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UNGASS COUNTRY PROGRESS REPORT

THAILAND
Report i ng Peri od
January 2008- December 2009
N Na at t i i o on na al l A AI ID DS SP Pr r e ev ve en nt t i i o on n a an nd d A Al l l l e ev vi i a at t i i o on n C Co om mm mi i t t t t e ee e
Tabl e of Cont ent s

Pref ace
Tabl e of Cont ent s
Li st of Fi gures
I. St at us at a Gl ance 1
1. Incl usi veness of t he St akehol der s i n t he Repor t Wr i t i ng
Pr ocess
1
2. St at us of t he Epi demi cs 2
3. Pol i cy and Pr ogr am Response 4
4. UNGASS Indi cat or Dat a i n an Over vi ew Tabl e 9
II. Overvi ew of t he AIDS Epi demi c i n Thai l and 15
III. Nat i onal Response t o t he AIDS Epi demi cs 39
1. Nat i onal HIV/ AIDS Aut hor i t y 39
2. Nat i onal Int egr at ed HIV/ AIDS St r at egi c Pl an 40
3. Pr ogr ess of Nat i onal Response t o HIV/ AIDS epi demi cs 40
Par t 1:
3. 1 Pr ogr ess t owar ds t he Decl ar at i on of Commi t ment on
HIV/ AIDS, Uni t ed Nat i ons Gener al Assembl y Speci al sessi on
on HIV/ AIDS, 27 June 2001
41
Par t 2:
3. 2 Nat i onal Commi t ment and Act i on 47
3. 2. 1 Nat i onal AIDS Spendi ng Assessment 47
3. 2. 2 Nat i onal Composi t e Pol i cy Index 50
3. 3 HIV/ AIDS Pr event i on 56
3. 3. 1 Bl ood Saf et y 56
3. 3. 2 Pr event i on of Mot her - t o- Chi l d HIV Tr ansmi ssi on 58
3. 3. 3 HIV Pr event i on among Repr oduct i ve Age Gr oup 66
3. 3. 4 HIV Pr event i on among Yout hs 73
3. 3. 5 HIV Pr event i on among Sex wor ker s ( SW) 79
3. 3. 6 HIV Pr event i on among Men who have Sex wi t h Men
( MSM)
87
3. 3. 7 HIV Pr event i on among Inj ect i ng Dr ug User s( IDU) 94
3. 3. 8 HIV Pr event i on among Mi gr ant s and Mobi l e
Popul at i on
103
3. 3. 9 HIV Pr event i on among Pr i soner s 114
3. 4 Tr eat ment , Car e and Suppor t f or PLHA and Af f ect ed
Fami l i es
117
3. 4. 1 Vol unt ar y Counsel i ng and Test i ng 117
3. 4. 2 Ant i r et r ovi r al Ther apy and OI Management 120
3. 4. 3 TB/ HIV Co- i nf ect i on Tr eat ment 128
3. 4. 3 Car e and suppor t f or HIV/ AIDS- af f ect ed Chi l dr en 130
3. 5 AIDS Vacci ne Devel opment 137
IV. Best Pract i ces 140
4. 1 Pr oj ect s r el at ed t o f emi ni zat i on of HIV/ AIDS 141
4. 2 AIDS Response t o Mar gi nal i zed Peopl e 145
4. 3 Holistic Care and Suppor t f or Chi l dr en Af f ect ed by HIV 148
I
Tabl e of Cont ent s
Annexes
V. Maj or Chal l enges and Remedi al Act i ons 150
VI. Support f rom t he Count ry s Devel opment Part ners 159
VII. Moni t ori ng and Eval uat i on envi ronment 169
Annex 1 Consul t at i on/ pr epar at i on pr ocess f or t he
Count r y Pr ogr ess Repor t on monit oring t he f ollow up
t o t he Decl ar at i on of Commi t ment on HIV/ AIDS
184
Annex 2 Cover sheet : Nat i onal Composi t e Pol i cy Index ( NCPI
2010 )
185
Annex 3 Pol i cy Indi cat or s: Vi ewpoi nt of Ci vi l Soci et y 189
Annex 4 Repor t on St i gma i ndex sur veys 200
Annex 5 Pol i cy on Impl ement i ng Repr oduct i ve Heal t h: Vi ew of
Ci vi l Soci et y
208
Annex 6 Nat i onal AIDS Spendi ng Assessment 2008- 2009 221
Annex 7 Nat i onal Moni t or i ng and Eval uat i on Wor ki ng Gr oups 229
II
Li st of Fi gures
Fi gure 1 HIV pr eval ence among mi l i t ar y r ecr ui t s 16
Fi gure 2 Inci dence of HIV : mi l i t ar y r ecr ui t s : 2005 - 2009 16
Fi gure 3 HIV pr eval ence i n ANC cl i ent s : 1991 - 2009 17
Fi gure 4 HIV i nci dence among ANC cl i ent s : 2005 - 2009 17
