Health experts in Thailand say the odds are stacked against them in combating one of the highest HIV prevalence rates in Asia, with only 2 percent of the country's AIDS budget going on condoms.
"The belief is that it is the responsibility of the people who want to buy sex that they have to protect themselves," said Somyos Kittimankhong, a senior member of Thailand's Department of Disease Control's Anti-AIDS Division. "But when they get infected, then it's the government's responsibility. It's silly."
The only Southeast Asian country with an HIV prevalence of more than 1 percent, Thailand's earlier success at containing its epidemic has stagnated. With 481,770 HIV infected people already living in the kingdom, there are more than 10,000 new HIV infections every year, according to the UN's 2010 report from the General Assembly Special Session on HIV/AIDS.
The most-at-risk groups are injecting drug users and men who have sex with men (MSM), but this infection trend is broadening to include couples in committed relationships where condoms will never be the norm, said Steve Kraus, director of the UNAIDS regional Asia and Pacific support team.
Thailand's Epidemic Model has projected that more than one-third of new HIV infections in 2010 in Thailand will occur in long-term relationships and 7 percent from risky sex.
Despite these figures indicating that the epidemic is shifting to the general population, most of the government's US$775,000 condom marketing and distribution budget continues to target commercial sex workers.
"Thailand thinks there are enough condoms easily available and affordable in the market, and they don't see the need for providing them," Michael Hahn, UNAIDS country coordinator for Thailand, told IRIN. "This assumption is now under review as the country plans its national strategy for 2012 to 2016."
|HIV/AIDS in Thailand|
|Total number of people living with HIV in 2010: 481,770|
|Cumulative AIDS infections in 2010: 1,148,117|
|Number of new AIDS deaths in 2010: 27,557|
|37 new cases a day|
|Half of all new HIV infections in Thailand are people under the age of 25.|
|74.8 percent of people in Thailand are optimistic that proper use of resources will stop the spread of HIV by 2015 (against 14.2 percent in Japan and 28 percent in the UK and US)|
|Source: UNAIDS, PDA|
Health officials are finding that the barriers to persuading people to have safe sex go beyond an insufficient budget for condoms; what is needed is a change in attitudes.
"Even though we have been doing condom promotion for many years - when we look at condom use, it is still too low," Somyos said.
Sixty percent of sexually active teenagers do not regularly use condoms, along with more than 50 percent of MSM and 40 percent of sex workers, according to the Department of Disease Control (DDC).
Praween Payapvipapong, an adviser to Population and Community Development Association (PDA), a Bangkok NGO, which has a condom-themed restaurant, gift shop and resort, has been focusing on making condoms more popular since before the HIV/AIDS epidemic hit the country in 1984. But condom use is still not where it should be, he said.
"Instead of equating condoms with sex work and sexually transmitted infections, we need to change the image - that they're for safety and for love."
Oui Rattanawitoon, a 35-year-old public health student who has done HIV/AIDS outreach at the village level, said many young people he worked with asked him: "But if you are faithful, then why would you need a condom?"
"The attitude of Thai people now is quite free and sometimes they do not realize the concern about HIV," he said. "And though some teenagers do know [about HIV], they are not scared of [it]; they are scared of not having sex."
Even people running public health campaigns do not always follow their own advice - especially in the heat of the moment, Oui said. "I know what I should do, but sometimes it is difficult."