The Kingdom of Lanna and the HIV Epidemic

As the Lanna capital, Chiang Mai, celebrates its seven hundred year anniversary, a new
and devastating epidemic is being visited upon its people. HIV has spread rapidly and
extensively in Thailand. but nowhere in the country has it reached the epidemic proportions
now seen in the northernmost provinces.(2) The interactions of HIV and human populations
have been complex and perplexing wherever the HIV virus has spread. Why some countries
and populations remain only slightly affected, while others are overwhelmed, is the subject
of intensive study and debate. It is tragically clear, however, and for reasons we only partly
understand, that Chiang Mai and it's surrounding countryside are the epicenter of severe HIV
and AIDS epidemic, an epidemic that may have profound.consequences for the northern Thai
people, their culture, and their way of life.
The Start of the Storm
HIV came comparatively late to Asia.(2) While central Africa, the United States, the
Caribbean, and parts of Western Europe underwent explosive epidemics in the early 1980s,
and perhaps before, Asia appeared to be spared.(3) There were reputable medical authorities
suggesting as late as 1985 that Asians appeared to be "resistant" to HIV. There were cases
of HIV and AIDS deaths in Thailand as early as 1984, but the majority of these were among
homosexual Thais with sex partners from the West.(1) These cases, it is now clear, did not
lead to the epidemic spread of HIV. Then, in 1988-1989, something unexpected happened.
The Thai national surveillance system for HIV, put in place just a few years before to track
the spread of the virus, began to report sudden and alarming increases in HIV infection rates.
Among women in the Thai sex industry HIV rates went from about 2% to over 40% in just
six months; one of the most rapid increases ever seen.(4) Shortly thereafter, men attending
sexually transmitted disease (STD) clinics, blood donors (mostly young men), and Royal Thai
Army Conscripts followed suit.(4) HIV had entered Thai society, and the first major HIV
epidemic in Asia had begun.
But it was an uneven epidemic. While most researchers assumed that Bangkok, with
its notorious commercial sex scene would be worst hit, the reality was far different. The
provinces with the highest HIV burden were places like Payao, Lamphun, Chiang Rai, and
Chiang Mai.(5) In 1991, for example, fully 1 in 10 young men conscripted into the Thai

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