Fi gure 5 HIV pr eval ence among ANC cl i ent s by age gr oup : 2005 -
2009
17
Fi gure 6 HIV pr eval ence among ANC cl i ent s by gr avi da : 2005 -
2009
17
Fi gure 7 HIV pr eval ence among mi l i t ar y r ecr ui t s and ANC cl i ent s
by r egi on
18- 19
Fi gure 8 HIV pr eval ence among bl ood donor s at t he nat i onal
bl ood bank of t he Thai Red Cr oss by sex and t ype of
donor : 1991 - 2009
20
Fi gure 9 HIV pr eval ence among bl ood donor s at t he nat i onal
bl ood bank by age gr oup : 2001 - 2009
20
Fi gure 10 HIV pr eval ence among f emal e and mal e SWs, and mal e
STI pat i ent : 1989 - 2009
21
Fi gure 11 HIV i nci dence per year : Indi r ect SW : 2004 - 2008 21
Fi gure 12 Syphi l i s sur vei l l ance among DSW and ISW dur i ng : 1999 -
2008
23
Fi gure 13 Per cent condom use wi t h sex wor ker s i n 2008 24
Fi gure 14 HIV pr eval ence f r om t he sur vey of MSM i n sent i nel
pr ovi nces dur i ng : 2003 - 2008
25
Fi gure 15 HIV pr eval ence among IDU : 1989 - 2009 26
Fi gure 16 Pr eval ence of HIV f or mi gr ant wor ker s and f i shi ng boat
cr ew Thai l and : 1997 - 2008
27
Fi gure 17 Hi st or y of sex of yout h i n hi gh school and col l ege i n
2008
29
Fi gure 18 Condom use among yout h : 2008 30
Fi gure 19 Tr ends i n STI among t he popul at i on under 25 year s
dur i ng 2000 - 2008
31
Fi gure 20 Est i mat es of t he number of new cases of HIV by
popul at i on and r i sk f act or : 1985 - 2010
36
Fi gure 21 Pr oj ect ed new i nf ect i ons by popul at i on and r i sk f act or :
1988 - 2010
36
Fi gure 22 Est i mat ed number of PLHA el i gi bl e t o r ecei ve ART and
number r ecei vi ng ART accor di ng t he AIDS t r eat ment
pol i cy of Thai l and
38
Fi gure 23 St r uct ur e of nat i onal AIDS Aut hor i t y 39
Fi gure 24 Pr eval ence of HIV among pr egnant women dur i ng : 1989
- 2008
59
Fi gure 25 Pr eval ence of HIV among f emal e SWs i n Thai l and : 1989
2008
80
Fi gure 26 HIV pr eval ence among a sampl e of f emal e SWs usi ng
RDS i n 2007 Bangkok and Chi ang Mai
80



III
Li st of Fi gures


Fi gure 27 Pr opor t i on of sex wor ker s havi ng and HIV t est and
Knowi ng t he r esul t i n 2007 and 2009 by sex
82
Fi gure 28 Pr eval ence of HIV among MSM by pr ovi nce : HIV sent i nel
sur vei l l ance dur i ng 2003 - 2009
88
Fi gure 29 Pr eval ence of HIV among Thai f i shi ng boat cr ew, ar my
r ecr ui t s, mi gr ant l abor er s, Thai and f or ei gn mi gr ant
pr egnant women i n 4 pr ovi nces i n 2006
106
Fi gure 30 HIV pr eval ence among Thai and Mi gr ant FSWs i n
sel ect ed pr ovi nce i n 2005
106
Fi gure 31 Per cent age of mi gr ant wor ker s r eached t o key
pr event i on i nt er vent i ons i n 2004 and 2008
110
Fi gure 32 Compr ehensi ve HIV/ AIDS Sur vei l l ance Syst em 171























IV
Li st of Tabl es


Tabl e 1 Resul t s of an pr eval ence sur vey of HIV and STIs among
ISW ( non- venue- based SW) i n Bangkok and Chi ang Rai i n
2007
22
Tabl e 2 Pr eval ence of NSU i n SWs by age gr oup f r om t he IBBS
dur i ng 2006- 7
23
Tabl e 3 Sel ect ed behavi or s of SWs i n Thai l and: 2004- 2008 24
Tabl e 4 Dr ug use i n yout h and adol escent s: 2008 27
Tabl e 5 Per cent age of Thai st udent s who coul d cor r ect l y answer
UNGASS AIDS knowl edge quest i ons by gr ade of st udent ,
sex and year : 2005- 2008
32
Tabl e 6 Di st r i but i on of HIV pr eval ence among sent i nel
popul at i ons; r ank of 15 pr ovi nces wi t h hi ghest
