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Afghans' AIDS tour to Thailand: Culture
shock
By Richard S Ehrlich
CHIANG MAI, Thailand - When a United
Nations-sponsored tour about communities with AIDS led
five doctors from Afghanistan into a risque Thai massage
parlor, the men seemed thrilled to learn a few tricks of
the trade. "Do you know what a breast massage is?" one
of the Afghan doctors later asked during dinner. "The
woman massages you with her breasts," he exclaimed,
drawing peals of laughter from his Afghan colleagues.
"You must get a fatty massage from a fat woman,"
another chuckling Afghan doctor added during the meal.
The next morning, however, the second doctor solemnly
stressed that he had been "joking" about "the ladies"
and insisted: "I am a responsible doctor from
Afghanistan."
The massage-parlor visit was
actually considered official business, as it was part of
a training course titled "Community-based Response on
HIV/AIDS" held in Chiang Mai from November 10-21. The
United Nations Development Program (UNDP), the Thai
government's Department of Technical and Economic
Cooperation and Chiang Mai University's Faculty of
Nursing invited the doctors, along with nearly a dozen
other health officials and social workers from
Afghanistan, East Timor and Sri Lanka, to visit Thailand
to learn more about dealing with HIV and AIDS in their
own countries.
"The aim is to enable the
visitors to return to their home countries with
practical means for community-based responses to
combating the spread of HIV/AIDS," said UNDP regional
communications officer Cherie Hart.
During the
course, the foreign doctors and social workers learned
how Thailand had worked to slow the spread of AIDS
(acquired immune deficiency syndrome) within its
borders, why patients live longer and prosper thanks to
new medicines and the way in which some Thai communities
had ended the "stigma and discrimination" against
carriers of the human immunodeficiency virus (HIV) that
can cause AIDS.
The delegates studied methods of
HIV transmission, attended lectures, visited hospitals,
met Thai doctors and patients and interacted with AIDS
survivors who had created cottage industries to finance
their treatment. They also visited a Buddhist temple
where monks were teaching local students how to use
condoms.
In addition, the UN invited a handful
of journalists to travel with the delegates for three
days to see how Thailand's experience in tackling HIV
and AIDS could benefit less-developed countries wrecked
by warfare. However, while the representatives from East
Timor and Sri Lanka appeared fairly sedate during the
tour, the Afghan doctors expressed intense culture shock
- often surprising the media and their hosts.
Throughout the tour, the Afghan doctors usually
appeared studious and serious, asking medical questions
in halting English and making notes. But while traveling
together in a separate mini van or eating after a
seminar, the five men from Afghanistan often regaled one
another about social behavior in Thailand, where, unlike
Islamic Afghanistan, women do not wear the
all-encompassing cloth burqas.
The five
Afghan doctors commonly cited Islam as the reason the
infection rate is low in their relatively isolated
country compared with bustling, Buddhist-majority
Thailand.
"It is because of the religion,
because in Afghanistan all people are Muslim, and Islam
does not accept things like Thailand," Dr Baz Mohammad
Shirzad, Jalalabad-based deputy director of
Afghanistan's Eastern Region Health Directorate, said in
a taped interview. "Islam says, 'You have a wife and
must be honest to the wife.' Islam does not accept sex
like Thailand's people," Shirzad said.
His
colleagues were also intrigued by the differences in
social behavior between Afghanistan and Thailand.
"Afghanistan's people, if they know about a
woman having sex with another [man] who is not her
husband, they suggest killing her," said Shafiqullah
Shahim, the Kabul-based Health Ministry's national
HIV/AIDS control program officer. "But in Thailand, it
is a simple thing, it is a common thing. Everywhere sex
is possible, in hotels, in restaurants, everywhere. This
is the main cause, I think" for the estimated 700,000
AIDS cases in Thailand, Shahim said in a taped
interview.
And indeed, the Afghan doctors were
able to witness the dynamics of the sex industry
first-hand when they accompanied a Thai doctor on a
visit to "commercial sex workers" in Thailand's
second-biggest city, Chiang Mai.
"There was one
place and the ladies were sitting there and they had
labels and numbers," Shirzad said. "The first lady was
'superstar'. The rate was very expensive. And on another
side sat other ladies. For the second line, the rate was
reasonable. And on another side sat some other ladies
and the rate was cheap," Shirzad added.
The Thai
doctor "told me that in all of Thailand, especially in
Chiang Mai, the HIV risk is very high because 40 percent
of the [sex workers] are HIV-positive," he said.
"In Afghanistan, from 1986 to 2000, we had one
[HIV] patient. He was an Afghan man who came from a
foreign country and got it from sexual contact. He came
to Kabul from Europe. From 2000 to 2002, we had seven
patients. Today in Afghanistan we have 15 patients,"
Shirzad said. He estimated that "about 200" people may
be HIV-infected in Afghanistan, though accurate figures
were impossible to obtain.
However, despite his
somewhat awe-induced comments, Shirzad praised
Thailand's recent ability to decrease the spread of the
virus and embrace patients stricken with HIV.
"Thai patients who are living with HIV/AIDS in
the community, they are participating in all activities
of the community," he said. "I think they are
successful."
(Copyright 2003 Richard S Ehrlich.)
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