The mastermind plotting Thailand’s conquest of Aids

I knew very little about Aids,” said Dr Praphan Phanuphak. That was back in 1984 when Thailand viewed the epidemic that was sweeping across the United States and Europe as happening elsewhere.

But then in November of 1984, Dr Praphan was sent a patient whose symptoms were mystifying his peers.

“He was a gay man from Denver, who had repeated skin infections and abnormal T cells,” recalls the doctor.

That visit was followed by another in early 1985 from a Thai male sex worker who had swollen lymph glands and T cells that were again strangely low. The man’s girlfriend had similar symptoms. In March of 1985, the first commercial blood test for HIV became available and by May, Dr Praphan was able to confirm his suspicions and diagnose the earliest known cases of HIV in Thailand.

“Until then I hadn’t paid much attention to news about the Aids epidemic,” admitted Praphan, who at the time was already a respected immunologist at Chulalongkorn University’s Faculty of Medicine and Hospital. In 1989, he became the director of the Thai Red Cross Aids Research Centre (TRCARC).

Now in his seventies, Praphan is one the main masterminds of Thailand’s innovative and participatory approach to the HIV epidemic. His commitment to finding low-cost yet effective solutions to health challenges has helped the country’s HIV response become a global model. 

“Dr Praphan has always been ahead of the curve,” said Tatiana Shoumilina, UNAids country director for Thailand. “It’s amazing how he always knows before anyone else the strategy that will exactly answer the very latest challenge thrown down by Aids.” 

Praphan is a member of Thailand’s delegation to the United Nations General Assembly Meeting on Ending Aids, which is taking place this week at the UN in New York. The meeting is focusing attention on the importance of accelerating the response to HIV over the next five years. The success of countries like Thailand in overcoming HIV will be showcased and will help set the world on a course to ending the Aids epidemic as a public health threat by 2030.

Praphan has always been driven by a passion to provide the very best for his patients.  

“I am called an activist doctor,” he said. “What I do is always for the benefit of my patients and my country.”

That commitment has made him view Aids from the perspective of the people at the heart of the epidemic. 

When the epidemic first emerged, hospitals and clinics had to report names of individuals who tested positive to the Public Health Ministry. Sometimes their identities were leaked and people lost their jobs or were stigmatised. 

“This meant that people at higher risk would often hide when they knew health officials were coming to do tests,” said Praphan. “Sex workers would call in sick.” 

This registration policy fuelled an environment of fear, which kept people who were most vulnerable to HIV in the shadows, hampering efforts to control the epidemic. So the Thai Red Cross Aids Research Centre made a special request to the government and set up a counselling and testing facility that protected the anonymity of clients. In July 1991, the centre opened the Anonymous Clinic, the first of its kind in Asia. 

“HIV was very scary,” said Sumir, who was diagnosed with HIV more than 20 years ago and goes by his first name. “This was the only place you could trust the results and be sure they were kept confidential. Here people were always very friendly and accepting. In other hospitals, you could see the fear in their eyes.”

The clinic became so popular that the government ended up lifting its requirement to register people who tested positive. The facility helped expand HIV testing and to this day remains Thailand’s largest voluntary counselling and testing centre, performing more than 25,000 HIV tests a year, helping to identify thousands of people living with HIV.

In 1991, it was estimated that there were more than 140,000 new HIV infections. Aids-related deaths had become so common it was said people were dying of the disease like leaves falling in the dry season. 

“I had nothing to offer because there was no treatment,” he said. “I attended two funerals but then I stopped, because if I was there then everyone knew the person had died of Aids and that wasn’t good for the family.”

Desperate, the doctor experimented with different drugs and even herbal medicines to try to boost the immune systems of people living with HIV. While the US approved the first antiretroviral drug, zidovudine (AZT), to treat HIV in 1987, it was unaffordable for most Thais. Praphan refused to watch his patients die and was determined to find a way to access the life-saving drugs. He set up a clinical trial unit with eminent Western researchers called HIV-NAT.

“We were trusted by pharmaceutical companies and they not only provided staff to conduct research but they also gave us the very latest medicine. We have been able to provide free ARVs [antiretrovirals] to more than 8,000 people.” 

This collaboration enabled his team to conduct ground-breaking research, but more importantly for Praphan it meant he could save lives.

“My father always thinks of how people will benefit,” comments Dr Nittaya Phanuphak who is head of the Thai Red Cross Research Centre’s Prevention Department and Praphan’s daughter. 

“If the research comes with data [then] we can publish a paper that’s good, but that’s not what drives him. As far as he’s concerned if you help people, that’s enough.”

“In 1998, I was really sick and then I met Dr Praphan. He included me in the study and I had access to free ARVs,” said Sirchai Jarupittya. “He gave me courage.” 

The HIV epidemic is constantly evolving. While initially sex workers and their clients were at higher risk of HIV, in the last few years the epidemic has been expanding rapidly among men who have sex with men and transgender people. Late last year, TRCARC opened Asia’s first transgender-specific facility, the Tangerine Clinic.

“For a long time I was like everyone else. I didn’t think that the health needs for transgender people and men who have sex with men were different,” said Praphan. “But one of our researchers convinced me that transgender people have health issues that are unique.”

Curiosity, openness and humility are qualities many people attribute to Praphan and may be part of the special mix that have kept him ahead of HIV. These qualities have made working with him both challenging and enriching for his staff and often resulted in a collaborative result that is larger than the sum of its parts. 

 “He saved my life,” said Sirchai Jarupittaya, who has known Dr Praphan for almost 20 years. “He made me realise that HIV is not that bad if we can accept living with it.”

Sumir said, “I’m sure thousands of people living with HIV would love to come and thank him for changing their lives. I’m so glad I can convey their immense gratitude to Dr Praphan.”

 

Saya Oka is regional communications adviser for UNAids Asia-Pacific.

Thailand is the first country to have eliminated mother-to-child transmission of HIV. See the story “Thailand eliminates mother to child HIV transmission” at www.nationmultimedia.com.