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Camillian Social Centre (CSC) is located in Rayong, a province in the eastern part of Thailand, the hub of the gigantic state-sponsored eastern seaboard development project. CSC is committed to the work on AIDS, both in caring of AIDS patients and prevention. It has officially been opened on January 29, 1997, and implementing various activities for some years. It is now in the last phase of its three-year plan of action, which is due to complete in June 2000. It has got some financial contribution from Caritas Switzerland.

In preparing a new project to carry on the work, CSC discussed with Caritas Switzerland to find out a possibility to seek a financial support from the latter. Both parties came to a common agreement that an evaluation be conducted and its recommendations be taken into account when designing a new project proposal, which should be completed by June 2000.

In the face of a need mentioned above, an evaluation process has been prepared and schedule worked out. The evaluation exercise has been started in December 1999 with the following details. Back To The Top

This objective is an attempt to assess the situation on AIDS in Thailand and Rayong and to locate CSC’s response in this situation, particularly in Rayong where it is located.

This objective will try to assess how the overall operation of CSC accomplishes its set objectives by looking at various services it provides both at the centre and elsewhere.

1.2.3 To draw lessons from CSC’s work and come up with recommendations for planning of the new phase of the project.

This objective will try to draw lessons from the work of CSC, its strengths and weaknesses, as well as proposing recommendations for its operation in the future. Back To The Top

This evaluation fundamentally employs a participatory and interactive approach involving all parties concerned. These people were involved in individual and collective interview, sharing of ideas, small group discussion and planning of action.

Participants who took part in this evaluation are patients, people living with HIV, volunteers and staff members of CSC, personnel of network organizations, both public and private, local hospitals, schools, and target groups of CSC (students, police, factory workers, community leaders), and so on. Back To The Top

1) CSC is able to draw lessons from its past operation, which can be shared to other organizations engaged in similar work on AIDS.

2) CSC can formulate its new plan of activities for the next phase, which is more effective in rendering its services to its beneficiaries and target groups and relevant to current situation.

AIDS in Thailand has spread through different risk groups in an initial period, started with homosexual men to intravenous drug users, prostitute girls, sex workers and clients, to housewives, fertile women in general and infants.

The plan on prevention and control of AIDS was successful to some extent. It could slow down the rate of infection in risk groups. However, the rate of infection in women in general is still rising and the infection area is not limited only in the North as in the first decade when we first found people with HIV in Thailand. The rate is also high in several provinces in the Central region. The fast spread of this virus is contributed mainly by a favorable factor of the modern way of life, especially a switch of economic and social structure in the country from agricultural sector to industry and service, which are concentrated in urban centres. This change accelerates a massive migration of rural labor into urban areas, leaving their families behind. This situation leads to ‘disintegration of family and community’. People become more individualistic and materialistic. All these are favorable factors for a fast spread of AIDS. Thai men are in the risk group to infect the virus and spread it further. This sexual behavior makes women in fertility age to be a risk group to infect the virus from their husbands.

From 1984 to November 30, 1999, the number of AIDS patients is 131,396 and 36,312 people died of AIDS. In 1999, there is a report of 12,927 AIDS patients and 2,781 people died of AIDS[1]. The number of men patients from 1984 to November 1999 is 103,128 and 28,268 are women. The ratio of men to women is 3.6:1.[2] Concerning age of people having HIV, the largest group is those who are 25-29 years, representing 28.4%, while people at the age of 20-29 are the largest group of all, representing 66.8%.[3] It is found that from 1984 to November 1999, the largest group by profession infected the virus is employees (44.0%) followed by farmers (21.0%), traders (4.3%), home work (3.0%) and civil servants (2.7%).[4] Risk factors for the same period include sexual relationship, intravenous drug using, infection from mothers and blood reception (82.8, 5.1, 4.8 and 0.04% respectively).[5]

From January to November 30, 1999, the region with highest rate of infection is the North followed by the Central, the South and the Northeast[6]. The ratio of the patients per hundred thousands people is 36.3, 28.7, 12.4 and 8.4 respectively. The top ten provinces with the highest number of AIDS patients are Payao, Chiengrai, Rayong, Phuket, Trad, Lampang, Chiengmai, Chantaburi, Lampoon, Petchaburi and Nakhonpathom. The ratio of AIDS patients per a population of one hundred thousands is 109.1, 80.3, 70.7, 65.7, 65.3, 63.4, 57.4, 52.4, 51.8 and 40.5 respectively.[7]

Payao Province has the highest rate in the North (the ratio is 109.1 per hundred thousands people). Rayong is the top of the Central region with a ratio of 70.7 patients per hundred thousands. Phuket is the top of the South with 65.7 patients per hundred thousands and Ubolratchathani of the Northeast has 14.6 patients.[8]

The top five diseases that are the causes of death of AIDS patients are Mycobacterium tuberculosis, Pulmonary or extra pulmonary (35,390 cases at 26.9%), Pneumocystis carinii (24,954 or 19.0%), Cryptococcosis (22,1111 cases at 16.8%), Candidacies (7,094 cases or 5.4%) and Pneumonia recurrent (bacteria) in one year (4,821 cases or 3.7%)[9]

The number of people with symptomatic HIV from 1984 to November 30, 1999, is 51,801. Of this number, 5,424 people died. In 1998, it is recorded that 9,681 people had symptomatic HIV and 853 died (in year of sickness). In 1999, there is a report of 4,960 symptomatic HIV people with a fatality of 354 cases.[10]

It is estimated that the number of orphans under five years old at 7,071 in 1999. She estimated that there were 51 orphans in 1990 whose parents died of AIDS and the number continued to rise year after year. The accumulated number of orphans as of 1999 is 21,321. For orphans below 12, the accumulated number in 1999 is 59,045. There are over 300,000 children under 12 whose mothers have HIV while both the children and their mothers are still alive. Most children between 5-12 years whose mothers have HIV and are still alive in the year 2000 will be orphans by the next two years.[11] Back To The Top

As mentioned earlier, Rayong is a province in the eastern region of the country having the highest number of AIDS patients and people having HIV and it ranks the third of the country, after Payao and Chiengrai, both of them are in the North. Rayong recorded a dead toll of 1,047 and 3,997 AIDS patients from September 1984 to November 1999.[12] The ratio of AIDS patients per a hundred thousand people in Rayong ranges from 70.68 to 155.67. It records the ratio of 70.68 in 1999, while the highest is in 1996 at 155.67. The year 1999 marks the lowest, while in the previous years the figures are over 139.36[13].

Rayong is located in the heart of the eastern seaboard development project. This is a mega project on national industrial development producing mainly for export. The government initiated this project to attract foreign investments by erecting industrial estates fully equipped with infrastructures with a good network of roads for transportation and a deep seaport linking Southeast Asia and the world. It also provides tax holidays and many other privileges to foreign investors and local manufacturers producing for export. This industrial development policy yields at least two outputs. The first is that local farmers who owned large track of land sold out their farmland to earn a lump sum of money and became employees in these industrial estates. The second is that factories erected in these industrial estates attract massive rural labour, whose farming activities failed due to the government’s priority on industrial over agricultural development. Most of the workers in this region came from other provinces, especially from the Northeast. The first group of local people who were farmers and sold out their land to big companies had a lot of money to spend. Factories workers also had money to spend, especially when they were away from home alone. In the evening, they liked to go out to pubs and food shops for a drink. Of course, these pubs and food shops are like mushrooms in rainy season and offer girls. Many old men in local communities also went to leisure places for sexual service, because they had much money from selling out their land, and infected AIDS. Local informants said most people in this generation died of AIDS.

The HIV sentinel sero-surveillance in prostitutes, direct and indirect, young military recruits, blood donors, intravenous drug users, pregnant women and men having VD check-up in Rayong from 1989-1997, shows that the highest infection rates are found in intravenous drug users and direct prostitutes respectively. Over half of the former have been found HIV positive since December 1991 and was as high as 65.63% in December 1995. One third of direct sex workers were found HIV positive in June 1997. The highest rate of this group was found in June 1994 when 54.05% were found HIV positive. Indirect prostitutes were also in the risk group when HIV positive rate is about 10% since June 1994.[14] It is a pity we do not have figures on other groups. However, social workers at Rayong Provincial Hospital told us that the risk groups also include fisheries workers. These people work in the sea for months and occasionally land for a rest. These workers travel around to different fishing ports. When they are ashore, they go to sex workers. In this case, they could infect as well as spreading the virus.

The situation on AIDS in Rayong is so alarming. An officer of AIDS desk in the provincial public health office of Rayong said a whole village of Ta Guan infected the virus. All the original villagers died of AIDS. Later, construction workers came to build their camp here. Again, all the construction workers infected the virus. Another officer of the labour social security desk of the provincial labour office told us that all members of a village in Mabtapud infected AIDS. Many of the informants, especially housewives in two local communities, said local Buddhist temples had cremation ceremonies of those who died of AIDS almost everyday. Most of them were young people in the twenties and early thirties. Back To The Top

The public and many communities do not accept people living with HIV/AIDS. They blame AIDS patients that it is them who infect and spread the virus. It is their mistake and sin and their suffering is sound. People do not like to mingle with AIDS patients and people with HIV for fear of infecting the virus, though they do not really understand the disease and how virus can be infected. AIDS caring or relief centre or hospices are rejected and driven from their neighbourhood. This situation puts pressure on people living with HIV and AIDS patients. They are severely under stress that they are not acceptable to society at large, especially in those who are facing economic problem. Furthermore, the number of service centre for this specific purpose is not enough to address the problem. In this situation, some people with HIV and AIDS patients always resorted to the last choice of committing suicide. Else, they created problems on society in different patterns.

