Bangkok AIDS Conference
SEX excerpt from Conference Report by Shaun Mellors
For leaders to put question marks where there ought to be exclamation marks is irresponsible, if not immoral. People pay with their lives because we override science with ideologies.
ABC, for example, as a strategy is epidemiologically and programmatically sound as was discussed during the conference. By severely twisting the concept, some have reduced the strategy to A, B with little or no attention to condoms.
As many people have demonstrated during this conference, condoms are a vital component of an effective prevention strategy and play a decisive role in preventing the transmission of HIV. While abstinence and fidelity are important factors in prevention, marriage and monogamy are increasingly a risk factor for many women where vulnerability is intimately linked to power and negotiation. Messages about monogamy to youth moreover are easily transformed as serial monogamy.
The Bangkok conference may be remembered for highlighting issues of women and youth, but women are not a homogeneous group and the diversity of lives and realities were not effectively reflected in the program content. We did not hear the voices of women drug users, women prisoners, lesbians, trafficked women, and the girl child? Women living with HIV have had a higher profile in the corridors, satellites and some programmatic sessions, but their voice was silent at the plenaries and other critical sessions.
We have to put the "sex" back into the epidemic, beyond just a route of transmission. There was no celebration of positive sexuality, no celebration of the lesbian, gay, bisexual and transgendered identities, no celebration or discussion of diverse sexuality, or of sexual rights. Although the issue of male to male sex behavior made it onto the program, the sessions focused covered it from a behavioral or intervention perspective and did not address sexuality and identity.
in the Media Center of the AIDS Conference . July 2004
AIDS march pushes condoms in Thai sex capital
14 July 2004.
BANGKOK, July 14, 2004 (Reuters by Ed Cropley) - AIDS activists of all shapes, sizes, ages, religions and sexual persuasions took their campaign to the heart of Thailand's red light district on Wednesday to drive home their safe sex and condoms message.
A rare people's moment in a major AIDS meeting held miles away in a swish convention centre, the march of around 2,000 snaked past the go-go bars of Patpong, notorious for its "anything goes" sexual mores and novel antics involving ping pong balls and bananas.
"This is our big day, a chance to get ourselves heard by the people that matter -- the drug users and sex workers," said Aphivat Kwangkaew, a gaudily dressed HIV-positive volunteer for the Mercy Centre, an HIV and AIDS centre in downtown Bangkok.
With banners depicting smiling condoms and slogans such as "Sex workers of the world unite", as well as a float carrying two giant dancing sperm, the overall message was clear.
"It's really important to get people to use condoms," said Suchanwud Kingkaew, 25, handing out packs on behalf of the Rainbow Sky Organisation, a community group working with homosexuals, transexuals and bisexuals in Bangkok.
Several bar girls, in their obligatory mini-skirts and high heels, came out onto the pavement to watch the procession.
Thailand, host of the 15th International AIDS Conference this week, has been praised for its success in the global fight against AIDS, reducing the number of new HIV infections a year from a peak of around 143,000 in 1991 to 19,000 in 2003.
As well as a mass public awareness campaign in the 1990s, much of this success is due to a 100-percent condom use campaign among sex workers -- despite Bangkok's reputation as the flesh-pot of Southeast Asia.
However, many argue that the era of choice for women is still far away and that an alarming number women -- especially outside the commercial sex industry -- have little say in whether their partners wear a condom.
"How can women negotiate for safe sex while eight percent of them experienced their first sexual intercourse through coercion," said a Statement of Thai Women handed out at the march.
"Thai law still allows marital rape and Thai culture believes it is the duty of the wife to respond to the sexual desires of her husband," it said.
Thailand's AIDS battle falters
Anti-AIDS effort, hailed as model for Asia, loses steam (excerpt) see entire News story
From 1991 to 2003, Thailand registered a drop in annual new infections from an estimated 143,000 to about 19,000, an achievement credited to a combination of political leadership, increased funding, public awareness campaigns and a pragmatic effort to work with prostitutes to promote condom use.
