Where is the AIDS/HIV in Thailand?

I want to start off this post with a very strong disclaimer: The goal of this post is not to minimize the risks of unprotected sex in any way. The goal is to look at facts and attempt to determine what is true and what is a myth in regards to AIDS/HIV in Thailand. Wear a condom. Always!

With that out of the way, let me give you some background. I’ve been reading various websites over the years and the people constantly mention the high HIV infection rate, especially in girls involved in prostitution. At the same time, Stickman has been quoted as saying that a large number of people he knows engage in unsafe sex (I believe I remember reading he said it was close to 50%). Rumors abound that many working girls will go without a condom for an extra tip. Stick also warns that there are several girls who are well known to be HIV positive and are still working.

If all of this is true; why isn’t there an AIDS/HIV epidemic in the farang community? With the amount of sex that goes on in Patpong, Soi Cowboy, Nana, Pattaya, Patong, and so on why are there so few stories about large numbers of farang men testing positive for HIV?

Now some might claim that the Thai authorities keep it hushed up or that someone who tests HIV positive isn’t likely to broadcast their status to all their friends. But that doesn’t explain why large numbers of men aren’t simply dropping out of the Thailand scene never to be heard from again as their AIDS begins to take hold. Surely people would notice this trend and comment on it, no? Nor does it explain why US, UK, other European, and Australian health officials aren’t sounding a loud bell warning the world about a large spike in cases from tourists recently returned from Thailand.

I don’t mean to propose that people aren’t contracting HIV in Thailand. I’m just asking why the societal impacts don’t seem to match up to the risk being reported.

First off, not everything may be as it seems. Do a large number of women go with farangs without requiring a condom? I don’t think anybody is ever going to be able to do reliable stats on that but my anecdotal evidence is that I’ve met not a single go-go dancer or bar girl who will let you party without a hat. I’ll even joke around and ask how much and not a one ever went for any reasonable offer (up to 1000 baht extra – over that and I guess people will do anything for money but I doubt few regulars to the scene are shelling out that kind of cash per session). By the way, I ask them both for educational purposes and to weed out anyone who would.

Of course my evidence is anecdotal as is Stick’s and others who make this claim so the only thing we can take away from this is maybe I’m too optimistic and the others are too pessimistic and the truth lies somewhere between.

Likewise I don’t know anybody who has ever told me they like to sleep with bargirls without protection. I’m sure some of my friends have done it from time to time or might make a habit out of it but they’ve never discussed it with me. Again, I think my anecdotal evidence runs the opposite end of the spectrum from others so somewhere between our two groups of friends must be the norm.

Lastly, when we see all of these numbers published about HIV/AIDS in Thailand and especially when the numbers concern women engaged in prostitution there is no distinction made between farang prostitution and Thai prostitution which may give misleading numbers. Just due to the sex education available to farangs back home they are far, far less likely to have sex without a condom than say a Thai army conscript who is losing his virginity in a brothel. For that and many other reasons (such as better outreach programs and regular testing) I think it would be safe to assume that sex workers servicing Thai clients are much more likely to contract and spread HIV than those servicing farang customers. So when you hear numbers being thrown around like “X% of Thai sex workers are HIV positive” it doesn’t necessarily mean that that X% of girls working on Soi Cowboy or Nana are HIV positive.

For instance, according to the WHO:

However, problems remain. Infection rates among injecting drug users remain high at 20%-45% nationwide. And in rural areas, HIV infection rates among sex workers have increased. In 1997, 20% of sex workers in rural areas were HIV-positive compared with only 7% in Bangkok. To make matters worse, studies carried out in rural areas reveal that only 50% of men who visit sex workers consistently use condoms. And as risk behaviour increasingly shifts from commercial sex to unprotected casual sex, efforts will be needed to sustain reduced infection rates.

I know this is an old report but it demonstrates how using one infection rate across the entire country is flawed logic. Let’s say the combined total is 14% (since most of the population in Thailand is rural and places like Chiang Mai at one point had rates as high as 40%, I’m assuming the numbers skew to the high side). Saying you have a 14% chance of meeting an HIV positive sex worker in a brothel in Buriram is way too low and saying you have a 14% chance in Nana is double the rate for Bangkok as a whole.

Also, as mentioned before, even in the 7% Bangkok number there is no breakdown between sex workers who service Thais and farangs. I think it would be safe to assume that a Thai brothel is more likely to adopt the Thai casualness towards requiring condoms than would be a farang owned bar on Soi Cowboy. And seeing as that there are more sex workers working in the Thai sex industry than in the farang sex industry, again, assuming a 7% infection rate for your average Nana go-go is likely to be a huge overestimate.

And on top of all that, there’s the tendency to automatically assume a sex worker is a female. There is a vibrant transgender and gay prostitution industry in Bangkok as well. Unfortunately, most educational and awareness programs are aimed at women so, again, I think one would have to assume that HIV rates would run higher in the gay and transgender sex industry which would inflate the Bangkok numbers (the number of gay brothels outside of Bangkok is assumed to be very small compared to within Bangkok) as they too are sex workers.

We may never know the actual truth about what the infection rate is in farang sex venues. Nor is it likely that we will ever hear any sort of accurate numbers regarding how many farangs are contracting HIV from sleeping with Thai prostitutes. Actually we might if there was an alarming trend but barring that the NGOs and other groups who gather this type of data would be doing Thailand a disservice if they were to indicate that the chance of contracting HIV in farang oriented sex venues was relatively low. Better to report the overall number so as to put enough scare into potential customers that they either think twice about going with a prostitute or concerned enough to insist on using a condom.

Again, I would like to close by saying that none of this is meant to downplay the likelihood or the consequences of contracting HIV. If anything it is more for the person who normally practices safe sex and has a condom break during intercourse with a go-go dancer and is wondering what the real chances of him contracting HIV might be without all of the hype and also without all the crazy conspiracy theories that purport everything from you can’t catch HIV from heterosexual sex to there being no link between HIV and AIDS. After reading way too many threads and websites with people giving inaccurate data on both sides of the argument I simply wanted to take a neutral look at the subject and invite people who may have found better data sources than I was able to to comment and better educate people on this important topic.

Wear a condom. Always!

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