AIDS/HIV in Thailand

Thai prostitutes; child prostitute

Health and Well-being

The rate of HIV infection is 50% or higher among female prostitutes in Northern Thailand. (New England Journal of Medicine, Sarah McNuaght, "Prohibition," The Boston Phoenix, 23-30 October 1997)

In 1990 there were fewer than 200 reported AIDS carriers, and only a handful of AIDS patients. By 1997, the number of reported carriers is believed to have far exceeded one million, with more than 30,000 deaths recorded in official papers. The AIDS epidemic has threatened to overwhelm at least six upper Northern provinces - Chiang Mai, Chiang Rai, Lamphun, Lampang, Phayao and Mae Hong Son. Hospitals in these provinces are usually packed with AIDS cases, who outnumber other patients. At a certain hospital ward in Chiang Rai, AIDS patients occupy 15 out of the ward's 22 beds. ("Opening our eyes to the Aids problem," The Nation, 20 May 1997)

Of 103 prostitutes tested for AIDS this year, 37.8% were HIV positive, most of them from Burma's Shan state. (Dr Sura Kunkongkaphan, Aphaluck Bhatiasevi, "Influx of Burmese sex workers via Mae Sai," Bangkok Post, 2 June 1997)

NGOs say most prostitutes come from provinces in the north; a large number after travelling to cities like Bangkok to work return to their villages once they become infected with HIV/AIDS. They in turn, infect others. AIDS is mostly transmitted through heterosexual contact. Men often get the disease from a prostitute then infect their wives who then infect their unborn children. Northern Thailand accounts for about half of the country’s 800,000 cases of HIV. (Sutin Wannabovorn, "Thai Prime Minister vows end prostitution, AIDS victims react," Reuters, 29 July 1997)

Thailand has the fourth largest number of AIDS cases in the world with nearly 60,000. This is only the number of officially reported cases and health workers say the actual number is several times higher. (Sutin Wannabovorn, "Thai Prime Minister vows end prostitution, AIDS victims react," Reuters, 29 July 1997)

More than 70% of Thailand’s returning migrants are HIV positive. The men buy women in prostitution when they are abroad. Of 500 returning migrants in Khon Kaen, more than 400 are HIV positive. Migration is a key factor in the spread of AIDS. (NGOs working on HIV/AIDS issues in Issan, recent informal sample by a doctor, IOM, Leyla Alnayak, "Returning migrants to Thailand show high AIDS incidence," Earth Times, 11 April 1998)

Since enforcement of the anti-prostitution law in December 1996, police pursue cases of child prostitution less frequently, partly because the cases are complicated. According to Professor Kritaya Archavanitkul of Mahidol University's Institute for Population and Social Research, "The police at local level do not cooperate much because the Interior Ministry has announced that police authorities will be penalized if child prostitutes are found in areas under their responsibility." (Aphaluck Bhatiasevi, "Child Prostitute Problem Worrying," Bangkok Post, 28 July 1998)

Enforcement of the Prostitution Prevention and Suppression Act of 1997 caused movement of many prostituted persons from brothels to restaurants and beer bars. This puts them out of the reach of health workers, which hampers efforts to control sexually transmitted diseases by driving prostituted persons from the mainstream red-light premises. (Aphaluck Bhatiasevi, "Vice purge hinders campaign as prostitutes go underground," Bangkok Post, 17 June 1998)

Budget cuts have forced the Communicable Diseases Control Department to cut its free condom distribution program from 45 million pieces in 1997 to 12 million in 1998. In fiscal 1999, the ministry has requested funds to buy 25 million condoms. (Aphaluck Bhatiasevi, "Vice purge hinders campaign as prostitutes go underground," Bangkok Post, 17 June 1998)

"2 million medical tourists expected by 2009?"

Thai prostitute holding a condom in Bangkok; Thai dancers

THAILAND:

Thailand expects to welcome about two million medical tourists this year, according to the Tourism Authority of Thailand and the Department of Export Promotion.

A 38 percent increase from the 2006 figures of 1.45 million was recorded. The combined revenue from the foreign patients of THB40 billion (US$1.15 billion) in 2006 is expected to rise to THB45 billion (US$1.3 billion).

Figures have been rising in recent years. In 2002, there were 630,000 medical travellers with a combined spending of THB18 billion (US$519.7 million). In 2003, the number was 973,532 with a spending of THB26 billion (US$750.68 million). In 2004, the number rose to 1.1 million with THB30 billion (US$866.17 million) in revenue. In 2005, the number reached 1.25 million with over THB30 billion (US$866.17 million) in revenue.

