When Slim Becomes Too Slim . . .

[Guest fountainhall]

I have been considering whether or not to write this post for a couple of days. I am finally doing so in the hope that it will stimulate thought perhaps more than any in-depth discussion. I just believe it is a topic which should be aired.

 

At the week-end, a farang friend and I had an enjoyable Italian dinner after which we went to a couple of bars, both of which we have visited from time to time. In one, which I shall not name, we noticed a go-go boy who has been with the bar for many months, if not more than a year. He has always been a fem-type, slim, tallish and with a lovely smile. We soon realised that he had dropped quite a few kilos since our previous visit. Indeed, he was so thin he seemed almost to fit the description, however unfair this may be, ‘skin and bones’.

 

We doubted this was a developing case of anorexia. Inevitably, our concern was that he must be ill, even though he was his usual smiling self and none of his colleagues seemed to be overly solicitous of him. We considered it none of our business and so made no enquiries of the mamasan or a couple of the boys we sometimes chat with. Yet on leaving we both reckoned there must be a reasonable chance that he is suffering from HIV. There could obviously be a number of other reasons, but in this case we assumed not.

 

There have been discussions on most gay Thailand Boards about the high rates of HIV amongst msm in this country. This experience shook me, however, for it was the very first time I have seen any barboy openly showing signs of something serious being wrong with his body. I wonder if other posters have noticed anything similar.

 

Obviously I hope my friend and I came to completely the wrong conclusion and that this particular boy will recover from whatever ails him. When we next visit in a few weeks, I may check with the mamasan if he is OK.

[Bob]

I'm a bit puzzled by the post and/or maybe didn't quite understand some part of it. Before continuing, let me say that I view your concern as reflecting a good character on your part.

 

Okay, with that out of the way (it's difficult to criticize somebody with good intentions), I really don't see where it's any of your business - unless you know the boy well enough to talk to him about his personal condition or unless somebody you know/trust has asked you to intervene. Just being overly skinny without more doesn't tell you a whole lot as it could be a variety of things (including the kid just liking being "skin and bones" much like many models these days). So my view is you're jumping to conclusions and I'd hope you'd first ask somebody in the bar you know well before doing anything else.

 

I've know a couple of bar boys (as friends, not "offs") who are overly skinny but they've been that way for 6-10 years). I've even mildly joked with them about it a time or two but neither they nor their friends expressed any concerns and I didn't feel it was appropriate to ask anything further.

 

In general, though, it's been my experience that bar boys, like many of their fellow countrymen, have "chunked up" a bit over the last 10+ years thanks, probably, to the western foods (donuts, fried chicken, chocolate, etc.) creeping into the southeast asian diets. It was rare that I saw a fat Thai kid a decade ago but they (the "little buddhas") are all over the place now. Sorta sad to me as a lot of those 10 year-old-behemouths are going to have health and social issues later because of their weight problems.

[Guest fountainhall]

I really don't see where it's any of your business - unless you know the boy well enough to talk to him about his personal condition or unless somebody you know/trust has asked you to intervene. Just being overly skinny without more doesn't tell you a whole lot as it could be a variety of things (including the kid just liking being "skin and bones" much like many models these days). So my view is you're jumping to conclusions and I'd hope you'd first ask somebody in the bar you know well before doing anything else.

Basically you are correct, which is why I hesitated before posting. Trying to be somewhat diplomatic about it all, the sense of my post may perhaps have got lost. It is my business only to the extent that I have visited that bar quite frequently over a longish period of time. So I know the regular boys who work there. This particular one was certainly slim when we first saw him. There is a difference in my view, however, between being slim for many months (as I said, it could be over a year) and then suddenly within a few weeks becoming a whole lot skinnier. I have seen lots of slim/skinny barboys. I can only say - in our judgement - the present condition of this one could not have been elective. He was, we reckoned, beyond the skinny stage,

 

I wanted to know if others had noticed anything similar in the bars - a sudden and very obvious decline in body mass. I agree that speaking to the boy or the mamasan prior to posting specific information would have been more relevant. Yet, my hunch is that this particular mamasan (and most others, I suggest) would never reveal anything about the state of health of one of his charges. The same would be true of the other dancers, even the ones we know quite well.

[payless]

Thought your post patronizing and out of order Bob, because you did not appear to take in the fact that the 0p observed 'the boy had gone from slim to a bag of bones' over a relatively short time period.