pr eval ence
34
Tabl e 7 Number of PLHA and AIDS pat i ent s as pr oj ect ed f r om
t he AEM
37
Tabl e 8 Thai AIDS expendi t ur e ( i n baht ) by pl an component by
t ype of expendi t ur e i n 2008 and 2009
47
Tabl e 9 Det ai l s of car e and t r eat ment expendi t ur es dur i ng 2008-
2009
48
Tabl e 10 Det ai l s of AIDS Pr event i on Expendi t ur e dur i ng 2008-
2009
49
Tabl e 11 At t i t ude of wor ker t owar d PLHA f r i ends who wer e
t r ai ned
69
Tabl e 12 Tr ends i n behavi or change of wor ker s af t er compl et i on
of t he t r ai ni ng
69
Tabl e 13 Resul t s of condom pr omot i on 70
Tabl e 14 Condom used of wor ker s i ncr eased ever y year 70
Tabl e 15 AIDS Act i vi t y i n t he wor k pl an 70
Tabl e 16 Changed i n pol i cy of wor ksi t e 70
Tabl e 17 Number of wor ksi t e cer t i f i ed as compl yi ng wi t h ASO
Thai l and St andar d
70











V
V

Abbrevi at i on

AEM Asi an Epi demi c Model
AFRIMS Ar med For ces Resear ch Inst i t ut e of Medi cal Sci ences
AIDS Acqui r ed Immunodef i ci ency Syndr ome
AMI Ai ds Medi cal Int er nat i onal
ANC Ant e- nat al car e
ARC Amer i can Ref ugee Commi t t ee
ART Ant i Ret r ovi r al Ther apy
ARV Ant i Ret r ovi r al
ASO AIDS- Response St andar d Or gani zat i on
BATS Bur eau of AIDS, TB and STIs
BMA Bangkok Met r opol i t an Admi ni st r at i on
BOE Bur eau of Epi demi ol ogy
BSS Behavi or al sur vei l l ance sur vey
CAB Communi t y Advi sor y Boar d
CAR Cent er f or AIDS Ri ght
CCM Count r y Coor di nat i ng Mechani sm
CICT Cl i ent Ini t i at ed Counsel i ng and Test i ng
CIDA Canadi an Int er nat i onal Devel opment Agency
CQI Cont i nuous Qual i t y Impr ovement
CSE Commer ci al sex est abl i shment s
DBS Dr i ed bl ood spot s .
DDC Depar t ment of Di sease Cont r ol
Di C Dr op- i n cent er s
DLPW Depar t ment of Labour Pr ot ect i on and Wel f ar e
DNA- PCR Deoxyr i bonucl ei c aci d pol ymer ase chai n r eact i on
DoC Depar t ment of Cor r ect i ons
DoH Depar t ment of Heal t h
EQA Ext er nal Qual i t y Assessment
FHI Fami l y Heal t h Int er nat i onal
FSW Femal e sex wor ker s
GAP Gl obal AIDS Pr ogr am
GDP Gr oss Domest i c Pr oduct s
GFATM Gl obal Fund t o f i ght AIDS Tuber cul osi s and Mal ar i a
HAART Hi ghl y Act i ve Ant i Ret r ovi r al Ther apy
HBV Hepat i t i s B Vi r uses
HCV Hepat i t i s C Vi r uses
HITAP Heal t h Int er vent i on and Technol ogy Assessment Pr ogr am
HIV Human Immunodef i ci ency Vi r us
HIV- NAT The HIV Net her l ands Aust r al i a Thai l and Resear ch
HRG Hi gh r i sk gr oups
HS Hi gh school
HSRI Heal t h Ser vi ce Resear ch Inst i t ut e
HV Hepat i t i s Vi r uses
IBBS Int egr at ed bi ol ogi cal and behavi or al sent i nel sur vei l l ance
IDU Inj ect i ng Dr ug User s
IEC Inf or mat i on Educat i on and Communi cat i on
IHQIA Inst i t ut e f or Hospi t al Qual i t y Impr ovement and Accr edi t at i on
ILO Int er nat i onal Labour Or gani zat i on
IOM Or gani zat i on on Mi gr at i on
VI
IPSR Inst i t ut e of Popul at i on and Soci al Resear ch
IRC Int er nat i onal Rescue Commi t t ee
ISO Int er nat i onal Or gani zat i on f or St andar di zat i on
LAOs Local admi ni st r at i ve or gani zat i ons
M&E Moni t or i ng and Eval uat i on
MARPs Most - at - Ri sk Popul at i on gr oups
MCH Mat er nal Chi l d Heal t h
met h Met hamphet ami nes
MHV Mi gr ant heal t h vol unt eer s
MHW Mi gr ant heal t h wor ker