In solving problems and impacts of AIDS, a management mechanism is the core of this operation. In the past, this mechanism has gradually evolved, especially organizational establishment, co-ordination and approaches and budget. However, the solution of AIDS problem is depending on joint efforts that requires co-operation and collaboration from various parties, therefore, management needs to be adjusted to cope up with local situation at any given time for effective operation and outputs.

Many people, especially target groups in Rayong, do not have a clear and proper understanding on HIV and AIDS. The interview shows that many of them hear about HIV and AIDS from television and newspaper and other campaign materials. Yet, they did not really know what it was and how it could be infected, and what AIDS patients look like. They saw AIDS patients in full-blown symptoms and they were reluctant to see or contact people with HIV. The also mentioned that they knew that one way of effective prevention against AIDS was to use condom. However, they did not realize that they did not know the proper method of using condom. They only learned this from the training provided by CSC. Back To The Top

Due to a worsening situation on AIDS infection, it poses an alarming problem to Thailand regarding economic and social development. The number of people living with HIV is as high as 700,000-800,000 and these people will develop to their last stage of AIDS in the near future. Prevention and control of AIDS is an urgent task and needs to be successfully carried out soonest to slow down the rate of its spread as well as caring for AIDS patients to live a normal life in society. It is obvious that at present, AIDS prevention by giving knowledge to the people alone is not enough. Therefore, Thai government is developing tactics and strategies to provide knowledge on behavioral change and promotion of positive attitudes towards, acceptance of and sympathy to AIDS patients and people living with HIV.[15] In addition, there is development of knowledge by promoting research, especially on AIDS vaccines in Thailand.

The Cabinet has set up a national committee on prevention and solution of AIDS on February 16, 1998. This committee comprises high-ranking officers from different ministries with the Prime Minister himself as its chairperson. In addition, a secretariat has also been set up under the Communicable Disease Department of the Ministry of Public Health. Its responsibilities are coordinating public and private sectors to set up a network of social services and counseling for people living with HIV/AIDS and their families. It will also co-ordinate with organizations at regional and local levels to design plan of action at local level. It will co-ordinate public and private sectors to set up a network to receive complaints on violation of rights of the people affected by AIDS. It will co-ordinate with educational and cultural institutions to develop plan of action to prevent AIDS with social and cultural tactics. It will co-ordinate with educational institutions to develop mechanism in research to foster wisdom in local community. It will co-ordinate with foreign organizations in conducting study and research with local scholars to give assistance to society.

A focus in the present policy of the Ministry of Public Health is “human person” as both beneficiary and self-care agent. In this regard, it will support family and community as the basic unit for this health care. It will decentralize its power by coordinating public and private sector, supporting people and community’s organizations at all levels to take part in decision-making, choosing a direction and managing local public health. Its main prevention policy is to change behaviors in risk groups.

The goal of the government in public health regarding AIDS question is to reduce the rate of new cases of AIDS infection down 40% by reducing infection rate of 1.5% in military recruits and 1.5% in women who are below 25 with the first pregnancy.[16]

The Ministry of Public Health develops five programs of action. They are health promotion to prevent and control AIDS, caring service, support to caring, counseling and buildings for AIDS patients.[17] The government also sanctioned 8,282.23 million Baht for the years 1997-2001 for this purpose.[18]

In Rayong, the state does not have clear policy in caring for AIDS patients. It prefers the patients to stay home and come to hospital for medical treatment of their complications. Local health stations, district hospitals and provincial hospitals providing medical care for AIDS patients who have complications and people living with HIV. There are also other state agencies concentrating on prevention, like the provincial office on public health working with local health volunteers and personnel, the provincial office on labour security and welfare working with factories to give knowledge to factory workers, and local municipalities that work with local communities.

The social workers of Rayong Hospital said with government support it gave 500 Baht per head per month to AIDS patients provided they had a domicile in Rayong and they were prepared to be known as AIDS patients to give education to others. However, due to limited budget it can only support 30 patients. It also has a fund to give support on cost of living of 50 cases.

The provincial office for labour protection and security has a training program on AIDS prevention. It also provides financial support in the form of scholarship for children affected by AIDS and occupational investment for patients who cannot work in factory anymore and vocational training. The assistance will be provided to workers both in formal and informal sectors, provided they could identify their employers who are small entrepreneurs or factories. In 1999, it has given assistance to 54 children and 20 in 1998. In the previous year, it got a budget of 600,00 Baht from the Ministry of Labour, but this year, it gets only 150,000. Back To The Top

2.5 Response from Private Sector

In fighting against AIDS, it is not only Thai government and its health ministry that are taking care of this work. There are also other organizations in private sector involved in this work. They are non-governmental organizations that are charitable organizations, foundations, associations, human rights organizations, children organizations, and so on. All of them in one way or another tackle the issue of AIDS in different aspects. Some of them work exclusively on AIDS, some integrate this work as part of their whole operation.

According to a directory of 1999 on NGOs involved in the work on AIDS[19], there are 91 organizations working in prevention, counseling, caring, assistance to people living with HIV/AIDS and networking of NGOs and people living with HIV.

We do not exactly know how many of them are involved in AIDS work in an integrated way. What we do know is that at least seven of them are seven networks of people living with HIV and at least 12 are umbrella NGOs involved in networking NGOs working on AIDS. Among them, there are also international organizations like UNAIDS, which does not implement activities by itself.

From my own experience and interview with many people, most NGOs prefer to build up networks with organizations with concrete activities. In so doing, they spend most of their time in meeting rooms. It is especially true with AIDS work that requires personal commitment and sacrifice. Many informants told me that there are only four hospices in Thailand. I personally think there are more, but all of them are small with capacity to accommodate a small number of patients. Most NGOs are involved in prevention, which is also an important aspect of AIDS work. Since it is not an intention of this evaluation and due to time limit, I did not try to get much information in this regard.

In Rayong, there are some non-governmental organizations working on AIDS. Most of them are involved in prevention with a few also involved in social welfare of AIDS orphans and families affected by AIDS, like providing scholarship to the children, loan for occupational development, and so on. However, there are less than 10 of them. This number is very small comparing to the alarming situation of AIDS epidemic in Rayong. In addition, there is no one doing the work like CSC, especially with an integrated approach combining caring, prevention and counseling in one place. They are, for example, Médecin sans Frontière (MSF) giving assistance and counseling, Ban Samaritan gives assistance to orphans and those affected by AIDS, an AIDS assistance centre in Pae giving assistance to community organization, and so on. Back To The Top

As of 1999, there are 29 Catholic organisations[20] involved in the work on AIDS in Thailand. Five of them are caring for the patients at different stages of AIDS. They are Shanti Dharma Clara House in Pathumthani, Human Development Centre in Bangkok, and Camillian social Centre in Rayong, St. Louie and Camillian Hospital. Thirteen Catholic organizations provide temporary shelter while the rest are working with risk groups and provide preventive training to their target groups.

Over half of these 29 Catholic organizations are concentrated in Bangkok Archdiocese. Only four are working in Chantaburi Diocese. The first one is the Rebirth Centre in Bangkla, Chachoengsao Province, which is working on rehabilitation of drug users. The second is the Fountain of Life Centre in Pattaya, Cholburi Province, which is working with sex workers. The third is Lorenso House in Cholburi, which runs an orphanage and the last one is Camillian Social Centre in Rayong.

These organizations are non-profit organization, dedicating to this work with their religious vocation to help relieve their pain of fellow human beings. Many of them adopt an integrated approach by rendering counseling service, providing shelter, training and caring of children, as well as caring for terminal AIDS patients in the same centre. These organizations have to work hard also to raise fund from Christians and other people of good will both in the country and abroad to support their work. All of them are small organizations with limited budget, except hospitals that are also providing other health care in general. Their number is still very small compared to the problem.

These Catholic organizations are co-coordinating with one another to share experience and lessons from their work and take common action. This co-ordination and co-operation is done through an umbrella of Catholic Committee on AIDS, which is an arm of the Catholic Commission for Pastoral Assistance to Health Care Workers under the Catholic Bishops’ Conference of Thailand.

We do know that there are also activities on AIDS, especially caring of AIDS patients, by Buddhists and Muslims. We know that some Buddhist monks are also giving assistance and care to AIDS patients. However, we do not know their number and detail of their activities due to limitation of time for this evaluation exercise. Back To The Top

Saint Camillus Foundation of Thailand is a legal entity of a Catholic religious congregation dedicated to the care of the sick. Earlier, most of its members were European missionaries. Now, it also has some local priests and religious brothers. Its operates a hospital in Bangkok, homes for lepers and homes for the elders in the province.

