Japanese Study on HIV transmission rate to foreigners in Thailand

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Why Japanese and Western people are infected with HIV in Thailand

By Yas(Kyo) Taniguchi

1. Thailand is the country in which most foreign people become infected with HIV.

Considering HIV infection through sexual contact, condom usage must almost perfectly prevent the infection. This fact should be well known to all people living in developed countries. It is well known to those who visit Thailand that HIV is widely spread among Thai people.

Nonetheless, quite a lot of foreign people have been infected with HIV in Thailand.

According to a paper titled “Sex, Sun, Sea, and STIs” reported in British Medical Journal dated March of 2004, 69% of UK heterosexual men who have been infected with HIV from 2000 to 2002 were infected in foreign countries. And 22% of them were infected in Thailand. As for women, 24% of them have been infected with HIV in foreign countries.

Why UK people, who have knowledge that condom usage can prevent HIV infection, have been infected with HIV in Thailand?

Condom usage rate among Western people (data of Germany heterosexual men) who visit Thailand for the purpose of sexual contact with Thai ladies is reported in this paper. It says that condom usage rate is only 30 – 40%!! According to this paper, visiting Thailand for the purpose of sexual contact (sex tourism) is very common among Western people. Be that as it may, 30 – 40% of condom usage rate is too low. It is obvious that having sexual contact with Thai sex workers is very dangerous.

Then, why do they have sexual contact with Thai sex workers without a condom in spite of having the right knowledge?

The answer is also reported in this paper. It states that many foreign people who visit Thailand for the purpose of sexual contact with Thai sex workers do NOT regard sex workers as prostitutes but intimate friends.

However, is this really fact? It is difficult to understand how people can visit a sexual massage parlor and do not regard the lady as a sex worker but an intimate friends. Also, even if you have sexual contact with an independent sex worker, that is obviously prostitution because they pay some money to the ladies.

Maybe there are some reasons why Thai sex workers are not regarded as prostitutes but intimate friends among foreign men.

2. One million sex workers at most

Please refer to graph#1 with regards to reported AIDS cases by occupation in Thailand: According to this data, the highest ranking is general hiring followed by unemployment in second place. The third highest occupation is priest (monk). This is interesting, because priests in Thailand cannot touch females due to religious reasons. The fourth occupation is housewives, followed by trades, children, employees, and government officers.


graph#1 AIDS cases by occupation in Thailand

I have seen many AIDS patients in Thailand, judging from my experience, most female patients excluding housewives are (ex-)sex workers. In this graph, nonetheless, sex workers are included in “others”. This means that few sex workers are infected with HIV.

Why does such a discrepancy occur?

In order to think about this we must understand Thai sex workers. In other words, how many females sell their bodies to men?

See the below table#1 (quoted from “Management anthropology of A-Go-Go” written by Junpei Ichinozawa published by Mekon Company) : According to this table, there are lots of discrepancies between the sources. For instance, according to the survey made by the Public Health Ministry, there are 63,941 sex workers. In contrast, Muecke states there are up to one million sex workers.

The difference between sixty thousand and one million is quite a large. Why does such a big difference emerge in spite of these surveys studying the same issues. And then, how many sex workers are really these in Thailand?


table#1:Estimated number of Thai sex workers

3. Sex workers anywhere

In order to fully understand Thai sex workers their workplaces must be discussed. See the following table #2. (This table is reported in “Immediate existing Thai AIDS and Japanese AIDS” written by Kyo Taniguchu, published by Bungeisya. This table was originally reported in “Management anthropology of A-Go-Go” and was reconstructed by Taniguchi.)


table #2:Estimate number of SWs in each area


Brothel, Chinese style brothel, massage parlor, street prostitute, call girl, (from the line 1 to the line 5), are obvious places for sex workers. 


Then, see the second group, from the line 6 to the line 16. These are A-Go-Go, membership club, karaoke club, beer bar, night club, gay bar, ramwon(Thai liqour) bar, pub, cocktail lounge, café, disco. Generally these are not places where prostitution is conducted. We usually go to these places to simply drink or to enjoy dancing. Although some ladies are working in these places, they do not work there for the purpose of selling their bodies. Also, although some men may sometimes go to such places to get acquainted with some ladies, they do not go there for the purpose of prostitution.

Table #2 implies that in Thailand most female employees in these places listed sell their bodies as sex workers. In addition to this fact, the number of the sex workers are worthy of attention. The number of sex workers in this group are approximate 85,000. This is about twice as the number of the first group, 45,000.  

Then, pay attention to the remaining segment. These places are far from typical prostitution locations, and these shops do not provide liquor. Refer to line 16, “open restaurant”. The number of sex workers in open restaurants is approximately 41,000. This is the highest among this table.