The figures may be correct, but critics argue that the practice of some Thai hospitals of counting one patient staying in the country going to hospital on three days, as three medical tourists, and including non-Thai outpatients (and there is a large population of resident expatriates as well a huge numbers of visitors) who only go to hospitals for prescription drugs, as medical tourists, hugely inflate the figure to as much as three times the real numbers.

The political problems of late 2008 caused a temporary hiccup. Curiously, the figures above ignore the loss of medical travellers due to political unrest. No one knows how many medical travellers were lost, but the Bank of Thailand estimates that it deterred 3.4 million tourists from visiting the country. Assuming the political problems are solved, the trend will be year-on-year increases in medical tourists going to Thailand - the disagreement is about how many.

Hospitals involved in medical tourism report some slowdown. But, despite a triple hit of political unrest, increased airfares and recession, they claim to suffer less than expected. Phyathai Hospital weathered the rough times through its focus on Persian Gulf customers. Currently, Westerners account for 5 percent of overseas patients at Samitivej Hospital, but sees more potential in the East than the West. Some Bangkok hospitals have contracts with Gulf state governments.

History of Southern Thai's Kingdom of The Malay Patani:

Following the end of the Second World War, as Malay nationalism was gathering momentum across the border and Thailand was forced by the British to give up its irredentist annexations during the war (the Shan States, Laos, Cambodia, and the northern Malay states), a group of Malay leaders in the Patani region submitted a petition to the British requesting the British Government to “have the kindness to release our country and ourselves from the pressure of Siam,” since they did not wish to “remain any longer under the Siamese Government.” For Patani, they pointed out, “is really a Malay country, formerly ruled by Malay Rajas for generations”. The year 1948 saw the establishment in Kelantan of GAMPAR, the Gabungan Melayu Patani Raya or Greater Patani Malay Association, supported by Tengku Mahyiddin, youngest son of the last sultan of Patani, which sought political union with Malaya. And the political ideology of the most prominent of the region`s separatist organizations that sprung up soon afterwards, such as the Patani United Liberation Organization (PULO), the Barisan Nasional Pembebsan Patani (Patani National Liberation Front or BNPP) and the Barisan Revolusi Nasional Melayu Patani (“Patani Malay National Revolutionary Front” or BRN), has been the national liberation of the “Patani Malays”.

The Muslims of southern Thailand are mostly ethnic Malays and speak Malay, rather than Thai. They were once part of an independent sultanate of Patani, comprising the present-day provinces of Pattani, Yala, Narathiwat, and parts of western Songkhla, that flourished from 1390 to 1902. That history as a separate political entity and the second-class status and political neglect the Malay minority has endured ever since within independent Thailand, provides the backdrop to the violence today.

Generally, the writ of the Thai kings stopped somewhere to the north of Malacca. In the 19th century, the British detached Kedah, Trengganu, and a couple other Melayu sultanates from Thailand, and joined them to Johore, Malacca, and a few others to form the Federated Malay States. For reason known only to the Brits the states of Patthani, Satun, and a couple others remained subject to Siam (then under the Chakkri dynasty, which has ruled Siam/Thailand ever since the Burmese burned Ayyutthaya in the 1760's).

The problems in southern Thailand are the results of decades of economic neglect, lack of employment opportunities for the local Muslims in both public and private sectors and cultural insensitivity of the bureaucracy. A solution to this requires greater efforts to respond and deliver to the demands of the local Malay Muslim population. This will contribute to building of peace and stability within Thailand.

Gaza crisis has implications on medical tourism

Pictures: Israel Zion women soldiers enjoying life; destruction & funeral of Palestinian children






MIDDLE EAST:

You would not dream of going to or sending customers to Iraq or Afghanistan for medical treatment. As much as hospitals, clinics and agencies protest that politics and war is not their concern, customers watch television and read newspapers. If a country seems at war or in crisis, then it is human nature to think twice and consider an alternative destination.

Thailand and India found that political unrest and terrorism did affect medical tourism numbers, and that business as usual only returns months after the end of the problem. Other countries with unstable governments or lawless areas, suffer, despite their denials, from visitors being scared away.

With hundreds of countries now to choose from, and many thousands of hospitals,clinics, spas and centres actively seeking medical tourists, it is easy to find an alternative to a troubled country.

Tourism crisis expert David Beirman, reported in eTurboNews, made some very interesting points on the Gaza crisis, which apply to tourism and medical tourism: “In 2008, Israel, the Palestinian territories, Jordan and Egypt all enjoyed record year for tourism arrivals. One of the key reasons that these four destinations enjoyed such strong tourism inflows was because there was a general perception that they all experienced relative stability during 2008.

