The Kingdom of Lanna and the HIV Epidemic

The social changes brought about in 19th century Europe by a continent-wide syphilis
epidemic may give us some idea about how HIV, another sexually transmitted infection, might
affect northern Thai society. Eighteenth century Europe has often been described as bawdy,
licentious, and sexually open.(16) The European literature and art of the age is often frankly
erotic in content. Syphilis had a profound affect on these traditions.(16) Incurable at that
time, disfiguring, transmitted from mother to fetus (as is HIV), and leading to blindness, heart
disease, psychosis and, in about 25% of cases, death, syphilis was widely feared and
stigmatized. Nationalism and blame of the "other" were a part of these fears. The English
called syphilis the French Pox, the French called it the Spanish Disease, medical authorities
blamed the epidemic on the "savage" peoples of the New World.(1) Syphilis infection for a
man meant the end of sexual life in marriage; for a woman, it was a mark of shame and
social disgrace. Within a relatively short time, the Victorian social codes began to develop
and spread. Gone were the scandals and peccadilloes of earlier times; sex was taboo as a
polite topic, fidelity in marriage the highest virtue, and virginity as essential for women until
motherhood. The only assurance that a man could have of syphilis-free children was the
absolute chastity of his wife and of himself. These social codes, while strictly adhered to in
public, were often impossible to live up to, especially for men: Victorian London had more
prostitutes than at any time in her history. Women, especially prostitutes, were often blamed
for syphilis, and the decline in status from the earlier courtesan and mistress traditions to the
pitiful street walker was extreme.
With Fleming's great discovery of penicillin (isolated from the common bread mold)
syphilis became treatable, and caught early, curable. But the negative social attitudes
associated with the disease did not change substantially. The social stigma, tragically,
continues to remain a crucial barrier to the control of the disease; because there is still so
much shame associated with this and other sexually transmitted infections, people are reluctant
to seek treatment, government programs have been targets of religious and conservative
groups, and sufferers remain reluctant to alert their sex partners and spouses to possible
exposure.(17) Thus, while the disease could be eradicated relatively easily (no penicillin
resistant strains have ever emerged, in contrast to many other infections,) it remains a
significant problem. When we think of an AIDS "cure" we would do well to keep in mind
that syphilis is fully curable, and yet recent epidemics have occurred in the United States, in
China, Cambodia, and Vietnam, and the disease has never been controlled in most of Africa,

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