AIDS IN ASIA: Hill Tribes Endangered at Thailand's Periphery

By the year 2000, Asia could be the region with the greatest proportion of people infected with HIV, and Thailand is the country hardest hit. Although often described as living on Thailand's periphery, the hill tribes of the northern mountains are not peripheral to the exploding AIDS epidemic.

HIV (human immunodeficiency virus - the precursor to AIDS) already infects hilltribe men, women, and children. An adult committed suicide after testing positive for HIV, and one baby, infected in its mother's womb, died of AIDS in a government hospital. But because HIV takes years to become AIDS except in infants, a body count conceals the severity of the epidemic: these few deaths will be followed by many among adults and children alike.

Full-blown AIDS (acquired immunodeficienty syndrome) hit Thailand later than North America, Europe, Africa, or the Caribbean. The first recorded case, in 1984, was a Thai homosexual man who had lived in the United States. Marjorie Muecke, writing in Asian and Pacific Population Forum, notes that most of the 10 known cases in 1988 were gay men, who were thought to have gotten HIV from foreigners. "Initially the small number of cases and their apparently foreign origin permitted complacency," she observes. By late 1988, more than 40 percent of those tested at drug detoxification centers in Bangkok were HIV-positive, yet most people remained complacent.

Meanwhile, HIV spread silently via heterosexual sex, which, Muecke reports, is now the "paramount route of transmission in Northern Thailand and may soon become so for the nation." Heterosexual transmission is fueled by a massive and pervasive commercial sex industry geared not only to sex tourism from abroad but also to local clients, who constitute the majority of brothel customers. It is also fueled by Thai sexual mores: men frequent brothels throughout the country, from big cities to small towns.

Heterosexual transmission is fueled by an economic system in which the sex industry is the only employment option for many young women. By some estimates, one million women - 4 percent of the women in Thailand - are in the industry, in which they vastly outnumber male prostitutes.

Prostitution in Thailand dates back at least to the fifteenth century. Urban migration in the late nineteenth century spurred its growth, and it further mushroomed during the Vietnam War to meet the demands of U.S. servicemen. Prostitution is illegal, but politicians, police, and other powerful people have a stake in it, and tourism, which includes sex tourism, is the nation's major foreign currency earner. (A bill to legalize prostitution is pending.)

At some brothels, all the prostitutes have tested positive for HIV. Unfortunately, the popular media and academic publications cast prostitutes as culprits rather than victims, suggesting that HIV passes from prostitute to client to his wife to their child. Yet the virus also passes from client to prostitute, with women perhaps as much as 10 times more likely than men to be infected during heterosexual vaginal intercourse with an HIV-positive partner.

Since 1989, Thailand's Sentinel Survey has tracked HIV infection among selected so-called risk groups such as intravenous drug users, prostitutes, and clients at clinics specializing in sexually transmitted diseases. Yet for political, economic, and cultural reasons, virtually everyone in Thailand is at risk - including more than 550,000 hilltribe people.

Karen, Hmong (Meo or Miao), Lahu, Lisu, Akha, and Mien (Yao), who live in Chia, Vietnam, Laos, and Burma as well as Thailand, speak their own languages and have their own cultures, but they are not isolated from the national societies. Social intercourse between the lowland majority and highland minorities is part of everyday life, and social intercourse includes sexual intercourse.


Trade and political relations have linked highland and lowland societies in South-west China and mainland Southeast Asia for centuries, and these links have increased in the postcolonial era as the region's states have sought to secure their frontiers. Since the 1950s, when the Royal Thai Government began to incorporate peripheral territory and peoples, the hill tribes have been steadily drawn into the national society.

From the 1950s onwards, forest land available to hilltribe slash-and-burn farmers has decreased. State-built roads cause soil erosion, government reforestation programs plant young trees in tribal fields, and loggers cut mature trees. As Thailand's poor have gotten poorer, landlessness has forced many lowland peasants to move to the northern hills. By overusing scarce land, hilltribe farmers also contribute to forest destruction.

As land for cultivation decreased, the tribal population rose dramatically, from some 250,000 in the mid-1960s to over 550,000 in 1988, with tribal refugees from war-torn Burma accounting for much of the increase. Thailand does not grant refugee status to these immigrants or recognize its contribution to the tragic situation that forces them to flee: Thailand's political and economic ties with Burma's rulers help perpetuate a military dictatorship with one of the world's worst human-rights records.