The 15th International AIDS Conference, which opens Sunday in Thailand, has recognized the country as a model, one of just a few nations that have reversed the explosion in rates of infection.
"Thailand is a leading light in the global fight against AIDS," said Hakan Bjorkman of the U. N. Development Program, who led a team that wrote a new report on Thailand's response to AIDS.
But there are fresh indications in some sectors of Thai society that the danger has not passed. U.N. officials said new infections are rising and remain high among drug users and homosexuals. They also said a growing majority of young people are not protecting themselves during sex. "Now the epidemic has evolved, and there are warning signs that Thailand may be in for a nasty surprise," Bjorkman said.
About 600,000 Thais have HIV, the virus that causes AIDS, and 53,000 of those infected die as a result of AIDS each year, according to official estimates.
About 12 percent of prostitutes are still infected, with rates highest in brothels near the Burmese border. One study of gay men in Bangkok found that 17 percent of those tested were infected. HIV is beginning to spread in the general population in southern Thailand, especially among pregnant women.
More challenges ahead (excerpt) see entire News story
In Thailand, the shifting AIDS picture is documented in a new report by the United Nations Development Programme. AIDS is spreading widely among men who have sex with men, many of whom see AIDS as a disease of prostitutes and often don't realize they're at risk. A recent Thai Ministry of Public Health-CDC study found that the rate of HIV infection among sexually active Thai gay men is 17% 20 times higher than in the general population.
Some of the men don't consider themselves gay. They engage in homosexual sex for money or as part of racy sex shows featured in some nightspots here.
Thailand also is home to an unusual group known as the Kathoeys (pronounced CAT-oys), the "third sex," a group of effeminate men or men who have had sex-change operations who are accepted in Thai culture because they're believed to be doing Karmic penance for misdeeds in earlier lives.
AIDS is also spreading more widely among adolescents, says Maj. General Suebong Sangkharomya, director general of the Armed Forces Research Institute of Medical Sciences, a 40-year collaboration with the USA on tropical diseases and HIV.
New wave of HIV in Thailand a worry -- NEW YORK TIMES
BANGKOK, Thailand - Thailand's AIDS program, widely promoted as the world's most successful in preventing the disease, is in serious danger of unraveling, the United Nations said in a report issued here on Thursday.
The United Nations said the report should spur discussion of the issue at the 15th International AIDS Conference, which opens here Sunday. The meeting is expected to draw at least 15,000 scientists, health workers, political leaders and advocates for AIDS patients.
Thailand has let its guard down, the United Nations said, allowing a new phase of the epidemic to become "a frightening reality." Prevention has lapsed, and the incidence of HIV is on the rise among young people, fishermen, construction workers and other migrant workers, drug users and gay men.
Thailand`s Vanishing Condoms
6 January 2004
(Bangkok) The UN`s AIDS agency in Thailand is expressing alarm over the disappearance of free condoms from gay saunas since the launch of a government AIDS campaign.
Owners of the saunas routinely remove the boxes of condoms from their businesses as quickly as they are delivered. They say that despite the government`s efforts to educate people about AIDS, police still routinely raid bathhouses and the condoms could be used as evidence against them if they were charged with operating sex establishments.
There are 21 gay saunas in Bangkok, many of which have hundreds of patrons every day.
"Anything that hampers access to tools of [HIV/AIDS] prevention jeopardizes the whole program," says Dr Swarup Sarkar, country program development adviser for UN AIDS.
He said UN-AIDS had raised the issue with officials from the Ministry of Public Health and that they were trying to map out a common position on the issue before other ministries and law-enforcement agencies were approached.
The disappearance of condoms from gay saunas comes at a time when the Public Health Ministry is beginning to face up to the AIDS epidemic among gay and bisexual men.
The ministry hopes to have its first-ever HIV/AIDS program for gay and bisexual men up and running before the World AIDS conference begins in Bangkok next July, said Dr Taweesap Siripasiri, adjunct director of the ministry`s collaboration with the US Centres for Disease Control.
