LOP BURI, Thailand — Thailand’s primary AIDS hospice at a Buddhist temple here, once a place of certain death, is now becoming overcrowded by the living — people whose lives have been saved by medication but are rejected by their families or neighbors.
Already an international leader in programs for prevention of H.I.V. infection, Thailand has over the past year become a pioneer in distributing low-cost antiretroviral drugs, which are available to all, for less than a dollar per treatment.
At the same time, though, Thailand has made little headway in easing a harsh stigma that was fed by its successful campaign against the disease. As more people are living longer, more are becoming outcasts in a family-based society where it is difficult to blend into the crowd.
Thailand has been on the front lines of the AIDS epidemic since it began in the 1980’s, when it was hit hard, and then in the 1990’s, when it became a model of prevention with public education campaigns.
Pointing up what experts say could be one of the next challenges as low-cost treatments spread around the world, the AIDS temple and a small satellite village have become, in effect, a new sort of leper colony.
“This is our new problem,” said the temple’s abbot, Alongkot Dikkapanyo, 53, who founded the hospice 14 years ago. “What should we do with a healthy person who is rejected by their family and can’t work? This will be a big burden on society in the future.”
In a special annex, the temple stores thousands of white cotton sacks of cremated remains that were never claimed by relatives. Cremations are fewer now, and these days, hundreds of homeless survivors wander the grounds, sweeping the footpaths, doing their laundry and helping to care for the sick.
Thailand’s successes in both prevention and treatment have brought with them another, perhaps predictable problem: the loss of a sense of urgency that has caused a slackening of prevention campaigns and the beginning of a rise in new infections.
In addition, experts say about 5 percent of drug recipients each year will develop resistance and need to switch to much more expensive “second line” drug treatments, which are covered by patents and will strain the government’s budget.
Since 1984, one million people have been infected in Thailand; 400,000 have died. In an August report, the World Bank estimated that without Thailand’s vigorous prevention program, a total of 7.7 million people would have become infected.
Fewer than 17,000 new infections are expected this year, said Patrick Brenny, the Thailand coordinator for Unaids, the United Nations agency dealing with AIDS. That compares with 143,000 new infections in 1990, according to the World Bank.