In running the hospital, under the name of Camillian Hospital, members of this congregation had to attend to the sick in the hospital, giving them spiritual services as well as counseling. When AIDS infection was reported in Thailand, this congregation was also alarmed and started to discuss how the congregation could address this tragic problem. The congregation agreed to put its hands on the issue. However, there was a question who would do the job and how to do it. This question remained unanswered until an Italian patient came to Camillian Hospital and died of AIDS. He was the first AIDS patient in this hospital and he was abandoned. At that moment, Fr. Giovanni Contarin was a resident at Camillian Hospital. He had to arranged a cremation of this Italian patient and Wat Sapan, a Buddhist temple in Phrakhanong, was contacted and accepted to render the cremation service. This is the beginning of a story that makes Wat Sapan as the only Buddhist temple in Bangkok that accepts to render a cremation service to the dead of AIDS patients. All other temples are reluctant and refuse to do so, for mythical fear of infection and hesitation of their believers.

After this, Fr. Contarin contacted Archdiocese of Bangkok to start a relief centre for AIDS patients. He started a project in 1992 in Bangkok to cater to the needs of HIV/AIDS patients. He has been working with HIV/AIDS victims ever since. He asked for a plot of land in a suburban parish. Instead of getting the land, he got a suggestion to rent a place as a trial phase. He then rented a housing unit in Soi Rawadee, Nondaburi Province. This place was selected because it was near Bamras Naradoon Hospital, a public hospital under the Ministry of Public Health. This hospital cares for AIDS patients in their last stage of life.

3.2 Soon Bantaojai (Relief Centre)

As earlier mentioned, a housing unit in Soi Rawadee was rented to give a temporary shelter to AIDS patients and to give counselling service to AIDS patients, people living with HIV and their families. This place was called in Thai “Soon Bantaojai” or Relief Centre. Soon Bantaojai literally means a centre of consolation. It was established in November 1993 with Fr. Giovanni Contarin as its director and Mr. Wiboonchai Yureun-ngam as its manager. Mr. Wiboonchai himself had HIV. This centre worked closely with Bamras Naradoon Hospital, as it always referred AIDS patients to this hospital for medical treatment.

The purpose of this centre was concentrated on counseling service for people having HIV and AIDS patients in their first stage. The centre wanted to help them have a proper understanding of their physical conditions and the process of transmitting the diseases as well as to facilitate them to live confidently and happily in society.

The need to establishing Soon Bantaojai was to help society get least impacts from HIV infection problem. The centre advised them how to take care of themselves and avoid infecting other people. It also participated in protecting human rights of people having HIV and AIDS patients resulted from misunderstanding of AIDS problem that would lead to discrimination and inappropriate action/behavior towards the infected.

Regarding activities, Soon Bantaojai offered counseling service to the infected in order to enable them to accept and adjust themselves towards the virus they have. It encouraged them to be able to live with human values and dignity. It provided information service on HIV/AIDS. If offered counseling service to family members of people living with HIV to help them have a proper understanding on HIV/AIDS and be able to live with the infected comfortably. It facilitated people having HIV to be able to help themselves and stand on their own feet. It offered pre-test counseling and advised anonymous blood testing clinic on request. If also offered post-test counseling to every case. It offered temporary residence for the infected people to help them relieve their anxiety and adjust themselves. It also provided information service on call for people who are not ready for personal counseling.

Soon Bantaojai was located right in the midst of urban communities. Due to misunderstanding and antagonistic attitudes towards AIDS patients, the centre met with series of protest. It was also the target of violent attacks and threat by local community. The conflict had appeared in newspapers since 1995 when there were demonstrations, protests and accusations. This conflict ended up in 1996 when the centre was attacked by explosives and shots that damaged its building. Through this confrontation, Soon Bantaojai was thus closed down and moved to a new location on April 25, 1996. The work was transferred to a new place in Rayong Province in the eastern part of the country where Camillian Foundation owns a plot of land donated by a benefactress some time ago. Back To The Top

3.3 Camillian Social Centre in Rayong

When Soon Bantaojai was closed down, a new centre was erected in Ban Huaypong, Tambol Mabtapud, Amphoe[21] Muang, Rayong Province. The land where this new centre is located belongs to Saint Camillus Foundation. It has got this land as a donation from a Catholic benefactress about 27 years ago. The new centre has got a name of Camillian Social Centre (CSC) and was officially opened January 29, 1996. The present location has been chosen because the land is the property of the Foundation. It has been chosen also because Rayong is the province with the highest rate of infection in the eastern region and the third in the country as earlier mentioned. In the province, there are several industrial estates and a large army of workers, mainly young people coming from other provinces including foreign workers.

CSC in Rayong is a relief centre caring for AIDS patients in their terminal stage, people and orphans living with HIV. It also runs training sessions for students and factory workers, community members and civil servants on AIDS and its infection and how to prevent themselves from this fatal disease. It operates an intensive care unit for AIDS patients who are helpless and in their terminal stage of life, wards for AIDS patients, both men and women, who can still help themselves. It also provides a dormitory and classes for orphans whose parents died of AIDS and children of AIDS patients. It provides training on the knowledge on AIDS, its infection and how to avoid infecting this virus.

CSC provides basic social services by giving temporary shelter for people with HIV/AIDS patients who are poor and abandoned by their families and society. It organises a communitarian setting so that AIDS patients would be in a familial atmosphere. It gives medical care of AIDS patients and people with HIV and refers AIDS patients with complication to local state hospitals. Back To The Top

1. To help reduce the pain and impacts of AIDS patients by providing medical treatment and care to the selected needy people of region 3 (eastern provinces).

3. To carry out public education and training programs to introduce prevention knowledge and skills, and to develop attitude of care and support towards AIDS patients.

4. To do outreach and counseling work to safeguard the human rights of HIV/AIDS patients, to provide community support, and to (build) network with other HIV/AIDS NGOs in the region and in Thailand.[22] Back To The Top

3. HIV positive, the effected families and other AIDS patients that stay in their own houses.

4. Students and factory workers who receive training and who come from the provinces of Rayong, Chonburi, Sattahip and Sriracha.

5. AIDS patients in general, who are discriminated against, and whose legal or human rights are violated. They can join the association of HIV+ “The Way, The Truth and The Life”.[23]

3.6.1 Caring

CSC has three buildings serving as living quarters for AIDS patients. The first building accommodates male patients with an intensive care unit. The ICU has a capacity of eight beds. The second building accommodates female patients while the last one accommodates orphans with HIV.

CSC has facilities to accommodate 40 patients. However, at present it accommodates 72 patients. They are 58 adults and 14 children. Not all of them live in CSC but some, especially those with families, live outside in houses rented by CSC. This group comes to CSC in the morning to work and return in the evening.

The number of patients changes often because of death. However, its accommodation facilities are always fully occupied. When a bed is vacant because a patient died, it will be allocated to a new comer within a few days, or even on the same day.

As of September 30, 1999, the total number of people admitted with an average stay of 20 days is 347. They are 109 female and 238 male. The largest group of patients was at the age of 21-30 followed by the age of 31-40, with a number of 139 and 119 respectively. They were born in different provinces, the biggest in Bangkok, Rayong, Chantaburi and Chonburi respectively. There were also 26 born in foreign countries. The total number of death is 169 with 118 returning to live in their families and communities.[24]

In the caring section, a volunteer female doctor occasionally visiting CSC to give a care on skin disease to the patients with a volunteer nurse from Médecin sans Frontière (MSF) and 5 people with HIV help in this section, especially in ICU. These five HIV infected people have not got any training in this field, but learned from their actual practice. This section has the following job description.

1. It co-ordinates with state agencies in referring patients. For example, a patient to be admitted has to go through a social worker of public hospital or provincial public welfare officer to inspect evidences as well as issuing document on medical treatment. An informant told me that the main reason for involvement of civil servant is to allow state agencies to monitor the situation on AIDS infection in the province. It also co-ordinates with state agencies when there is a need for medical treatment for complication or ongoing hospitalization (as prescribed by physicians/hospital).

2. It organises in-service training for patient staff members on caring of patients who are helpless, like cleaning their bodies, changing diapers, feed patients who are unable to eat by themselves, boiling medical equipment, laundry of clothes and bed sheets.

3. Gives advice to patients and their families on self-caring, as well as prevention from spreading the virus or infecting more virus.

4. It co-ordinates with Médecin sans Frontière (MSF) and Cholburi Province on AIDS medicines for orphans having HIV and children affected by AIDS.

5. It prepares medicines for patients with complication as prescribed by hospitals.

6. In case of patients with wounds, personnel in this section will clean the wounds daily in the morning and evening. Back To The Top

The prevention team comprises three members who do not have HIV. This is the only team with people like this, with a cook who is not HIV infected people. There is a co-ordinator, a secretary and a part-time resource person. The training employs an approach of communication techniques and peer educator group.

This team will contact different organizations, schools, factories, leisure places, like pubs and food shops where there are sex workers, and local communities to present a prevention training program mainly for one whole day. It also works with provincial health office and provincial labour security and protection office to give training on AIDS prevention to their personnel, after which the trainees will have a short visit to CSC to have a direct encounter with AIDS patients. For students, it will give a priority to secondary students because there will be input on sexuality in the training, as students at 14-15 start to have sexual relationship.