The strategy would be among the first of its kind in Asia, where public health officials have been reluctant to address issues relating to gay and bisexual men.
There has been a "universal silence" about the AIDS epidemic among gay men in Asia, said the UN`s Sarkar, but with police in Bangkok anxious to prosecute gay bathhouses, efforts to reach the community are going nowhere.
A pioneering study conducted earlier this year found that 17.3 per cent of gay and bisexual men in Bangkok were HIV positive.
Researchers tested 1,121 men for HIV and interviewed them. They found an alarming rate of unsafe sexual practices, while a significant number of those surveyed said they had had sex with women as well as with men.
Forty-four per cent of the men had had unsafe sex during the preceding six months. More than one third (36 per cent) said they had also had sexual intercourse with a woman or women, 22 per cent of them during the preceding six months.
Most of the men tested were young, with the average age being 26.9 years. Those aged 18 to 22 were nearly twice as likely to be HIV positive.
by Peter Hacker, 365Gay.com News centre, Asia Bureau Chief, ©365Gay.com ® 2004
Prevalence and risk factors for HIV infection among men who have sex with men in Bangkok
By: F van Griensven1, S Thanprasertsuk2, S Naorat1, R Jommaroeng3, T Siraprapasiri1, K Ungchusak2, G Mansergh4, R J Jenkins4, R Stall4, K Kangkarnrua3, P Mock1, P Phanuphak5, J W Tappero1
1Thailand MOPH - U.S. CDC Collaboration, Nonthaburi, Thailand; 2Ministry of Public Health, Nonthaburi, Thailand; 3Rainbow Sky Organization, Bangkok, Thailand; 4Centers for Disease Control and Prevention, Atlanta, United States; 5Thai Red Cross Society, Bangkok, Thailand
Background: HIV prevalence and associated risk behaviors among men who have sex with men (MSM) in Thailand are unknown. This information is crucial to inform and implement targeted preventive interventions for this population.
Methods: A cross-sectional assessment, using venue-day-time sampling, was conducted at parks, sauna's and entertainment venues. Participants were 1,121 Thai men who were 18 years or older, residents of Bangkok, and who reported oral or anal sex with a man during the past 6 months. Oral fluid specimens were tested for HIV antibody. Demographic and behavioral data were collected using an interviewer-administered Palm based automated questionnaire.
Results: HIV prevalence was 17.3% (194/1,121). Mean age was 26.9 years (median 25 years), and university education was completed by 42.5%. Sex with men and women during the past 6 months was reported by 22.3%; sex with a woman ever, 36%; and unprotected intercourse (anal, vaginal or both) during the past 3 months, 44.1%. Alcohol use during the past 3 months was common (73.7%); other drug use was rare (2.5%). 491 men (43.8%) had ever been tested for HIV, but none reported to be HIV positive. Multivariate logistic regression analyses showed lower education, recruitment from a park, self-identification as homosexual, practicing both receptive and insertive anal intercourse, increasing years elapsed since first anal intercourse, and increasing numbers of male sex partners to be significantly and independently associated with HIV prevalence.
Conclusion: HIV infection is common in Bangkok MSM. HIV prevention programs are urgently needed to prevent further spread of HIV in this young and sexually active population. Development of user-friendly HIV voluntary counseling and testing, and access to care services are warranted.
July 24, 2004 Bangkok Post (english language newspaper)
Unsafe Sex Blamed for Tourists' STDs
Report: Some get HIV travelling in Thailand
A senior health official blamed unsafe sex by foreign tourists for a news report that many young tourists, particularly those from Britain and Germany, went home with sexually transmitted diseases (STD), including HIV.
Charal Trinvuthipong, acting permanent secretary of public health, said the government was already providing free condoms in about 60,000 places which offered sexual services. Also, a campaign has been actively conducted to raise public awareness about protective measures in a bid to curb sexually transmitted diseases, Mr. Charal said.