 

It is humanity to care for people and perhaps the poster should raise his concern with the bar owner or appropriate person connected to the bar.

There could be many reasons for weight loss easily researched on the internet and of certainly HIV+/AIDS is one them.

 

Since 1984 when AIDS information has been recorded over one million people in Thailand have contracted the HIV virus and more than half of those have died. (I suspect those figures are understated.) If the op can assist in anyway from another adding to the grisly statistics then good. It might weigh on his conscience if he does nothing.

 

I think Bob comparing what kids looked like 10 years ago or whenever is irrelevant to this topic though it might be of interest to some in another topic.

[Bob]

I understand your dilemma, Fountainhill, and my guess is you'll be quite alert to any opening that develops to resolve your concerns. My guess (only a guess) is that if none of the other boys (who work there) that you know well don't say something or indicate they're aware of a problem, then it's likely not a problem in reality or at least one you can deal with.

 

As for Khun Payless: I'm doubtful that Fountainhill took offense at my comments or he would likely have said something to that effect (I've not seen where either he or I have been shy about saying something before) but, then again, he can speak for himself.

[Guest fountainhall]

I appreciate payless' comments but assure him and Bob that no offence was even considered. I posted as I thought the matter deserved at least an airing and in the knowledge that some will not agree.

 

As to Bob's point about other boys saying something, that surely is not the 'Thai way'? They must be aware of their colleague's physical condition. But what they know or suspect amongst themselves they would hardly be likely to share with farang, I reckon - even farang they have chatted and had drinks with many times.

[Bob]

I appreciate payless' comments but assure him and Bob that no offence was even considered.

 

And none was intended.

[Guest colinr]

I have been considering whether or not to write this post for a couple of days. I am finally doing so in the hope that it will stimulate thought perhaps more than any in-depth discussion. I just believe it is a topic which should be aired.

 

At the week-end, a farang friend and I had an enjoyable Italian dinner after which we went to a couple of bars, both of which we have visited from time to time. In one, which I shall not name, we noticed a go-go boy who has been with the bar for many months, if not more than a year. He has always been a fem-type, slim, tallish and with a lovely smile. We soon realised that he had dropped quite a few kilos since our previous visit. Indeed, he was so thin he seemed almost to fit the description, however unfair this may be,

[Guest fountainhall]

Someone reduced to skin and bones as a result of HIV would I suspect be in the last stages of the disease and incapable of walking let alone being a go-go dancer. So I suspect, and hope, that you've come to the wrong conclusion.

I suspect you are talking about the final stages of full-blown AIDS rather than HIV. Looking at some of the research papers this morning, there seems to be no 100% proof that HIV leads to AIDS although AIDS can not occur without HIV and there is a mountain of evidence linking the 2. HIV infects the immune system and as the body's defences are stripped away, it starts to develop a variety of different conditions, incluing

 

HIV can have a profound affect on the gastrointestinal system and nutrition. Like any virus, HIV can cause symptoms ranging from poor appetite to diarrhea

http://aids.about.com/od/newlydiagnosed/a/hivsymptom.htm

 

I am not sure of the point at which the transition to AIDS occurs, other than it seems to be when the body's t-cell count drops below 200.

 

http://www.thebody.com/cgi-bin/bbs/showflat.php?C=&Board=living&Number=35590

 

So, if anyone is infected with HIV and not undergoing drug therapy, one result could be a loss of appetite leading to loss of body weight. I stress 'could'.

[Guest colinr]

Grateful for clarifications, Fountainhall. You know more about this than I do!

[Guest fountainhall]

Thanks. Like many, though, I tend to learn as I go along. The internet is a marvellous invention!

 

I am glad you made the post for another reason, though. In this day and age, everyone - gay, straight, whatever - really must take time to know more about this dreadful illness which has robbed tens of millions of their lives, will inevitably kill many millions more, and would be killing yet more were it not for the antiretroviral drug therapies. These are no cure, but they do enable those infected to reduce the virus to virtually zero and stop destroying their bodies' immune systems. Yet, researchers are now finding that this comes at a cost. As has been stated before in a thread earlier last year, a large group of males in their 50s who have been on the drug therapies for many years are now starting to show symptoms of illnesses more usually associated with those in their 80s.

