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Thailand and Aids
CASE NUMBER: 356
CASE MNEMONIC: AIDS
CASE NAME: Thailand AIDS and Trade
A. IDENTIFICATION
1. The issue
By the year 2000, most new cases of acquired immunodeficiency
syndrome (AIDS) will occur in Asia. This prediction was made by
the World Bank on December 4, 1995. Evidence is growing rapidly
suggesting that its epicenter is shifting from Africa to Asia. Of
the 15 million people worldwide estimated to have contracted the
virus by 1995, 3 million were in East Asia, excluding Australia.
Thailand has been considered to be the hot spot of HIV over the
last 10 years. It is also the first country in the region to be
hit by the epidemic. The World Health Organization estimates that
there are over 800,000 cases in Thailand. But besides being one of
the largest "producers" of AIDS, Thailand also has much experience
with AIDS, an acceptance of its realities, and the political and
industrial will to stem its devastation.
2. Description
AIDS can be conceptualized as a product. This product is a
composite of three sources, drugs, prostitution, and unbridled
economic and social growth. It is a product that causes death and
drains resources that could be used elsewhere. In Southeast Asia
it is also a product considered by many to be exported from
Thailand to other countries, whether it be the huge sex industry
and its effects, or the smuggling of heroin and its addictions
across regional borders.
Thai-AIDS also has another facet. As officials in other
countries are just beginning to grapple with AIDS and its affects,
many continue to deny its potential devastations. But, while AIDS
has had an overwhelming affect on Thailand, Thai officials have
gotten over denial and have mounted one of the most aggressive
awareness campaigns in the world. While it may be to late for
Thailand to avoid immense social and economic costs, other
countries can learn from Thai strategies to avoid catastrophes in
their own countries.
Thai-AIDS is a destructive commodity that has thrived in one
of the most socially liberal, capitalistic, and fastest growing
economies in the Asia Region. As other countries liberalize their
economies and continue to be affected by the huge cultural and
economic presence of Thailand, they must realize that they are to
an extent importing AIDS (even countries not opening their
economies such as Burma have seen high increases in AIDS rates) at
an alarming rate and must convince themselves to accept the
information, prevention techniques, and strategies Thailand has
instituted, before it becomes to late. In short they must accept
the whole package. They can no longer deny AIDS as just a Thai
disease and must confront its potential harms within its borders,
and must accept Thailand's experience and know-how in education,
technology, prevention and treatment. If they decide to import the
whole package, not just the disease, they may avoid devastating
their social environment as well as the minimal resources they have
to use on other environmental concerns.
Acquired Immunodeficiency Syndrome has taken its toll on most
of the world, having its most devastating affect on the African
continent, and its most precipitous increase in India. To single
out Thailand as a country exporting AIDS to its Asian neighbors may
seem like a stretch. But, when considering it embodies itself in
the form of heroin being smuggled from Thailand used in countries
such as China, Thai prostitutes working in droves in Cambodia,
Vietnam and Burma, and Thailand's immense social and cultural
influences in the region as the gateway to the west (among other
things), Thailand must be looked at as one of the major sources of
the disease, and one that impacts its neighbors more than any other
country.
If Asian Development Bank estimates are correct, by the year
2000, Asia will account for more than half of the world's total HIV
infections. "It is expected that the HIV/AIDS epidemic in Thailand
will continue to expand, with heterosexual intercourse being the
most important mode of transmission," a Health Ministry report
says, "By the end of the century, mortality due to AIDS could
become the leading cause of death in Thailand." (Branigan 1993, A1)
Some experts believe that the epidemic may be impossible to
control. A closer look at Thailand reveals the components for
potential disaster; sex tourism, export of prostitutes abroad,
rampant corruption including payoffs by brothel owners to police,
the involvement of organized crime, foreign pedophiles and
widespread child prostitution (where poor village girls have been
known to be sold into sexual slavery.)
Thailand not only has two types of the virus, HIV 1 and HIV 2,
but two substrains of the more common first type that have been
designated A. and B. Substrain A resembles the virus in the United
States and is found mainly in Bangkok and the south, while
substrain B is similar to the virus found in Africa and is more
prevalent in the north of Thailand. After spreading through
Thailand's homosexual community starting around 1984, the HIV virus
began decimating intravenous drug users in the late 1980s, then
expanded among heterosexuals through prostitutes and male customers
alike beginning around 1989. Now it also takes a high toll on
mothers and newborns, through the frequenting of prostitutes by
Thai men.(Fairclough 1995, 32)
One of the reasons Thai-AIDS is so far advanced compared to
its regional neighbors can be attributed to the dark side of
prosperity that has engulfed Thailand. This began with the Sex
trade spawned during the Vietnam War, where U.S. soldiers would
come to Bangkok for their rest and relaxation and desired to be
entertained. With enough dollars this created an entire sex
industry.
