HIV Positive in Thailand

SEARO | WHO in the South-East Asia Region| World Health Organizationn

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Thailand has gone through a major reform of governance and its health service system with the Decentralization Act in November and the introduction of universal health coverage in Government reform involved the devolution of authority for some operations from the central government to the provincial and local administrations. There were changes to the structure of the Ministry of Public Health, and in the management of the AIDS budget as part of this decentralisation. Following enactment of the official ministerial proclamation in , the Ministry of Public Health implemented structural reforms at central and regional levels.

In particular, at the central level, the role of the National AIDS Committee shifted from policy and budget support for implementation and development to co-ordination, monitoring and technical support. A portion of the prevention budget and much of the task of implementation was decentralised to local administrative organisations.

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Other related line ministries made budget requests for HIV prevention activities through their own agencies. Apart from antiretroviral treatment, which has been centrally managed, the budget for HIV clinical services for opportunistic infections was integrated into the national health insurance scheme, and allocated to health service outlets in the form of per capita lump sum payments [34]. The national AIDS response is integrated into numerous and diverse programmes of participating agencies and line ministries.

However, starting in , no specific AIDS budget was defined. It became the responsibility of each ministry to allocate a budget line for HIV control. The budget for health of the population was allocated as a lump sum based on per capita needs, including AIDS. This approach promoted a multi-sectoral response and removed the constraints of a centralised budget. For example, under the arrangement, local administrative organisations were made responsible for paying a monthly allowance to PLHIV. Provinces were also expected to prioritise and budget for health issues at the local level.

This made financing directly available at the local level rather than indirectly through a centralised funding mechanism. While this decentralisation has led to some positive changes, the risk that there may be varying capacities and awareness across provinces regarding continued investment and engagement with HIV has remained a challenge [35]. This package entitled all Thai citizens to free medical services and health promotion and prevention. At the introduction of the scheme, antiretroviral treatment was excluded from the service package, but included in The Ministry of Public Health had begun to engage with civil society partners in Thailand on the issue of HIV prevention and treatment since the early s.

Apart from working closely with the government, Thai civil society has successfully held governments accountable, and championed the cause of equal access. The minister agreed, in principle, to their demands, and doubled the budget for ART and also committed the government to include ARVs in the universal health scheme. At that time, there were fewer than individuals receiving ART.

Arguably, civil society action has been fundamental in shaping government policy, an illustration that a well-informed and motivated civil society, which is able to negotiate and partner with government agencies, can be highly beneficial to the AIDS response.

We conclude by noting that, despite the outstanding successes of Thailand's AIDS response, the programme is faced by a multitude of challenges. HIV is a chronic disease, and in the context of Thailand's ageing population, it poses the twin challenges of maintaining life-long quality services for HIV patients and sustaining behavioural change to maintain primary prevention gains. Stigma and discrimination in healthcare settings is still a major obstacle to a more effective response to HIV. Observed behaviours towards KAPs among health staff in two Thai provinces indicate disturbing levels of discrimination [38].

Thailand has also struggled with ongoing policy and legislative barriers that have an impact on access and quality of services. Despite recent progress in reducing barriers to access for example, no further requirement for parental consent for HIV testing in young people; a pilot harm reduction policy in 19 provinces; and health insurance for healthcare for migrants Thailand has a rocky road to travel before ending AIDS [24].

The Ministry of Public Health is also implementing a programme to reduce system-wide stigma and discrimination in healthcare settings, and address human rights concerns. We would also like to acknowledge Tom F Joehnk for editorial support. The authors do not have any conflict of interest to declare.

MS is a staff member of the World Health Organization.

The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the World Health Organization. National Center for Biotechnology Information , U. Journal List J Virus Erad v. Author information Copyright and License information Disclaimer. This is an open access article published under the terms of a Creative Commons License. This article has been cited by other articles in PMC.

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Methods This is a review paper that draws on published literature, unpublished sources and routine behavioural and serological surveillance data since Introduction Thailand's first case of HIV was reported in Open in a separate window. Methods This review draws on published literature and unpublished sources and routine behavioural and serological surveillance data since Results We distinguish our findings over two phases. Health governance and reform Thailand has gone through a major reform of governance and its health service system with the Decentralization Act in November and the introduction of universal health coverage in Partnership The Ministry of Public Health had begun to engage with civil society partners in Thailand on the issue of HIV prevention and treatment since the early s.

Conclusions We conclude by noting that, despite the outstanding successes of Thailand's AIDS response, the programme is faced by a multitude of challenges. Declaration of conflict of interest The authors do not have any conflict of interest to declare. Independent introduction of two major HIV-1 genotypes into distinct high-risk populations in Thailand. AIDS ; 8 Suppl 2: Preventive intervention to reduce sexually transmitted infections: Arch Intern Med ; J Acquir Immune DeficSyndr ; HIV and syphilis infection among men who have sex with men — Bangkok, Thailand, — Brown T, Sittitrai W.

Estimates of recent HIV infection levels in Thailand. Thailand's response to the HIV epidemic: Impact of Thailand's HIV control programme as indicated by the decline of sexually transmitted diseases. AIDS ; 9 Suppl 1: Rojanapithayakorn W, Hanenberg RS. Decreasing incidence of HIV and sexually transmitted diseases in young Thai men: Kanshana S, Simonds RJ. National programme for preventing mother to child HIV transmission in Thailand: Evolution of interventions to prevent mother-to-child transmission of hiv: Siriraj Med J ; Reduction in mother-to-child transmission of HIV in Thailand, — Evaluating programs to prevent mother-to-child HIV transmission in two large Bangkok hospitals, — J Acquir Immune Defic Syndr ; Bangkok, , cited in Phanuphak et al [24].