“However, the picture for 2009 is far less optimistic, at least for the short to medium term. In 2008, the interplay of tourism between Israel, Jordan and the Palestinian territories and Egypt was positively influenced by the relatively benign security environment. Israel, the Palestinian Authority, Jordan and Egypt face a challenging 2009. The eruption in Gaza has created a whole range of perceptual and security concerns about the safety of travelling to Israel and these concerns will also apply to Palestine, Jordan and Egypt.

“To add further intensity to the challenges the global economic downturn will mean that the four destinations will switch from being the highly affordable destinations they were in mid 2008 to relatively expensive destinations. The fact that many hoteliers in the four destinations have significantly increased their prices in recent months has exacerbated this problem. A recession usually means that travel does not stop but tourists tend to gravitate to destinations closer to home or those that are very affordable. Israel, Egypt, Jordan and Palestine have all enjoyed positive growth from the discretionary travel market and will find that their longer haul markets may look elsewhere on both security and economic grounds.”

Haifa University’s Dr Yoel Mansfeld wrote some years ago that surges of conflict and terrorism had a negative impact on tourism to Israel and the immediate region. And in his analysis, peaks and troughs in international tourism arrivals to Israel were heavily influenced by the perceived security environment. Many agencies and hospitals promote their services as medical treatment with a cheap holiday. So when the holiday trade gets hit, so will the medical tourism trade.

Hospitals and agencies in regions hit by war, terrorism and political unrest have mostly failed to connect with consumers on their concerns. Websites remain unchanged. In a period when medical tourists are less certain of their ability to pay for treatment, political problems can be the tipping point that makes them change destinations or even stay at home.

Medical tourism needs to find ways of satisfying real or imagined customer concerns. Your hospital may be hundreds of kilometres away from troubled areas, but customers’ geography is very hazy.

INDIA Medical tourism...still lagging behind South East Asia

INDIA: Medical tourism need to grow by 2015

The Associated Chambers of Commerce and Industry of India (ASSOCHAM) has predicted that medical tourism will grow between 22 and 25 percent in 2009 and will start to have an annual growth rate of 30 percent from 2010 to reach the size valued at about Rs95 billion by 2015.

Currently, the size of medical tourism in India is measured at Rs15bn. ASSOCHAM estimates that India is poised to become an epicentre for medical tourism from throughout the world.

ASSOCHAM says that at least a six -fold (!!) increase is anticipated in the size of medical tourism by 2015, and worldwide patients will make India as a preferred choice for medical treatment because of cost (??).

Projected market value for the Indian medical tourism market is as follows: Rs15 billion in 2008, Rs19.5 billion in 2009, Rs25.35 billion in 2010, Rs32.95 billion in 2011, Rs42.84 billion in 2012, Rs55.69 billion in 2013, Rs72.40 billion in 2014 and Rs94.12 billion in 2010.

ASSOCHAM estimates that the cost of surgery in India can be one tenth of what it is in the US and Western Europe and sometimes even less. A heart-valve replacement that would cost US$200,000 or more in the US for example, goes for US$10,000 in India and that includes round-trip air travel. Similarly, a metal-free dental bridge worth US$5,500 in the US costs US$500 in India.

The Chamber has estimated that 180,000 foreigners visited India for treatment from various parts of the world in the eight and half months since April 2008. It expects the number will increase between 22 to 25 percent this year.

If ASSOCHAM is correct, this would put the current number of medical tourists to India at 270,000 a year from now, 670,000 by 2012, and 1.3 million by 2015.

Medical tourism in Israel in peril

ISRAEL: Boom in medical tourism in peril

Medical tourism in Israel will total NIS 160 million in 2008, compared with NIS 100-110 million in 2007, according to a study by The Center for Academic Studies at Or Yehuda.

The survey claims that 48 percent of the patients came from Eastern Europe, mostly Russia and Ukraine; 37 percent came from Jordan, Cyprus, Turkey, the Palestinian Authority, and other neighbouring countries; and, 14 percent came from the United States and Western Europe.

Sixty-five percent of the patients came to Israel for complex or risky surgical treatments and 35 percent came for various cosmetic treatments.

This contradicts long-standing figures from the country’s tourist board that the main market is Germany. The economic crisis is expected to reduce the number of cosmetic surgical treatments of foreign patients in 2009. Recent attacks on Gaza will make Westerners wary of planning trips in a country at war.

Widely circulated press reports on the study omitted certain crucial information that throws serious doubt on the study’s accuracy.

Although there are over forty medical tourism and travel agencies promoting medical and health tourism, and scores of hospitals and clinics seeking business, the study only interviewed 100 patients in three centres; Hadassah Medical Organization in Jerusalem, Tel Aviv Sourasky Medical Center (Ichilov Hospital), and Tel Hashomer Medical Center.This very unscientific sampling technique shows yet again why you have to be very wary of widely circulated reports on country statistics.