Many of the problems plaguing Bangkok today are
representative of the effects of unregulated free market
capitalism. The sex industry itself began here in response to rest
and relaxation visits by U.S. troops but continues today unabated,
no governing structures have been developed to handle unbridled
growth in any industry. This has resulted in a lack of ability to
contain many of its environmental problems let alone an incurable
disease.
While more people per capita drive Mercedes Benzes in
Bangkok than anywhere in the world, the country has so little
central planning, and no subway, which makes it impossible to drive
them. Most of Bangkok still throws its garbage, and flushes its
toilets, untreated, into the city's canals (THAICAN). Only last
year did Bangkok get its first small waste-water treatment
facility.(Rich 1996, A26)
Most point to a free market that overran the government, and
was able to buy off every environmental regulation with corruption.
There are still fears that the government will not be able to catch
up to the market, and with it not be able to reverse the
devastating trend of environmental abuses. A study done in 1990
found that Thai children by the age of 7 had lost six points off
their average I.Q as a result of breathing the air in Bangkok.(Rich
1996, A26)
A by-product of Thailand's growing environmental problems is
that investors are looking more towards its neighbors to continue
investing (or exploiting) and developing the region. Of the many
lessons to be learned from Thailand's present dilemmas is that of
AIDS. Countries such as Burma, China, and Vietnam while accepting
increased western investment seem to put a quota on the information
they will believe about AIDS. Overwhelming growth, prostitution,
drugs and a lack of government regulations along with government
denial were the key components in Thai-AIDS. These ingredients are
being imported precipitously in neighboring countries. As top
business executives in Thailand predict AIDS to propel Thailand to
economic disaster, Burma, China and Vietnam have a choice, pay now
by accepting the entire AIDS package, not just the disease, or pay
later in a much bigger way.
Vietnam
"So far not many people think AIDS is a problem in Vietnam,"
Vice Premier Nguyen Khanh says. As Thai officials had done before,
Vietnam is trying to downplay its potential devastation. Vietnam
is in the middle of remarkable economic growth, and Vietnam
officials fear, as did Thai officials almost six years ago, that an
AIDS awareness campaign would scare away tourists and foreign
investors.
Looking at official statistics, Vietnam would seem to have
one of the lowest rates of HIV in Southeast Asia. Vietnamese
officials seem to credit this to years of isolation, and maintain
that those that test positive for AIDS are foreigners, mostly Thai
fisherman. But this is not very accurate picture. The government
has been criticized for continually testing low-risk groups, such
as elderly people and monks so the ratio of HIV cases would stay
low.
Le Dien Hong, deputy chairman of the National AIDS
committee, points out that "all the necessary factors for an
explosion are here. Contact with the outside is increasing, while
people's knowledge about HIV and AIDS is still very low. At the
same time the plague of prostitution and drug abuse is increasing
uncontrollably."(Hiebert 1993, 34) Yet there still is not enough
data in Vietnam to make a realistic estimate as to the spread of
HIV.
Table 1
Cumulative AIDS cases reported in 1992 by governments.
Vietnam 0
Cambodia 0
Thailand 909
China 11
Burma 16
India 242
Brazil 36,249
The Communist Party blames the increase in AIDS on social
problems on the opening of its doors to the outside world, and its
launching of a market economy in the late 1980s. All these
characteristics ominously mirror what Thailand was faced with when
HIV first was discovered within its borders. But, "Vietnam has the
possibility of doing something in an accelerated time-frame and
avoiding high levels of infection like Thailand," says Robert
Bennoun of Save the Children. "But they +will lose three or four
years if they don't meet AIDS head on." While many experts admit,
even within Vietnam, HIV is an undeniable reality, money and a
sense of urgency must be forthcoming. Although Vietnam has limited
resources to put towards AIDS treatment and prevention, it must
start by admitting it is not just a foreign problem. Taking
austere measures, and learning from Thailand's past mistakes and
subsequent strategies can make all the difference in the world.