A report said 69% of British-born men with heterosexually acquired HIV were infected through sex while abroad, as were a quarter of women. "Of these men, 22% were probably infected in Thailand," the report said. A study was done between 2000 and 2002 of STD infections, such as syphilis and HIV, in young travellers and sex tourists. Moreover, a study of male German sex tourists in Thailand showed that most were aged 30-40, single, with well-paying jobs Of these people, only 30%-40% used condoms, the study showed.
However, Dr. Charal said many of those travellers ignored safe sex practices. "They might have had sex, without protection, with risk groups such as teenagers and those outside sex services. Such groups still had low protection rates."
-- Bangkok Post, Reuters
The Silent Continent
Why is there so little discussion of men who have sex with men in Africa?
What could be done to facilitate this dialogue?
In a session on human rights, Ronald Lwabaayi presented a study on sexual minorities, violence and AIDS in Africa.
The presentation was about hidden epidemics: the HIV epidemic fuelled by sex between men, and the epidemic of violence against sexual minorities such as men who have sex with men.
Only a small number of studies have been conducted on this particular group in Africa. Yet most of them reach the same findings: the life of these men is characterised by violence and rejection from the community or family.
The problem seems to be on a wider scale than one might realise. A study in Senegal found 13% of men interviewed said they had been raped by a policeman.
Bisexual behaviour is widely reported and documented. Thus we know that most men who have sex with men have also have sex with women or are married, said Mr Lwabaayi. The potential for the diffusion of HIV by these groups is consequently very high.
He concluded that, in spite of these facts, in most African countries there are as yet no prevention, care or treatment programmes to reach sexual minorities.
The lack of information contrasts with how the western world is working to reduce HIV transmission and stigma for men who have sex with men. At one of the poster sessions in Track C one could learn every detail about negotiated safety in couples, about unprotected anal sex with steady or casual partners, about the influence of several drugs on safer sex, and even about the sexual behaviour of partners who met via the internet.
Most of the posters suggested that research findings should be included in further prevention programmes.
Although this research was of a high standard, there was perhaps some feeling of frustration among delegates, wondering why so much work had to be done simply to confirm what is already known and documented. Worse, the new old knowledge leads to so little new action in terms of prevention.
In Western countries, the rise of new infections in men who have sex with men is a very serious concern. But it can be argued that the commitment, resources and energy of many of the researchers could have been better invested in poor countries.
The research gap between the North and the South is mirrored by a gap in dialogue about the sometimes difficult issues involved. Gay activists of the North, who play a crucial role in ensuring that studies are conducted to meet the needs of the gay community, could address the issue with more emphasis. In particular, they could also advocate for behavioural and epidemiological studies on communities in the South.
International AIDS conferences are an obvious platform to discuss the relevant issues and experiences. But these opportunities could be better exploited, with health ministry representatives from all countries meeting on this specific subject.
Benefits would accrue in many areas; we should not forget that prejudice runs deep in many parts of the world, particularly Africa. In the North it has taken a long time for state agencies to become comfortable with working with gay organisations.
Gay activists have, of course, started to make contacts between the North and the South. Asian gay NGOs have shown in recent years that even in very difficult societal contexts, in countries where homosexuality may be prohibited by law, minority voices can be heard.
More and more gay organisations are forming in Africa, and their experience is growing. It is perhaps worth giving more recognition to the community work they do, which will certainly be crucial to successfully turn back the tide of HIV/AIDS in the continent.
Sex between men is widespread around the world. It is time to face this reality.
In the developing world, particularly Africa, our understanding of the situation is still far from complete. Further studies are needed, to allow targeted HIV prevention programmes. And people need to talk about the issues so that they become as normalised within wider society as they are currently in small communities.
HDN Key Correspondents Team
Thailand bans lone women from bars in sex trade crackdown
BANGKOK, Feb 14, 2002 (Reuters) - Thai police are clamping down on lone women with a law to keep them from entering bars unless accompanied by a man, starting with Valentine's Day.
