Spreading the word, not the disease

Volunteers from the New Generation Group, working to educate detained youth in responsible approaches to sex.

Peer-to-peer training with help from AIDSNet. Officials say this is a particularly effective way of getting students to listen.

Recently, learning post was invited by UNICEF-Thailand to meet people involved in a number of HIV education projects up in the northeastern province of Khon Kaen. Their stories provide some cause for optimism but also bring home the fact that there is much to be done in order to stamp out prejudice and make for a better future.

In many developed countries, the threat from HIV has diminished slightly over the years. That’s not to say it still isn’t a problem. Europeans, for example, continue to be warned that without the usual precautions, the risk of contracting the virus remains high. In developing countries, most notably those on the African continent and right here in Asia, the number of HIV carriers continues to escalate at an alarming rate. In some of the more devastated areas in Africa, nearly a third of the local population is living with HIV/AIDS.

So, why the disparity? Apart from the obvious economic factors, there is one element that distinguishes nations who claim success from others who are battling a virulent epidemic. Education.

The HIV virus thrives on ignorance. Stigma and prejudice are its greatest associates, lending a helping hand as the virus passes unhindered from one body to another. On the other hand, realistic education, based both on prudence and protection, is the enemy that stands in its way.

Developing countries tend to have a conservative and often deeply religious moral outlook. Some argue that this in itself should provide an adequate antidote to the practices that lead directly to HIV/AIDS. But it doesn’t and most statistics prove it. Less educated adults, particularly men, tend to go through many sexual partners, even when married, and the virus spreads like wildfire. Community leaders dismiss the use of contraception and treat the matter of sexual relations as a taboo subject. Meanwhile, HIV winds its merry way through the populace and the problem gets worse.

Here in Thailand, grass-roots community projects are making a difference but volunteers face an uphill battle in rural communities where lack of awareness, with its related prejudices, still holds sway.

Dr Pope Kosalaraksa

Dr Pope Kosalaraksa, a pediatrician and associate professor at Khon Kaen Univerity, has spearheaded a project that promotes treatment and care of HIV-affected children in the area. "We’re using a holistic approach," he explains, "by providing psychosocial support as well as medical. We believe it is important to look after all the problems at the same time – physical and emotional"

The project has been running for 4 years and Dr Pope has witnessed some tangible improvements in that time. For instance, most of the medication required to treat patients is now produced domestically, although some specialist medication still needs to be imported which inevitably places a burden on finances.

Whilst the availability of treatment is less of an issue in Thailand, the complex way it is administered causes some difficulty. The latest treatments are a cocktail of different pills that, when taken at regular intervals, boosts the immune system which has been decimated by the disease.

"It’s difficult for children to be disciplined enough to take the medication," Dr Pope points out. "Many of these kids are being brought up by grandparents because their parents have already died of AIDS and they often don’t take care of the children seriously enough."

The complications of treatment can be compounded by negative attitudes and misinformation. It transpires that a great number of HIV patients will travel to hospitals in other provinces, simply to avoid knowledge of their illness leaking out into the local community. The costs of treatment outside a patient’s own province is much higher than if they choose to be treated locally and with the extra travel expenses, it is easy to see why many sufferers struggle to make ends meet.

Dr Pope and his team work with local volunteers to educate parents on how to care for their HIV-affected children and occasionally make home visits. Generous funding has been forthcoming but the availability of staff with the background and, indeed, psychological stamina to care effectively for patients is hard to come by.

Nonetheless, Dr Pope remains optimistic. "In the future," he says, "when visibly effective treatment gives more confidence to communities, it may help to change attitudes. Ignorance cannot last."

Amnart Chamchuen

Those with first-hand knowledge of the virus can play a vital role in educating those around them. Across the country, over 500 groups of people living with HIV/AIDS (also known as PHAs) have been set up and are making inroads in reducing intolerance and encouraging young people especially to take care when it comes to HIV prevention.

Amnart Chamchuen is deputy director of the Isaan PHA network and was diagnosed HIV positive fifteen years ago. "When I first got the results of the blood test, I felt down and hopeless," he recalls. "I thought of suicide and nearly rode my bike into a big truck." Luckily, his wife and family eventually came round to understanding his predicament and, today, he leads a fairly active life.

A few years after his diagnosis, Chamchuen joined the PHA network and was soon out in the field showing students, villagers and locals how to protect themselves. He also serves as a positive example of how living with the disease doesn’t make you an ‘untouchable’. "Infected people need to be strong," he says, "otherwise we’ll never change attitudes."

There are 193 PHA groups in the northeastern area with around 5000 members in total. They visit local communities and schools, organise events and give talks. One of their most significant achievements has been to gather reliable data on the number of people living with HIV/AIDS in each province — no easy task when you consider that many are afraid to disclose their status in order to avoid social rejection. By encouraging people to fill in anonymous questionnaires, the groups have established a database that provides an accurate assessment of the current situation. The hope is that, once the government sees these figures, appropriate measures can be taken.