BURMA
Many in Burma consider AIDS an immigrant virus. Returning
prostitutes from Thailand have spread AIDS to Burma at an alarming
rate. Unlike Thailand, Burma lacks funds, expertise, medical
professionals and the state will to counter the insurgency. With
its military dictatorship, and dismal human rights record, many
consider Burma the weakest link in the anti-AIDS chain in Southeast
Asia. Even though Burma has been one of the most isolated
countries in the world, AIDS has still moved freely across its
border from Thailand. Add to this intravenous drug use and many
experts consider Burma to have one of the most rapidly growing
infection rates in the region.
The State Law and Order Restoration Council (SLORC) which has
governed Burma with an iron fist over the last 40 years, has let
the Burmese economy deteriorate to a point where many will do
anything to survive. Stemming the flow of prostitution rackets
from Thailand, and controlling drug addiction (where as much as 85%
are considered to have AIDS) do not seem to be on the agenda. With
a collapsed social structure, most doctors in jail, and a failure
by the government to create a sense of urgency, it may be
inconceivable for Burma to follow Thailand's lead. But while Thai-
AIDS components are now plentiful in Burma, prevention and
education are not, AIDS in Burma could easily reach catastrophic
levels.
CHINA
Chinese women have also taken the virus home with them after
working in the Thai sex trade. Addiction to heroin from Thailand
(and Burma) is also on the increase in Southern China. China's
modernization, an odd mixture of progressive economics and medieval
politics, has left this vast country ill-equipped to cope with such
a complicated social problem.
The rigid Maoism that four decades ago virtually wiped out
China's historic curse of opium addiction is crumbling as tens of
millions of entrepreneurs, thanks to economic liberalization, have
escaped the strong central government controls that once dominated
their lives. But China's lingering police-state mentality leaves
little room for the kind of creative solutions that have been taken
in Thailand. As of now the police take the chief responsibility
for curing China's drug addicts and prostitutes. The tactics used
have neither had success at curing the problem or stemming its
spread. (Mcgregor 1994, A1)
With its huge population, suppressive government and disdain
towards western ideals, it would seem that an AIDS catastrophe is
undeniable here. Yet, although the problem is mainly concentrated
in the southern provinces close to the Thai border (in the
Guangdong and Yunnan provinces), China does seem to be attempting
to deal with the disease.
In November of 1993, China set up two national surveillance
centers to conduct blood tests and provide technical help to health
departments nationwide. On October 28, 1995 the Health Ministry
announced that it was undertaking a large-scale public education
campaign on AIDS prevention and would mobilize China's hospitals to
enforce a rigid blood-screening code.(Tyler 1995, A3)
Relatively few people have been tested in China, and
officially there are only 2428 reported cases of HIV infection
nationwide. Privately, estimates made by health officials reach
over 100,000. That there has been any mobilization of prevention
and education at all is seen by some as a testament to the fact
that the Thai experience has forced them to consider AIDS as no
longer just a "Western" disease. The same country that has helped
to spur the rise of this epidemic is the same country that is
teaching that it is a real epidemic with far-reaching effects.
While there are many factors to consider in understanding how
Southeast Asian countries became susceptible to this epidemic, and
yet others while contemplating how each individual government will
be most effective in stemming the disease, it is Thai-AIDS that has
provided most of these countries with much of their AIDS problem as
well as an introduction to how to deal with it. Indeed, in five to
10 years, experts say, Thailand may appear to be the lucky one,
having escaped relatively unscathed compared to its neighbors.
"They don't know they're sitting on a time-bomb," says Mechai
Viravaidya, chairman of the Population and Community Development
Association. "At least we heard something ticking and we did
something about it."(Fairclough 1995, 32)
3. Related Cases
HOOF case
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CIGAR case
CODEX case
Keyword Clusters:
(1) Trade Product = AIDS
(2) Bio-geography = TROPical
(3) Environmental Problem = HEALTH
4. Draft Author: Kenneth Baker (August, 1996)
B. LEGAL CLUSTER
5. Discourse and Status: DISagreement and ALLEGation
Human Rights groups, the World Bank, medical
professionals and business leaders are all urging the Thai
government to continue its urgent campaign of AIDS awareness and
prevention. Allegations have been made back and forth
between Southeast Asian neighbors about who is most
responsible for the drug and prostitution trade. Western
influences and the negative effects of capitalism and
corruption are also alive in the present discourse. Action has
been taken to monitor and prevent the spread of AIDS,
but more concrete and far reaching measures must be taken.
