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July - September 2002
Although Thailand has experienced one of the world's most threatening HIV/AIDS epidemics, it has also conducted a most successful public health AIDS prevention campaign. Recently, GIS has become an important tool in the country's fight against the disease. The adoption of GIS as part of these prevention efforts provides an interesting case study in technology transfer across the globe made possible through personal relationships.
The AIDS Epidemic in Thailand
The first reported case of AIDS in Thailand occurred in August 1984. The HIV epidemic in the country started in the late 1980s and initially involved high risk groups--intravenous drug users and commercial sex workers and their customers. The virus then spread to the friends and families of members of these groups.
By 1992, the epidemic had spread so rapidly that 12.5 percent of the young men being inducted into the Royal Thai Army (RTA) from the most heavily impacted part of the country, the Upper North, tested positive for HIV-1. The following year, 3.7 percent of all young men screened before induction and 5.1 percent of men above the age of 21 tested positive. This population of young Thai men, chosen by national lottery each May and November, has become an important indicator not only of the overall prevalence of HIV-1 in the country, but also of the impact of the national AIDS prevention campaign.
Beginning in November 1991, the RTA began testing all army personnel for virus antibodies before induction. These young men were also given counseling on AIDS risk factors. About the same time, government officials initiated a number of strategies to combat the disease including widespread dissemination of information on AIDS prevention and the use of condoms. The government distributed free condoms, closed many commercial sex establishments, provided counseling to commercial sex workers, and required that sex workers use condoms.
The results were dramatic. By 1999, just six years after the growth peak of the epidemic, overall HIV-1 prevalence rates among young men tested prior to induction declined by two-thirds to just 1.3 percent. Among 21-year-olds, prevalence rates declined to just 1.1 percent. In the heavily impacted Upper North region, rates declined from 12.5 percent to just 1.6 percent, representing a reduction of 81.6 percent. In only one region, the South, did the epidemic continue to grow. The prevalence rates in this area increased from 2.0 percent to 2.5 percent over the same period.
The RTA and United States Army medical personnel, working jointly under the auspices of the Armed Forces Research Institute of Medical Sciences (AFRIMS), noted that there were broad regional variations in the occurrence of disease and recognized the need to use GIS methodologies to analyze the epidemic. As a result, in January 2001, officials from the RTA and the Research Foundation of the State University of New York (SUNY) signed a memorandum of agreement that initiated a fruitful collaboration between SUNY faculty and AFRIMS staff.
Personal Connections Lead to Technology Transfer
The principal players in this collaboration are Kalyanee Torugsa, an RTA colonel and veterinarian; Dr. Scott W. Anderson, a geography professor at the SUNY College at Cortland; and Lt. Col. Arthur E. Brown, a physician with the U.S. Army Medical Corps.
It was Brown who brought Torugsa and Anderson together from opposite sides of the globe. Brown has spent much of his professional life in Thailand, first as a civilian conducting medical research on leprosy and malaria, and later as a medical officer attached to AFRIMS. His current assignment is coordinating a preventive AIDS vaccine trial among more than 15,000 residents in two Thai provinces. He and Anderson have been friends since their undergraduate days at Dartmouth College. A casual conversation between the two about their current professional interests during Brown's stateside leave in the summer of 2000 became the impetus for the collaboration.
Torugsa is responsible for the AFRIMS unit that collects and analyzes data on all RTA inductees. She and her superior officers had been looking for a way to use GIS to improve the analysis and presentation of the immense amount of information collected on the epidemic. Implementing GIS proved to be a challenge because GIS professionals are still rare in Thailand. Torugsa needed advice on choosing hardware and software, collecting and managing data for future GIS purposes, and--especially--acquiring GIS skills. Working with Anderson provided a straightforward way to introduce an unfamiliar technology to her program, and her collaboration with Anderson was supported by the RTA chain of command.
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