In Thailand, as in many other countries, getting the government to provide an adequate response to HIV/AIDS has been a long and frustrating battle. The struggle to engage government in the HIV/AIDS pandemic in Thailand can be traced through the activities of Mechai Viravaidya, a Thai AIDS activist and politician, who has proved to be a "leader who forces people to confront what they would otherwise wish to avoid."

As spokesman for the government of General Prem Tinsulanonda from 1986-88, Mechai Viravaidya was already apprehensive about the potential devastation HIV/AIDS could wreak in Thailand and disturbed by the government's silence on the issue. Because of his position in government, however, he found it difficult to articulate his concerns.

Rather than wait for government to act, Mechai decided he would start the fight against HIV/AIDS through the Population and Community Development Association (PDA), an NGO he had established in 1974. As an NGO involved in family planning and community development, PDA was ideally suited to play a role in HIV/AIDS awareness and prevention. In 1987, PDA launched a campaign to promote HIV/AIDS awareness involving the production and distribution of audiotapes, videocassettes, books and pamphlets. PDA staff also ventured  into the community to give lectures and provide information on HIV/AIDS.

From mid-1988 to July 1989, Mechai was a visiting scholar at Harvard University in the United States, where he spent much time researching HIV/AIDS. Upon his return to Thailand, it was clear that the situation had radically deteriorated, with HIV spreading rapidly among injecting drug users (IDUs). In December 1987, 4% of IDUs had tested positive to HIV; in March 1988, the percentage had jumped to 16%, and by September 1988, to 43%. The second wave had arrived and it was only a matter of time before such infection patterns would be replicated within other population groups.

Continuing government indifference

The major problem continued to be government indifference to HIV prevention. The government's response was limited to the Ministry of Public Health (MoPH), which insisted on dealing with HIV/AIDS primarily as a medical rather than a social problem. Action was limited to tracking the disease rather than pursuing a policy of education and prevention. This one-dimensional approach was leading Thailand toward potential disaster. At the International Conference on AIDS in Montreal in June 1989, Mechai warned that given Thailand's ubiquitous sex industry, the spread of HIV into the general population would be explosive.

In Thailand, Mechai took the battle to the streets, starting with Bangkok's Patpong Road, the country's best-known red light district. With PDA staff he handed out free condoms to sex workers, filled condoms with helium and released them as balloons and held a Miss Condom beauty pageant. As intended, these events attracted media attention and helped to spread the message about HIV/AIDS.

Nevertheless, getting the message out to society at large and promoting change of long-held attitudes and sexual behaviour were going to be difficult without government cooperation. The government and the army controlled most radio and television stations. The government also had the power to pass legislation and mobilise the various ministries needed to launch a major awareness campaign.

Forcing the turning point

To force government to take action, a new approach was needed. As long as government viewed HIV/AIDS as a purely medical problem, little change would occur. In 1990, Mechai brought together a team of leading economists and social scientists to prepare a report on the expected direct and indirect economic and social costs of HIV/AIDS in Thailand: these were estimated to reach US$8 billion by the year 2000. These findings were presented at the International Conference on AIDS in Bangkok in 1990.

Unable to ignore the issue any longer, the government asked Mechai to brief the Cabinet in December 1990. The administration agreed to create a National AIDS Advisory Committee (NAAC) and appointed Mechai as chairman. Unfortunately, having finally gained the government's attention, the military overthrew the government in February 1991. After only one month in operation, the new government dissolved the NAAC. What initially appeared to be a major setback, however, became the turning point in Thailand's fight against AIDS. Careful not to antagonise civil society, the military rulers decided not to take over the reins of government themselves, but rather appoint a civilian as Prime Minister. The new Prime Minister offered Mechai the post of Minister attached to the Prime Minister's office, responsible for Tourism, Public Information and Mass Communications – the very departments that had put up so much resistance to the campaign against HIV/AIDS. In addition, Mechai requested and was granted responsibility for the National HIV Prevention Programmes.

As an appointed rather than an elected government, the new administration was free from the usual factionalism of Thai coalition governments and the constraints of an administration seeking re-election. It was therefore able to move quickly on a number of fronts, including HIV/AIDS. It appointed a new National AIDS Committee, with the Prime Minister as chair and the Minister of Public Health as deputy chair. Assisted by the National Economic and Social Development Board (NESDB), Mechai established an AIDS Planning and Coordination Bureau to coordinate a multi-sectoral AIDS strategy.

Funding for the fight against AIDS increased from 62 million Baht (US$2.5 million) in 1991 to 1.2 billion Baht (US$48 million) under the civilian prime minister. All sectors were brought into a programme whose main themes were education, prevention, and understanding and compassion for PLWHAs. The education campaign employed all 488 government radio stations and 15 TV stations. Education of government officials was made mandatory and AIDS education was introduced as part of the course work in all higher education institutions, as well as in the last two years of primary school and throughout secondary school.

Increased monitoring of the disease was undertaken, with random testing of sex workers throughout the country. A 100% condom use policy was promoted. These actions and the hugely increased awareness resulting from the campaign led to immediate results: condom use increased dramatically and sexually transmitted infection (STI) rates fell from 410,406 in 1989 to 22,765 in 1997. In 1989, a survey showed that 25% of sex workers were using condoms; by 1994 this figure had risen to 93%.

Individual leadership makes the difference

It is impossible to estimate the number of lives saved by Mechai Viravaidya's leadership in tackling the HIV/AIDS problem in Thailand, but they would surely number in the hundreds of thousands. Thailand's successes in the war against AIDS were a direct result of forcing Thai society and government to confront issues that they would much rather have avoided and then challenging them to change ingrained habits and beliefs. Of course, success often breeds renewed apathy and this is true in the case of AIDS in Thailand. Mechai, as well as the PDA, continue to play a major role in HIV/AIDS education and – through advocacy – to ensure this issue remains on the agenda of present and future governments.