6. Forum and Scope: Thailand and REGION
7. Decision Breadth: 10 (Thailand, Vietnam, Cambodia,
China, Burma, India, Philippines, Indonesia, Bangladesh)
8. Legal Standing: Treaty
While non-governmental organizations may be the most
effective in creating a sense of urgency and a network to
deal with AIDS, many countries in Asia are still relatively
isolated. A regional agreement would be necessary to contain the
AIDS virus. Through an agreement countries could better share
medical information, prevention techniques, and treatment programs
while also better controlling drug and prostitution trades along
the borders. There is an AIDS conference which takes place every
year in Thailand, (last year in Chang Mai) which studies the latest
topics on AIDS. Although this conference is attended by most Asian
nations, there is a breakdown between the discussions and needs
drawn from the conference and the ears of the policy makers of the
individual countries. If other countries in the region would make
Thailand a partner in their AIDS campaigns and commit business and
industry leaders to creating a sense of urgency, it would
facilitate the work of NGOs and possibly slow the increase of HIV.
A. GEOGRAPHIC FILTERS
9. Geographic Locations
a. Geographic Domain: Asia
a. Geographic Site: East Asia
c. Geographic Impact: Thailand
10. Sub-national Factors: NO
Although AIDS is an epidemic in both the major cities and the
countryside, the governments at the federal level will have to
provide the initiative to fight this disease head-on. Local
officials neither have the financial means or power to implement
effective and far-reaching policies.
Even in cases such as the Yunnan province in China,
where local officials are much more familiar with the disease,
laws, prevention techniques and public awareness campaigns, the
initiative must still be taken by Bejing, who finds it much easier
to deny the existence of the problem, as it is less prevalent
there.
11. Type of Habitat: TROPical
A. TRADE FILTERS
12. Type of Measure: ADMINistrative
The governments of these authoritarian countries provide the
means for setting a structure to regulate illicit trade, technology
and information, corruption, and create social awareness.
13. Direct vs. Indirect Impacts: INDirect
14. Relation of Measure to Environmental Impact
a. Directly Related: Yes AIDS
a. Indirectly Related: No
c. Not Related: No
d. Process: Yes Health
Trade measures can be related to the AIDS epidemic
through the transfer of technology, medical advances,
experienced workers, and potential partnerships.
15. Trade Product Identification: AIDS
16. Economic Data
Thailand has the economic resources necessary to carry out a
substantial anti-AIDS campaign. The 1995 AIDS budget was $68
million. Countries where economic growth has yet to take off,
where limited resources and capabilities stand in the way of
effective prevention efforts, will suffer more. (Fairclough 1995,
31) Top business executives are still fearful that Thailand is
headed toward economic disaster. Government data suggest that
Thailand stands to be decimated socially and economically if the
spread of HIV is not checked. Worries abound from scaring off
visitors to a doubling of health-care costs annually, to those
fears that AIDS could (through loss of work etc.) swallow up as
much as 10% of the country's gross national product. AIDS
threatens to economically devastate Thailand's regional
neighbors, who have less resources to fight the disease.
17. Degree of Competitive Impact: Low
Thailand has been fortunate compared to its neighbors. Its
prevention efforts have been made easier by a relatively efficient
and extensive government bureaucracy, a pervasive media and an
educated and literate population. Although other countries in the
region are less fortunate, the only industry that may be impacted
in the immediate is tourism.
18. Industry Sector: Services
As Mechia Viravaidya, former government minister of the AIDS
fight, says, " AIDS is in every industry, and AIDS has no
boundaries.
19. Exporters and Importers: Thailand and Many
D. ENVIRONMENTAL CLUSTER
20. Environmental Problem Type: Health
AIDS is a problem of global proportions, with the
potential to affect much of the human race.
21. Species
22. Resource impact and Effect: Medium and REGULatory
The toll on resources will become greater as Asian governments
continue to deny the potential devastation of AIDS. As the
epidemic continues to spread across the region, and across economic
classes, more resources will be needed. As of now the cost is
somewhat limited to health costs, lost work and tourism costs. But
as the disease continues, more and more resources will have to be
pulled from other environmental and development concerns. In
Thailand, the Health Ministry expects there to be between 2 and 4
million HIV infections by the end of this century.
This number would overwhelm the hard-pressed health care
system and cost the country more than $9 billion by the end of the
decade, up to 10% of its annual gross domestic product. (And
Thailand is a country taking AIDS head-on.)
Standards must be accepted regionally for prevention,
and for education and treatment of at risk individuals and the
general population. The movement of Thai prostitutes and drugs
over the border must also be dealt with and controlled. Finally, a
sense of urgency must be incorporated through an agreement between
countries to mount a campaign against AIDS and its components.
