A tale of AIDS in two countries

Swaziland:

Deaths on a large scale began here only in 2000. Suddenly the obituary pages of the national newspapers began to rival the sports pages in length, and the young as well as the old found their friends there. Funeral homes and coffin makers began their macabre ascendancy as this developing nation’s foremost growth industry. A wave followed not just of orphans, but also of children impoverished because AIDS killed the breadwinners of extended families. Today more than 150,000 of these orphans and vulnerable children exist on the margins of survival there.

Thailand:

As part of the [100 Percent Condom] campaign, public health officials aggressively focused on bars, brothels, nightclubs and massage parlors for condom education, promotion and distribution. Sex workers were likewise offered counseling, testing and treatment. The openness of sex venues there and health officials’ access to the women in them made this a relatively simple intervention.

Venues that did not agree to require condom use were shut down. Signs appeared over bar doors saying, “No condom, no sex, no refund!” And the government put resources behind the effort, distributing some 60 million free condoms a year.

A wider national effort was also under way. Condoms appeared in village shops and urban supermarkets, and frank H.I.V. education was introduced in schools, hospitals, workplaces, the military and the mass media. Thais worked hard to reduce fear and stigma and to support those living with H.I.V.

This national mobilization was classically Thai — funny, nonthreatening and sex-positive. When we briefed the Thai surgeon general on an H.I.V. prevention program for soldiers, he said, “Please be sure the program maintains sexual pleasure, otherwise the men won’t like it and won’t use it.”

It worked. By 2001, fewer than 1 percent of army recruits were H.I.V. positive, infection rates had fallen among pregnant women, and several million infections had been averted.