Supatra Nacapew

Since HIV/AIDS work began in Thailand, it has focused on the narrow goal of containing infections. Supatra Nacapew attempts to broaden and redirect the field to tackle discrimination against people with HIV/AIDS, linking individual problems to systemic failings, ordinary citizens to powerful officials, and the rights of persons with HIV/AIDS to universal human rights that benefit everyone.

Supatra Nacapew partners traditional efforts to prevent the spread of HIV/AIDS in Thailand with a congruent effort to control and prevent the spread of attendant discrimination. Her Center for AIDS Rights is the first in the country to place the rights and wellbeing of people with HIV/AIDS at the center of its agenda. Rather than fighting for the interests of persons with HIV/AIDS in isolation, Supatra links their interests to those of the broader society. She demonstrates that giving people with HIV the right to obtain equal access to life-preserving drugs and medical care sets a precedent, establishing a right to health care that benefits everyone. Similarly, when schools eliminate barriers to entry for children with HIV/AIDS, the effect is to cement the right to education for all children. She shows that eliminating compulsory blood tests of job seekers protects all workers from unfair practices and job discrimination.
Casting a wide net, Supatra’s work brings together victims of discrimination, members of occupational groups, government officials, and donor agency representatives. On any given day, Supatra and her team may negotiate with a factory owner to end a prohibition on staff with HIV/AIDS, offer legal advice to a group of sex workers, or meet with a government minister to encourage policy changes. The work is deliberately diverse, and calls for the cooperation of an expansive network of professionals: when a minister commits to new regulations, academics can ensure they are effectively written, nongovernmental organizations can monitor enforcement, persons with HIV/AIDS can make complaints about breaches in compliance, and lawyers can take up cases of violation.
While Supatra often talks about her work in terms of the rights of individuals, ultimately she prizes its benefit to communities above all. Her programs directly profit the victims of discrimination, but they aim to secure rights and improve the quality of life for all people in Thailand.

The estimated 635,000 persons living with HIV/AIDS in Thailand face routine violations of their basic rights. Feeding upon widespread ignorance and fear, prejudice denies people with HIV/AIDS jobs in factories and offices, places in schools, and access to proper medical care. Most people see the lives and rights of persons with HIV/AIDS as unrelated to their own.

Although Thailand led Southeast Asia in adopting policies and directing resources towards HIV/AIDS in the 1980s and 1990s, its approach has been limited to prevention and containment of the virus. The focus on limiting its spread has been understandable, given that over one million people have already died from AIDS in Thailand. However, unlike some of its peers in the region, Thailand has not diversified its strategies beyond simple prevention. Concerns about protecting the rights of people who have HIV/AIDS have begun to enter public debate, but they have not obtained adequate attention. Nor has there been sufficient recognition that ending HIV/AIDS-related discrimination would reduce the rate of transmission of the virus.

The rights of people with HIV/AIDS are protected under law, and the Office of the Attorney General is mandated to oversee and guarantee these rights, yet the office itself breaches them. For instance, one of its books suggests that only sexually promiscuous people and drug users contract the virus, implying that all persons with HIV/AIDS fall into one of these two classes. Government trainers—who have themselves undergone mandatory blood tests prior to getting their jobs—wonder aloud why special consideration needs to be paid to people who are going to die soon anyway.

Citizen sector groups have also failed to connect work on HIV/AIDS with human rights. AIDS support groups have, like the government, concentrated their efforts on devising education plans and monitoring projects to restrict spread of the virus. These organizations have little knowledge of human rights, and fail to see its relevance to their work on HIV/AIDS. Human rights groups in Thailand have traditionally avoided HIV/AIDS, preferring conventional activities on civil and political rights.

Supatra established the Center for AIDS Rights in 2000, focusing on the need for legal assistance and counseling in rights violation cases. She also helped to found the Thai Network of People who are HIV positive (TNP positive), which helps people with HIV/AIDS to take action on the issues that affect their lives. The TNP positive now includes over 600 peer support groups nationwide.

Supatra’s center protects workers who face discrimination because they are HIV positive. One of the center’s branch offices is located in Rayong, home to a large population of workers who are typically excluded from government programs. Factory owners in the city commonly submit workers to blood tests, sometimes at the workers’ expense, and sack anyone found to be HIV positive. Upon receiving a complaint, staff members from the center visit the factory and talk with the owner. Frequently they find that the owner or manager has ordered the tests out of ignorance of how the virus is transmitted, and after negotiations, is prepared to drop the practice and reinstate sacked workers. The center monitors the factory to ensure the manager does as promised. In the case where the manager refuses to stop testing, the center takes legal action to force compliance. Similarly, where a doctor has been involved in mandatory testing, the center notifies the patient not to pay the associated charges, informs her of her right to sue the doctor, and notifies a medical council of the violation. Supatra estimates that the center is involved in around 300 such cases per year and gives legal assistance to about 50 cases.