Although the process is still ongoing, the current statistics don’t make for pleasant reading. Indications are that the number of people living with HIV/AIDS in the area is increasing and bigger than first thought, making the northeast a hotspot for the disease and the worst hit locality in Thailand. And so, the fight goes on.

"We want to make AIDS a big issue," says Chamchen. "There are 15,000 new cases every year. This is much worse than SARS. We have to speak the truth and not cover up the scale of the problem."

Hidden away from society for their crimes, children in detention centres are as much in need of education as their peers outside, if not more so. Because they tend towards unrestrained behaviour, it is likely that, once released, many will go on to have a high number of sexual partners. Indeed, sexual activity within such institutions is a major headache for administrators, despite the fact that boys are separated from girls.

Supattra Sanmeung is the young head of New Generation Group, a small legion of youthful volunteers who educate children at a juvenile detention centre in Khon Kaen. Their primary goal is to inculcate a healthy and responsible attitude towards sex, backed up by adequate protection to prevent the spread of sexually transmitted diseases. "I think our work is important," she says. "We try and build up relationships with the children so that they will talk to us about their feelings and ask us questions."

But there is thorny dilemma here. Unprotected sexual activity does occur amongst a small number of teenagers within detention centres, despite being prohibited, and there have been instances where boys naively used plastic bags to protect themselves. But with condoms available, it is argued, the boys would expose themselves to less risk.

On the other hand, some say that having condoms available condones sexual behaviour amongst those not mature enough to take responsible decisions. "We have to be accountable for children from 8 to 20 years old," notes centre director Surakit Unkurarat. "It’s difficult for us to distribute condoms because of the age group. Not giving condoms will cause less of a problem."

Nonetheless, the New Generation group are making progress and many of the boys we spoke to say that they know far more about the dangers of casual sex than they did previously. That said, theory is one thing and human nature another. 20 year-old Aek (not his real name) who is being detained for drug dealing, told us that he knew about condoms but strayed when he was allowed out for a short while to see his family. "I got drunk one night and then had sex with a girl but I didn’t use a condom," he admits.

AIDSNet materials

The current generation of children and teenagers are at the front line in the battle against HIV/AIDS and in them lays the most hope. Much of today’s prejudice comes from the older generations who have lived in quieter and simpler times. The next generation of adults, it is believed, will be more open and able to cope with the complexities of the 21^st century.

The AIDS Network Development Foundation (AIDSNet), sponsored by UNICEF and the European Commission, has education as one of its prime objectives. Working on the principal that young people listen to their peers as much as adults, AIDSNet train youths to deliver programmes on STD infections and promote safety.

Sutisa Sributwong

"The level of sex education in schools is negligible," suggests project officer Sutisa Sributwong. "In general, teenagers think it’s cool to have sex but the knowledge that they have is often incorrect. For example, some boys think that most young girls are virgins, so they don’t bother to use a condom." There is also a marked contrast between urban and rural youth. "Rural kids tend to have less opportunities for sex," she notes, "but they also have less education. That’s why we are targeting kids that don’t go to school."

Whilst AIDSNet may seem like a worthy enterprise, they have met resistance along the way, including from some teachers who misunderstand their intentions. "They think that we are promoting sex," says Sributwong. "But we are getting the students to think about the consequences and consider what they are actually doing."

Parents, too, are often unwilling to let their children be taught in this way. Many believe that sex is a subject best left until they reach adulthood. But this only promotes ignorance until it’s too late, according to Sributwong. "We are also trying to reach out to parents and get them to talk openly about sex with their children. That will be quite effective," she says.

It is easy to blame youth for much of society’s problems. Society, however, must take active responsibility if it is to change to meet the challenges faced by today’s young people. Here, the media have an important part to play in the fight against AIDS but sadly, in Sributwong’s view, the messages that drive youth culture often impede the work done by groups such as AIDSNet.

"The media provide selective messages which often reflect the lifestyles of media practitioners," she notes, "but they usually conflict with the messages of responsibility that we are trying to promote. For instance, after a movie showed a youth taking the ‘morning-after’ pill, the kids wanted to know all about it." She also accuses the media of showing constantly negative images of people suffering from HIV/AIDS. "This only re-inforces the prejudice," she observes.

AIDSNet and groups like them are no puritans. They just want to be able to engage young people in realistic discourse, free from bigotry or outdated values.

There is some hope. Things are changing for the better as more and more people begin to understand that doing nothing or resorting to needless persecution leads the way backwards, not forwards.

The last word should go to the boy who was ejected from school simply for carrying the HIV virus. "I want to tell to adults to realise the feelings of people living with AIDS," he wrote. "I have the right to study. I don’t want to be in torment. I want to educate the teachers to have the psychology to understand the children. Although we are sick, we don’t give any trouble to others. Adults, please listen to the young. When adults are angry, they should control their mood and be fair to children. I also would like the price of medicines to be cheaper. The Prime Minister should emphasise the AIDS issue and help organisations that work on AIDS."