1. It contacts enterprises, like companies and factories in various industrial estates in Rayong, food shops and restaurants to present a project on prevention of HIV/AIDS infection and invite staff members or leaders or volunteers in these enterprises to get training at CSC

2. It contacts educational institutions in Rayong to present a project on prevention of HIV/AIDS infection in educational institutions, and invite teachers and student leaders in those institutions for a training program to be held at CSC.

3. It contacts state agencies, like municipalities, to be an agent in inviting community leaders for a training program.

4. It co-ordinates with state agencies, such as the provincial office for public health, the provincial office for labour welfare and protection, the municipality of Tambol Mabtapud, and the provincial office for elementary education to provide training for personnel of various enterprises in Rayong, construction workers of Italian-Thai Company, teachers and parents and representatives of various local communities in Rayong.

5. After the training, there is a monitoring through interview, discussion on behaviors and attitudes after the training, knowledge and understanding on HIV/AIDS, as well as problems when extending the idea to people around them, as well as distributing documents and information, displaying of exhibition and organizing various activities in those institutions with an action plan and follow-up.

6. It prepares documents for distribution to trainees, training program and subjects. Training session begins at 09.00 to 16.00 hours. Each session takes place for one, two or three days depending on the target group.

7. It prepares a semi-annual report and submits it to the Department of Communicable Disease Control, the Ministry of Public health and an English version for Caritas Switzerland.

8. It evaluates outputs of the training program with statistics for each group of trainees to assess how they understand HIV/AIDS before and after the training through a pre-test and post-test questionnaire.

9. It arranges documents and keeps filing on documents related to the prevention program.

This prevention program has three main target groups, namely workers in enterprises, students and civil servants. The prevention program is mainly done with training of the three target groups with similar objectives.

1. To provide proper knowledge and understanding on HIV/AIDS (to workers, teachers, students, civil servants).

3 To motivate workers, teachers, students and civil servants to realize the need for prevention against HIV/AIDS and avoid risk behaviors.

4 To allow workers to discuss matters on sexuality openly by promoting the proper use of condoms to prevent HIV infection and other venereal diseases.

5 To provide knowledge and promote proper understanding and positive attitudes in students towards people living with HIV and AIDS patients in family and community.

6 To raise awareness of civil servants on the need to prevent infection of them and people around them, as well as avoiding risk behaviors.

7 To build capacity of civil servants in disseminating the knowledge and understanding on AIDS to other people properly.

8 To help civil servants to gain a positive attitude with sympathy and compassion to people living with HIV and AIDS patients in family and community.

1. It supports state agencies as the base for training of civil servants by requesting co-operation from concerned officials to give proper knowledge and understanding on HIV/AIDS, proper use of condoms and AIDS prevention.

For students, CSC will be the base of this training. It will invite students to attend the training at CSC. Factories will be the base for training of workers.

2. It wants to form a group of leaders in AIDS prevention in state agencies, teachers and students by supporting personnel who are prepared and have willingness as well as having good human relationship and are leaders in campaign to prevent AIDS infection.

3. It wants to form peer support group and peer visiting project with application of communication and role-play skill.

4. It gives an emphasis on proactive approach of prevention by accompanying civil servants to gain a direct encounter with AIDS patients and people living with HIV and sharing of experience, as well as giving counseling on prevention to develop potentials and strengthen families/communities.

5. It gives assistance on up-to-date information or organizes special activities in their organizations.

6. It monitors various agencies to give advice on activities by meeting their leaders every quarter for one year.

7. It designs pre-test and post-test questionnaires to assess understanding and knowledge of trainees.

A training program will take place for one, two or three days depending how the target groups find it convenient and fruitful. However, the daily program will start from 9 a.m. and end at 4 p.m. The size of each group will be around 20 trainees. For students, the preferable group will be those in senior high school, vocational students or university students, teachers in concerned schools/educational institutions.

The training will start with a pre-test and orientation. Then, resource persons will share knowledge on basic communication skill followed by a workshop on role-play, a presentation on knowledge on HIV/AIDS. Afternoon sessions will begin with prevention from infection of HIV/AIDS with a slide presentation. The last session will be an interaction, encounter, dialogue and exposure to the life of the people living with HIV and AIDS patients living in the centre. The training program ends with sharing of personal impression and a post-test.

From May 1998 to April 1999, CSC has contacted 140 companies and offices in Rayong and its vicinity with 43 positive response while others refused to join due to their problems resulted from the current economic crisis. It contacted 51 schools and 42 responded positively. It contacted 8 state agencies and four of them responded positively. It also contacted 8 NGOs with 6 positive responses and two did not respond at all. There were 655 students attended the training. Among them 362 are boys and 293 are girls. The total number of workers attended the training is 144. They are 81 men workers and 63 women workers. The total number of trainees from state agencies and local communities is 67. Among them 38 are men and 29 women.

In monitoring the training, the co-ordinator of this section will contact the trainees and their supervisors/teachers and to encourage them to form groups and initiate activities to disseminate the knowledge on AIDS and HIV and how to prevent its infection as well as avoid risk behaviors. CSC encourages these enterprises, state agencies and schools to come up with a plan of action on what they would like to do to disseminate the knowledge and proper understanding to their friends and relatives. This plan is considered to an essential part of the prevention program in forming peer educators group as change agent.

CSC also renders a service on study trip. It regularly welcomes visitors to have a direct encounter with people living with HIV and AIDS patients. This service is considered part of the preventive education. The trip is normally a short visit of a few hours to half a day and it was mainly spent on dialogue with members of the centre after a brief orientation. The total number of visitors from May 1998 to April 1999 is 644 in 22 groups[25]

The prevention program also faced some problems in the course of their operation and has come up with steps to be taken to solve them. It states that communities in Rayong and its vicinity have a high percentage of Thai migrant workers living with foreigners. There are all types of migrant workers, domestic and foreign, men and women, and most of them are single and in their reproductive age. It has developed strategies to keep up with the increasing complexity of AIDS problems by bridging the potential/capacity of PLHAs and the social needs of healthy people to curtail the epidemic. With a holistic approach combined with proper education, healthy persons can co-exist and live together with PLHAs and thus restore social balance to the benefit of both PLHAs and communities.[26] Back To The Top

This section is in charge of food preparation for staff members and patients living in the centre. There is a cook who does not have HIV with five people with HIV working in this section. Apart from preparing food, they have to go to market to buy raw materials. In addition, they also have to prepare food and snack when CSC organizes parties or meals for trainees attending training sessions at CSC.

The child centre is set up to accommodate and care for children whose parents died of AIDS. The front building of the centre serves as an accommodation and classroom for AIDS orphans. The work with children living with HIV, whose parents have died of AIDS or are staying at CSC, has started in around May 1988. It has officially been opened with a religious ceremony in November 1999.

This child centre is attended by five people. There is one teacher does not have HIV teaching Thai language, mathematics, games and drawing. Two Danish volunteers teach English teaching. Teachers also lead children to do various activities, like exercise and handicraft, as well as teaching them virtues on love, mutual aid and unity. Miyo, a tribal girl from the North and has HIV with her younger sister who is free from HIV help take care of these orphans to clean themselves and take medicines on time.

At present, there are 14 children staying and studying at this child centre. Nine of them lost their parents because of AIDS. They are the main group studying at the centre. The remaining still live with their parents who have AIDS and also stay at the centre. The youngest is 5 years old and the eldest is 12.

Daily program starts with classes in the morning followed by games and exercise in the afternoon. However, this program is flexible depending on interest and mood of the children. Back To The Top

The forum started with an initiative of some members who got together and set up a forum called ”Bantaojai” in march 1998. The founding members are Mr. Adirek Poethong and Mr. Boripat Donmon with Fr. Contarin as their advisor. Mr. Boripat was the first chairperson. This forum gradually extended to outsiders, but not successful because they did not know who these members were and they did not want to express themselves as people with HIV. At first, the membership was 40. Then, the forum published a folder to introduce the forum and distributed the folder in local health centres.

Actually, the idea of grouping people living with HIV together originated from the Thai Red Cross Association. The idea was widely accepted and many public hospitals and health stations will support people living with HIV coming to get medical treatment to form a forum. Therefore, most provinces have this kind of forum. In Rayong, there are three forums.

The purpose in setting up this forum is to foster mutual aid and development of quality of life of people living with HIV and AIDS patients, as well as providing counseling and encouragement to develop quality of these people so that they can live a normal life. It wants to help people with HIV to understand life and get together for mutual aid, and not to spread the virus to other people as a sardonic expression against society or infect more viruses.

The forum co-ordinated with CSC to ask for a space and facilities as an office of the forum, as well as co-ordinating with the prevention section in providing people with HIV/AIDS as resource persons. Six members who are people with HIV are directly in charge of this work.

It also co-ordinates with local hospitals, provincial, community and village office of public health and other agencies in Rayong to do public relations to extend membership. The forum has just held its general meeting on December 1, 1999, to elect a new committee. The new chairperson is Mr. Chettha Malee and the name of the forum has been changed to the current name of “Bantaojai”. The forum expresses the following objectives.