23. Urgency of Problem: High
Asian countries with a less vigorous health campaign
could pay an even higher price than Thailand. DRI/McGraw
Hill estimates that the disease could cost Asian economies
$38 billion to $52 billion by the year 2000, and the number of
deaths will be in the millions. (Fairclough 1995, 31)
This says nothing of the economic and social costs
felt most strongly at the local level. If this epidemic
continues unabated cost estimates could become much greater.
24. Substitutes: Condoms
E. OTHER FACTORS
25. Culture: Yes
The culture of many of these Asian countries contribute
to the speed with which AIDS may spread; from the presence of
brothels in Thailand, the lack of monogamy by Indian husbands, to
the general increase in drug usage in the region. Also
contributing in countries such as India, is the lack of speaking
frankly about sex. The culture as well as the government adhere to
strict Hindu laws that condemn the open discussion of sex. This
makes it difficult to launch any progressive campaigns for public
awareness.
26. Human Rights: Yes
AIDS as a disease must be accepted, and those that have
contracted the disease must be treated as human beings.
Many who contract the disease are considered outcasts and
condemned by society and the government as they wait to die.
27. Trans-Boundary Issues: Yes
Drugs and prostitution must be contained, or information and
education must make them safer. Countries in the Asia
region must realize that they are truly interdependent when it
comes to their actions concerning this epidemic, and that it will
continue to directly affect them. Thailand must be made a full
partner in any AIDS fight, and not just be considered the "black
sheep" of the region.
28. Relevant Literature
Bejing Review. "China drafts plan to combat AIDS." 2 April
1990, 13.
Bejing Review. "Campaign to build up anti-AIDS awareness."
11 December 1995, 6.
Branigan, William. "Asia Faced With AIDS Catastrophe."
Washington Post, 2 December, 1993, A1.
Brown, David. "Fast Action Needed to Prevent Spread of AIDS
in Asia." Washington Post, 9 August 1994, A10.
Economist. "India's Deadly Statistic." 29 February 1992, 37.
Economist. "Termites in the Basement (AIDS spreads in Thailand,
India, and the Philippines)." v 328, 18, September 1993, 42.
Economist. "AIDS: Counting the cost." 23 September 1994, 12.
FairClough, Gordon. "A gathering Storm." Far Eastern Economic
Review, 21 September 1995, 31-36.
Far Eastern Economic Review. "Fatal Inertia." 21 June 1990,
28.
Hiebert, Murray. "Ambivalent Campaign." Far Eastern Economic
Review, 8 July 1993, 33-35.
Lili, Cui. "AIDS challenge for China." Bejing Review, 26
November 1990, 11.
Lintner, Noung. "Immigrant Viruses." Far Eastern Economic
Review, 20 February 1992, 31.
Magistad, Mary. "Vietnam looks to Thailand for Strategies to
Counter AIDS." Washington Post. 2 January 1993, A15.
Mcgregor, James. "The Opium War." Wall Street Journal, June
1 1994, A1.
Mathews, Paul. "A note on the politics of AIDS in the Philippines."
Journal of Contemporary Asia, v 24, 1994, 95-100.
Mcdonald, Hamish. "The Africa syndrome: India confronts the
spectre of a massive epidemic." Far Eastern Economic Review, 20
February 1992, 28-9.
Nadel, Alison. "Malaysia's quandry: efforts to halt spread of
disease are opposed by religious groups." Far Eastern Economic
Review, 25 March 193, 42-43.
Owens, Cynthia. "Business Leaders Join Forces in Effort to
Combat AIDS Crisis in Thailand." Wall Street Journal, 12 February
1993, B4.
Padong, Poom. Interview by Author, 20 November 1995. Desk Officer,
Thailand, WWF, Bangkok Thailand.
Rich, Frank. "Bangkok Traffic Jams." New York Times. 20 March
1996, A26.
Schrage, Micheal. "U.S. Should Make Thailand Full Partner In
Effort to Develop an AIDS Vaccine." Washington Post, 23 July 1993,
A23.
Tyler, Patrick. "Heroin Influx Ignites a Growing AIDS Epidemic in
China." New York Times, 28 November 1995, A3.
Wall Street Journal. "AIDS in Asia Alarming." 3 August 1994, A9
(w).
Wall Street Journal. "China Plans AIDS Centers." 17 November
1993, 12.Wall Street Journal. "Epitope." 23 February, 1993.
Washington Post. "Epidemiology: Center of AIDS shifting to
Asia." 4 December 1994, A2.
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