Humanitarian Efforts in the Face of the HIV/AIDS Pandemic:
Lopburi, Thailand

Although it has been reduced, the rate of HIV transmission in Thailand still needs to remain under a watchful eye. Therefore, national programs, including the prevention programs in the uniformed services, must be sustained in order to maintain control over this daunting disease. This necessitates humanitarian efforts and civil-military collaboration to assist in mitigating the effects of a 20-year-old epidemic.

Wat Phra Baht Nam Phu exemplifies this collaborative effort. Situated 120 km north of Bangkok, Thailand in the rural town of Lopburi, it reaches out through its humanitarian efforts to people living with HIV/AIDS. Lopburi, under King Narai, was once the capital of Thailand and has been home to many civilizations for more than 1,200 years. Many people in Thailand have long known Lopburi for its high prevalence of monkeys, which attract tourists from across the land. However, Lopburi is now becoming widely known for its Buddhist-founded AIDS temple. In 1992, the Buddhist monk Dr. Alongkot Dikkapanyo turned a normal upcountry Buddhist temple into a small hospice to care for patients with fully blown AIDS. Initially an eight-bed facility, the temple has grown to have a capacity of more than 400 beds. The grounds of the temple and the homes in this community are nestled in a lush green pocket of forest against a mountain backdrop overlooking the fields of Lopburi. Humanitarian efforts and aid provided by Dr. Alongkot, the Royal Thai family, the Supreme Patriarch, members of the Buddhist faith, and the Royal Thai Army have augmented the growth of this facility since it opened its doors more than 10 years ago. It has provided a place of serenity for people who have contracted the virus and been shunned by others.

Surrounded by the forested mountains of rural Thailand, the Buddhist temple Wat Phra Baht Nam Phu exemplifies the meaning of the word refuge. At first glance, the temple’s iconographic symbols are what one might expect at such a place. Upon closer inspection, however, Wat Phra is unlike most places in the world. Each member of the community that dwells inside is either seropositive with the Human Immunodeficiency Virus (HIV) and/or afflicted with Autoimmune Deficiency Syndrome (AIDS), or solely focused on assisting and caring for those in need. The humanitarian efforts demonstrated by this community and facility in the changing face of the HIV/AIDS pandemic illustrate the many challenges that lie ahead for the much larger, global community.
The index case (first known case) of AIDS in Thailand, discovered prior to the advent of testing for the presence of the HIV virus, was reported in 1984 (UNAIDS/WHO, 2002). In 1988 and 1989, the first major pulse of the epidemic hit Thailand. Data from 2001, little more than a decade later, estimate the total population of Thailand at 63,584,000. The estimated adult prevalence of HIV/AIDS is 1.8% and the number of AIDS-related deaths in 2001 was approximately 55,000. AIDS-related deaths have recently surpassed motor vehicle accidents as Thailand’s number one cause of death (UNAIDS/WHO, 2002). More than one in every one hundred Thais is currently infected with HIV, which extrapolates to between 650,000 and 1 million people.

The main routes of transmission have been changing, which confirms the importance of epidemiological assessment. At the onset, transmission of the virus principally revolved around the commercial sex trade and intravenous drug use. Due to the success of the national civil program implemented by the government, and the military program implemented by the Royal Thai Army, both prevalence and incidence of the disease were reduced. However, there is a new wave of transmission occurring among wives and non-commercial sexual partners of men who were infected during the early waves of transmission (Joint UN Programme, 2004). There is also concern for higher-risk groups, such as members of the uniformed services in Thailand. The Royal Thai Army (RTA) played a major role in the early epidemiology of transmission of the virus, causing the emerging epidemic to affect national security. This resulted in the need for a collaborative effort between civil and military sectors to combat the epidemic. The RTA’s initial surveillance provided information and insight into the Thai epidemic, influencing national policy. In 1990-1991, the government launched a national campaign that partnered and mobilized all sectors of government to reduce HIV transmission. The RTA has since documented its experience and prevention program in a report included in the UNAIDS Best Practices Series (Joint UN Programme, 2004).

Although Bangkok is a well-developed urban center, Thailand, for the most part, is a developing country. It still succumbs to misconceptions about HIV/AIDS, and in many places, infected people are discriminated against and stigmatized. It is the government’s policy to have families care for AIDS sufferers; however, the situation is more complicated because the majority of these families refuse to care for them. Due to a lack of awareness and education on HIV/AIDS, some families are fearful of ‘getting sick.’ Others do not want to be stigmatized themselves for having cared for a seropositive family member. Although not isolated to Thailand, stigmatization and discrimination of people with HIV/AIDS has persisted since the epidemic began more than 20 years ago. Wat Phra Baht Nam Phu is a place that breaks those barriers and is devoid of this disabling environment and perspective. Although home to more than 300 people living with HIV/AIDS, it is not a community of victims.

