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Ravages of AIDS threaten Thailand's children

CHIANG RAI, Thailand -- One evening, Nisarat, who is 10 and has the virus that causes AIDS, snuggled up to her 63-year-old grandmother. The disease claimed the child's parents years ago.


"Will you go before me, or will I go before you?" the child asked. Her painful question reflects the challenge Thailand faces as it struggles to care for more than 300,000 children orphaned by AIDS. She is among the 670,000 people infected by HIV, the virus that causes AIDS. Thailand has the largest number of confirmed AIDS cases in Southeast Asia.

Thailand fought AIDS aggressively in the 1990s and became a role model for the developing world. But today, officials and activists warn, complacency has set in. The country is faced with rising infection rates in some groups and the enormous problem of caring for the offspring of some of the 450,000 AIDS patients who have died since 1984.

Nisarat, whose caseworker allowed access to her and her grandparents on condition that only their first names be used, looks healthy, despite a blotchy skin disease that prompts older boys to teasingly call her "ghost face." She has gained 25 pounds since going on antiretroviral drugs two years ago.

She rides her bike, and swings a watering can as she heads to a vegetable plot she tends at school. But she also suffers from epilepsy. She has severe headaches, stomachaches, and high fevers. Her teacher won't allow her to play sports because she thinks it could trigger a seizure. Her mother died when she was a year old. Two years later, she lost her father. Caseworkers say both died of AIDS.

She is learning to help her grandmother, Auy, whom she calls Ma, and her grandfather, Sawant, or Pa, who is 71, sick, and unable to work or feed himself. Besides taking her own doses of drugs twice a day, she makes sure Sawant gets his medicine. She washes her own clothes, washes the family's dishes in a bucket, and cooks vegetable curry.

"She is learning, little by little," Auy said.

"We just hope that she will live," Sawant said.

Auy works seven days a week, rising at 3 a.m. to haul charcoal to the market to sell, then laboring in the rice paddies for nine hours, earning $2.50 a day. "Next year, I might not be able to work the fields anymore."

Nisarat tries to concentrate on her studies. She likes English. "Bat," she said, practicing with a visitor. "Rat, cat!" she said, pointing to a gray kitten romping at her feet. She likes meditation. "It makes me feel calm," she said of her twice-monthly sessions with a meditation teacher. She has friends, like Wanlee, 11, who also has HIV, also lost her parents to AIDS and lives with her grandmother.

But sometimes reality seeps in. "I worry," Nisarat said, her eyes moist, "that I will have no one to live with."

Nisarat receives antiretroviral drugs free from Access, a nonprofit group working with children with AIDS that buys the medicines with government subsidies. Nationwide, only about 15,000 people receive the drugs, but an estimated 150,000, including 20,000 HIV-infected orphans, need them desperately, UN officials said.

Thailand has slashed infection rates by 80 percent, to 21,000 a year. Its condom use campaign targeted sex workers. But success has bred complacency, said Hakan Bjorkman, a representative of the UN Development Program. "Gone is the heyday of aggressive condom campaigns and politicians talking openly about the problem," he said. "HIV/AIDS has fallen off the political radar screen in Thailand."

Prevention efforts are faltering, he said. Only a fraction of young people are being reached by meaningful AIDS education, and government spending on AIDS has fallen -- from $53 million in 1996 to $30 million this year, Health Ministry statistics show.

Sombat Thanprasertsuk, director of the ministry's AIDS and tuberculosis unit, acknowledged that a greater effort must be made to raise awareness. "People feel relaxed, that they can't get AIDS," he said. He is concerned about a possible resurgence among gay men. Among intravenous drug users, the infection rate has risen as high as 50 percent in the past five years. And a recent government crackdown has driven users underground, activists said.

In a slum near the Chao Phraya River in Bangkok, the Rev. Joseph Maier -- a Redemptorist priest known here as Father Joe -- and his staff at the Human Development Foundation care for 41 babies and children and 26 adults with HIV, as well as 220 other children without it. The open, breezy three-story complex teems with life, and with children struggling to live.

Phannarai, 7, skipped around a girlfriend as she waited for the truck that would take her to a Catholic school, the only school in her neighborhood willing to accept HIV-positive children.

James, who is 8 but looks about 5, lost his parents to AIDS. He lies in a crib, where a caregiver changes his diaper several times a day. His favorite food is instant noodles.

"They're alive and happy and fight and steal things," Maier said, "except they're going to die."

Some parents come, knowing they will die and leave children who will live.

Areerat Forrest, 39, a Thai woman who has AIDS, came to the shelter two months ago with her daughter Cherie, 11, and son Andrew, 9 -- both HIV-free. The children's father, a British-born mechanic, died in 1999. Two weeks ago, Forrest was sent to the hospital, where, on a recent Saturday, she lay on a bed, emaciated, hair gone, skin mottled and the color of charcoal, eyes half-closed.

"I touched her feet," Andrew said. "They were cold."

"Mom couldn't talk," Cherie said, her dark brown eyes brimming with tears.

When her mother became ill about a year ago, Cherie frequently missed school so she could look after her. She washed and massaged her mother, and placed a hot water bag on her stomach to ease the pain. She prepared her medicines and soaked and boiled vegetables for her to eat.

She recalled the days when she and her mother would gather wild vegetables and sell them. "We would compete to see who could shout louder," she said, brightening at the memory. "I would shout, `Would you like some veggies? Only 5 baht! They are beautiful and will make you beautiful!' "

Today, she lives in a foundation-run home, where she keeps a stuffed Mickey Mouse on her bed. She said her mother was a heavy drinker and was raped by a man with HIV. She said her mother warned her not to copy her. "She meant that what she did was a mistake, the drinking, everything."

Cherie spoke with great tenderness.

"I'm worried," she said. "I miss her."

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