The clampdown comes amid a controversial social order campaign by the government of Prime Minister Thaksin Shinawatra and has angered women's rights activists who say the law is outdated and impossible to implement fairly.
Police in the Thai capital Bangkok have sent a letter to owners of entertainment venues setting out existing regulations and reactivating a 40-year-old law aimed at curbing prostitution.
"We're looking on a case-by-case basis, but at some bars and discos, if we think something will happen with women by themselves, we'll give a warning," police spokesman Pongsapat Pongcharoen told Reuters.
"We're looking at the bars which have women going in to get men customers and going out to have sex," he said.
Dave notes: "Special Services" by employees of "Entertainment Places" are exempt from the prostitution law. But a women coming into a bar not working for the bar of strip club is not covered by the prostitution exemption. They has been lots of talk about crackdowns as the "social order" campaign of the new PM is very controversial and probably due to Western pressure again to impose Western morality on a far different culture where sexuality in Buddhism is just normal and natural.. not the sin of Christian traditions in the West (that have no true biblical basis).
Legalise prostitution in China
South China Morning Post, (dated: July 29,2004)
August 2, 2004
Before the recent 15th International Aids Conference in Bangkok, Premier Wen Jiabao issued an unprecedented statement that openly outlined China's Aids prevention and control plan. This top-level policy statement is the latest evidence of China's growing acceptance of its Aids problem. Beijing's continued commitment is welcome, but existing Aids control polices often impede effective prevention work among high-risk groups.
While needle sharing remains the main source of HIV transmission, sexual transmission stands at 10 per cent, and is steadily rising. The sex industry is seen as the primary source of this increase. If Aids is to be kept from entering the general population, the rate of sexual transmission must be controlled. Current policies leave sex workers socially and legally marginalised, inhibiting the effectiveness of HIV/Aids outreach and prevention programmes.
China has an estimated 840,000 HIV cases, of which 80,000 are Aids patients. Since 1985, more than 150,000 people have died. China's HIV prevalence rate remains low, at 0.1 per cent. However, new infections are increasing at a striking annual rate of 30 per cent. The male to female ratio of HIV infections has fallen from 9:1 in 1991 to 4:1 in 2001. Authorities believe the total number of HIV/Aids cases could swell to between 10 and 15 million in six years if comprehensive and proactive prevention measures are not taken.
China's sex industry has proliferated dramatically in the past 25 years. According to conservative estimates, there are 6 million prostitutes, and a recent study valued its underground sex industry at 30 billion yuan.
The majority of sex workers are young, unmarried, domestic rural-to-urban female economic migrants with limited job and educational opportunities. While women account for 45 per cent of the total workforce, their average annual income is only 80 per cent of men's. In addition, the majority of female sex workers have not entered high school. Faced with gender-based discrimination in the workforce and diminishing opportunities in education, rural women and girls are compelled to enter the sex industry.
Sex workers act as a bridge which can channel HIV from high-risk groups into the general population. Shanghai health officials have reported that 80 per cent of females and 20 per cent of males in the city were infected by their spouses. A nationwide survey showed that the majority of sex workers' clients are middle-class men under 35. This trend is likely to increase as China redirects its economic development priorities to its mid-level cities and towns.
Prostitution is illegal in China, and given the political climate surrounding HIV/Aids, linking its control to periodic strike-hard anti-prostitution campaigns will remain a mainstay of health and public security policy. While these raids may have positive political benefits, they fail to produce long-term reductions in the number of sex workers or clients. Instead, they force sex workers to become highly mobile and increasingly reluctant to take part in voluntary counselling and testing programmes because they fear the legal and social stigmatising consequences.
Beijing should consider decriminalising a regulated sex industry to avert an increase in sexual transmission rates, and thus an uncontrolled explosion of HIV/Aids cases in China. This would expand the social and legal space in which HIV/Aids prevention programmes could effectively operate. Evidence has shown that punitive HIV/Aids control policies are not only ineffective, but also inhibit those who are actively trying to reach the most vulnerable groups.