MMT Met hadone mai nt enance t her apy
MOE Mi ni st r y of Educat i on
MOL Mi ni st r y of Labour
MOPH Mi ni st r y of Publ i c Heal t h
MOU Memor andum of under st andi ng
MSD Medi cal Sci ences Depar t ment
MSD Medi cal Ser vi ces Di vi si on
MSM Men who have Sex wi t h Men
MSW Mal e Sex Wor ker s
MTCT Mot her t o Chi l d Tr ansmi ssi on
NAC Nat i onal AIDS Commi t t ee
NAMc Nat i onal AIDS Management Cent er
NAP Nat i onal AIDS Pr ogr am
NAPAC Nat i onal AIDS Pr event i on and Al l evi at i on Commi t t ee
NAPHA Nat i onal Access t o Ant i r et r ovi r al Pr ogr am f or PHA
NASA Nat i onal AIDS Spendi ng Assessment s
NGO Non- Gover nment Or gani zat i on
NHSO Nat i onal Heal t h Secur i t y Of f i ce
NHSP Nat i onal Heal t h Secur i t y Pr ogr am
NNRI Non- nucl eosi de r ever se t r anscr i pt ase i nhi bi t or s
NSU Non speci f i c Ur et hr i t i s
OI Oppor t uni st i c Inf ect i ons
ONCB Of f i ce of t he Nar cot i cs Cont r ol Boar d
PCM Pr ovi nci al Coor di nat i ng Mechani sm
PCR Pol ymer ase Chai n React i on
PEP Post Exposur e Pr ophyl axi s
PHIMS Per i nat al HIV Int er vent i on Moni t or i ng Sur vei l l ance Syst em
PHOM Per i nat al HIV Out come Moni t or i ng Sur vei l l ance Syst em
PICT Pr ovi der Ini t i at ed Counsel i ng and Test i ng
PLHA Peopl e Li vi ng wi t h HIV/ AIDS
PMTCT Pr event i on of Mot her To Chi l d HIV Tr ansmi ssi on
PPAT Pl anned Par ent hood Associ at i on of Thai l and
PR Pr i nci pal r eci pi ent
QI Qual i t y Impr ovement
RDS Respondent Dr i ven Sampl i ng
RH Repr oduct i ve Heal t h
RHIS Rout i ne Heal t h Inf or mat i on Syst em
RTF The Raks Thai Foundat i on
SD NVP Si ngl e- dose of Nevi r api ne
SR Sub Reci pi ent
STI Sexual l y Tr ansmi t t ed Di sease
SW Sex Wor ker s
SWING Ser vi ce Wor ker s i n Gr oup
VII
TAO Tambol Admi ni st r at i ve Or gani zat i ons
TB Tuber cul osi s
TBCA Thai l and Busi ness Coal i t i on on AIDS
TDN Thai Dr ug User s Net wor k
THE Tot al Heal t h Expendi t ur e
TICA Thai l and Int er nat i onal Devel opment Co- oper at i on Agency
TOT Tr ai ni ng of Tr ai ner s
TRC Thai Red Cr oss
TUC Thai - US Col l abor at i on
TWG Techni cal Wor ki ng Gr oups
UA Uni ver sal Access
UIC Uni que Ident i f i er Code
UNAIDS Uni t ed Nat i ons Pr ogr am on HIV/ AIDS
UNDP Uni t ed Nat i ons Devel opment Pr ogr am
UNESCO Uni t ed Nat i ons Educat i onal , Sci ent i f i c and Cul t ur al
Or gani zat i on
UNFPA Uni t ed Nat i ons Popul at i on Fund
UNGASS Uni t ed Nat i ons General Assembl y Speci al Sessi on on HIV/ AIDS
UNHCR The Uni t ed Ref ugee Agency
UNICEF Uni t ed Nat i ons Chi l dr en s Fund
UNIFEM Uni t ed Nat i ons Devel opment Fund f or Women
UNODC Uni t ed Nat i ons Of f i ce on Dr ugs and Cr i me
USAID Uni t ed St at es Agency f or Int er nat i onal Devel opment
VCT Vol unt ar y Counsel i ng and Test i ng
WHO Wor l d Heal t h Or gani zat i on
WRAIR Wal t er Reed Ar my Inst i t ut e of Resear ch
YPFS Yout h and PHA Fr i endl y Ser vi ces
















VIII

Pref ace
Af t er t he Uni t ed Nat i ons Gener al Assembl y Speci al Sessi on on HIV/ AIDS
( UNGASS) was convened i n June 2001, 189 r epr esent at i ves of count r i es
ar ound t he wor l d si gned t he accompanyi ng decl ar at i on on AIDS, showi ng
consensus of t he wor l d t owar d t he concept ual f r amewor k and t he
Mi l l enni um Devel opment Goal ( MDG) t o never al l ow t he r et ur n of t he HIV
pandemi c.
