HIV and AIDS in Thailand

[CrazyExpat]

here are very few developing countries in the world where public policy has been effective in preventing the spread of HIV and AIDS on a national scale, but Thailand is an exception. A massive programme to control HIV has reduced visits to commercial sex workers by half, raised condom usage, decreased the prevalence of STIs (Sexually Transmitted Infections) dramatically, and achieved substantial reductions in new HIV infections.1

Thailand, though, is also a reminder that success can be relative. Its well funded, politically supported and comprehensive prevention programmes have saved millions of lives, reducing the number of new HIV infections from 143,000 in 1991 to 19,000 in 2003.2 Nonetheless, more than one-in-100 adults in this country of 65 million people is infected with HIV, and AIDS has become a leading cause of death.3

Unless past efforts are sustained and new sources of infection are addressed, the striking achievements made in controlling the epidemic could now be put at risk. Factors such as an increase in risky sexual behaviour and a rising number of STI cases have led to concerns that Thailand could face a resurgence of HIV and AIDS in coming years.

The first case of AIDS in Thailand occurred in 1984.4 For the next few years, gay men, sex workers, injecting drug users and tourists were more commonly affected than other groups. The government took some basic measures to deal with the issue, but an epidemic was not yet apparent. Most of these measures were aimed at high-risk groups, as the government believed that there was not yet sufficient reason to carry out prevention campaigns among the general public.

At the same time, public awareness of the issue was increasing. The case of Cha-on Suesom, a factory worker who became infected with HIV following a blood transfusion, was widely broadcast through the media after he agreed to allow his story and identity to be publicised in 1987. He became well known after appearing on TV shows and in national newspapers, allowing the public to appreciate the human side of the epidemic. Cha-on and his wife had both been fired from their jobs as a result of his HIV-positive status, and the injustice of this situation helped to increase public sympathy for people living with HIV. 6

Between 1988 and 1989, the HIV prevalence among injecting drug users rose dramatically from almost zero to 40%. The prevalence among sex workers also increased, with studies in Chang Mai suggesting that 44% of sex workers were infected with HIV.7 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.8

The prevailing view was still that HIV and AIDS had come from abroad and were mostly confined to a few individuals in high-risk groups. It was still not generally recognised that the epidemic would spread more widely. One government official insisted that the situation was under control, and stated that:

Some members of Thailand’s parliament proposed that all foreigners should be required to pass an HIV test before being admitted to the country.10 In keeping with the view that the threat was limited, the government only spent $180,000 on HIV prevention in 1988.11

The 1990s

It was not until 1991, when a new Prime Minister, Anand Panyarachun came to power, that AIDS prevention and control became a national priority at the highest level. The new prime minister took several important steps that have since been credited with helping to slow the epidemic.

Firstly, the AIDS control programme was moved from the Ministry of Public Health to the Office of the Prime Minister, which increased its political influence. The budget increased almost 20-fold to $44 million in 1993.12

Secondly, a massive public information campaign on AIDS was launched under the leadership of cabinet member Mechai Viravaidya, a well-known Thai AIDS activist and politician. Anti-AIDS messages aired every hour on the country's 488 radio stations and six television networks, and every school was required to teach AIDS education classes.

The high-profile campaign was initially unpopular with the influential tourism industry, and tourism indeed temporarily declined. However, once AIDS had a prominent place on the national agenda, opposition to the measures gradually faded and support increased.13

Thirdly, and perhaps most importantly, the '100 percent condom program' was initiated.14 This programme aimed to enforce consistent condom use in all commercial sex establishments. Condoms were distributed free to brothels and massage parlours, and sex workers and their clients were required to use them. Brothels that failed to comply could be closed. Without this programme, it is estimated that Thailand’s national HIV prevalence would be ten times higher than it currently is.15

A number of repressive policies, such as mandatory reporting of the names and addresses of people living with HIV who attended hospitals, were also repealed.17

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.

The second ‘National Plan for Prevention and Alleviation of the AIDS Problem’, which covered the period from 1997 to 2001, maintained the previous effective programmes, whilst adopting a more holistic approach, which included mobilizing the efforts of communities and people living with HIV/AIDS.18

Between 1996 and 1997, a randomised controlled trial was carried out to study the provision of short-course AZT (zidovudine) to prevent mother-to-child transmission of HIV in Bangkok. This study showed that AZT reduced transmission of HIV from mother to child by 50%.19 Following this, a number of pilot programs were initiated in Thailand.20 21 The successful results of the pilot studies led doctors in most provinces to demand government support for short-course AZT to prevent mother-to-child transmission of HIV. By 1999, AZT was being used in most hospitals in Thailand.22

Then in the late 1990s, the Asian Financial Crisis resulted in a significant reduction and reorientation in the 1998 budget for AIDS prevention and control. Funding for medical interventions (including antiretroviral drug and treatment of opportunistic infections) was scaled back significantly. Support for condom distribution was also reduced.23 By 2000, domestic funding for HIV and AIDS prevention was roughly one quarter less than it had been in 1997.24

2000 onwards

In 2000, combinations of antiretroviral drugs (ARVs) started to be used to treat people living with HIV in Thailand. This therapy, sometimes known as HAART (Highly Active Antiretroviral Therapy), can prolong the lives of people living with HIV and delay the virus from progressing to AIDS. In subsequent years the number of people accessing ARVs increased dramatically, significantly reducing the number of people dying from AIDS. In 2000 the government also started a national system to monitor its mother-to-child transmission of HIV programme.25

In 2003 the government made an official commitment to ensuring adequate treatment for all people living with HIV, and set targets to improve treatment access. As these plans have been carried out, the third "National Plan for the Prevention and Alleviation of HIV/AIDS in Thailand" (which runs between 2002 and the end of 2006), has worked towards the target of reducing HIV prevalence to less than 1% and providing access to care and support for at least 80% of the people living with HIV and other affected individuals.

By the end of 2007, national HIV prevalence was 1.4%, down from 1.8% in 2003 and more than 2% a decade earlier.

HIV and AIDS in Thailand