What’s behind the massive HIV crisis hitting gay Bangkokians.
By Mim Koletschka, illustration by Temsiri Pothipattananont.

HIV is making a comeback and no one’s talking. In 1993, with cases of over 800,000 people infected with HIV, higher than any other country in the world, Thailand went up in arms with massive anti-HIV campaigns. We succeeded with lowering the rate of infection, however, the hot issue of HIV became cold and forgotten after the late 90s’ economic crisis. By 2000, funding for HIV prevention was one quarter less than it had been in 1997. Without Philadelphia to pull our heartstrings, massive campaigns, nor media outrage, the crisis is now going unchecked and unvoiced.

), the situation is already catastrophic. As of 2007, one in three venue-going MSMs were infected by HIV, according to a joint study on male Thai nationals frequenting gay venues in Bangkok carried out by the Thai Ministry of Public Health and the US Center for Disease Control and Prevention (see A Controversial Study). HIV is a sexually transmitted disease. Discuss HIV and you must discuss risky sexual behaviors: unprotected sex, multiple partners, sex under the influence, the list goes on. This is not to be confused with a description of a gay lifestyle. Nor is it a comparison with straight men or straight couples. Without further data to clearly state why the number is so high and what exactly are the causal factors, we at BK spoke to the experts facing the problem to examine some of the behaviors that could be linked to the alarming infection figures.

Sex Under the Influence

In the aforementioned 2007 Thailand Ministry of Public Health and US Center for Disease Control and Prevention (TUC) study, 20.7% of the men sampled used drugs such as MDMA (ecstasy or E), methamphetamine (ice, crystal), ketamine (K), cocaine and poppers (an inhalable nitrate)—a huge leap from 2003’s 3.6%. Experts say it’s difficult to establish how exactly drug use can be linked to HIV infection but it’s clear that it needs to be taken into account. Among HIV positive men, the TUC study revealed the ratio of poppers users

Kem (not his real name), 21, a student, spoke to us of his use of drugs when having sex: “I take ice. It gets me excited. I also take E. Mainly, I take it during sex. The sex gets better. I get more courageous and the sex lasts longer.”

Less sensational, alcohol is perhaps much more deadly because of how readily available it is. Alcohol consumption in the TUC study was at 77.6%. Alcohol may be legal, but it still produces some of the same effects as illegal drugs: diminished self-control, bad judgment and less consideration of risks.

Top (not his real name), 26, recalls, “I had a boyfriend, we always had protected sex. One night, we both got drunk and had sex without using condoms. The following morning, I was really scared and said we needed to get tested. At first, he didn’t want to go but then we went to Bumrungrad and got the test. He found out he was HIV positive.” Top’s insistence on going to the hospital paid off. Top had a prophylactic treatment (see Resources) that was successful and he subsequently retested as HIV negative (he was lucky, too, see Tips for Safer Sex ). Top’s friend received treatment for HIV.

Venues

Massage parlors, clubs, saunas: it’s impossible to get an exact figure of the number of places where gays might meet a potential sex partner. Kittinun Daramadhaj, president of Rainbow Sky Association of Thailand believes that there’s been a big increase in such venues and that this could be cause for the increase in HIV infection rates.

However, there is no hard data to support this claim; indeed, the alternative must be considered. In other countries or even cities in Thailand without gay venues, sexual encounters happen outdoors or in public toilets. In these places, there’s no way to reach out to gays with the education (pamphlets, posters) and equipment (condoms and lubricant) needed to fight HIV. Gay venues are just the opposite—ideal spots to reach gays and attempt HIV prevention at the moment when it matters most. Even so, a lot of saunas in Thailand could do more. Kittinun says, “Customers will get a condom in their locker and can ask for more at the front desk.” Nonetheless, speaking to gays here who had been to saunas abroad, Thailand has a long way to go, compared to some other countries where you’ll find saunas with overflowing condom and lube dispensers in every booth.

“Not everyone who goes to a gay sauna will have penetrative sex,” says Kittinun. “Of course, those that do have anal sex need condoms but some choose not to use any. Either because they dislike it or can’t be bothered to go to the desk to get one.”

Dot Com Sex

Unfortunately, just as some saunas do little to prevent HIV transmission, not all gay websites (or websites used by gays) practice this kind of social responsibility. “I’m really worried about the internet. It includes all those networking sites, Hi5, Camfrog, etc,” says Kittinun of popular networking websites used by gays here to hook up. “Cam sex is safe, of course, but the majority of users then go and meet each other.”

Top says, “I’m sick of going online, but I just can’t stop myself. I’m always looking for a guy. I don’t even know why I’m doing it. I have safe sex but when you have a lot of partners, accidents happen. I’ve had three real scares from having sex with guys I met online. I’m really lucky to still be HIV negative.”

Silence=Death

Yes, some gays have behaviors that are risky and increase their risk of getting infected with HIV. No, cracking down on them or their venues is not the solution, on the contrary. What is needed is plans that understand and accept these behaviors and finds ways to encourage safe sex that speak to MSMs.

Tied in with the double lives many MSMs lead, the secrecy and the sense of isolation, is the lack of sex education in Thai schools and society. Thanet believes that, “Thai education provides little sex education. It exists but just not enough. They don’t teach students how to put on condoms, how to use the different equipments properly, they don’t provide straight-forward ways of prevention.”

Kittinun agrees, “Simply put, if you don’t talk about homosexuality, gays, MSMs and transgenders, then you’re not tackling HIV.”
Guadamuz adds, “Most Thai guys are living with their families and are in the closet at work. When you don’t have an MSM community to belong to, the only place to meet other gays, even if it’s just to talk, is online or at gay venues.”

According to him, the infection rate is either staying the same or is on the increase. Either way, help is needed now: “They [MSMs] are just not getting the message. We need more money and support to make them understand. They need to get the message, ‘Look you’re in trouble.’”

“I’m terrified. I know there are a lot of people infected with HIV out there,” says Kem. “If I keep on living like this, I probably will die.”
Unfortunately, it’s not fear of death that makes people wear condoms, it’s love of life. “I think people’s perception of HIV/AIDS hasn’t changed in recent years,” says Wipas Wimonsate, medical research technologist for TUC. “There is still fear and discrimination. People should understand HIV/AIDS is treatable, although not yet curable, and not a stigma.” Get tested, know your status, play it safe.