AIDS Epidemic Seriously Underestimated in Thailand

BANGKOK (Reuters) - Nine times as many Thais have died of AIDS than officially reported, according to a joint study released Tuesday, and the worst is still to come.
Alessio Panza, head of the European Union's AIDS program in Bangkok and one of study's authors, said it showed more than 222,000 Thais had died of the disease since 1985, against just 24,667 deaths reported by the Public Health Ministry.
The study also estimates more than 270,000 Thais have the disease, three times more than the official estimate of 90,637.
It projects the total number of AIDS deaths in the country will reach 286,000 by 2000.
"Preliminary calculations show that the vast majority of AIDS-related mortality in Thailand is still to come," it said.
The study was conducted by the European Union and the Institute of Population Studies at Bangkok's Chulalongkorn University. It based its findings on changes in overall mortality statistics between 1989 and 1996.
Panza attributed the discrepancies between the study and the official figures to "AIDS fatigue" and the stigma the disease still carries, which leads to causes of death going unreported by health workers and families of victims.
"Under-reporting is a worldwide phenomenon and is related to the resources allocated to the health system," he said. "Even countries with a lot of resources have under-reporting."
"The problem is that many medical staff don't consider collecting the data a useful activity, so they either don't do it or invent the figures."
The report was co-written by Godfried Van Griensven, an affiliate professor at Chulalongkorn, and Suwanee Surasiengsunk, an assistant professor at the university's department of statistics.
The former is working on a project with the Health Ministry and the U.S. Center for Disease Control and Prevention.
A summary of the study said "excessive" increases in mortality occurred between 1989 and 1996 and could be observed especially in northern Thailand.
It found the highest increases occurred in 20- to 24-year-old females in the northern province of Chiang Rai, where deaths related to AIDS rose from 0.83 per 1,000 females in 1990 to 8.46 percent in 1996.
Many of Thailand's large numbers of sex workers come from Chiang Rai province, which borders Laos and Myanmar (formerly Burma).
The study said that nationally in this age group, 25 percent of all deaths were attributable to AIDS, while in the 25 to 29 age group the figure was 40 to 50 percent.
"In the north, 80 percent of deaths in the 25 to 29 age groups is attributable to AIDS," it added.
The study extrapolated from its findings that in 1996 a total of 1 million Thais were infected with HIV, the virus that causes AIDS, not far off the Health Ministry estimate of 800,000.
However, Panza said there was evidence to show the number of new HIV infections had sharply declined between 1993 and 1996.
Tests on new military recruits, for example, showed infection rates of less than 2 percent of those tested in 1996 compared with approximately 4 percent in 1993. Tests conducted on pregnant women also showed declines, he said.
However, since 1996 there had been a troublesome increase in the infection trend in parts of northern Thailand, apparently due to increased use of intravenous drugs, he said.
The far north of Thailand forms part of the Golden Triangle, one of world's leading sources of opium and its derivative heroin, most of which originates in Myanmar.