The UNGASS Decl ar at i on emphasi zed t he i mpor t ance of col l abor at i on of t he
var i ous sect or s i ncl udi ng t he gover nment , busi ness, ci vi l soci et y, l abor
or gani zat i ons, and PLHA or gani zat i ons i n i mpl ement i ng t he pr ogr ams t o
conf r ont t he AIDS chal l enges at ever y l evel of soci et y, i ncl udi ng pr event i on
of new i nf ect i on, expandi ng access t o car e and t r eat ment , and mi t i gat i ng
t he i mpact of AIDS.
In or der t o moni t or i mpl ement at i on i n suppor t of t he Decl ar at i on goal s,
UNAIDS and par t ner s devel oped a f r amewor k of i ndi cat or s t o assess pr ogr ess
of r el at ed pr ogr ams, and r equest ed t he si gnat or y count r i es t o r epor t on
t hese i ndi cat or s ever y t wo year s.
As par t of t he 60
t h
UN Gener al Assembl y on June 2, 2006, pr ogr ess and
successes i n i mpl ement i ng pr ogr ams i n suppor t of t he UNGASS Decl ar at i on
wer e r evi ewed ( r ef : Agenda It em 45) .
Acknowl edge and recogni ze t he si gni f i cance of t he f act s t hat :
AIDS i s a gl obal cat ast r ophe t hat t hr eat ens devel opment and secur i t y
of nat i ons.
Ther e has been pr ogr ess i n mobi l i zi ng gl obal r esour ces t o combat AIDS.
One- t hi r d of t hi s f undi ng i n 2005 came f r om gover nment s of mi ddl e
and l ower - i ncome count r i es.
Issues of concern:
The spr ead of HIV i n women.
That hal f of new i nf ect i ons ar e among t hose under age 25 year s.
That t her e ar e appr oxi mat el y 2. 3 pedi at r i c cases of HIV/ AIDS; many
count r i es do not have adequat e ARV dr ugs t o t r eat t hese pedi at r i c
HIV i nf ect i ons.
Reaf f i rm t hat :
It i s al ar mi ng t hat t he spr ead of HIV/ AIDS has i mpact ed ever y r egi on
of t he wor l d.
IX
There is a need f or concern f or prot ect ion of human right s and basic f reedoms.
Eradicat ion of st igma and aversion t oward PLHAs is t he f oundat ion f or ef f ect ive
solut ions t o AIDS.
Access t o ARV dr ugs i s an i mpor t ant and f undament al pr i nci pl e.
Recogni ze t hat :
HIV/ AIDS i s bot h a cause and consequence of pover t y
Ther e i s unnecessar y spr ead of HIV and AIDS deat hs
Ever y sect or needs t o wor k t oget her i n an ef f ect i ve way
Ways must be f ound t o el i mi nat e pr obl ems and obst acl es i n t he body
of l aws, r egul at i ons, and measur es t hat bl ock access t o pr event i on,
t r eat ment , car e and suppor t
Convi nced t hat t he i mport ant el ement s of resol vi ng t he AIDS cri si s
consi st of :
Pol i cy i mpr ovement
St r ong l eader shi p
Bei ng st eadf ast i n t he commi t ment t o t he Decl ar at i on
Ful l par t i ci pat i on of al l sect or s
Adequat e r esour ces f or ef f ect i ve i mpl ement at i on
Reaf f i rm our commi t ment t o i mpl ement f ul l y t he Decl arat i on of
Commi t ment on HIV/ AIDS, ent i t l ed Gl obal Cri si s Gl obal Act i on .
Adopt ed by t he General Assembl y at i t s t went y-si xt h speci al sessi on,
i n 2001.
Thai l and has pr evi ousl y pr epar ed and submi t t ed t hr ee r epor t s on nat i onal
pr ogr ess as measur ed by t he UNGASS i ndi cat or s i n t he year s 2004, 2006, and
2008. Each t i me, t he obj ect i ve was not mer el y t o send t he r epor t t o
UNAIDS but t o use t he r epor t pr epar at i on pr ocess as a means t o st r engt hen
t he moni t or i ng and eval uat i on of t he Nat i onal AIDS Pr ogr am on a cont i nuous
basi s.
