Thailand
HIV/AIDS profile
Thailand is recognized for its development success in the region. In 2005, per capita gross national income was US$ 8020 and just over 32% of the population lived on less than US$ 2. Per capita government expenditure on health stood out among its neighbours at US$ 160. Thailand’s experience in addressing HIV/AIDS is often referred to by other countries in developing their own response.
The HIV/AIDS epidemic began with the first HIV/AIDS transmission from an HIV-positive homosexual male to a commercial sex worker in Thailand in 1984. While the early AIDS cases were reported predominantly among Thai homosexual males, subsequently, the virus spread rapidly to injecting drug users, and to sex workers and their clients.
Between 1988 and 1989, the HIV prevalence among injecting drug users rose dramatically, from virtually zero to 40%. The prevalence among sex workers also increased, with studies in Chang Mai, northern Thailand, suggesting that 44% of sex workers were infected with HIV. The rising level of infection among sex workers led to subsequent waves of the epidemic among the male clients of sex workers, their wives and partners, and their children.
HIV transmission fell rapidly in the 1990s as a result of the strong focus on prevention. In 1991, AIDS prevention and control became a national priority at the highest level. The AIDS control program was moved from the Ministry of Public Health to the Office of the Prime Minister, increasing its political influence, and the budget was increased almost 20-fold to $44 million in 1993. A massive public information campaign on AIDS was launched and the '100 percent condom program' was initiated. Without this programme, it is estimated that Thailand’s national HIV prevalence would be ten times higher than it currently is.
It has been estimated that over 5.7 million HIV infections have been averted thus far through prevention efforts in Thailand, reducing the number of new HIV infections from 143,000 at its peak in 1991 to 19,000 in 2003. Among commercial sex workers, HIV prevalence peaked in the mid-nineties and has constantly declined since then. The HIV prevalence among injecting drug users, however, remained high at 33% in 2003 and poses a major challenges to HIV control in Thailand. The HIV prevalence among the other high risk groups in 2003 was: female direct sex workers (10.87%); male sex workers (7.90%), fishermen (6.86%); male STD clients (4.00%); female indirect sex workers (3.67%); and blood donors (0.27%).
While recognized for its early success in turning the tide against HIV/AIDS, Thailand is also a reminder that success can be relative. 231,712 AIDS cases had been reported as of January 2004 - of whom nearly 80% were in the age group 20-39 years. In 2004, about 17,000 people in Thailand were newly infected with HIV in 2004. In 2006, UNAIDS reported an estimated 580,000 people living with HIV/AIDS in Thailand. Based on recent projections by the Thai working Group on HIV/AIDS, the cumulative number of people with HIV/AIDS in Thailand in 2006 is estimated to rise above 1,109,000, including more than 550,000 who have died.
At present, an estimated one-in-100 adults are infected with HIV and AIDS has become a leading cause of death in Thailand. A growing number of people living with AIDS require effective treatment. In response to this, government spending and programming has focussed increasingly on providing treatment and care. The use of generic drugs led to more than an eight-fold expansion in treatment provision between 2001 and 2003, with only a 40% increase in budget. The national treatment campaign was boosted by a grant from the Global Fund to Fight AIDS, TB and Malaria. By the end of 2005, 60% of those requiring antiretroviral medication were receiving them.
From 1992 to 1996, the National AIDS program received dramatic increases in funding. The government provided it with more than $80 million annually by 1996. Then in the late 1990s, the Asian Financial Crisis resulted in a significant reduction and reorientation in the 1998 budget for AIDS programming. By 2000, domestic funding for HIV and AIDS prevention was roughly three quarters of what it had been in 1997. The vast majority of the current AIDS budget is allocated to care and support for positive people and their families – with not enough spending on prevention. This is below par for a country with a firmly-established epidemic that is mainstreamed into the general population and where high-risk behaviour remains so prevalent.