1. Promote and deepen relationship among people with HIV/AIDS and with their communities, society and family.

2. Provides counseling service to its members and families staying in the centre and outside.

1. Open for application for membership, hold monthly meeting of the members, and visit members living outside the centre to share experience.

2. Give training and counseling on how to lead a life, and give both personal and phone counseling service.

3. Create income-generating jobs and vocational training for interested members, such as paper folding, sewing, glass painting, batik designing, making greetings card, key holders, artificial flowers, and so on.

7. Organize various activities in the centre, such as celebration on World AIDS Day, Mother’s Day, as well as other social and cultural gathering to deepen relationship and unity among people living with HIV and AIDS patients.

It also raises fund by distributing donation boxes in the name of the forum to mobilize fund. It delivers and sells products made by the members of the forum to earn income. It also co-ordinates with private sector and NGOs to seek their financial contribution.

At present, the forum has 73 members in and outside the centre, adults and children as well. They are 42 men, 20 women, 5 boys and 6 girls. All people living in the centre are members of the forum.[27]

The forum hopes that through its operation the patients will have energy and courage enough to realize their values and live their life with quality without being desperate or hopeless. While they can breath, they got to have power to struggle to overcome what they are facing with pride.

It has a plan to set up an office at Rayong Hospital to render counseling service to people living with HIV and AIDS patients who come to the hospital for medical treatment. This idea is resulted from the fact that only a few people dare to show themselves as people with HIV. Therefore, an existence of a counseling office at Rayong province will enable these people to visit and get counseling service from it more conveniently. It will also help the forum to extend its membership. Talk with Rayong Hospital to ask for space is underway. Back To The Top

The origin of the eastern network is the operation of the forum of the Way, the Truth and the Life (later changed to Bantaojai). This forum is in the east, but it is under the network of central region. The eastern network covers forums in eastern provinces of Rayong, Chonburi, Chantaburi, Trad, Prachinburi, Chachoengsao and Srakaew. At present, the eastern network has its office at CSC and 10 groups in 7 provinces are its members. It held a meeting on 17-18 February 2000 to provide a platform for its members to meet, discuss and share experience on health caring and how to lead a life in society. It also provided news on AIDS, as well as giving advice on setting up groups of people living with HIV.

In 1999, the network got a financial support of 300,000 Baht from the Communicable Disease control Department, the Ministry of Public Health. It then held a seminar on 18-20 October 1999 in close collaboration with Access, an AIDS Access Foundation, to strengthen the network of people living with HIV and set up a committee of the eastern network. This newly elected committee held its first meeting on 8-9 November 1999 at CSC. Then, the network has visited many groups in the region

Three people living with HIV are directly working for this network with the following job description.

1. Co-ordinates with the national co-ordinating committee of AIDS NGOs, groups and forums in eastern provinces to share information with one another.

2. Support organization of groups/forums of people living with HIV in the areas of eastern region.

5. Organize training on counseling, caring, visit and training of leaders for groups and forums.

6. Distribute powder milk to children with HIV and those affected by AIDS. Back To The Top

The main target group of prevention program is young people, especially students, because they are in the age group with high risk. CSC would like to help them have a proper understanding on AIDS and HIV, its infection. The selection will be done by their supervisors or teachers. CSC only gives them training and follow-up in close collaboration with their teachers and bosses. Most students and sex workers taking part in training at CSC were not forced to attend the training. They voluntarily joined the training because they were interested in the subject and a visit to a place where there are AIDS patients and people living with AIDS. In this case, they would benefit from the program. Among all the target groups attending training at CSC and interviewed in this evaluation exercise, only police of Huaypong Station were forced by their superior to attend the training. I have met two groups attending training at CSC. The first is 27 sex workers from Pattaya and the second was 26 vocational students from Darasamut Business Administration College in Cholburi. All of them voluntarily applied for this training because they were interested in the subject and wanted to have a direct encounter with AIDS patients. It is rationale for the first group because they are in the risk group and the second is young people, also vulnerable to infection of HIV.

For AIDS patients and people living with AIDS that will be admitted to CSC will be those who are poor and abandoned by their families and rejected by their communities and relatives. These people have to get a recommendation from social workers in public hospitals. For the people living with HIV and AIDS patients, after being screened by social workers in local hospitals, Fr. Giovanni Contarin will be the only one having the authority in admitting the patients.

People living with AIDS and AIDS patients will be involved in daily activities at the centre, which is good. It is also more effective to involve these people in the management of their local forum and network. Saengchai and Boripat said the other regional network of AIDS patients was managed by a non-HIV person. He was good in mobilizing more members. However, this person did not care much for a strong forum like the one at CSC. This forum has invited this person several times to attend a meeting or take part in activities at CSC, but he refused to come. When the forum visited him in Chonburi, he was not happy to receive members of the forum. This shows that it will be more effective and worthwhile to have HIV infected people organizing the forum and the network by themselves, because they will have a sense of belonging and feel that they become proud of their work. Many of them are happy to stay at CSC because they feel warm by staying with people sharing the same fate, like belonging to the same family. They become more encouraged and help one another as they can. This helps them to be proud and realize the value of themselves.

Factory workers. At present, most factories like to employ young people, especially freshmen, because their salaries are lower and they are more energetic than older workers are. Many of them are still single and come from other provinces. Therefore, they are in the risk group to infect HIV. The statistics show that young people are the largest group of people having HIV and AIDS patients. In Rayong, people died of AIDS at present were at their twenties and thirties. It is legitimate and urgent to help these factory workers to really understand AIDS/HIV so that they will avoid infecting it. They should also be helped to understand people living with HIV/AIDS so that if their relatives are not fortunate, they will be able to care for them with a positive attitudes.

This centre is operated at a big budget, because caring for patients is quite expensive due to high cost of medicines. Therefore, fund raising is a hard job. So far, Fr. Giovanni has to work hard to seek financial support from different donor agencies, state agencies, friends and some fund raising activities, like selling products made by the patients.

In 1997 and 1998, it got 400,000 Bath per year from the Communicable Disease Control Department and 1,600,000 in 1999 for caring and prevention.

However, it is not an aim of this evaluation to study this aspect in detail. The above information only gives an overview picture of its financing.

4.1 Integrated Approach of CSC

In the Camillian Social Centre or known as Relief Centre setting tries to rebuild a new home as one family for people infected by HIV virus and AIDS patients. The care, concern, encouragement and closeness that are claimed to be the main goal the centre wants to achieve for the benefit of all patients who are abandoned by their families.”[28]

Since CSC is also accommodating AIDS patients as a hospice, there is also a question whether a hospice is feasible because it is expensive and ineffective to accommodate the ever-increasing number of AIDS patients. Leaving AIDS patients or people living with HIV is the best solution to help these people feel at home with care of their family members.

At present, there are more AIDS patients and most of them are abandoned by their families because of the syndrome itself and also because of economic reason, as AIDS medicines are very expensive because they are imported. By and large, society does not accept the reality of AIDS patients. Actually, present society is less hospitable and mutual aid but more individualistic. The presence of a hospice will foster people to be have concern on and help others more. For Catholics, a hospice provides an opportunity for them to be witness by caring for the sick. A hospice also helps AIDS patients to feel that they are not abandoned and they can die with human dignity. A hospice is also the last resort of AIDS patients.

I was told several times by informants that AIDS patients were left in front of the centre at night and in the morning Fr. Contarin came out to find them helpless. Is it possible to just ignore these people because the centre does not have vacant rooms? Is it possible to take them to local hospital and leave them there, and if so will they be admitted? These are serious questions that policy-makers have to answer.

At present, a hospice becomes more acceptable to state hospital, although it is the government policy to encourage AIDS patients to stay at home. Due to actual situation, state hospital could not run a hospice by itself due to several limitations. Catholics can do it and can do it well.[29]

However, a hospice approach also possesses limitations and weaknesses. It affirms AIDS patients that they are have to stay in a hospice because they are actually abandoned. This is psychological painful for them and it hurts their spirit. A hospice is a symbolic representative of disintegration of family, kinship and society. This sacred task of caring is left as a burden of a hospice. In addition, AIDS patients who come to stay in a hospice will feel that they will certainly die and they are approaching their last day. A hospice is very expensive and very few people can afford to operate, or it is difficult to find financial resources to support its operation.[30]

“The HIV/AIDS prevention program is a kind of contribution from patients to community. This aims to spread a clear and right knowledge, understanding, awareness and positive attitudes towards people living with HIV/AIDS to community focusing its promotion to local factory/company and school personnel.”[31]

CSC provides services on prevention, caring, counseling, childcare centre and organizing and networking, with of course religious service. It calls this as integrated approach, combining all aspects related to people living with HIV and AIDS patients together in one place. Prevention service is rendered through a short one-day training at CSC. This training is provided with theoretical inputs and some practical exercise and ends with a dialogue with people living with HIV or AIDS patients. It also allows target groups and other interested groups to have a short visit for a few hours at the centre to have a direct experience and dialogue with sick members of CSC.

