HIV and AIDS in Thailand

by: Natalie Bliss and Alyssa Hill

​Human Immunodeficiency Virus is a disease that was discovered in the 1980’s. Research has shown that the source of HIV was likely from chimpanzees and jumped over to the human population around the 1800’s. HIV attacks the immune system killing the T cells. A lack of a strong immune system leaves the body more susceptible to common sickness because it cannot properly fight it off. HIV positive individuals go through different stages of the disease. One of these stages is when the immune system becomes so damaged that it can start developing major infections and infection related cancers and is called acquired immunodeficiency syndrome also known as AIDS (FDA 2012). HIV is spread through body fluids such as blood, semen, vaginal fluids, and breast milk. The most common ways of contracting HIV is through anal or vaginal sex or sharing drug injection equipment with an infected individual. There is currently no cure to HIV however there are medications called antiretroviral drugs you can take to help your body fight infections (CDC,2013).
​Living with HIV/AIDS is a very challenging task among all cultures. People from Thailand specifically face a few obstacles that the average HIV positive individual from the U.S. might not have to face. Thailand has seen HIV/AIDS statistics that are much higher than any other country in Asia. “In 1998, there were approximately 23,000 HIV-positive women who gave birth in Thailand. In 2007 there were 250,000 HIV-positive women, aged 15 and over in Thailand” (Liamputtong, 2013). Seeing these rates helps us determine that not only does Thailand have a problem with this deadly disease, but it has also expanded to the point of an epidemic.
​Emotional challenges have been tied to this disease in many cultures. Symptoms such as anxiety, fear, self-blame, and social stigmatization are common. In Thai culture, they put a special emphasis on appearances and morals. This causes the symptoms of emotional challenges to be much more severe. Because of the emotional challenges present in this culture some natives are known to commit suicide upon discovering they have tested HIV positive. Though Thailand does not persecute for different religious beliefs, the majority of the Thai people practice Buddhism. Part of the Buddhist religion has to do with the idea of Karma, that any good or bad action done by a person causes a good or bad consequence in return. The main source of HIV infection for women in Thailand has been shown to be from sexual intercourse in monogamous relationships according to studies that have been conducted so far. However, because HIV is spread through bodily fluids it can therefore be passed to an offspring if the mother is positive. This is a big issue in Thailand because many women do not know they have the disease until they are already pregnant (Liamputtong, 2013). Due to the social isolation this disease causes, family in Thailand is essential to the management and care of this difficult disease.
​Thailand has a high burden of HIV and AIDS with as many as 610,000 people living with HIV by the end of 2007 (Ishikawa, 2010). People living with HIV/Aids in Thailand face multiple challenges including coping with HIV-related disclosure and stigma and maintaining positive family relationships. HIV disclosure has been identified as a key stressor for people living with HIV in Thailand (Li, 2010). In addition to disclosure, it is necessary to address stigma as an HIV-related stressor. It has been documented that a high level of perceived stigma exists in Thailand, and a significant association between stigma and depression is prevalent (Li, 2010).
​Since Thailand is a strongly family oriented society, and typical Thai families are tightly knit, the treatment of those dealing with HIV affects the entire family. Due to the social support offered by family the treatment of those dealing with HIV is substantially better than those dealing with the disease individually (Li, 2010). The internalized shame of those dealing with HIV/AIDS correlates directly to amount of social and family support these individuals have. The more support, the more likely they are to comply with treatments and regimens as well as have a positive outlook on the management of their disease.
​A study in Thailand was conducted resulting in the conclusion that involving families and implementing behavioral intervention was successful in improving the quality of life of people living with HIV (Li, 2010). Interventions determined by medical staff must be performed in a systematic, collaborative manner to ensure that their culture, religion and most importantly family, were all implemented in the plan of care. Because the Thai family culture is so essential in the lives of those living with HIV/Aids, treatment can become a challenge for the entire family.