Thai national guidelines for the prevention of mother-to-child transmission of HIV: Asian Biomed ; 4: National program scale-up and patient outcomes in a pediatric antiretroviral treatment program, Thailand, — National expansion of antiretroviral treatment in Thailand, — Thai national guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents , Thailand.

Burden of disease in Thailand: BMC Public Health ; World Health Organization Thailand: This may be the result of a lack of information about HIV or a lack of access to services. Globally, transgender people are the most at-risk group of sex workers, with HIV prevalence estimated to be on average nine times higher than for female sex workers and three times higher than for male sex workers. There are more than 75, transgender people living in Thailand.

A large proportion of transgender people also sell sex making them increasingly vulnerable to HIV. There are a number of reasons transgender men and women are being left behind in prevention and treatment work. Discriminatory heath systems, transphobia, family rejection and a lack of access to education and employment all discourage transgender people from seeking HIV services. Although the need for harm reduction is increasingly accepted in Thailand, a largely punitive policy and legal environment focused on drug control continues to undermine access. Thailand still operates compulsory detention centres for people who use drugs, which deters many from seeking essential health services.

Migration can put people in situations that heighten vulnerability to HIV, due to factors such as social exclusion and a lack of access to healthcare services or social protection. In South-East Asia, HIV prevalence among migrants to Thailand from neighbouring countries is up to four times higher than among the general population. In a behavioural survey conducted in 24 provinces among migrant workers aged , Fishermen and those working in the sea-food processing industry were particularly likely to pay for sex.

Global information and education on HIV and AIDS

In Thailand, the vast majority of sex workers are migrants from villages, who use the income from sex work to support families in their home communities. As of September 30, , the number of migrants who registered with the migrant health insurance stood at 1. HIV-related stigma and experiences of stigma and discrimination in healthcare are recurring barriers that prevent people from testing for HIV.

Criminalisation is also an issue, especially for people who use drugs who fear arrest or detention. Ethnicity or migrant nationality, sexual orientation, mental health issues or being co-infected with tuberculosis, are additional layers of stigma that prevent people from testing. Age has also been a barrier to HIV testing, although a ban on people aged 18 and under testing for HIV without parental consent was lifted in New approaches have been introduced to increase access to, and demand for, HIV testing among key affected populations, including the following:.

This is a five-year project that started in and is being implemented in Thailand by FHI and local community-based organisations. Those who test positive for HIV are then supported by their peers to access treatment and care. As of , HIV self-testing kits oral or blood-based have not been granted a clinical licence.

However, a self-testing pilot study among men who have sex with men and transgender women was being conducted with a view to wider implementation if proven effective. In , 6, people in Thailand became infected with HIV. Roughly two-thirds of whom were identified as male 4, infections among those classified as men, compared to 2, infections among those classified as women.

There were less than new infections among children years. Subsequent condom distribution and awareness campaigns have since run and often target young people. Despite this, condom use among this age group is low. For instance, Thailand has the second highest rates of teenage pregnancy in South East Asia. In , health authorities launched a new, three-year condom campaign aimed at young people, distributing about 40 million free condoms per year.

Nearly all general secondary and vocational institutions provide comprehensive sexuality education CSE , either as an integrated or standalone subject or both. It is not available for children of younger ages. Diverse topics are covered in the CSE curriculum including the prevention of teenage pregnancy, sexually transmitted infections and HIV, and sexual anatomy and development.

Thailand launches new national strategy to end the AIDS epidemic by | UNAIDS

However, topics that relate to gender, sexual rights, sexual and gender diversity, gender inequality, safe abortion and safer sex for same-sex couples are less often taught. Surveys show that people in Thailand under the age of 25 have lower levels of HIV knowledge and HIV testing and counselling than those over age Thailand has made great strides in reducing its mother-to-child-transmission MTCT rate. Harm reduction services for people who inject drugs, such as needle and syringe programmes NSPs , are available in Thailand, although they are limited.

On average, a person who injects drugs in Thailand received just 14 clean needles and syringes per year in A reduction in the number of NSPs in Thailand began in ; two years later 24 out of 38 sites had shut. This was due to a sudden termination of a partnership with local pharmacists due to reduced funding. In order to increase access, O-zone, a Thai non-governmental organisation, has been implementing a peer-led, community-based methadone delivery service in the mountain village of Santikhiri in Chiang Rai province, where peer outreach workers operate methadone delivery at a drop-in centre with supervision from Mae Chan Hospital.

Initiated in , the initiative attracted media attention and support from government agencies and has since been replicated in Huay Pung in Chiang Rai province. It began to be piloted in Thailand in By , PrEP pilots were operating at five sites for men who have sex with men and transgender women.

Between 4, and 4, people in Thailand were using PrEP as of , with this number expected to rise to between 7, and 7, by the end of As use of antiretroviral treatment in Thailand increases, so does the potential for transmission of drug-resistant HIV. In a study of people, mainly men who have sex with men, an overall HIV drug resistance prevalence of 9.

Authorities have frequently used this order to detain and charge peaceful protesters.

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