The work of CSC is more integrated than the work of Soon Bantaojai at Soi Rawadee, as it incorporates caring with preventive program of training, action plan of target groups for ongoing activities on campaign for AIDS prevention, as well as forming peer group (like cell group or change agent). The government only promotes the use of condom, but most NGOs are more successful than the government because they build up peer group as model in AIDS prevention and dissemination of the knowledge further. Fr. Contarin said Thailand was considered the most successful in AIDS prevention in Asia.

4.2 Training Approach and Process

One-day seminar is too short. However, it is relevant to many target groups. However, an experience in organizing a three-day live-in seminar with students from three schools proved to be effective. It has helped link students from different schools who can play an important role in educating their fellow students on HIV and AIDS, and form peer group in their respective school with ongoing activities, certainly with active and regular support and monitoring of CSC.

Theoretical inputs should be accompanied by interaction with people living with HIV and AIDS patients in CSC to promote a better understanding and positive attitudes towards these suffering people. The interaction and dialogue with people living with HIV and AIDS patients will give a direct experience to the target group to gain a better understanding of the disease, its infection, the life and attitudes of the people having HIV, development of disease. This is a very effective method of learning

Training should be participatory, fostering sharing of experience and ideas on the cause of the diseases. The sharing will involve the trainees in teaching one another through their personal experience as well as analyzing their risk factors. This approach proves to be effective. The provincial health office of Rayong likes this approach when learning from CSC and adopts it for its training program.

Training subjects include communication skills, knowledge on AIDS and HIV and its infection, how to prevent infection of the fatal virus and proper use of condom. However, because modern media only promotes consumerism and freedom and present society becomes more individualistic, the above subjects are far from adequate. CSC should also provide knowledge and raise their awareness on values of human person, human life, man and woman, sexuality and the value of and pride in familial fidelity serve as better choice of social, cultural and religious values for the people, especially younger generation.

The size of trainees in each group is also important. In order to facilitate a good training programmed with active participation of the trainees, the size should be not large or too small. CSC allows about 20 people in each. This proves to be efficient to facilitate sharing of experience among the trainees and appropriate to the available time.

Normally, the training will be given in one whole day because it is more convenient for trainees. Early, it used to organize a training program for 2-3 days, but it was not convenient. Looking at the pre-test and post-test, we will find that the trainees did not gain much knowledge on AIDS, because it is very theoretical.

CSC also receives visitors for some hours. They come in small groups to have direct experience and personal dialogue with members in the centre. This direct experience and dialogue is valuable and effective in raising awareness of the visitors. Information provided in various types of media is very theoretical and creates very negative impression on audience. That is why people and society at large look down or reject people living with HIV and AIDS, or else they do not truly realize its fatal effects.

A visit to CSC to have a direct encounter with people living with HIV and AIDS patients helps the visitors to change their attitudes. All the informants expressed in the same voice that a visit to CSC has helped them to change their attitudes towards AIDS patients. They become more sympathetic to these people and are more positive to approach them. This is a very important element of the prevention training provided by CSC. It is also very useful for visitors on their short visits to CSC to have a direct encounter with the patients. This aspect should be maintained and offered to many more groups.

The problem is that housewives get the training while husbands do not attend such training, while the latter have more risk because of their behaviour. The municipality of Mabtapud regularly organises training on AIDS prevention for housewife groups in local communities. It also co-ordinates with CSC in inviting its resource person to share knowledge in this kind of training. Of course, part of the training will be dedicated to a short visit to CSC. In this concern, CSC should work more closely with local municipality to invite husbands for the training and encourage ongoing activities in communities or field training for youth in communities.

Concerning training duration, most of the trainees voiced out that one day was too short to get a thorough knowledge on AIDS. This corresponds to result of the post-test. Students at Paknam Rayong Witthayakhom School attended a three-day live-in seminar. The sessions were held at CSC and these students stayed in a bungalow. About five students from three local schools attended this training. After the training, these students from different schools become friends. I think this kind of live-in training should be given serious consideration, as it seems to be more effective for young people like secondary students. Back To The Top

We have to admit that the concept of hospice is debatable. All the informants, students, workers, civil servants and social workers, expressed that it was better to keep AIDS patients at their homes, allowing their family members to take care of them. Staying at home will make the patients feel warm and relaxed. However, if we look at the respondents we will find that none of them have relatives with HIV, except two housewives from local communities and a civil servant at the municipality of Mabtapud whose relatives died of AIDS. In reality, most families that have relatives with HIV do not want to keep them at home but prefer to send them to some other places, like hospital or hospice, or just left them on roadside. In addition, most of the patients themselves do not want to stay at home as they are afraid they would be a burden for their families. People staying at CSC are those who cannot stay outside anymore. They are rejected, abandoned and do not want to stay outside.

Fr. Giovanni said the work at Soi Rawadee focused only on prevention. Caring has been started when CSC was established here in Rayong per recommendation of Caritas Switzerland and reality of AIDS situation. Normally, CSC will accept people with HIV and AIDS patients, for a short stay of 20 days before sending them back to their families and communities after giving them counseling. When they returned, CSC will not follow up these people because it lacks human resources to do this job and it has a lot of work to do. It only asks other organizations or state agencies to help follow up these patients.

The head of the provincial health office told me that at the beginning Fr. Contarin did not have an intention to run a hospice. The fact that many patients are abandoned on streets and the degree of the problem of AIDS in Rayong is very serious, CSC cannot avoid caring for them and it gets a full support from the health office. In this regard, the health office sends its local health volunteers to have an exposure program at CSC to get a direct experience. The health office also likes the participatory approach employed in the training and adopts this approach in its training of local health personnel.

Involvement of patients in activities is the main concern of CSC. This involvement gives them dignity, pride and psychological well being. They will realize their value and will not be desperate or have a tendency of committing suicide. Furthermore, keeping these people busy will occupy their thought and concentration, avoiding their worries and fear of the forthcoming death. Involvement in activities at CSC also earns them some income, though minimal. They earn this income to pay for their personal expenses. Some could also send this money to support their families. This income also helps them to avoid being burden of their families.

CSC will ask if its members would like to do some jobs at the centre, like cleaning house, laundry, sweeping floor, collecting trash, work in ICU to care for terminal patients, taking care of HIV children, and so on. The members are free to accept or deny the jobs. If they do not like to do anything, they are free to choose so. They can sit together or alone to do reading or watching television, which CSC provides cable channels that broadcast 24 hours.

In assigning jobs, CSC will ask the consent of the patients if they want to do that job. CSC will also consider their health condition if they can do the jobs. If not, CSC will not involve them. Any patient with full energy and strength will be offered a harder job, weaker ones with light jobs like sweeping floor or collecting trash and leafs.

However, involvement of patients in regular jobs has a problem of continuity, especially in caring. There is no continuity of experience in caring for the patients because the patient personnel also died of AIDS, as the rate of mobility is very high. In addition, no patient would like to do this job because it is a hard and exhaustive work. An assistant in caring section, who also has HIV, told me that sometimes she almost had no time to rest. She had to clean the body of patients, feed them, change diaper, and so on. Feeding is very slow because the patients are slow in eating. Back To The Top

4.4 Handicrafts

The forum, with full support from CSC, initiates income-generating activities for people living with AIDS and staying at the centre. This initiative aims at helping HIV infected people to spend their time worthily to earn some income, rather than just sitting around doing nothing, and these activities will occupy their thought instead of being idle and are worried about their future with fear.

Products made from these people can be sold to the public and tourists. Saengchai has HIV and has potential to train others on how to do various income-generating activities. He told me that he knew a chief of one district office in Bangkok and could arrange to sell the products with a free booth located in a busy street. He also said the forum could pay fair wage to HIV infected people and sell the product in market at lower price. The products can be labelled as made by HIV people or the less-fortunate.

However, the question is whether most members in the centre are capable of doing it or have physical strength to do it. I witnessed that many of them were not doing anything because they are affected by meningitis. The second question is the continuity of the marketing. If Mr. Saengchai passes by, what will happen to link with market channels? Will there be anyone to carry on this task? These are serious questions to be answered. Back To The Top

4.5 Personnel

Personnel involved have to be committed to the work with sacrifice, which is very difficult to find. They have to dedicate themselves to work for others, especially the sick who do not have good looking and they have to take a risk of infected other related diseases, like tuberculosis. In addition, they need special training on health care with a capacity to give moral and spiritual support and counselling to the patients

CSC organized a training workshop for two groups of trainees. The first workshop was held on August 25-29, 1997, and the second on September 1-5, 1999. This workshop was sponsored by Caritas Switzerland with Dr. Raphael Baltes, an expert from Switzerland as a resource person. Twenty people (8 male and 12 female) took part in the first workshop while 16 (6 male and 10 female) took part in the second. The main training subjects were communication skill with counseling, sexuality and knowledge on HIV and AIDS. Mr. Uthai Tanara, a teacher of Assumption College in Rayong in charge of pastoral activities of the students, also attended a training on counseling given by Dr. Baltes. Many health personnel and teachers in the eastern region were also invited to take part in this training. This is also one of the first step in building up local contacts. Back To The Top

4.5.1 Prevention Team

The team of prevention program, comprising a coordinator and a resource person, is quite capable. This is the only team of personnel of CSC that is not infected by HIV (Fr. Contarin, religious members, two Danish volunteers, a volunteer at the childcare centre and a cook are also free from HIV). The main resource person is working part-time. He will be at the centre when there is a training program. Actually, he serves in the Royal Navy but he has more time available and could ask permission to do this job. His boss always allows him because it is a charitable work. His name is Adirek Poethong, a local resident and a Catholic. He has been involved in the work on family development for sometime before joining CSC. He got training on family life promotion and learned skill in leading human relationship games and group dynamics as well as values of family, human person, human life, sexuality and so. He also attended the training given by Dr. Baltes. In a sense, he is quite capable for his task as resource person.