Russia is increasingly becoming the major source of tourists to Israel. Tourism from Russia has grown steadily since September, when Israel waived its visa requirement under a reciprocity agreement with Moscow. The two countries launched direct charter flights from Eilat to Moscow and St Petersburg just last month.

To date, the Israeli government has taken no action to promote or to curb medical tourism and has allowed the industry to develop undeterred and unregulated. According to government spokespeople, 15,000 foreigners came to Israel's hospitals for treatment in 2006. The number of foreign patients grew to 20,000 in 2007. The figure for 2008 is expected to be 30,000.

Entrepreneurship to change US healthcare market

UNITED STATES: Entrepreneurship to change US healthcare market

The US healthcare market does not work like other markets. Because health care costs are usually paid for by a third party – either by the insurance provider or by the government, patients are not price-sensitive and providers don't feel the need to compete for their business.

“Lack of competition results in a highly artificial market plagued by problems of high costs, inconsistent quality and poor access,” said Devon Herrick, senior fellow with the National Center for Policy Analysis (NCPA).

Herrick is the author of the report entitled Health Care Entrepreneurs: The Changing Nature of Providers published by the NCPA last month.

But in healthcare markets where patients pay directly for all or most of their care, providers almost always compete on the basis of price and quality.

Herrick cited the following:

• Cosmetic surgery: Since it is rarely covered by insurance, patients pay out of pocket and are sensitive to prices. They typically compare prices before surgery and pay a price that has been falling over time in real terms.

• Laser eye surgery: Competition is holding prices in check and improving quality in vision correction surgery, including accurate correction, faster healing, fewer side effects and an expanded range of conditions that can be treated.

• Medical tourism provides cash-paying patients healthcare outside of the US in high-quality facilities that rival domestic facilities. Patients can save 30 to 50 percent by going abroad.

What lessons can be learned from these examples of entrepreneurship in healthcare?

“The most important is that entrepreneurs can solve many of the healthcare problems that critics condemn,” said Herrick, adding that Public policy should encourage, not discourage, these efforts.

NCPA is a non-profit, non-partisan public policy research organization established in 1983. The NCPA's goal is to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector.

According to the latest official statistics, 7 million Americans have their own annual individual health insurance, four million more buy short-term cover, 83 million are covered by government schemes and 45.7 million have no health insurance at all. The figures for employer health insurance are confusing as they integrate policies paid fully by the employer with policies paid for only by the employee under a group offering.

www.ncpa.org

MALAYSIA Online portal helps increase foreign patients

Despite the global economic downturn, Malaysia expects to see a 28 percent rise in foreign patients seeking medical treatment in the country.

Among the reasons cited is the establishment of a one-stop medical and tourism online portal that facilitate all needs of overseas-based patients be it consultation, treatment, accommodation or tours.

MalaysiaHealthCare.com (MHC) chief executive officer Suresh Ponnudurai said the country would continue to attract health tourists from countries such as Indonesia, Singapore, Bangladesh and Japan and those from the Middle East and Europe.

“Malaysia is one of the region’s centres of medical excellence owing to its quality and affordable facilities and services. About 360,000 health tourists visited Malaysia in 2007, a 20 percent increase from 2006. The use of technology and the internet has positioned the healthcare industry as one of the best in the region.”

Malacca received more than 64,000 medical tourists last year, mostly Indonesians, and was ahead of Penang, Federal Territory, Johor and Selangor. The numbers are expected to increase after the upgraded Batu Berendam Airport opens to bring in tourists from neighbouring countries. Also, a 300-bed private hospital Straits of Melaka Specialist Centre will be developed in Klebang within the next two years.

MHC acts as a channel to network, integrate, facilitate and manage all aspects of health and medical tourism for health tourists and service providers such as hospitals, travel and insurance agents, airlines and hotels. Medical tourists can schedule their treatment and holidays by making online bookings for services.

The country’s Health Ministry will be launching a special website on health tourism next month to disseminate information worldwide on the Malaysia’s medical tourism industry.

Health minister Datuk Liow Tiong Lai said the website will include information on the medical facilities and specialist services available, as well as the payment rates, to make it easy for those interested to seek treatment in Malaysia.

He added the ministry will indirectly help private hospitals in the country attract tourists who wanted quality medical treatment and healthcare.

In line with the government's aim of developing the medical and health-based tourism sector, the ministry held a promotion drive and briefing in Indonesia and Vietnam last year. These promotional efforts will be extended in 2009 to several other countries including Australia.