Photo by babasteveHIV prevalence dropped from about 20% in 1991 to less than 1% by end of 2005 in Phayao. Suwat, who headed the team conducting HIV surveillance studies in this region of northern Thailand, is also an ardent Buddhist, advocating holistic approaches to life, in order to respond effectively to AIDS. The opportunity to interact with Suwat presented during the recent SALT Visit facilitated by The Constellation for AIDS Competence, when we went to ‘Suwat Land’ - The house of nature and of life in Phayao.
How did Phayao made the landmark shift in reversing the HIV tide?
“We look at the human life and not just AIDS. People living with HIV are not living with HIV alone. People with or without HIV, live with their families, in their respective communities, with their sorrows and joys, and so when we talk to them we need a more holistic approach” said Suwat.
We need to talk about other issues too because not only HIV but other things effect the life as well. “AIDS is just one part of the life” said Suwat.
He further shares that “When I go to office, people keep telling me that AIDS is the most leading cause of death”. Suwat focuses on ‘leading causes’ to stay alive and healthy. “We have to take care of people’s lives not just limited to the AIDS-related care. People without HIV too sometimes die earlier than people with HIV. Everybody without HIV will get sick sometimes during their lives and may develop similar symptoms too” said Suwat. He focuses on a range of issues affecting the quality of one’s life. “People should eat properly, get diagnosed and treated for opportunistic infections properly, take good care of themselves… take care of others with HIV in the community as they look after their relatives or friends” ponders Suwat.
Dr Jean Louis Lamborey, from The Constellation for AIDS Competence, who had worked in northern Thailand for years earlier, said that Suwat produces a detailed report with HIV prevalence data every six months using military conscripts which is classified as per indicators like the district, pregnant women, age, society, sexual behaviours, number of sexual encounter, and a range of other indicators.
Once Suwat brought all data on Dr Lamborey’s desk, and asked “Dr Lamborey, here are your data. Do you think we will ever understand AIDS with this data? We should use ‘both sides’ of the brain”.
Why was HIV prevalence high in northern Thailand?
Suwat responds that values of people in northern Thailand were different, and they wanted to have fun. Initially sex-work was stigmatized in this part of the country as well, but when money started coming in due to sex-work and families prospered on this money with material benefits, the stigma associated with sex-work became non-existent making sex-work as an economic status.
When this part of the country was worst-hit by AIDS, nearly every family had a person living with AIDS. Communities in northern Thailand had no choice but to learn to live with AIDS.
But why doesn’t this seem to happen in other places hard-hit by AIDS?
Suwat had no clear answer. He said possibly it might be due to the different religious or cultural contexts in different countries.
Suwat advocates a comprehensive, integrated and holistic approach to a healthy life. He says government often have contradictory policies or programmes. For example in Thailand, there is a policy making it legal to brew alcohol locally, and another policy to encourage Thai people to quit alcohol use. So unless policies are congruent to each other, the desired effect will not be seen in the society.
“Some diseases don’t have a social impact like diabetes, hypertension, but some like alcohol, AIDS and drugs have a profound social impact. So when one person is impacted by alcohol, drugs or AIDS, whole family or affected community should be considered to be ‘sick’ or ‘ill’ because all of them have to face the consequences. Therefore they all need to understand how to manage and respond to the ‘illness’ effectively” explains Suwat.
There are different responsibilities we all need to shoulder to effectively respond to AIDS.
Suwat shares the findings of a study in a small group of individuals in Thailand conducted few years back. These men were using glass penile inserts while having sex. The study participants said that they use it ‘for fun’. ‘Because women scream’, since these glass penile inserts might be cutting through the condom and hurting women’s vagina. This stimulated and aroused these men. Suwat’s study changed the policy and an active awareness campaign was targeted at the above-mentioned group explaining the negative consequences of using glass inserts including cancer, infections, and a higher risk of surgical removal of the outer skin or scrotum.
In 1990s, when the AIDS had worst-hit this region, the healthcare workers were finding it difficult to cope with the onslaught and overwhelming grief around them. Dr Petshri Sirinirund, who was then working with the Health office of the Phayao, took all the healthcare workers on a retreat to help them come to terms with AIDS. They reflected on AIDS in their personal lives, as a spouse, a parent, a lover or a child, and also on their own vulnerabilities and risks to HIV. The order of that day was ‘understand yourself, then you will be able to understand others’.
