Reconciling Moral Issues with Effective Policy by Aaron Anderson
Posted by benjamincrookston on April 8, 2008
I feel that one of the greatest complications facing public health officials today is reconciling “moral issues” with effective policy. I came to this conclusion while studying the efforts of the Thai government in its fight against HIV/AIDS.
Because of Thailand’s “vibrant” sex industry, HIV/AIDS spread rampantly in the country. Between 1989 and 1991, HIV infections rose from 3.5% to almost 22%. Infections in army conscripts rose six fold. Thailand appeared headed for a health disaster. However, thanks to the heroic, if not controversial, efforts of Thailand’s National AIDS Committee and its “100% Condom Program,” HIV was brought back under control.
Many health leaders in Thailand recognized that it would be impossible to stop people from visiting sex workers, so they sought a more pragmatic approach—they would make sex safe.
The so called “condom czar” of Thailand, Mechai Viravaidya spearheaded the effort. I watched a video of his efforts in which he explained that in order for the program to work, sex had to become less taboo. He explained that comedy had to become part of the campaign. Mr. Viravaidva impressed me with his efforts, however controversial they might have been. I was struck by images of him blowing up condoms like balloons in front of school children, handing out condoms wholesale in bars, and, most strikingly, him giving speeches in between strip shows about safe sex.
Viravaidva was primarily responsible for stopping the AIDS crisis in Thailand, however, I do not believe that such tactics would ever fly in the United States—and many other countries for that matter. Viravaidva created an innovative and successful program for his native Thailand, but replicating his tactics elsewhere probably won’t work. I think Thailand provides an excellent case study not necessarily for HIV prevention, but for demonstrating the importance of local leaders developing their own solutions for their own constituencies.