From: matthew@ooc.uva.nl (Matthew Lewis)
Newsgroups: sci.med.aids
Subject: Conference newspaper - Thursday 23 July - part 4
Date: 24 Jul 92 12:47:57 GMT
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Note: non-commercial reproduction.
Archive-Number: 5776

(article continued from part 3)

...

Surapong Charoenkuwatana:
Not enough information

The most pressing problem for people with AIDS in Thailand, says 
Surapong Charoenkuwatana, is that most of them are fired as soon 
as their employers learn they have the disease. "Even the 
government does it. Officially, they have a policy not to fire HIV-
positive people or people with AIDS but they throw that away."
Surapong, who himself has AIDS, hopes that a proposed law will 
change this. Under the new law, which should go into effect in two 
or three years, employers will be obliged to hire seropositive 
people and there will be a penalty for firing them. 
Charoenkuwatana says the problem is a lack of understanding. 
"Especially outside Bangkok, there is not enough information. For 
the past two or three years, some newspapers have begun writing 
about people who were fired because of AIDS. Television has only 
very recently given attention to it. Radio is still a big problem. Most 
DJs know nothing about AIDS and are afraid to touch it." 
Surapong tested positive for HIV in 1985 and was diagnosed with 
AIDS in 1989. He is a freelance journalist, specialising in consumer 
electronics. He is his own boss and has no problems with 
discrimination. "There is still a lot of work for me." Surapong 
became infected by having sex with a prostitute. The question of 
whether he could remember which one makes him giggle. "Sir, I 
had more than 500 of them. I just had bad luck."
Surapong frequented massage parlours for about seven years. "We 
have very beautiful girls in Thailand, especially in the north. But it 
is difficult to meet them and therefore most single men in 
Thailand, but also many married men, go to massage parlours."
Surapong chairs a self-help group in Bangkok. There are about 200 
in the group, including both seropositives and those diagnosed with 
AIDS. They exchange information on drugs like AZT or DDC and on 
food. "Since I was diagnosed with AIDS I drink milk every day," says 
Surapong.
Massage remains a major topic. "We had someone over from France 
who taught us about a special healing massage for AIDS patients. We 
set up a course and tried the technique on each other."

...

Nobby Gilmore
Human rights are ideas

"Human rights are ideas," says Nobby Gilmore of the McGill Centre 
for Ethics and Law in Montreal, Canada. "You can make rules and 
laws, and that should be done, but in the long run it comes down to 
how people exercise them in a day-to-day fashion. It is often an 
individual decision. Like being at a cocktail party and hearing 
people talking badly about someone. Do you ask them to stop it?"
Gilmore is a 50-year-old physician who occasionally sees patients 
but now specialises in ethics and law at McGill University. For six 
years he chaired Canada's advisory commission on AIDS and now 
advises Canadian prisons on how to deal with AIDS, drugs and HIV- 
positive people.
He says three words are essential in the discussion of AIDS and 
human rights: leadership, communication and accountability. 
Leadership is necessary on a national and individual level: do 
politicians speak out about the need to give houses and jobs to HIV 
positives? Do individuals protest when they see a neighbour with 
AIDS being stigmatised?
Communication is important because people should be aware that 
they have certain rights.
Accountability makes it clear who is responsible for what.
Gilmore says the main problem for Canada, as in most industrialised 
countries, is that no one can dictate changes in attitude and 
behaviour. "The rules and laws are generally OK. There is no 
violation of human rights at a governmental or institutional level. 
But at an individual level there is still a lot of discrimination and 
stigmatisation. It is difficult to prove it but it's there."
One remaining problem in Canada that must be addressed on a 
governmental level is that sexual orientation is rarely included in 
anti-discrimination statutes and policies. "Only three provinces 
have included sexual orientation. The federal government says they 
want to include it in the human charter, but they have said that for 
10 years now and there has been no action."
Gilmore says that in most industrialised countries there is more 
good news than bad on the AIDS and human rights front. In Canada, 
for example, condoms and bleach for cleaning needles are available 
in prisons, there are human rights commissions in every province, 
needle-exchange programms and sex education have been set up, 
immigrants are not required to be tested, and there is a Medicare 
system for the poor.
"Once I heard someone from Uganda say that the human rights we 
are worried about would be called privileges in many other 
countries. 
"I am afraid that's true."

...