Probably this number, 41,000 is not only employees but also includes female customers. Almost all open restaurants in Thailand do not collect entrance fees, and anyone can enter a restaurant or bar even if she does not place an order. Perhaps the number, 41,000 includes ladies who enter restaurants as customers and look for their own clients. Likewise, in the next line, coffee shop or sauna, some ladies look for their customers in these places also.

It is important to mention the number of employees in Thai style massage. Many tourists do not realize that Thai style massage shops are prostitution facilities. In fact, however, some Thai style massage shops provide sex workers as well. One Japanese man told me: He visited a Thai style massage shop in Bangkok, not knowing the shop provided sexual services. According to him, the massage lady recommended him to take a sexual service during the Thai style massage. He was almost forced to have sexual contact by her. Moreover, the lady did not use a condom! He suffered from severe general fatigue after coming back to Japan. He visited a hospital and was diagnosed with acute hepatitis B. Fortunately he was not infected with HIV. He was obliged to be hospitalized for a month. (Details of this story is introduced in “Immediate existing Thai AIDS and Japanese AIDS”.

It is also interesting that some workers work in barbers or hair salons as barbers, hairstylists, or beauticians. A foreigner might be approached by a lady about sexual services. 

What does “hotel” , the third line from the bottom, mean? Perhaps this does not mean employees of hotels. There are lots of ladies who visit for the purpose of selling their bodies to hotel guests, particularly foreign tourists.

See the below picture #1. This is the lobby of a hotel in Bangkok. It is about 2 AM. Suddenly it started raining heavily and lots of ladies entered the lobby to avoid the rain. I took this picture from the coffee shop located in the corner of the lobby. Some ladies approached me and started talking to me and asked if I wanted to spend the night with them. Probably most of them worked in the street, came to the hotel to avoid the rain, and started their “business” there. Remembering the table #2, they were firstly categorized in “street” (the 4th line), and then were categorized in “hotel” (the 3rd line from the bottom). This means that table #2 has some fluidities.

Be that as it may, it is surprising that hotel employees do not give warning against such ladies.


picture #1 :The lobby of a hotel in downtown area of Bangkok. About 2:00 AM. Their “business” attitudes are overwhelming.

By the way, what proportion of sex workers in Thailand are infected with STIs including HIV?

At present, such data cannot be found. It is understandable because even the number of sex workers is not fully known.

Graph #2 shows HIV infected ratio among sex workers in Saint-Petersberg, Russia. This graph shows the trend that sex workers having more customers are more likely to be infected with HIV. 67% of sex workers who have more than 20 customers a week are HIV positive. This makes sense because more sexual contact relates to greater risk of contracting HIV.

graph #2 HIV positive ratio by number of customers among sex workers in Saint Peterberg, Russia 2003
Source:T.smolakaya,et al. XV International AIDS Conference, 11-16 July 2004. Abatract No.THOrC1371


Considering this graph, even if we cannot understand the correct number of sex workers in Thailand, we can expect that Thai sex workers who have more customers are likely to be infected with HIV. Also, a high ratio of HIV positive means also a high ratio of other STIs.

We could conclude that the more attractive a sex worker is the higher possibility that she has HIV.

4. Crazy resort place “Phathaya”

Phathaya is located east of Bangkok (three hours by bus), and is well-known to many foreigners as a resort place. Phathaya has a history of R&R (rest and relaxation) for soldiers in the USA during the Vietnam War. Quite a lot of women gathered to Phataya for the purpose of selling their bodies to US soldiers. And then, after ending the war, Phathaya has prospered as a resort place.

There are lots of open bars which target Western people. Picture #2 is a typical bar for Western people. Some ladies are standing inside the counter, and some Western men are sitting outside. There is a ring for Thai style boxing on the left side of this picture. The Western men are enjoying watching a boxing match as well as talking with the ladies. If a man and a woman agree to spend the night together, they will go outside and walk hand in hand.
 


Picture #2 An open bar in Phathaya

While Western people like open bars, Oriental people seem to like closed shops. Additionally, they seem to like ladies wearing costumes. See the picture #3. There is a closed shop where some sex workers are working. The signboard says “May I help you?” in Chinese, Korean, and Japanese.



Picture #3 A pub (closed shop) in Phathaya. Do Oriental people like costumes?

Shops where sex workers work are not only bars. Quite a lot of ladies work as street girls. Picture #4 shows some street girls who are doing their business on the street. If you walk by them, you will be talked to in poor English or Japanese.



Picture #4 Street girls in Phathaya

5. The reality of a Bangkok night

The population of Bangkok is approximately eight million. But this does not include tourists and middle or long staying people. Some people say that the actual population of Bangkok may be more than ten million.

It is obvious that quite a lot of women go to Bangkok from their hometowns for the purpose of prostitution. The picture #1 (a hotel lobby in midnight) shows that.
 