 

This from the British Medical Journal

 

Compared with people without HIV infection, patients with the infection who are treated with antiretrovirals have increased risk for several “non-AIDS” complications, many of which are commonly associated with ageing . . . As a consequence of the changing spectrum of HIV associated disease, the medical management of HIV infection is evolving—a lower proportion of time is now spent managing drug resistance and short term toxicities and a higher proportion is spent managing these premature age associated complications.

http://www.bmj.com/content/338/bmj.a3172.extract

 

And this from a much longer – and more scary – article from New York Magazine

 

Another Kind of AIDS Crisis

 

Some fifteen years into the era of protease inhibitors and drug cocktails, doctors are realizing that the miracles the drugs promised are not necessarily a lasting solution to the disease. Most news accounts today call HIV a chronic, manageable disease. But patients who contracted the virus just a few years back are showing signs of what’s being called premature or accelerated aging. Early senility turns out to be an increasingly common problem . . . One large-scale multi-city study released its latest findings this summer that over half of the HIV-positive population is suffering some form of cognitive impairment. Doctors are also reporting a constellation of ailments in middle-aged patients that are more typically seen at geriatric practices, in patients 80 and older . . .

 

Whether this is a result of the drugs or the disease itself, or some combination, is still an open question and certainly varies from patient to patient and condition to condition. Either way, it is now clear that even patients who respond well to medications by today’s standards are not out of the woods. Current life-expectancy charts show that people on HIV medications could live twenty fewer years on average than the general population. “It’s spooky,” says Mark Harrington, who heads Treatment Action Group, a New York–based HIV think tank. “It seems like the virus keeps finding new tricks to throw at us, and we’re just all left behind going, What’s going on?”

 

The newest data show that middle-aged patients have dramatically increased rates of bone loss and fractures for their age. Some 60 percent of HIV-positive men in their forties have osteoporosis or its predecessor condition, a problem that typically isn’t diagnosed in men until well into their eighties. Jules Levin, founder and executive director of the New York–based National AIDS Treatment Advocacy Project, only found out about this two years ago, when he stumbled and shattered his wrist. He was 57 at the time and in exceptionally good shape, other than his undiagnosed osteoporosis. “This is what opened my eyes to all of this stuff,” he says. “Aging is the No. 1 problem in HIV today.”

http://nymag.com/health/features/61740/

 

With governments having made swinging reductions in the budgets for public information campaigns about HIV AIDS, a lot of younger people are growing up with little knowledge of the disease. They have come to understand that it is now more of a chronic illness than a death sentence. Consequently the safe sex message is getting lost - as is evidenced by the increasing rates of HIV in many countries, especially amongst young people (here in Thailand as much as anywhere else, I supsect) - and habits like barebacking which would have been anathema to most gay people 15 years ago, are on the increase.

 

Antiretroviral drugs are vital in the fight against HIV and AIDS. But they are far from the cure we once thought they were.

[Guest colinr]

More useful info. My original post was prompted by memories of seeing a friend in the last stages of AIDS in Nakorn Sri Thammarat a few years ago. I have a friend in London who has been on AIDS drugs for I guess about 20 years - since his mid-fifties. If I manage to see him on my next visit I'll be interested to see whether he's suffering any of the side-effects you mention. But I won't mention them to him of course.

[Guest colinr]

Sorry! I'm not very good at this and have inadvertently repeated FH's last post. All I wanted to say was that he has furnished yet more useful information. My original post was prompted by memories of a friend in Nakorn Sri Thammarat a few years ago in the final stages of AIDS. I have a friend in London who has been on AIDS drugs for some 20 years - since his mid-fifties. If I see him on my next visit I'll be interested to discover whether he suffers from any of the side effects mentioned by FH. But I won't mention them to him,of course.

[Guest fountainhall]

Like you, I have one friend in Hong Kong with HIV. He was diagnosed back about 1996 when he was around 40 and immediately flew to London to see the top specialist there. He has been on retrovirals ever since. Frankly, I have not noticed any deterioration in any aspect of his health - although he has kept me waiting an inordinate amount of time the last couple of times we had lunch!

[TotallyOz]

My first thought would have been drugs and not HIV. But, I do not know the boy or what he is like.

 

Part of the problem with HIV is that many of the boys that are positive in Thailand never get tested. They don't want to know and it is something most do not want to work with. I have known 2 HIV positive boys in LOS and both were given chances for taking top quality medication and both refused and both are now dead. I am not sure why this mentality seems prevalent in Thailand. HIV is treatable but many in LOS do not want to do the work to take care of their life. I heard one boy even say he "got a do over."