Oliver Kanene:
A positive result means no job

Oliver Kanene, a 36-year-old lecturer in journalism at a college in 
Lusaka, Zambia, cannot talk openly about his HIV-positive status. "I 
have children at school and I am afraid of the reaction of their 
teachers. I have work mates and I do not know if I can handle the 
way they will look at me when I tell them I am HIV-positive."
Kanene is not an exception in Zambia. A large part of the population 
is HIV-positive. Kanene has spoken with some doctors and done 
some calculations himself: "About 25% of all women between 15 
and 35 are HIV positive, about 20% of all malnourished children in 
Zambia are positive."
There is a worrisome contradiction: Zambia has a higher 
proportion of HIV-positive people than European countries and yet 
it is much more difficult to be open about it. "I have HIV-positive 
friends in London, Spain and Italy. There, you can live a normal 
life."
The problem is that most Zambians confuse being HIV-positive with 
an AIDS diagnosis. "They think you are dying. That's nonsense. I 
have known since January 1987 that I am positive. I feel good and 
maybe I will live for ten more years."
Only a handful of Zambians talk openly about their serostatus. 
"People who are in protected situations, who have less to fear. Who 
will not lose their jobs. For all the others it is a stigma. They 
immediately think that someone who is HIV positive has been very 
promiscuous. People do not dare to be interviewed in the 
newspapers. It is a disease of shame."
An additional problem is that institutions such as banks require an 
HIV test when someone applies for a job. A positive result means no 
job. "The media in Zambia are not very educated. People are just 
not aware that the risk of infection from someone who is HIV-
positive is not a serious problem so long as you don't have sex."
Kanene has assembled a group of seropositive people. With financial 
aid from the Dutch embassy in Lusaka, they have produced a book of 
stories by HIV-positive people. "It is so important to have the right 
information at the right place. For instance, when you go to the 
shanty townships, the ghettos, people ask questions like: how is it 
possible that there is no danger if a mosquito who feeds on an AIDS 
patient or HIV-positive person and then bites someone who is not 
yet infected? Those are very basic questions."

