The first HIV cases were reported in homosexuals; it then spread to IV drug users; to female and male commercial sex workers; then to heterosexual males; and finally to their families. Figure 3 shows the trend in risk factors for HIV infection between 1984 and 1995. There was a 4.5-fold increase in the incidence of AIDS between 1990 and 1992 (Figure 4), primarily affecting the 15–49 age working group. In the HIV-infected group, 95.45 percent were found to have a STD also. Those who earn their living as commercial sex workers are most affected, followed by the low-income labor group. The implication of this statistic is that HIV infection occurs at the same time as STD infection.

Figure 3. Risk Factors and HIV Infection in Thailand, 1984–February 1995

Figure 4. AIDS Cases in Thailand, 1984–1994

STD Screening, Diagnosis and Treatment

Preventing infection is the most effective way to reduce the adverse consequences of STDs. The estimated total number of people newly infected with STDs is declining in Thailand. Gonococcal and non-gonococcal infection continues to have the highest incidence, possibly due to drug resistant strains and improper treatment regimens. There has been a marked decline in syphilis (5–6 percent of all STDs). At Chulalongkorn University Hospital, the incidence was 3 percent in 1982, 2.1 percent in 1985 and 1.4 percent in 1992.

STD prevention and control activities focus on:

• Case finding by

  • serological testing for syphilis and routine STD screening among high-risk groups as well as the general population
  • offering premarital and prenatal VDRL, RPR test and FTA-ABS or TPHA confirming test
  • VDRL screening among high school students, military conscripts, commercial sex workers and all STD clients
  • routine culture for N.gonorrhoeae among commercial sex workers and all STD clients
• Case management. Diagnostic methods and treatment guidelines have been well established and distributed to all STD facilities including both government and private sector services. Routine diagnostic tests such as RPR, VDRL, Gram s stain, culture media for gonorrhea, as well as a simplified manual, are supplied for government facilities. Treatment guidelines are routinely updated. 
• Contact tracing. Partner notification or contact tracing has been well established in Thailand for more than 20 years. Primary or secondary contacts are named by the index patient. With the network of STD services throughout the country, the contacts about whom full information is obtained can always be traced.
• Health promotion and counseling. Positive health practices, safer sex and condom use have been well promoted (Figure 5). An intensive program for 100 percent condom use in brothels has been in place since 1989. Mass education through outreach programs for the general population as well as high-risk groups has been done routinely. STD counseling is currently being implemented at all levels of services through the primary health care system.
• Control potential source of STD infection. A survey of commercial sex workers is conducted twice per year. They are asked to have routine checkups at least once every 2 weeks. Serology screening for syphilis is routinely done every 3 months.

Figure 5. Condom Use in Thailand Brothels, 1982–1990

Program Management

The central VD division, regional VD center and university hospital clinics plan the provision of STD services. Monitoring and evaluation are conducted every 6 months. The indicators for evaluation include:

• Number of blood donors screened/treated
• Number of patients diagnosed/treated according to guidelines
• Number of contacts named by the patients and number successfully traced
• Number of commercial sex workers routinely examined and number of all commercial sex workers

In the Chulalongkorn University FP Clinic, counseling of patients with STDs is focused on preventing new infection, increasing compliance with treatment and followup and offering patients guidance for discussion with their partners. To prevent both reinfection and spread of disease through the community, contact tracing using STD caseworkers and patient referral has been expanded. As part of this effort, all family planning professionals are being trained in partner notification skills.

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