Laos Faces the AIDS Time Bomb

Just outside the terminal of Vientiane's Wattay Airport the visitor's attention is captured by the image of a fierce-eyed yaksa, or demon, apparently preparing to dine on the world with the aid of a three-pronged trident. The sign is a reminder--if any were needed--that the AIDS virus has already crossed the Mekong, and that the Lao PDR currently faces the threat of a serious pandemic.

As the sign states in both Lao and English, "AIDS is a world wide problem". To date, however, land-locked Laos seems to have avoided the high incidence of HIV infection currently afflicting, to a greater or lesser degree, all neighbouring regions--that is, Yunnan, Burma, Vietnam, Cambodia and Thailand. Why should this be? And what, if anything, can the Lao authorities do to maintain the situation?

As the prongs of Wattay Airport's yaksa indicate, AIDS is spread primarily through unprotected promiscuous sex or through using contaminated needles. More often that not, this means that prostitution and narcotics are the main vectors of the disease--so that, as a general rule, AIDS is harder to contain in societies with extensive commercial sex industries and serious drug addiction problems. This painful reality is already being confronted in Thailand, where HIV infection is widespread. Laos' less developed neighbours, too, are facing a deteriorating situation as nascent sex industries mushroom in Saigon, Phnom Penh and Hainan, whilst drug abuse levels soar in Burma and Yunnan. The question arises, where does Laos fit in this disastrous equation?

To consider drug abuse first: The rugged mountains of north-western Laos are, of course, at the centre of the notorious Golden Triangle. Opium cultivation was actively encouraged for taxation purposes under the French colonial regime, and both France and the United States used opium and its derivatives in the most cynical of ways to promote and pay for their war efforts in Indochina. Traditionally, opium was cultivated by Lao Sung highlanders--particularly Hmong and Mien--and transported by Yunnanese Chinese traders known as Chin-Haw.

In the aftermath of World War II and the communist revolution in China, renegade Kuomintang troops took over much of the drugs trade in both Burma and Laos. Lao government involvement in narcotics trafficking reached its most notorious level in the three-way Ban Huay Sai "Opium War" of 1967, when the Royal Lao Army under General Ouane Rattikone seized control of a large opium caravan following a three-way struggle with Shan forces and the KMT. By contrast during the same period the Pathet Lao communists, in their base area provinces of Phong Sali and Hua Phan, seem to have steered clear of the trade.

Unfortunately this "clean hands" policy does not seem to have survived the communist seizure of power in 1975. Faced with a disastrous financial situation, and with most of the educated middle classes fleeing the country, it is now generally accepted that clandestine opium and heroin production became an important mainstay both for elements of the Lao army and for numerous officials at provincial level.

Today Laos remains the third largest opium producer in Asia (after Burma and Afghanistan), and there is significant opium addiction in Phong Sali, Hua Phan, Luang Phabang and Sieng Khwang provinces. Happily for Laos--though not for the outside world--nearly all the refined heroin production is earmarked for export. Only expensively refined No 4 heroin is suitable for injection, and consequently most Lao opium addicts are restricted to the less expensive No 3 "Brown Sugar", or more usually to raw opium. Both are smoked, rather than injected, and hence the problem of contaminated needles, so destructive in richer societies, is less common in Laos. Indeed, the country remains so poor that there are often shortages of needles and syringes even at the provincial hospitals. In Laos opium addiction remains a killer--but more usually through prolonged addiction than through AIDS.

David Henley / CPA

Despite many advances, good health care for all remains a pious hope in Laos.

Turning to sexual promiscuity, it seems clear that traditional Lao society differed little from that of Thailand's Lao-populated north-east. Prostitution certainly existed--and during the time of America's "Secret War" in Laos between 1963 and 1975 it positively boomed. All this came to an end when the Pathet Lao seized power, however. Tempered by thirty years of harsh existence in the remote limestone caves of Hua Phan and Phong Sali, the new Lao leadership brought to Vientiane a revolutionary puritanism quite foreign to Lao tradition.