Pr epar at i on of t hi s pr ogr ess r epor t was accompl i shed by t he ef f or t s of t he
Wor ki ng Gr oup, compr i sed of r epr esent at i ves f r om t he gover nment , NGOs,
ci vi l soci et y, t echni cal exper t s and i nt er nat i onal or gani zat i ons who
col l abor at ed t oget her t o pr oduce a compr ehensi ve summar y of pr ogr ess. It
i s hoped t hat t hi s r epor t i ng pr ocess wi l l ser ve as one t ool t o advance t he
AIDS pr ogr am t o r each i t s t ar get s f or access t o pr event i on, car e and
t r eat ment , uni ver sal l y and equal l y, and i n accor dance wi t h t he NAP f or t he
pr event i on and cont r ol of AIDS f or t he per i od 2007- 2011.
1
1. Incl usi veness of t he St akehol ders i n t he Report Wri t i ng
Process
Pr epar at i on of t he Thai l and pr ogr ess r epor t f or 2010 accor di ng t o t he
UNGASS decl ar at i on on HIV/ AIDS was successf ul l y compl et ed onl y t hr ough
t he col l abor at i on of al l t he pr ogr am par t ner s f r om t he publ i c sect or , ci vi l
soci et y, t echni cal speci al i st s, and i nt er nat i onal or gani zat i ons. They wer e
i nvol ved i n ever y maj or st ep of t he r epor t wr i t i ng pr ocess begi nni ng f r om
t he f i r st par t i ci pat or y consul t at i ve meet i ng t o det er mi ne t he t i mel i ne,
assembl y of dat a f or t he i ndi cat or s, wr i t i ng t he r epor t , anal yzi ng pr obl ems
and l i mi t at i ons of t he i ndi cat or s i n t he 2008 pr ogr ess r epor t , and summar y
of l essons l ear ned and r ecommendat i ons t o be appl i ed t o i mpr ovi ng t he
r epor t pr epar at i on pr ocess f or 2010.
The cur r ent r epor t was engi neer ed by st af f of t he Nat i onal AIDS Pr ogr am
( NAP) wor ki ng gr oups i ncl udi ng t he Advi sor y, t he Execut i ve and Moni t or i ng
and Eval uat i on Wor ki ng Gr oups and sub- gr oups compr i si ng 16 t eams i n al l .
The composi t i on of t he wor ki ng gr oups i ncl uded r epr esent at i ves of t he
government , ci vi l soci et y, t echni cal speci al i st s and i nt er nat i onal or gani zat i ons.
The member s had t he t ask of assembl i ng t he r el evant dat a f or t he i ndi cat or s,
t abul at i on and anal yzi ng t he val ues and t r ends of t he i ndi cat or s, and
pr epar i ng r epor t s f or each i ndi cat or ar ea. The f i nal st ep of t he r epor t
pr epar at i on pr ocess was t he conveni ng of a semi nar t o sol i ci t a wi de r ange
of opi ni ons f r om var i ous sect or s and l evel s on t he out put of t he 16 wor ki ng
gr oups and sub- gr oups. These opi ni ons wer e f ed i nt o t he anal ysi s of t he
pr ogr ess, pr obl ems, obst acl es and i mpl ement at i on pl an of t he Nat i onal AIDS
Pl an t o meet t he t ar get s f or access t o equi t abl e pr event i on, car e and
t r eat ment , and t ar get s as speci f i ed i n t he nat i onal i nt egr at ed st r at egi c pl an
f or AIDS f or t he per i od of 2007- 2011. Next , t he Moni t or i ng and Eval uat i on
( M&E) wor ki ng gr oup i ncor por at ed t he r esul t s of t he semi nar i nt o r evi si ons
of t he dr af t pr ogr ess r epor t , and pr esent ed t hi s t o t he Nat i onal AIDS Pl an
Coor di nat i on, Pl anni ng, Budget ar y, and M&E Sub- commi t t ee f or
consi der at i on. Fi nal l y, t he r epor t was submi t t ed t o t he Nat i onal AIDS
Commi t t ee ( NAC) f or t hei r appr oval .