( forwarded by: Edmund Settle is programme co-ordinator for the China HIV/Aids Information Network and founder of the China Aids Survey. http://www.casy.org. email: Edmund.Settle@miis.edu )
Rainbow Sky Association (in Thai)
Thailand's first officially registered gay association, a private non-profit organization, working for public interests especially for the homosexual, bisexual and transgender community. 5/F Panjaphat Bld, 1 Patpong Rd, Suriyawong, Bangrak, Bangkok, 02-632-6957, 02-632-6958, English language assistance: 01-341-4591, FAX 02-632-6956, email.
HIV PREVENTION AND 100% CONDOM PROGRAMS
Human Rights Watch
THE ISSUE: Latex condoms, the only device to protect against sexual transmission of HIV, have been at the cornerstone of global HIV prevention efforts since the beginning of the AIDS epidemic. Guaranteeing access to condoms requires ensuring an adequate stock of condoms in public health facilities and other health outlets; providing comprehensive and age-appropriate information about the effectiveness and correct use of condoms; and taking steps to empower vulnerable groups, particularly women, to negotiate condom use with their sex partners. Investing in comprehensive HIV prevention programs that include condoms has been shown to reduce the number of people infected with HIV enough to slow the epidemic spread of AIDS.
IN THAILAND: The national 100 percent condom program established under Prime Minister Anand Panyarachun in 1991-92, which combined regular screening of sex workers for sexually transmitted diseases (STDs) with provision of an ample supply of free condoms in sex establishments, is widely cited as a best practice model in HIV prevention. The program resulted in a dramatic increased condom use and a decrease in demand for commercial sex, averting an estimated 200,000 HIV infections between 1990 and 2000. Human rights groups have criticized 100 percent condom programs for providing a pretext to penalize sex workers and clients who do not use condoms or who become infected with HIV or other STDs. Such penalties serve no public health purpose and, in fact, may detract from condom promotion efforts by driving sex workers underground and away from health services. Recent reports further suggest that supplies of publicly funded condoms have dwindled in Thailand since the inception of the 100 percent condom program in the early 1990s.
AROUND THE WORLD: Condoms are under increasing attack by governments and social conservatives who favor HIV prevention programs that stress only sexual abstinence and marital fidelity. In 2003, the administration of U.S. President George W. Bush earmarked one third of prevention spending in the Presidents Emergency Plan for AIDS Relied (PEPFAR) to abstinence until marriage programs. The same year saw the removal of scientific information on the effectiveness of condoms from the websites of the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID), as well as the appointment of physicians who oppose condom use to the Presidents Advisory Council on HIV/AIDS (PACHA). The Holy See (the Vatican), which enjoys non-member permanent observer status at the United Nations, has consistently sought to omit references to condoms from U.N. policy documents. In October 2003, the head of the Vaticans Pontifical Council for the Family, Alfonso Lopez Trujillo, claimed falsely that condoms contain microscopic pores that are permeable by HIV pathogens. Governments in predominantly Roman Catholic countries have succumbed to pressure by national bishops conferences to impose legal restrictions on condoms and comprehensive HIV/AIDS information.
Governments, U.N. leaders and international donors should use the occasion of the International AIDS Conference to reassert the central importance of condoms in HIV prevention. They should call for the expansion of comprehensive programs that include condoms and comprehensive information about HIV/AIDS and the defunding of programs that give emphasis to abstinence and fidelity at the expense of condom information and services.
FOR MORE INFORMATION: Human Rights Watch, Unprotected: Sex, Condoms and the Human Right to Health in the Philippines, Vol. 16, No. 6(C), April 2004; Human Rights Watch, Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Programs in the United States, Vol. 14, No. 5 (G), September 2002.
Search Google for more "Sex Condoms AIDS"
Bill & Melinda Gates Foundation
ignores HIV Prevention in Gay Communities .
see also: Network of Sex Work Projects website (mit links)
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