The second one is the coordinator. Her name is Sununta Wannam. She is from Bangkok. She finished a bachelor degree in business administration and started working with Catholic Office for Emergency Relief and Refugees in a refugee camp at Koh Poe in Cholburi. Later, she joined a finance company briefly before contacting the Fountain of Life Centre, working with entertainment workers in Pattaya. However, the centre advised her to contact Fr. Contarin. She did so and got a job. She has been working here for two years. She admitted that at the beginning she was afraid to infect the virus and other complication. Now, she is quite alright to handle it.

Having observed two training sessions at CSC, I find that both of them are good resource persons. They way they gave the training was so attractive. The language they use is the same language young people speak. It is not surprising there is always laughter from trainees. Workers, students, police, villagers and civil servants who have attended the training at CSC told me in an interview with them that they liked the way the two resource persons gave the training. It is not boring, easy to understand, friendly and participatory, although I find that they did not gain much knowledge perhaps because of a limitation of time.

Sununta, known as Tuk, is also good in dealing with people. She accompanied me to several places. The people there know her and were very friendly with her. She is also good in articulating ideas and opinions, sometime even pushy. I am sure she is good in coordinating with different organizations and state agencies. However, she admitted that she was not good in planning because she has never got training on planning, monitoring and evaluation (PME) and never had an experience to do so. Back To The Top

4.5.2 Chief Executive Officer

Fr. Giovanni alone has to do all the work by himself. His tasks include overseeing the whole centre, admitting patients to the centre, taking sick patients with complication to hospital, arranging formalities and religious ceremony for the dead, and so on. He has to contact and communicate with donors and write reports and project proposal to find money for operation of the centre. He is also busy receiving visitors. All members of CSC said in the same voice that Fr. Giovanni is always busy and he works very hard. However, the members of CSC said that they like the Fr. Giovanni works, as he gave freedom to the members to work and supported them to do activities.

He is a dedicated person and is friendly in dealing with people. He is very disciplined and likes the patients to be so. He is an Italian and a religious priest belonging to Camillian Society, thus is acceptable and respected by the members of CSC and the people he is in contact with. Normally, as a religious, Fr. Contarin has a term of five year and definitely there is no extension. He has served this centre for a few years before a religious community has been established at CSC. Therefore, his term at CSC begins again. Back To The Top

4.6 Co-ordination

CSC co-ordinates and maintains regular contact with all concerned state agencies. For example, it works with Rayong Hospital asking its social workers to screen AIDS patients who would like to come to CSC. It has a good relationship with personnel, especially social workers, of this hospital. Patients have to be recommended by social workers from public hospital. This means that the social workers will interview the patients to get personal background. They will only refer AIDS patients who do not have relatives or are rejected, abandoned and poor, and proved to be helpless. They also help locate their relatives. If they could find their families, they will send these patients back home. They also help the patients to find other alternatives or seek assistance from other organizations or state agencies as the case may be. Each year, Rayong Hospital refers about 15 AIDS patients to CSC. This kind of screening also helps state agencies to be alert of and update the situation on AIDS in the province.

CSC maintains a good relationship with local state agencies. Ms. Chalermsri, the head of the provincial communicable disease control office knew Fr. Contarin well. She attended a training programe on counseling organized by the Catholic Commission for Pastoral Assistance to Health Care Workers, per announcement of Dr. Kumnuan Ungchoosak of the Public Health Ministry who is also the chairperson of the Catholic Committee on AIDS. Fr. Contarin also attended this seminar and came to know Ms. Chalermsri in this training. She also invites Fr. Contarin and some people from CSC to sit in a provincial committee on AIDS set up by the government policy.

CSC also works with the provincial office on labour security and protection. It regularly gets invitation from this labour office to provide training to workers coming from different factories as part of a national plan on AIDS prevention in factories. It will invite factories in Rayong, especially in industrial estates, to send two or three worker leaders to attend a short training on AIDS prevention. Resource persons from CSC will be invited to this training as well. As part of the training, the worker trainees will have a short visit to CSC to have a direct encounter with patients at different stages of AIDS.

CSC itself does not have much connection with NGOs on AIDS at present. Co-ordination with other NGOs is mainly done by the forum. CSC will work more with Catholic organizations involved in health or AIDS work. Fr. Contarin said he did not like to associate with NGOs much because they did not work. They prefer to have meetings. In the past, he used to attend meetings with these NGOs doing networking. Later, he was bored of meeting and talking. However, the forum of Bantaojai continues to co-ordinate with NGOs, like Care Thailand in Rayong, ACCESS, AIDSNet, and so on. Through this co-ordination, there is sharing of experience and lessons from the work, scientific development in medicines, and participation in a common action against discrimination and violation of human rights. It also takes part in a protest against patent of AIDS medicines that make them expensive for the patients.

Two members of the forum “Bantaojai”, the forum of people living with AIDS in the centre, are members of the provincial committee on Social Investment Fund (SIF), a fund set up after the economic crisis to help the poor with seed money to start collective income-generating activities. This committee meets monthly to consider application for low interest loan submitted by the poor and the less-fortunate, including people living with HIV. Back To The Top

4.7 Monitoring and Follow-up

In follow up and monitoring the trainees, CSC will encourage the target group to come up with an action plan to implement ongoing activities on AIDS prevention. This has been done at Technique Rayong Vocational School with young boys in risk group. These boy students are in risk group because they are young and they are drinkers. Some schools, like Pae Raksa Mata School, regularly organize play to launch campaign on AIDS prevention with its students.

In monitoring the work of CSC, there is no systematic and regular monitoring and evaluation of the work. There was no staff meeting to report progress of the work, draw lessons from activities, assess problems and obstacles, or identifying strengths and weaknesses. The only monthly meeting is the meeting of the forum. However, some matters of CSC were also discussed in this meeting, though not often. Members of the forum told me that there were a few meetings held the CSC. This kind of meeting did not occur often.

Regular and systematic monitoring and evaluation is an essential element for effective operation and progress. On the whole, it looks as if CSC is lacking this regular monitoring and evaluation system, as well as planning. The factors of this lack, to my understanding, are the load of work that the available personnel have to do, the limited number of personnel, the capacity to do so, and the lack of someone to co-ordinate this PME. Back To The Top

5.1 Conclusion

Camillian Social Centre is a place for caring of AIDS patients, accommodating people living with HIV who are rejected and abandoned by their families and communities. They are economically poor and psychologically under pressure and fear. Although CSC did not want to operate a hospice, but it could not stand watching people dying on street without anyone looking after them. In the light of this situation, CSC is really responding to the reality, whether it likes it or not. It responds to this reality as a human and a religious community. As far as objectives are concerned, CSC has not changed any objectives since its preceding centre in Soi Rawadee, excepting adding an objective on intensive caring of terminal AIDS patients when moved to Rayong. Having committed to do this work, it does it well. It is building a “communitas caritatis”, a community of charity, love, fraternity and solidarity, for the community of people living with HIV and AIDS patients at CSC. It is highly recommended that it maintains the integrated approach of AIDS work, incorporating caring, prevention, counseling and networking at the same place, through co-ordination with various parties concerned, be they state agencies, NGOs and private sector, as well as religious organizations.

We realize that the work of CSC is admired by its target groups and target groups. At least two state agencies indicated that the work of CSC is well done. They admired the effort, commitment and contribution of CSC in AIDS prevention and caring. They viewed the work of CSC, especially on caring as having high standard. The location is good and the complex is clean and comfortable for the patients to live in and the care is perfect. However, they also pointed out a negative aspect of this good living place that the patients did not want to leave this place to go back to their families, if they could go back. This is because the life at the centre was so comfortable and they have freedom to do what they like to.

We have to admit that it is rather difficult, or even impossible, to assess success or failure of CSC in caring for people living with HIV and AIDS patients. Apart from those who are sent back home after some days at the centre and after getting counseling, all members of CSC will come to their last day, sooner or later, because of AIDS. It is also difficult to assess the success or failure of the prevention training it provides. However, most of the target groups who have attended the training at CSC are happy with the program and knowledge they gained from the training, especially the experience of direct encounter with AIDS patients and a dialogue with people living with HIV. The post-tests show that these trainees did not gain much knowledge on HIV and AIDS because time is too short and the subject itself is highly technical. Having talked to them, I find that the direct encounter with AIDS patients helps them understand the seriousness of the virus and infection much better and clearer. To this extent, I am sure the prevention program is very successful.