In assembl i ng t he dat a f or t hese i ndi cat or s t hi s was t he f i r st t i me t hat dat a
f r om t he pr ovi nci al l evel was used f or i ndi cat or s t hat st i l l have some
l i mi t at i ons, such as Indi cat or 11 concer ni ng t he i nt egr at i on of AIDS i n t he
I. St at us at a Gl ance
2
l i f e ski l l s school cur r i cul um, Indi cat or s 10 and 12 concer ni ng t he suppor t f or
school i ng and r el at ed assi st ance f or AIDS or phans and ot her af f ect ed
chi l dr en, and dat a on AIDS- r el at ed expendi t ur es i n t he f i el d f r om var i ous
sour ces, especi al l y t hose suppor t ed by t he l ocal admi ni st r at i ve or gani zat i ons
whi ch ar e not yet abl e t o numer i cal l y summar i ze t hi s expendi t ur e or t he
pr opor t i on of t he budget spent on AIDS. The dat a f r om t hi s r evi ew of t he
si t uat i on can be appl i ed t o t he basel i ne dat a set t o hel p f i l l gaps i n t he
por t i on of t he r epor t on nat i onal expendi t ur es on pr event i on and cont r ol of
AIDS t o achi eve a hi gher l evel of compl et eness.
2. St at us of t he AIDS Epi demi cs
Thai l and has set t he t ar get t o r educe t he number of new cases of HIV by at
l east hal f of t hose pr oj ect ed f or 2011 despi t e t he f act t hat t he
epi demi ol ogi cal and behavi or al sur vei l l ance over t he past 3 t o 4 year s
i ndi cat es t hat t he number of new HIV cases has not decl i ned i n al l gr oups,
especi al l y i n adol escent s, among whom t her e was an i ncr ease i n HIV and
sexual l y t r ansmi t t ed i nf ect i ons ( STIs) . In addi t i on, t he HIV sur vei l l ance dat a
show an i ncr ease i n t he l evel of i nf ect i on among pr egnant women and
mi l i t ar y r ecr ui t s aged 20 t o 24 year s. Thi s i ncr ease i s consi st ent wi t h r i sk
behavi or dat a i n yout h whi ch r epor t ed an i ncr ease i n sex- par t ner mi xi ng
wi t hout condom use, whi ch coul d be cont r i but i ng t o t he i ncr eased r i sk f or
STIs and unwant ed pr egnancy. Thi s can be seen f r om t he age di st r i but i on of
STI pat i ent s i n whi ch t he hi ghest number of cases was i n t he 15- 24 year age
gr oup, and f r om t he dat a t hat one i n f i ve women who del i ver ed a chi l d i n
2008 was under age 20 year s.
In t he gener al popul at i on t he nat i onal t r end i n pr eval ence of HIV i nf ect i on i s
one of cont i nuous decl i ne si nce 1996. At t he t i me of t hi s r epor t , t he
pr eval ence of HIV i n pr egnant women was under 1%, and under 0. 5 per cent
i n new mi l i t ar y r ecr ui t s. In any event , t he spr ead of HIV i n some pr ovi nces
of Thai l and i s st i l l sever e, especi al l y t hose whi ch r ecei ve a l ar ge number of
t our i st s, and pr ovi nces bor der i ng on t he east er n seaboar d and Gul f of
Thai l and. These pr ovi nces i ncl ude Phuket , Chol bur i , Tr ad, and Samut
Songkr am, and i n whi ch HIV among pr egnant women i s near l y 2%. The
Upper Nor t h r egi on of t he count r y, whi ch exper i enced t he hi ghest l evel s of
HIV pr eval ence i n t he ear l y par t of t he epi demi c st i l l r epor t hi gher
pr eval ence of HIV among pr egnant women ( i . e. , 3%i n Payao and Ut t ar adi t ) .
Among t he hi gher r i sk gr oups, when compar ed wi t h 2005, t he number of
new i nf ect i ons among i ndi r ect and st r eet sex wor ker s near l y doubl ed by
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2008. Appr oxi mat el y f i ve t i mes as many i ndi r ect and st r eet sex wor ker s
exper i enced new HIV and STI i nf ect i ons as br ot hel wor ker s. Thi s i s
especi al l y wor r i some si nce pr opor t i onal l y mor e of t he i ndi r ect sex wor ker s
ar e out si de of t he f or mal HIV pr event i on pr ogr am t han t he di r ect sex
wor ker s, and may not be r ecei vi ng t he same l evel of car e and i nf or mat i on
about pr event i on of HIV and STIs.
HIV i nf ect i on among men who have sex wi t h men ( MSM) r emai ns hi gher and
does not show any i ndi cat i on of decl i ni ng. HIV among MSM i s hi gher i n l ar ge
ur ban cent er s and i mpor t ant t our i st l ocat i ons. Never t hel ess, t he i nt ensi f i ed
pr event i on act i vi t i es among t hi s popul at i on over t he past t wo year s,
especi al l y i n Bangkok, ar e st ar t i ng t o show r esul t s i n t er ms of r educed HIV
pr eval ence, f r om 30. 7%i n 2007 t o 24. 7%i n 2009.