In free-wheeling Vientiane and the lowland towns of the Mekong Valley, rigid control became the order of the day. Personal liberties were curtailed, with passes being required to move from one village to another. Traditional religious festivals were frowned on, religion was discouraged, and people were obliged to spend hours each day listening to Marxist platitudes at political seminars. Personal dress and lifestyle were strictly monitored, and all signs of 'decadent bourgeois culture'--such as rock music, dancing, and Western fashions--were vigorously condemned.

In April, 1976, the Lao communists turned their attention to "decadent elements" in Vientiane, Savannakhet, and the other main cities. Nearly two thousand of the most incorrigible drug addicts, prostitutes, "hippies" and gamblers were rounded up and sent to one of two islands--Done Thao for men, Done Nang for women--situated in Lake Nan Ngum, some 80 kilometres north of the capital. Faced with the probability of arrest, and already discontented by the rapidly deteriorating economy, many other denizens of Vientiane's fabled night life simply crossed the Mekong, seeking greener pastures in the massage parlours and bars of Thailand.

Many of the new economic and social policies implemented by the Lao PDR were extremely unpopular with the easy-going, fun-loving Lao people. In some cases--as with Buddhism and temple fairs--the government was obliged to back-track in an attempt to regain popular support. Prostitution, though, was as effectively eliminated as the "oldest profession" can ever be, and Vientiane--vividly characterised in 1975 by the American writer Paul Theroux as a place where 'the brothels are cleaner than the hotels, and opium is easier to find than a glass of cold beer'--became a very chaste place indeed.

To date, the Lao People's Revolutionary Party has been in power for 22 years, and throughout this period it's hostility towards social evils like prostitution has hardly changed. Even in the period of chin thanakan mai, or "new thinking", which began in August, 1991, and continues today, the Lao authorities have remained very suspicious of external--particularly Thai and Western--cultural influences.

David Henley / CPA

At a bar in Vientiane, Laos.

To this end the government-controlled radio and television, as well as papers like Pasason Vanarthit and Aloun Mai, regularly warn Lao youth against adopting extravagant lifestyles, visiting bars, or--in the case of the girls--abandoning the traditional sin dress in favour of more revealing Western fashions. Western and Thai rock music, though extremely popular, still sends shudders up the spines of the old revolutionaries in government house. Yet despite this official disapproval, Vientiane is slowly undergoing a transformation. Bars and nightclubs have sprung up along the banks of the Mekong, though open prostitution remains all but unknown. Disco music increasingly shatters the calm of the early evening, whilst amongst the young Western fashions are all the rage.

All this is in marked contrast not merely to Thailand, but also to Laos' Indochinese partners, Cambodia and Vietnam. Although savagely suppressed by the Khmer Rouge in 1975-78, the commercial sex business is back in Cambodia with a vengeance. Dance halls, massage parlours and bars--all venues for prostitution--proliferate not only in the capital, Phnom Penh, but also at Poipet on the Thai frontier, at Sihanoukville and Koh Kong, and throughout the western provinces. Similarly in Vietnam an expanding sex trade flourishes in Saigon, and prostitution has re-emerged throughout the country--even in formerly staid Hanoi. The results are painfully predictable, with the WHO predicting dramatic increases in rates of HIV infection for both countries.

The rulers of the Lao PDR know that they are facing an AIDS time bomb which they are economically and clinically unequipped to handle. They also know that they are surrounded by a rising tide of HIV infection. Like the rest of the world, it seems they can only strive to limit the epidemic, whilst at the same time hoping for a cure to be found. In the meantime, though Vientiane is slowly rediscovering its nightlife, it is at present far less raunchy than Bangkok, Phnom Penh or Saigon. Given the current circumstances, it is not impossible that, in the long term, this may prove to be one of the main achievements of the Lao revolution.

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