Rather, Wat Phra Baht Nam Phu is a community of friends, companions, and humanitarians. The despair of having HIV/AIDS is not noticeable as you walk the grounds and talk with its residents. Happiness is seen in the steps of a seropositive four-year-old, whose mother and father have both died after succumbing to the disease, as she dances and performs on stage in the auditorium for a cadre of visitors who frequent the temple daily. Optimism abounds in the eyes of a 40-year-old man who was recently initiated on antiretroviral (ARV) treatment recently available to some members of the community. Comradery is evident as three residents lift weights and hit the rowing machine in a designated exercise area. All of these examples illustrate the optimistic and thankful outlook of community members during their daily life at Wat Phra Baht Nam Phu.

Yet, as you traverse the grounds and the hospice where 30 beds are reserved for the most ill, there is also an obvious bite of reality — a bite of reality like that of a great white shark. It is impossible to resist feeling empathy as you witness the jaws of HIV and AIDS clamping down on these patients. Natural progression of the untreated disease has rendered these patients severely immuno-compromised and susceptible to opportunistic infections that a normal immune system can counteract. As a result, the syndrome of AIDS takes hold and greatly diminishes the patients’ chances of survival. The temple’s incinerator is testament to this fact. At times, there are three burials (incinerations) in one week. Amazingly enough, amidst the poor prognosis, patients still muster a smile and deliver a greeting. Most are even willing to have their pictures taken.

One seropositive patient, Anne, a former sex worker, welcomes the dialogue, friendship, and attention. Greeting visitors with a smile, she poses for pictures. As the still photos are taken, one can’t help contemplate the dichotomy of our worlds. Guests to the temple gaze wide-eyed upon these patients. Patients are not on display; however, most realize that seeing the effects of the disease might prevent further transmission by providing lasting visual images in the minds of the visitors. For some visitors, including some of the military medical participants at the HIV/AIDS Joint Regional Training Center in Bangkok, a visit to the temple is a life-changing experience.

According to Father Bossano, a Catholic priest and 5-year volunteer at Wat Phra Baht Nam Phu, the temple sits on grounds donated by the military. Lopburi is also home to the largest military base and most intense concentration of RTA soldiers in Thailand. The RTA is active in its humanitarian efforts at Wat Phra Baht Nam Phu. In addition to having donated the land, the RTA provides aid in circumstances that may require manpower, construction, and even transportation of goods. The RTA delivers much of the water brought to the temple and facilities. In a country that has not fully come to terms with the HIV/AIDS epidemic, the RTA stands out as both a humanitarian and a pioneer of HIV/AIDS-control efforts. The RTA is well known throughout the Asia-Pacific region for its model HIV/AIDS prevention, control, and mitigation efforts in the Armed Forces; and its success in reducing the HIV prevalence rate in its ranks is much touted. In 2003, in its efforts to continue as a pioneer in the fight against HIV/AIDS, the RTA signed an agreement with U.S. Pacific Command (PACOM) and its HIV/AIDS Prevention Program Implementing Agent, the Center of Excellence in Disaster Management and Humanitarian Assistance (COE), to create the aforementioned HIV/AIDS Joint Regional Training Center (RTC) in Bangkok. To date, the partnership has collaborated to execute seven regional workshops that directly trained 166 military medical personnel (mostly physicians) from 22 countries.

As part of each weeklong training, the RTA provided many of these military physicians the opportunity to visit Wat Phra Baht Nam Phu to see first-hand the fruits of humanitarian labor. Thus, through humanitarian efforts, Thailand has not only created a haven for people living with HIV/AIDS, but also an educational center to raise awareness of the HIV/AIDS situation in the Thai community, government, and military. Wat Phra Baht Nam Phu is a community that exemplifies an enabling environment and because of this, many of its residents are able to improve their mental and physical well-being. This environment fosters the individual and collective growth of its residents and is void of stigma and discrimination.

In many regions of the Asia Pacific, ARV treatment is challenging due to lack of access and delivery infrastructure, and thus can dramatically reduce average life expectancy. The expanded availability of ARV treatment is also a promising change within countries such as Thailand, and may eventually allow some residents to assimilate back into their respective communities. Over the years, collaborations like Wat Phra Baht Nam Phu, as well as prevention efforts between the national government and the RTA, have proven essential to Thailand’s HIV/AIDS mitigation efforts. As the HIV pandemic continues, the temple in Lopburi province stands tall as yet another example of the grace of compassionate humanitarian relief.

References
Joint United Nations Programme on HIV/AIDS. (2004). HIV/AIDS prevention and control: an experience of the Royal Thai Army in Thailand. UNAIDS Series: Engaging Uniformed Services in the fight against AIDS. Case Study 3.

UNAIDS/WHO. (2002). Epidemiological Fact Sheet on HIV and Sexually Transmitted Infections: Thailand. Retrieved July 26, 2004 from UNAIDS/WHO: http://www.who.int/emc-
hiv/fact_sheets/pdfs/Thailand_EN.pdf