Thailand launched the Citizen AIDS Assembly, under Mechai's direction. It holds meetings in every village to report on the local issues surrounding HIV/AIDS. The villages then report to the districts, which report to the provinces, and so on up to the national level. The idea is to keep an open dialogue between the government and the people and to make the county's leaders aware of exactly what work needs to be done.

Mechai also developed the "Positive Partnerships" program. This model of micro-economics grants a small loan to an HIV-positive person with an HIV-negative business partner. Mechai's philosophy is that charity alone is not the answer. He believes developing countries need to use their own resources to fight the epidemic, because assistance from the outside world will eventually run out. "Mother's milk will not last forever," he says.

Thailand's successes and failures highlight key requirements in the battle against HIV/AIDS: open-minded, frank education; political will; financial commitment; and strong leadership. As former Prime Minister Anand Panyarachun responded when asked why Thailand has been relatively successful in its fight against AIDS:"We had a Mechai."

* Note: Figures reflect most recent statistics from UNAIDS and the World Health Organization.

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posted may 30, 2006; updated june 19, 2006

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