Prevention efforts such as public information and education campaigns are now few and far-between. Public concern about HIV/AIDS has ebbed. The inadequacy of programming directly aimed at some key circuits of HIV transmission is a particular cause for concern and is putting the public at risk. There are already signs that the epidemic could grow in coming years; reports suggest that the rate of sexual transmitted infection (STI) transmission has increased, condom use has decreased and risky sexual behaviour is on the rise.
Unless preventive efforts are sustained, the epidemic could quickly grow, especially within new and existing vulnerable groups such as spouses of sex workers clients, young people, mobile populations and drug users. Challenges for the country include reviving intensive HIV prevention efforts, providing care and support to people living with HIV/AIDS and maintaining political commitment at the highest level and in every government ministry.
National Strategic Framework
The Ninth National Economic and Social Development Plan (2002-2006) stressed the adoption of a holistic, human-centred approach, which had brought reform through the public service systems, especially the health care system. In addition, the plan provided assurance and gave opportunity to comprehensively improve the standards of medical and health care services.
According to Thailand’s former Prime Minister Thaksin Shinawatra, Thailand’s policy on AIDS was as follows: (Thaksin Shinawatra’s speech of opening ceremony on 11 July 2004 of the XV International AIDS Conference, Bangkok, 11-16 July 2004):
- Promote education and understanding among Thai citizens regarding HIV/AIDS and prevention measures. Everyone should recognize the importance of this epidemic so that all parties involved could work together.
- Develop a system of medical, public health, social and consultation services so that PLWHA could improve the quality of life. The goals were to reduce mother-to-child transmission to 3%; provide treatment for opportunistic Infections through the National Universal Health Care Scheme (30-Baht health-care program); include antiretroviral medications in the National Universal Health Care Scheme; encourage everyone who was living with HIV/AIDS to have an appropriate job; provide treatment and care for orphans and other affected children; and revise the laws and regulations to help alleviate the problem.
- Accelerate the development of medical biotechnology, traditional medicine, and AIDS vaccination research to have the most effective method in preventing and alleviating the HIV/AIDS problem.
- Utilize the “Power of the People” strategy to prevent and alleviate the HIV/AIDS problem. By consolidating the power from all the parties involved, namely the government sector, private companies sector, public companies sector, and the general population sector, the major strength could be used to develop concrete and effective measures to prevent and alleviate the HIV/AIDS problem.
The policy as stated above was consistent with the National Plan for the Prevention and Alleviation of HIV/AIDS Plan (2002 – 2006) which had a vision statement that read: “Individuals, families and communities form a strong and healthy society where people possess wisdom and knowledge, have a mutual sense of concern, and work together to prevent and alleviate the HIV/AIDS problem.”
The 2002- 2006 National Plan spelled out goals, targets and strategies which emphasize the participation of individuals, families and communities in HIV/AIDS prevention and alleviation; the support to be extended to them by health and social welfare services; the development of knowledge and research; international cooperation; and integrated management of HIV/AIDS prevention and care.
The main objectives were to have individuals, families, and communities take responsibility and act together in a sustained fashion to prevent and alleviate the HIV/AIDS problem, and to strengthen the foundations of society in order to facilitate the process.
The specific targets were outlined as follows:
- Reduce the HIV prevalence in the reproductive age population less than 1%.
- At least 80% of the PLWHA and affected individuals would be receiving and/or having equal access to proper care and support from public, private and community providers of social, economic, educational, and primary health care services.
- Local administrations and community-based organisations throughout the country would efficiently and continuously develop work plan and carry out the work on HIV/AIDS prevention and alleviation.
In the 2002-2006 National Plan issues such as non-discrimination, access to care, multisectoral approach and international co-operation were reflected but there still remained a need to address non-discrimination and rights issues, targeting a few specific groups such as injecting drug users.
The next National HIV/AIDS Plan, covering the period 2007- 2011, is currently under preparation. The plan will need to incorporate a clear focus on prevention and public information if Thailand is to prevent a resurgence of its HIV epidemic .
The information presented in the HIV/AIDS country watch originated from the web site of the Joint United Nations Programme on AIDS (UNAIDS) – www.unaids.org (November 2006).
For more information please visit:
http://www.undp.or.th/focus/hiv.html