Bangkok has almost every kind of facility for prostitution. In addition to these, there are quite a large number of independent sex workers.
 
See picture #5. This is a street named Thaniya located in downtown Bangkok. Thaniya is known as the Japanese street, many Japanese working men as well as Japanese tourists visit some shops in Thaniya. In Thaniya as well, almost all ladies sell their bodies to Japanese customers. In Thaniya, there are many ladies who are well liked by Japanese people.
 


Picture #5 One scene in Thaniya. Some people say that women here are well liked by Japanese and are actually recruted.

6. Prostitution situation in Northern Thailand

In the beginning of the 1990s, the wide spread of HIV in the northern Thailand was a big issue. Some reports said that one in four sex workers in this area were HIV positive. At present, perhaps the infected ratio of HIV is not so high. However, there are still lots of people who are HIV positive.

There are some points which differ from Phathaya or Bangkok.

Firstly, prostitution cost is remarkably cheap. In some facilities, one prostitute costs a couple of US dollars only! In such facilities, condom usage is questionable. Cost of a condom and that of prostitution are almost same. In this situation, is appropriate condom usage made? In fact, there are some HIV positive men who might be infected with HIV in prostitution facilities in the northern Thailand.

Secondly the low age of sex workers is worthy of attention. In Phathaya or Bangkok, the ratio of sex workers in their teens is not so high. (Although this tendency has changed recently.) In northern Thailand, on the other hand, there are quite a lot of sex workers in their teens.

Right or wrong prostitution is very difficult issue. However, it is obvious that prostitutes in their early teens cannot be permitted. Some people say that sex workers must be protected from disadvantaged circumstances and must be given proper rights. This is completely correct. However, this opinion should be applied for adult women only. Early teen sex workers have not finalized their identities and have very little knowledge about STIs. This situation should not occur, regardless of their reasons.

In northern Thailand, there is another problem called trafficking. It refers to women who go to Thailand illegally and work as sex workers. Most of them are from Myanmar, Laos, and the south of China. If they are infected with HIV through prostitution, they cannot be treated in Thailand. Additionally, they cannot go back to their countries because of HIV infection. In early the 90s, many Myanmar ladies who were infected with HIV in Thailand were said to be killed by Myanmar government.


7. Love, Marriage, and Hopeless love

If you are asked “Is prostitution a good thing or bad thing?” Perhaps almost all people will answer “it’s a bad thing” or “it’s not a good thing”. It is obvious that prostitution is not a good thing. However, it is also obvious that prostitutes (= sex workers) have existed throughout human history.

At present in Japan as well, prostitution facilities exist. Also, some people make sexual contact with money with independent sex workers.

Then, is prostitution a necessary evil? This issue cannot be told so simply. One of the reasons is that there are lots of real love or sometimes marriages between sex workers and their customers. There are lots of such stories in Thailand.

The fact that some Thai sex workers do not give their bodies to anyone might be a reason for emerging real love. They make sexual contact with men who they like, and keep chastity against other men.

As introduced in my book “Immediate existing Thai AIDS and Japanese AIDS”, some real love stories occur between sex workers and their customers. Both men popular with women and not popular have fallen in love with Thai sex workers.

Even if prostitution is a bad thing, not a good thing, or a necessary evil, can anyone condemn a couple who get married and make a happy life?

If there are 100 loves, there are 100 ways of love. Love between sex workers and their customers have a variety of endings. It is certain that many couples make happy lives. On the other hand, however, a lot of relationships end in unhappy results.

For instance, it is not rare for a man who falls in love with a sex worker is disappointed to discover that she has a real lover (who is a Thai man). It is a common situation that Japanese men lose their Thai lovers who have a real Thai boy friend, after they give the Thai lady all their property.

One news report stated that a Japanese man committed suicide after discovering that a lady he was in love with had a Thai boyfriend.

Unhappy results were not exclusive to young men only. Recently older Japanese men stay for a long time in Thailand and get married to a Thai lady (some men stay in Thailand for the purpose of marriage with a Thai lady). Some newspaper reports say that some Japanese people were found dead with unknown reasons after getting married. In some cases, police re-investigate the dead bodies due to suspicious circumstances.

There is a variety of love between a sex worker and her ex-customer. That is to say, such a love does not essentially differ from an normal love.

However, it is very important to note that sex workers and their customers have a large risk of STIs including HIV.

Many people have to have the right knowledge about STIs before they fell in love with sex workers and get blinded by the power of love. People who have to have the right knowledge are sex workers in facilities, independent sex workers, and their customers.

All sexually active people risk being infected with STIs unless of course they never have any sexual contact. This means all people have to have the right knowledge and know the risks of STIs. This may not be usually talked about in common conversation. The most effective treatment for lifestyle diseases is apparently prevention. Likewise, the most effective treatment for STIs including HIV is to have the right knowledge.

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