While the Center for AIDS Rights is concerned with the interests of individual victims, it links specific violations to systemic deficiencies. Supatra points out, for example, how work on the rights of children with HIV/AIDS began with mediation and legal action in individual cases but ultimately led to policy change. Concerned by the number of instances where children with HIV/AIDS were being denied entry into schools, the center met with representatives from various government ministries and convinced them to set up a working group to monitor the rights of these children. The center also held meetings with the Minister for Social Development and Human Security, who has lacked a clear policy on children with HIV/AIDS for years despite his mandate to secure health care for children and disadvantaged groups. On the center’s urging, the minister wrote a new policy in partnership with a broad coalition of citizen sector groups. Supatra worked with UNICEF to establish a working group to monitor and advocate for the rights of children with HIV/AIDS while her staff pressured the Ministry of Education to support those rights in public schools. The center has since obtained approval to publish a guidebook for teachers as a first step to address obstacles at the level of school administration.

A lawyer by profession, Supatra leads the field in defining legal access to anti-retroviral drugs and affordable treatment for persons with HIV/AIDS as human rights. In 1997, she represented a person with HIV/AIDS, taking the pharmaceutical manufacturer Bristol Myers Squibb and the Department of Intellectual Property to court over a patent on an anti-retroviral medicine. In 1999, the court sided with Supatra, removed the patent and allowed the generic equivalent on the market, resulting in a substantial reduction in the cost of the drug. The case was the first of its kind in Thailand, and it attracted considerable interest among HIV/AIDS coalitions in other countries, which have studied it as a model for legal action against pharmaceutical corporations and government agencies.

More recently, Supatra has been fighting to ensure that anti-retroviral medicines are covered by social security programs. After the Center for AIDS Rights began receiving complaints that the government social security fund was not fulfilling its obligations to persons with HIV/AIDS, it submitted complaints to hospitals and to the administrators of the fund, but to no avail. The fund, which provides health coverage to more than seven million people, refused to include drugs for treatment for HIV positive, claiming that they were still “experimental.” The center took on this issue full time, preparing a campaign plan along with the Thai Network of People who are HIV positive.

Supatra then initiated contact with the chairman of the AIDS Association of Thailand, a prominent doctor, to draw up a set of principles for the treatment of HIV/AIDS for adoption by the Pathology Association of Thailand. This was a carefully calculated move: the social security fund follows the treatment principles established by the Pathology Association, of which this doctor is also a senior member. Supatra then met with officials from the Ministry of Labor who agreed in principle that the fund should cover anti-retroviral drugs, and convinced them to make their decision public. A working group was formed to monitor the change in policy and address specific complaints. Finally, in May 2003, treatment for HIV/AIDS was explicitly included in the coverage of the fund, and hospitals nationwide were instructed to provide treatment accordingly. While there are still many private hospitals and doctors resisting the change, Supatra and her colleagues continue to monitor developments closely and take action on individual cases. She is also now turning her attention to the ‘30 baht gold card’ fund, with some 46 million members whose health plans do not cover the treatment of HIV/AIDS.

Supatra sees the Center for AIDS Rights becoming the leading advocacy body in the region on HIV/AIDS-related law and human rights. She uses her professional background and growing reputation to build a network of lawyers to support cases brought to them by the center. Meanwhile, she looks for every available avenue to advance her work, including various commissions and working groups under government ministries, the Thai Senate, the National Health Administration, the Lawyers’ Council, the National Human Rights Commission and the National Coalition on AIDS.

As the success of the center grows, agencies in countries around the world have begun to turn to it for support and advice. Discussions are underway on new projects in Burma, Cambodia, and Laos, and the center is working with the International Labour Organization on a global code of practice on HIV/AIDS in the world of work. Supatra has also authored many manuals on HIV/AIDS, human rights and labor issues, directing her specific efforts on HIV/AIDS towards the universal principle that all persons have equal rights.

Supatra Nacapew was born in Srisaket, one of the poorest areas of Thailand. Her father, an officer at the district government office, succumbed to gambling and abandoned his family. Her mother, a teacher whose school closed in the aftermath of her husband’s departure, was left to raise seven children. Unable to manage by herself, she split up the family, and over the next decade Supatra stayed with a long chain of relatives across Thailand. Although the experience was unsettling, she recalls that it also made her strong and independent from a young age.

While she was living in different households, Supatra had a number of experiences that affected her later decision to enter law school and work for the public good. At 12, she was sexually harassed by one of her relatives, and this bitter personal experience of rights violation compelled her to protect the rights of others. During secondary school, her mother sent her to stay with a public health officer doing outreach work in the countryside. Her work as his assistant exposed Supatra to the lives of poor rural farmers and public health issues. She almost became a nurse, but after reading a novel about a female lawyer using her skill to help poor people she decided to apply to law school. In 1983, she won a prestigious scholarship to attend Thammasat University.

After four years of study in Bangkok amid well-off urban students intent upon joining law firms and doing business, Supatra did not stray from her vision of working for the underprivileged. Like many graduates in Thailand looking for a way into the social sector, she joined the Thai Volunteer Services on a two-year placement with the Women’s Rights Protection Center of the Friends of Women foundation. After completing her volunteer work in 1989, she stayed on as staff and later become director of the center. In 1992 she became coordinator of the AIDS project of the Center for Labor Information Services and Training. In this position she began to realize the extent of discrimination practiced against persons with HIV/AIDS, as well as the accompanying total neglect of their rights. She decided to commit her professional career to their cause, and founded the Center for AIDS Rights in 2000.