The hills of Northern Thailand are part of Southeast Asia's infamous Golden Triangle where Burma, Laos, and Thailand meet - the source of much of the world's heroin. The region's tribal people cultivate rice, corn, and other subsistence crops, as well as various cash crops, including opium poppy, from which heroin is refined. Thailand has never been the Golden Triangle's primary producer, but since the 1958 ban on opium production, the government's efforts to eradicate poppy cultivation have resulted in a marked decrease in production among hilltribe farmers. Nonetheless, Thailand's Golden Triangle remains a major conduit for opium and heroin smuggling from Burma.

As Edith Mirante notes, the heroin trail through mountainous tribal areas from Thailand to Burma to China's Yunnan Province is also the "AIDS Route". The media have focused on intravenous drug use along this trial, but trade itself, with its attendant travel, is an additional risk factor. Just as truck routes in Africa carry HIV, so do caravan routes in Southeast Asia. HIV hitchhiking along trade routes doesn't require needle tracks to continue its travels; unprotected sexual intercourse is enough.

Hilltribe people have traditionally used opium as a medicine to treat coughs, diarrhea, and pain. Until the 1970s, the usual hilltribe opium addict was an older man or, less often, woman who had begun smoking during an illness. Since then, however, more and young men and women have turned to opium as the economic situation in the highlands has deteriorated and poverty and the draw of Thai society have threatened tribal cultures. As in U.S. inner cities, addiction in Thailand's tribal villages is symptomatic of demoralization and despair.

Increasingly, hilltribe people have been smoking or injecting heroin rather than smoking opium. In highland villages far from lowland markets, intravenous drug users are unlikely to have disposable needles or bleach to clean reusable ones. Even if drug users know about AIDS, they may not know how it is transmitted or how to protect themselves.

Medicinal shots with unsterilized needles by quack "injection doctors" can transmit HIV to highlanders. So also can local customs, such as tattooing or ear piercing. Yet, just as Brooke Schoepf, a contributor to The Time of AIDS, observes for Africa, there is no need to search for exotic customs or bizarre sexual practices to explain HIV's rapid spread. Unprotected heterosexual intercourse, the prime cause of HIV infection in both Africa and Northern Thailand, is probably the mode of transmission that most threatens Thailand's tribal minorities.

"Primitive" and picturesque hill tribes are touted by the Tourits Organization of Thailand and tour companies. Tribal villages are favored destinations for both foreign and Thai tourists, some of whom seek sexual encounters with hilltribe youth. Ironically, although many Thai consider hill tribes dirty and backward, the tribal "other" is eroticized, with hilltribe beauties - or Thai women in hilltribe costume - appearing in Thai pornography. Despite the sometimes prudish sexual morality of tribal cultures, Thai see hilltribe societies as characterized by free sex.


Prostitution is not indigenous to Thailand's hilltribe societies, but many tribal women and some men work in the lowland commercial sex industry, from the North to the southern border. Some hilltribe women have been kidnapped or tricked into prostitution with promises of education or employment, while others have been sold or indentured by parents impoverished by opium addiction or failed crops. Still others, constrained by the lack of jobs, "choose" to become prostitutes in the same way that poor rural Thai women do.

Tribal women usually end up in the so-called low-class brothels where clients pay little per visit. Sex workers in these establishments have a higher rate of HIV infection than those in higher-priced brothels in part because they have intercourse with more clients - sometimes 20 per day. Low-priced prostitutes are also more likely to contract syphilis or gonorrhea, which cause genital lesions that speed HIV's spread.

A tribal women who speaks broken Thai may not even know about AIDS, much less how to protect herself. Even if she knows a latex condom can protect her, she might not be able to obtain one - or a 20 a day - whether because she is enslaved and confined to the brothel, doesn't know enough Thai, or has no money. Even if she has a condom, she might not be able to convince her client to use it, whether because of her inability to speak Thai or their unequal power relation.

While hilltribe men are less involved in the sex industry as prostitutes, they are adopting the Thai practice of patronizing brothels. In addition, pressure on hill land means that subsistence farming no longer provides a secure livelihood, so highland men have begun migrating to work in the lowlands. Like Thai migrant workers before them, such wage laborers visit prostitutes. Since these men are likely to have low-paying jobs, they frequent the low-priced brothels.