*************

Chantaiwipa Apisukh:
Empowering women to decide for themselves

By William Check
After Chantaiwipa Apisukh graduated from college in Thailand, she 
spent several years in the US. In 1984 she returned home.  "I left 
home because I wanted to see things," she says. "Then it was time 
to go back. We had a baby daughter, and I would like her to go to 
school in Thailand and to know the country." 
In 1985, after holding several jobs, Apisukh founded EMPOWER 
(Education Means Protection Of Women Engaged in Recreation), an 
organization working with women in the sex industry to help them 
obtain basic rights, such as protection from AIDS, and to provide 
access to education for those who couldn't attend school because of 
restrictions, such as a lack of time. 
Apisukh's attitude has changed profoundly since that time. "In the 
beginning it was maybe right that I presented myself as an educator 
helping bad women. But when we got to know each other it wasn't 
like that. We share food and drinks. Now I don't see these women 
as selling their bodies. I don't see this as immoral or illegal. I just 
see it as a way of life." 
Apisukh's altered view of sex workers creates problems. "The way 
that I look now, it is hard for me to see why this is an issue and to 
tell people what I have learned." 
Seeing sex work in a new way made her realize how difficult 
solutions are. "People are working for their food and for their 
parents at home." She describes going with a friend who was a sex 
worker to the woman's village. "In her village she was the leader of 
her family. But in the bars she was called an animal, a chicken. So 
how can we stop that problem?"  
Her view of the connection between prostitutes and HIV and other 
STDs has also radically altered. Typically women are seen as 
spreaders of disease. But Apisukh sees women also as receivers. 
"When we talked to bar owners and customers, they blamed women 
and tried to change them. Now we are trying to cooperate with the 
owners about how they could make their business safer. And we 
want to know why some men have to work hard and spend a lot of 
money to come to Thailand." 
Transformation
Apisukh's transformation began with a sense of adventure. "The 
reason that I went to Boston, it was not related to what I am doing 
here. People who went to America were looking to dig the gold. I 
didn't have any interest in those years in working with a social 
problem." During her stay in New York she worked with church 
groups and the Asia Resource Center. "At the centre, I found out a 
lot of things that I didn't know when I was in Thailand," which 
made her aware of the value of facts. When she and her husband 
returned home, they found many changes. "There were lots of 
billboards on the highway. When I left, I did not see any highways in 
my country." Office buildings and shopping centers had also come 
to Thailand. 
Apisukh's husband worked for a magazine in Tokyo while she and 
her daughter lived with her father. She ran a laundromat, wrote 
correspondence and worked for a church organization. Then her 
husband returned to Thailand and they started an export-import 
business. She laughs now about the venture. "I don't know how to 
make money. We failed in the business." 
During this period, she had a transforming experience. "Many 
times I had a lot of problem at the airport. Later I found that a 
woman carrying a Thai passport had to be treated very differently. 
Authorities searched my body, to find out whether I carried drugs 
or whether I was trained to sell my body." 
She was curious about this. "That was a problem I found myself. So I 
had to find out the answer myself." She found that the Thai 
government had heavily promoted tourism, especially tourism for 
sex. Many people from rural areas came to Bangkok for jobs. Ten 
years later, 700,000 women work in prostitution and many men 
come to Thailand on sex tours. 
Television shows in foreign countries depict this sex industry, and 
men all over the world see Thai women as prostitutes, Apisukh 
says. "People don't see the other side of the picture that women in 
Thailand are struggling." 
"Indirectly," Apisukh says, "all of the women were forced to become 
sex workers, because of low education, low life conditions and low 
self-confidence. So we asked how could we work with these women 
to get them to understand the reality?" 
The result was EMPOWER. It began in the Patpong area of Bangkok, 
and has now spread to three other provinces. It first recruited 
women who worked in bars, restaurants or teahouses, and has now 
extended to massage parlors and brothels. 
Apisukh jokes about enrolling only 3,000 of the 700,000 sex 
workers in Bangkok. "We had a meeting and we calculated how long 
it would take to reach all the women. So we smiled: it would take 
300 years. So we have to work for three or four generations." Paid 
staff currently number 12, with two volunteers. 
EMPOWER's goal, Apisukh says, is "to teach sex workers to protect 
themselves and to gain self-reliance. We want to see them gain 
empowerment so they can make their own decisions." EMPOWER 
provides a drop-in unit for teaching in English and in Thai. AIDS-
related work includes a sex education project and an education and 
counseling project for HIV-positive persons. 
EMPOWER works closely with owners of bars and other businesses 
that employ sex workers, because without their cooperation the 
women would have no power to protect themselves, Apisukh says. 
The group also works with customers to build up awareness that 
STD and AIDS exist in Thailand, and that without their cooperation 
these diseases cannot be stopped. 
Apisukh has adopted a nonconfrontational strategy for working with 
bar owners. "We are good customers. We drink a lot of beer and we 
dance and the owners like us. Without their permission the women 
cannot come to our centre." EMPOWER gets condoms from the 
Ministry of Health and gives them to owners and managers. "So far 
we have been good with the owners. They like us because we 
perform a drama to promote condoms with humor. We bring in 
customers and they buy drinks." 
EMPOWER staff must go to bars some nights, and must know how 
to drink and how to handle themselves in bars. Sometimes they 
work until the early hours of the morning, so they must be able to 
get home safely. 
Perhaps Apisukh did not succeed in her business because her heart 
was not in it. She has proven expert at fund-raising for EMPOWER. 
The group got seed money from WHO and a one-year grant from 
AmFAR, as well as four-year support from the Ford Foundation and a 
grant from the Australian government. They receive contributions 
from international churches and support from the Thai Ministry of 
Health. As well, Apisukh says, "We have a very good relationship 
with Christian Aid in London." 
Apisukh's adventurous spirit also pervades her personal life. "I'm 
still learning everything and doing many experimental things," she 
says. She took music lessons with her daughter, and the whole 
family learned to swim. "We want very much for our daughter to be 
a brave woman," she says. "Now we have to learn to do everything 
that we didn't do when we were young."

***************

"We can talk about sexuality - but not too directly"

By Simon Rozendaal
Information, information and information are the three priorities 
for Morocco, says Abdellah Benslimane, director of the Pasteur 
Institute in Casablanca: "We have to go into the rural areas and tell 
people about AIDS and sexuality. They know almost nothing about 
it. The television stations need to do much more. Not something on 
AIDS every two months, but more consistently."
Information on AIDS has to be modelled according to each 
country's distinct social culture. "Morocco is an Arabo-Muslim-
Maghreb country. That means we resemble other Arab countries 
but also have a close link to Europe. With that mixture, we have to 
find a specific way to address our people on sexuality. We can talk 
about it, but not too directly. Our social contract does not permit us 
to."
Until recently, AIDS has not been as big a problem as in subSaharan 
African countries. This could afford Morocco the opportunity to 
learn from the experience of its neighbours. Morocco has to take 
care not to make the same mistakes," says Benslimane. 
"The government is starting to implement policies, things are 
moving, but not fast enough."
Because local strains of HIV resemble those found in Europe, 
Benslimane traces European roots for the first Moroccan AIDS 
patients. "The first one, for instance, worked as an immigrant in 
Italy, Belgium and France and got infected after a transfusion in a 
French hospital. 

Although the first AIDS patients were mainly homosexuals and drug 
users who were infected outside Morocco, the disease is now self-
perpetuating with about 70 per cent of the Moroccan AIDS cases 
being among heterosexuals. Officially, the number of AIDS cases is 
105 but Benslimane believes there may be five times that number.

**************

end of text

-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands
Newsgroups: sci.med.aids