Tuesday, September 25, 2007
12:00 a.m. Eastern Time
Tackle Public Health And Poverty Together, Says Thai Policy Leader
Who Has Led Efforts Against Population Growth, HIV/AIDS
In Health Affairs Interview, Mechai Viravaidya Warns Against Complacency On AIDS
And Stresses The Importance Of Reaching Young Children With Public Health Messages
Bethesda, MD -- Thailand's "Positive Partnership" program, one of that nation's many innovative public health efforts, provides business loans to HIV-positive Thais who find an HIV-negative business partner, Mechai Viravaidya tells Glenn Melnick in an interview published today on the Health Affairs Web site. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.6.w670
"The person who is not infected has the responsibility of changing attitudes and behavior in their community towards people living with HIV and AIDS," says Viravaidya, a former Thai senator and government minister who for over three decades has been a leader in campaigns against excessive population growth, HIV/AIDS, and other public health threats. The Positive Partnership program "has created new lives for these HIV-positive people. Discrimination rates are down, they're accepted in their community, their income is good, and 84 percent of the partnerships repay their loans on time. This is higher than repayment rates for regular bank borrowers."
In his discussion with Melnick, conducted over several days in December 2006 and January 2007, Viravaidya stresses the importance of complementing public health efforts with poverty reduction strategies through initiatives like the Positive Partnership program. Organizations that provide health care in the developing world "are all trying to solve health problems that are the consequence of poverty, but they don't address the root cause of poverty. Hence, they will never be sustainable," says Viravaidya, the founder and current chair of the Population and Community Development Association, a leading public health nongovernmental organization (NGO) in Bangkok.
Viravaidya says that only the business sector can provide the business skills and credit sources that the poor need to move up the socioeconomic ladder. "Government doesn't know how to make money. It only knows how to take money," and NGOs "have big hearts but not much acumen for business," he tells Melnick, the director of the International Public Policy and Management Program at the University of Southern California in Los Angeles.
Other Interview Highlights:
Using Lay People To Distribute Birth Control Pills. In the early 1970s, even using nurses and midwives in addition to physicians, Thailand was able to reach only women in urban areas with oral contraceptives. Therefore, in 1974, the country began training community members in every village to distribute contraceptives, with medical back-up. "That was the beginning, and Thailand's population growth rate came down and down," from 3.3 percent per year in 1972 to 1.6 percent in 1984 and 0.5 percent today, according to Viravaidya.
Promoting Condoms. Viravaidya found innovative and humorous ways to familiarize Thais with condom use. "The condom is a great friend. . . . You can use it as a balloon. You can put Coca-Cola into it. You can use the lubrication for after-shave lotion," he would tell rural school teachers, who in turn would teach their students about condoms.
Viravaidya compensated for a lack of funding by creating events, such as condom-blowing competitions, tailored to draw free media coverage. When a hostile author tried to ridicule him by proposing to call condoms "Mechais," Viravaidya treated it as "a public relations windfall -- the opportunity to have condoms become synonymous with my name was too good to be true."
Thailand's Leadership Is Wavering On Fighting HIV/AIDS. "When the HIV/AIDS crisis first materialized, Thailand had a government led by people who would not acknowledge the problem" for fear of scaring tourists, Viravaidya says. In 1991, under a more "enlightened" prime minister, Anand Panyarachun, Viravaidya organized a comprehensive AIDS information program involving the governmental, business, religious, and educational sectors: "Everyone joined. Gas stations and McDonald's restaurants gave out condoms; banks and insurance companies distributed printed AIDS information to their customers and to the public."
This aggressive strategy has scored important successes, but much remains to be done, "and there are signs that the Thai government's commitment to controlling HIV/AIDS is wavering. Since the Asian Financial Crisis of 1997, public expenditure on HIV/AIDS has fallen by 50 percent. Such myopia will have long-term consequences unless it is quickly rectified," Viravaidya warns.
Lessons For The Developed World. Asked by Melnick what Thailand's experience can teach countries like the United States in dealing with health problems such as obesity that are linked to behavior and lifestyle, Viravaidya cites the importance of reaching young children: "We . . . had a song that every child knew, perhaps the equivalent of 'Jingle Bells,' where we changed the words into a song with every contraceptive method." In addition, "in schools that we run, we are teaching children in the first three grades how to cook healthy foods as a way to teach them healthy eating habits."
ABOUT HEALTH AFFAIRS:
Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.
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