CSC is also a field of learning for others to visit and learn experience on the care of AIDS and a direct encounter with people who are living with the fatal virus and those who are suffering from its complication. It has accumulated much experience from its long involvement in this work. It should systematically draw lessons from the work on caring, prevention and counseling for publicity and sharing with other organizations involved in the same work, especially Church organizations, as it is also a Church organization and has a close relationship and belong to the same network. Through sharing with other organizations, it will further enrich its lessons and experience to serve its target groups better. Back To The Top

Looking at advantages and disadvantages of the work of CSC, we would like to highlight only some main advantages and disadvantages. CSC is located right in the area with the highest rate of infection. Its presence is a great contribution to the effort on AIDS prevention and caring in the province because no one is doing it. State agencies, especially those involved in health care, cannot do what CSC is doing. There are also NGOs working in this province, but small in number and they do not have activities like CSC. Therefore, the presence of CSC and its work is a valuable contribution to the communities in Rayong. In addition, it has got good co-operation and support from local state agencies.

Integrated approach CSC is adopting is also an advantage. This approach helps all its target groups to see the link of prevention, caring, counseling, childcare and spiritual service with participation of the patients themselves. This is in fact a holistic approach combining all aspects of life of people living with HIV. This approach is in fact the strength of CSC.

The care of AIDS patients provided by CSC is highly appreciated by parties involved, be they patients, health personnel and relatives of AIDS patients and people visiting the centre. Involvement of patients in the work is also an advantage. This involvement and caring method gives dignity to AIDS patients as human person. They are proud they can take part in daily activities of the centre and see the value in themselves.

The other strength of CSC is its prevention program, which incorporate a direct encounter with AIDS patients and HIV infected people. This is perhaps the best method to help the target groups of the prevention program to change their attitudes towards the patients and understand them from their viewpoint. This should be fostered more and more.

Concerning disadvantage of CSC, the presence of modern and clean buildings with generous care of the patients would attract people living with HIV to the centre. Many want to come to stay at the centre because it is comfortable and everything is free. They do not have to pay for anything, but receive allowance especially when they work if they choose so. There are also cases when AIDS patients were left in front of the centre by their families. Back To The Top

Given the above information, analysis and conclusion, I would like to propose the following recommendations for effective operation to accomplish the objectives set forth by CSC and to effectively cope up with the alarming situation on AIDS in the province of Rayong and its vicinity. Some points are only confirmation of what CSC has already done and is still carrying on, some are new areas of strategies that CSC adopt to be even more effective in its attempt on AIDS prevention.

1. Training at CSC seems to be stricter and more effective. It is more effective to organize training program with process and subjects designed by CSC plus an interaction with AIDS patients. This is because CSC can direct and supervise the training by itself. However, it should continue to co-operate with state agencies and factories or schools to provide training at their locations provided a program should be arranged to visit CSC to have a direct encounter with people with HIV. Though the training at CSC seems to be more preferable, but it should also occasionally provide training in the field per request and when it is inevitable due to limitation of time and participants of factories or state agencies. Certainly, there should be a visit to CSC as well. In addition, more human relationship games should be provided especially to students who are young people and like to have fun. This is an effective instrument for education and organization of the young.

2. Peer educator approach is valid, but peer group should be organized, especially with students in schools, with regular monitoring and support from both CSC in close collaboration with school administrator and teachers. Considering its available human resources, it should select and concentrate its effort in some schools, preferably 3-5 schools, and form peer groups for ongoing campaign with students in schools. To my experience in interviewing its target groups, I recommend two schools. They are Technique Rayong Vocational School, which has over 5,000 students at the age of around 14-18, and Paknam Rayong Witthayakhom School with high school students. In the first case, I see a great potential in carrying out ongoing campaign at the school because a teacher in charge is very supportive and active. She is also friendly with her students, especially those in risk group. For the latter case, students in this school have already made friend with students in other schools who have also attended a three-day live-in training program organised by CSC. These students asked CSC to organize training again. They have taken part in an exhibition on World AIDS Day organized at a local shopping centre in last December. The live-in seminar would be effective for students because they are young. So, why not take this opportunity to form a proper understanding and positive attitudes in them. We have so much media promoting negative attitudes towards AIDS patients and people living with AIDS. Therefore, why not organize something that is positive for young people. This also serves as a method of regular monitoring with ongoing activities.

3. Regular personal contact should be made with executive personnel of schools and companies. They are the key decision-makers. According to the experience of the prevention team of CSC, they found that chief executive officers of schools and factories are the ones who make decision to send their students or workers to attend training provided at CSC or not. They said if contact was made through someone else, like secretaries, that school or factory would not send anyone to the training. On the contrary, if the team had a chance to explain the program directly to chief executive officers, then approval was likely. In the past, contacts were done mainly by phone. A document maintained at CSC shows that phone contact was made everyday for several times. Personal contact and visit to those schools and factories were minimal. I think personal contact is very helpful to the work in finding target groups for prevention training at CSC. Therefore, CSC should maintain regular personal contacts with chief executive officers of these institutions.

4. There should be mutual planning of all concerned staff members and volunteers with regular collective monitoring system of staff meeting to follow up the work, identify problems and obstacles and mutually search for appropriate solution. This planning method will foster participation of those involved in the operation. Adopting this collective planning, CSC will not only promote participatory approach in training and in caring, but also in the overall operation of CSC. Only through this participatory, the continuity, sustainability and sharing of experience will be guaranteed.

5. Through the course of its long operation, it has accumulated rich experience and lessons on caring of AIDS patients and prevention. Therefore, it should try to disseminate these lessons and experience to state agencies, other non-governmental organizations and Church organizations. This sharing can come out both in documentation and sharing sessions. It should be a school for others to come and learn.

6. CSC should work more closely with some state agencies, especially the communicable disease control desk of the provincial office for public health to prepare local communities to accept and care for AIDS patients at their homes and communities. This is possible because state agencies have already stated its willingness to work with CSC in preparing local communities for this purpose. This is not only a strategy to keep AIDS patients at home, it is also an effective method of prevention. With the presence of AIDS patients and people living with HIV, community members will realize the tragedy and suffering yielded by this deadly virus. Hopefully, this realization will lead them to avoid risk behaviors and adopt a positive attitude towards those who are suffering from this disease, as well as helping care for them.

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[1] Situation on AIDS Patients in Thailand, the Ministry of Public Health, November 30, 1999

[2] Table 1, Situation on AIDS Patients in Thailand, the Ministry of Public Health, November 30, 1999.

[3] Op. cit.

[4] Op. cit., Table 2.

[5] Op. cit., table 6.

[6] Op. cit.

[7] Op. cit., table 5.

[8] Op. cit.

[9] Situation on AIDS Patients in Thailand, Ministry of Public Health, November 30, 1999.

[10] Op. cit.

[11] Annual and Accumulative Estimate of Orphans in Thailand Under 5 and 12 Whose Mothers Have HIV for 1990-2000, Watini Boonchalaksamee and Philip Gast, in “AIDS and Children: Estimate for 2000, the Demographic and Social Research Institute, Mahidol University, 1994, p.15.

[12] Table 4, Situation of AIDS Patients in Thailand, Ministry of Public Health, November 30, 1999.

[13] Table 5, Op. cit.

[14] Table on HIV Sentinel Serosurveillance in Rayong from 1989-1997, Provincial Public Health Office of Rayong

[15] National AIDS Committee, the Office of Prime Minister

[16] Summary of main points in Public Health Plan in the Eighth National Economic and social Development Plan for 1997-2001, the Minis try of Public Health

[17] The Plan on AIDS Prevention and Control

[18] Op.cit.

[19] Directory on AIDS NGOs, 1999, a website by Thai NGO-COD

[20] Directory of Catholic Organisations working on AIDS, 1999, the Catholic Commission for Pastoral Assistance to Health Care Workers.

[21] Amphoe is equivalent to a district. It is a unit of local administration. The smallest unit is Mooban, or a village, Tambol, or a sub-district, Amphoe, or a district, and a province.

[22] Project Proposal for Funding, Updated to December 1999, CSC, p. 3

[23] OP. cit. P.3

[24] Project Proposal for Funding, Updated to December 1999, CSC.

[25] Project Midterm Activities Report: for patient care, HIV prevention and alleviation of AIDS epidemic in Thailand from May 1988-May 1999, CSC, p. 2-7.

[26] Op. cit., p. 8.

[27] Progress Report of Bantaojai Forum, CSC, February 21, 2000.

[28] HIV and AIDS Patients: A Case Study of Their Historical Lives at Camillian Social Centre in Rayong Province Thailand, Sr. Voranuch Parnommit, a doctoral dissertation, p. 10.

[29] Proceedings of an annual seminar on AIDS: A Challenge for the Church in Thailand towards the Third Millennium, the Catholic Committee on AIDS, 4-6 October 1999, Salesian Retreat House, Hua Hin.

[30] Op. cit.

[31] Op. cit.

Background and Objectives of the Evaluation

1.2 Objectives

1.3 Approach and Methodologies

1.4 Participants

1.5 Time-frame

1.6 Expectations

2.1 Situation on AIDS in Thailand

2.2 Situation on AIDS in Rayong

2.3 Attitudes and Reaction from the Public and Communities

2.4 Response from Public Sector