Bobby Ramakant-CNS
How did Phayao made the landmark shift in reversing the HIV tide?
“We look at the human life and not just AIDS. People living with HIV are not living with HIV alone. People with or without HIV, live with their families, in their respective communities, with their sorrows and joys, and so when we talk to them we need a more holistic approach” said Suwat.
We need to talk about other issues too because not only HIV but other things effect the life as well. “AIDS is just one part of the life” said Suwat.
He further shares that “When I go to office, people keep telling me that AIDS is the most leading cause of death”. Suwat focuses on ‘leading causes’ to stay alive and healthy. “We have to take care of people’s lives not just limited to the AIDS-related care. People without HIV too sometimes die earlier than people with HIV. Everybody without HIV will get sick sometimes during their lives and may develop similar symptoms too” said Suwat. He focuses on a range of issues affecting the quality of one’s life. “People should eat properly, get diagnosed and treated for opportunistic infections properly, take good care of themselves… take care of others with HIV in the community as they look after their relatives or friends” ponders Suwat.
Dr Jean Louis Lamborey, from The Constellation for AIDS Competence, who had worked in northern Thailand for years earlier, said that Suwat produces a detailed report with HIV prevalence data every six months using military conscripts which is classified as per indicators like the district, pregnant women, age, society, sexual behaviours, number of sexual encounter, and a range of other indicators.
Once Suwat brought all data on Dr Lamborey’s desk, and asked “Dr Lamborey, here are your data. Do you think we will ever understand AIDS with this data? We should use ‘both sides’ of the brain”.
Why was HIV prevalence high in northern Thailand?
Suwat responds that values of people in northern Thailand were different, and they wanted to have fun. Initially sex-work was stigmatized in this part of the country as well, but when money started coming in due to sex-work and families prospered on this money with material benefits, the stigma associated with sex-work became non-existent making sex-work as an economic status.
When this part of the country was worst-hit by AIDS, nearly every family had a person living with AIDS. Communities in northern Thailand had no choice but to learn to live with AIDS.
But why doesn’t this seem to happen in other places hard-hit by AIDS?
Suwat had no clear answer. He said possibly it might be due to the different religious or cultural contexts in different countries.
Suwat advocates a comprehensive, integrated and holistic approach to a healthy life. He says government often have contradictory policies or programmes. For example in Thailand, there is a policy making it legal to brew alcohol locally, and another policy to encourage Thai people to quit alcohol use. So unless policies are congruent to each other, the desired effect will not be seen in the society.
“Some diseases don’t have a social impact like diabetes, hypertension, but some like alcohol, AIDS and drugs have a profound social impact. So when one person is impacted by alcohol, drugs or AIDS, whole family or affected community should be considered to be ‘sick’ or ‘ill’ because all of them have to face the consequences. Therefore they all need to understand how to manage and respond to the ‘illness’ effectively” explains Suwat.
There are different responsibilities we all need to shoulder to effectively respond to AIDS.
Suwat shares the findings of a study in a small group of individuals in Thailand conducted few years back. These men were using glass penile inserts while having sex. The study participants said that they use it ‘for fun’. ‘Because women scream’, since these glass penile inserts might be cutting through the condom and hurting women’s vagina. This stimulated and aroused these men. Suwat’s study changed the policy and an active awareness campaign was targeted at the above-mentioned group explaining the negative consequences of using glass inserts including cancer, infections, and a higher risk of surgical removal of the outer skin or scrotum.
In 1990s, when the AIDS had worst-hit this region, the healthcare workers were finding it difficult to cope with the onslaught and overwhelming grief around them. Dr Petshri Sirinirund, who was then working with the Health office of the Phayao, took all the healthcare workers on a retreat to help them come to terms with AIDS. They reflected on AIDS in their personal lives, as a spouse, a parent, a lover or a child, and also on their own vulnerabilities and risks to HIV. The order of that day was ‘understand yourself, then you will be able to understand others’.
Bobby Ramakant-CNS