Young tribal women, besides those in the sex industry, have also joined the ranks of migrant workers. In the late 1980s, rural Thai women left domestic service for higher-paid factory jobs, and hilltribe women replaced them as maids. Domestic service can become sexual service, whether in Thailand, Edwardian England, or the United States, so these young women are also vulnerable to HIV infection. HIV-positive migrant workers, whether they are male or female, carry the virus to the hills when they return.


Like minorities around the world, Thailand's tribal people are at great risk of contracting HIV/AIDS because little information about modes of transmission and methods of transmission and methods of protection reaches them in languages and forms that they readily understand. While the Thai government broadcasts information about AIDS prevention on radio and TV and many non-governmental organizations conduct AIDS education, few programs are aimed directly at tribal minorities.

In the North, local officials provide instruction in Thai to headmen of both lowland and upland villages, but the effectiveness of this outreach depends upon how well headmen communicate this information at the village level. The government-run hilltribe radio station carries some information in tribal languages, and a Christian organization, the New Life Center, runs an educational campaign among tribal minorities staffed by an Akha public-health specialist and a Lahu nurse.

Hilltribe women are particularly vulnerable to HIV because they are less likely than the men to understand Thai, the language in which most information about HIV/AIDS is available. Moreover, unequal gender relations put women at risk. A hilltribe wife or girlfriend can't easily question her husband or lover about his activities or urge him to use a condom, even if one is available.

Because women are at risk, children are too. Statistically, one in three children born to HIV-positive women will be infected. HIV can also pass from mother to child via breast milk, but HIV-positive tribal women will have to continue to breast-feed their children because markets are distant and formula expensive.

Hilltribe cultural values don't encourage condom use. Highland religions celebrate fertility in humans, livestock, and crops: many children means much blessing from spirits and ancestors. Also, patrilineal groups such as Akha, Hmong, and Lisu, place great emphasis on male children. And, like farmers elsewhere, all tribal minorities want children to work the family fields.

Women in patrilineal hilltribe societies are precariously placed. Unless they provide their husbands with children, especially sons, they are liable to be divorced. Will married HIV-infected women be kept and cared for, or, as they fail to produce healthy children or themselves sicken, will they be divorced? Will they be accepted back by their natal families? Akha tradition, for example, only lets divorced women stay with their natal kin for a short time. Since a divorced woman suspected of being HIV infected is unlikely to remarry, she may well end up a beggar or brothel prostitute in the lowlands.

Finally, hilltribe women are at risk because of the growing demand for "AIDS-free" women in Thailand's sex industry. A booming broker business provides brothels with women from Thailand, adjacent Burma, and distant Southwest China. This demand leads to younger and younger women - and children - being forced into prostitution.

Not only are individual tribal people at risk, so too are entire tribal peoples. More AIDS education in tribal languages is urgently needed, but knowledge is for naught if latex condoms are unavailable. As Thailand's AIDS epidemic explodes and lost labor and medical costs strain the now booming economy, necessary funds and labor are less likely to be available for preventing HIV infection and treating AIDS among tribal people at the periphery.

Acknowledgments: The authors thank Ellen Cooper, Marjorie Muecke, Lucille Newman, Usanee Pengporn, Vichai Poshyachinda, Brooke Schoepf, and Vicharn Vithayasai for generously sharing their time and expertise.


Mark A. Bonacci, Senseless Casualties: The AIDS Crisis in Asia, International Voluntary Services and Asia Resource Center, 1992.

Paul Handley, "Facing Up to AIDS: Thailand's Exmple," Far Eastern Economic Review, February 13, 1992.

Marjorie A. Muecke, "The AIDS Prevention Dilemma in Thailand," Asian and Pacific Population Forum, Vol. 4, No. 4, 1990.

Brooke G. Schoepf, "Women at Risk: Case Studies from Zaire," in Gilbert Herdt and Shirley Lindenbaum, eds., The Time of AIDS: Social Analysis, Theory, and Method, Sage Publications, 1992.


The New Life Center disseminates information about AIDS to hilltribe people as an adjunct to its efforts to deal with the exploitation and abuse of young tribal women in Thailand's extensive sex trade. The center has trained several young educated tribal people from three language groups to circulate among the tribal villages and teach about AIDS. Printed and audio-visual materials in these languages facilitate the effort.

Funding for continuing the center's AIDS education and expanding it to more language groups is needed. Send tax-deductible contributions to: International Ministries, American Baptist Churches, P.O. Box 851, Valley Forge, PA 19482. Include a note stating your check is for thee AIDS-education program of the New Life Center, Chiang Mai, Thailand.

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