​HIV and AIDS not only impact those who are infected, but also on their family members, especially children. It was estimated that more than 289,000 children had lost parents to AIDS by 2001 (Ishikawa, 2010).  Children affected by AIDS frequently experience increased poverty, physical abuse and poor psychosocial health (Ishikawa, 2010). Children affected by AIDS find it difficult to communicate their concerns and anxieties to others, so they remain silently neglected.
​In the article Breaking down the wall of silence around children affected by AIDS in Thailand to support their psychosocial health, a study was completed consisting of 9 families and 8 children. The study was designed to explore a neglected area of study about the causes of poor psychosocial health in children affected by AIDS and how their needs can be meat. The article explains that parents create a wall of silence surrounding their children to help protect them and this study is identifying if this method is conducive to the psychosocial health and wellbeing of children associated with HIV and AIDS. Data was collected from observation and an interview process over a period of 12 months. The topic of AIDS was not discussed in the interviews unless the children brought it up.
​Children’s psychosocial experiences were found to fall into five main categories, bullying and discrimination, isolation and loneliness, parents HIV status and death, concern about own infection risk, and discussion. Results inform readers of this article that children in Thailand are being bullied and rejected because of the status of HIV in their families. The lack of education on HIV/AIDS in the community, especially in the young population, presents children with a clouded understanding of what the disease is and places the children who are affected by the disease in a position to be bullied and discriminated against. Because of the rejection they feel these children isolate themselves to avoid being bullied, creating a void in their social growth. Parents HIV status and death was not communicated very much between parent and child. The parents believed that it was not something that their children needed to be worried about and thus avoided the conversation. The children then feel that it is unacceptable to talk about their feelings with their parents and become emotionally unstable. Due to the family taboo of discussing HIV and Aids in Thailand, children were not educated on the matter and their fears about contracting the virus went unaddressed. Most children in the study new HIV was life threatening, but didn’t understand the transmission process. Several of the children believed that because their parents were infected, that they were automatically infected as well.
​HIV and Aids is a disease that not only affects those who are physically battling it, but it affects those who are most precious to them. This study has shown that family members, children specifically, are psychosocially affected by AIDS. The wall of silence built to protect them prevents them from truly being able to express and understand the disease and how to cope. There is an urgent need to raise awareness in Thailand of the positive role that open communication between families facilitates in supporting psychosocial needs.
​Although HIV/AIDS is an epidemic that requires much sacrifice and courage, the Thai family culture is one of extreme loyalty and support. Although individuals may struggle with the aspect of social isolation because of the strict morals in the Thai culture, the family unit is an essential role in the caring of those who are struggling with this disease. Although the prevalence of HIV/AIDS is rampant in Thailand, there is hope because of the strong family culture and respect they selflessly give.

References:

Li, L. (2010). Improving the health and mental health of people living with hiv/aids: 12-month assessment of a behavioral intervention in Thailand . American Journal of Public Health, 100(12), 1-9.

Ishikawa, N. (2010). Breaking down the wall of silence around children affected by aids in thailand to support their psychosocial health . AIDS Care, 22(3),

Liamputtong, P., Haritavorn, N., & Kiatying-Angsulee, N. (2012). Living Positively: The Experiences of Thai Women Living With HIV/AIDS in Central Thailand. Qualitative Health Research, 22(4), 441-451. doi:10.1177/1049732311421680

Thato, R., & Penrose, J. (2013). A Brief, Peer-Led HIV Prevention Program for College Students in Bangkok, Thailand. Journal Of Pediatric & Adolescent Gynecology, 26(1), 58-65. doi:10.1016/j.jpag.2012.09.011

undefined. (24 April 2013). HIV/AIDS. In Center for Disease Control and Prevention. Retrieved 1 May 2013, from http://www.cdc.gov/hiv/basics/whatishiv.html.

undefined. (28 March 2012). HIV/AIDS Timeline/History. In U.S. Department of Health & Human Services. Retrieved 1 May 2013, from http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm117935.htm.