211^th Meeting – July 2001

NGOs and the AIDS Crisis in Chiang Mai

A talk by Dr. Vincent J. Del Casino

The summary for this meeting is based on an abstract from a paper Dr. Del Casino delivered at the 7^th International Conference on Thai Studies, Amsterdam, July 1999  

Abstract:

HIV/AIDS and the Spaces of Health Care in Thailand
Vincent J. Del Casino Jr.

In the 1990s HIV/AIDS has become one of the most important socio-economic issues facing Thailand’s upper northern region. The Thai government has argued that the number of HIV/AIDS persons living in this region far exceed the capacity of government health care facilities to care for their needs. Based on this perception of a health care and social welfare crisis, the Thai government has pushed forward an agenda of ‘community supported home based health care’. In this context, non-governmental organizations (NGOs) and community-based organizations (CBOs), specifically a network of people living with HIV and AIDS (PLWHA) support groups, have been targeted for funding by both the Thai government and international funding organizations for the purpose of developing local capacities to handle the growing crisis. 

The larger objective of this paper is to understand how, why, and in what ways NGOs have used their position within the growing AIDS care infrastructure in Thailand to alter and define the spaces of health care for PLWHA and link these spaces to a set of broader political, economic, and social welfare goals at the local level. This objective involves an investigation of the organizational, spatial, and discursive relationships existing among this key NGO, a subset of its outreach communities, and the everyday social spaces of PLWHA seeking to negotiate the intricate web of non-governmental and governmental health care and social welfare programs.

To negotiate the complex health-care and social welfare bureaucracies in Thailand and to provide ancillary services to PLWHA, AIDS Organization has helped sustain the growth of PLWHA support groups in Chiang Mai. These groups are designed to educate individuals about medications, facilitate employment for PLWHA, provide counselling and family-related services, lobby politicians and inform clients of their legal rights, create linkages between various health and social services, and raise awareness in local communities in order to combat prejudice and discrimination. In addition, AIDS Organization has used their position as local AIDS activists to push for transparency in local politics and a more integrated ‘community’ response not just to AIDS, but to other social/economic problems linked to AIDS.

In addition, AIDS Organization has worked actively to both challenge the hegemony of biomedicine in health care and expand the role of other community members in PLWHA care. This includes the organization of village healers (maw muang) through the development of maw muang groups and ‘Traditional Thai Medicine’ (phet phaen thai) or ‘holistic health care’ centers. Phet phaen thai is seen by AIDS Organization as a bridge between the psycho-social and physical dimensions of health care that modern medicine (phet phaen bajuban) fails to realize. The work of AIDS Organization may thus go beyond organizing PLWHA and challenge the meaning of health care in Thailand: a system dominated by hospitals and health stations practicing phet phaen bajuban. At the same time, however, acting as a self-defined link between the state and the community of maw muang, AIDS Organization may assist in the expansion of the regulatory framework of the state’s health care apparatus.

Through these activities, AIDS Organization seeks to re-institute a ‘traditional’ system of cooperative community-based organization and health care for PLWHA. AIDS Organization’s reproduction of a set of dualistic discourses—traditional/ modern, rural/ urban, state/ civil society, Western/ Eastern—fails, however, to recognize the mutual constitution of these discourses and the spaces they occupy. The spaces they are organizing are not constituted out of some natural, or organic, ordering of the world, but are instead the products of a systematic partitioning of the world into geo-political bounded spaces by the state. PLWHA seeking care in these spaces are confronted with a bounded messiness that masks this power. Their bodies, and the daily activity spaces PLWHA occupy including the PLWHA support group, may become another site for the constitution of state and local power. Health care is therefore not simply about care, it is about the control and definition of the social and political body of the targeted populations. In discursively defining the community as ‘organic’ and the government as ‘artificial’ or phet phaen thai as ‘holistic’ and phet phaen bajuban as ‘bifurcated’, AIDS Organization fails to recognize the ways in which their work may reproduce power relations and regulate not just health care, but the socio-political bodies of PLWHA, and others, more broadly.