Pr eval ence of HIV among i nt r avenous dr ug user s ( IDU) at t endi ng
det oxi f i cat i on cent er s i s st i l l hi gh, at l evel s of 30% t o 40%. Never t hel ess,
r esul t s f r om t he l at est ( 2009) sur vey r ound usi ng t he r espondent dr i ven
sampl i ng ( RDS) met hod f ound t hat t he pr eval ence of HIV i n Bangkok and
Chi ang Mai was l ower t han t he nat i onal pr eval ence f or t hi s gr oup ( i . e. , 24%
and 11%r espect i vel y) .
In gener al , HIV i nf ect i on among t he popul at i on of i nt er nat i onal l abor
mi gr ant s i s hi gher f or t hose wor ki ng i n t he f i sher i es i ndust r y t han ot her
occupat i ons. Thi s di f f er ent i al i s possi bl y because of t he nat ur e of t he wor k
and hi gher sex r i sk behavi or of f i shi ng boat cr ew. Sex wor ker s i n Thai l and
who ar e f or ei gn mi gr ant s have hi gher l evel s of HIV t han t hei r Thai
count er par t s. Li mi t at i ons of educat i on and Thai i l l i t er acy ar e bar r i er s t o
accessi ng i nf or mat i on and ser vi ces f or pr event i on of HIV and STIs.
In sum, t he epi demi ol ogi cal and behavi or al dat a i ndi cat e t hat t he number of
new HIV i nf ect i ons i n Thai l and has not decr eased. A t r end of i ncr easi ng
spr ead of HIV i s not ed i n t he popul at i on of adol escent s, and HIV pr eval ence
r emai ns hi gh i n t he t r adi t i onal l y hi gher - r i sk popul at i ons and shows no
i ndi cat i ons of decl i ni ng any t i me soon. These pat t er ns of spr ead of HIV
pr esent a chal l enge f or r educi ng t he i nci dence of HIV by hal f i n 2010 as
t ar get ed i n t he mul t i - nat i onal agr eement on Uni ver sal Access, and accor di ng
t o t he t ar get s speci f i ed i n t he NAP pl an f or 2007- 2011.
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3. Pol i cy and Pr ogr am Response
Thai l and has exper i enced t hr ee decades of t he HIV/ AIDS epi demi c. To t hi s
day, AIDS i s st i l l havi ng an adver se ef f ect on Thai dai l y l i f e, t he heal t h
syst em, and soci o- economi c wel l - bei ng of t he count r y. The count r y has
l ear ned how mul t i sect or al col l abor at i on woul d enhance t he f i ght agai nst
HIV/ AIDS. Even t hough t he pol i t i cal si t uat i on has not been f avor abl e dur i ng
l ast 3- 4 year s, t he st r engt h of t he par t ner shi ps among sect or s st i l l keeps
par t ner s movi ng t he AIDS r esponses i n t he count r y.
However , at t he NAPAC meet i ng on 24 Jul y 2009, t he pr i me mi ni st er
expr essed hi s vi ews i n commi t t i ng t o t he count r y r esponse t o HIV/ AIDS and
showed st r ong l eader shi p by ser vi ng as t he NAPC chai r and has t he pol i cy of
accel er at i ng t he r educt i on of new i nf ect i ons by hal f by 2011 as st at ed i n t he
cur r ent Nat i onal AIDS Pl an whi ch cover t he year 2007- 2011.
The measur es t o achi eve t hi s consi st of publ i c medi a campai gns, condom
pr omot i on, pr event i on i n yout h and most - at - r i sk popul at i on gr oups,
i ncl udi ng use of j oi nt KPI i ndi cat or s t o pr omot e par t i ci pat i on of al l sect or s,
st r engt hen net wor ks, and gal vani ze t he l ocal admi ni st r at i ve or gani zat i ons,
and t he pr ovi nce t o t ake owner shi p and l eader shi p i n advanci ng t he AIDS
pr ogr am goal s i n t he mont hs and year s ahead.
Dur i ng 2008- 2009, t he subcommi t t ee f or advanci ng t he pr event i on pr ogr am
ef f or t , managed by t he Coor di nat i on Cent er f or Devel opment of HIV
Pr event i on Appr oach and Mechani sm; has suppor t ed var i ous agenci es,
gover nment and ci vi l soci et y or gani zat i ons t o i mpl ement HIV pr event i on
t hr ough 3 st r at egi es i ncl udi ng ( 1) publ i c i nf or mat i on campai gns; ( 2)
st r engt heni ng t he HIV pr event i on net wor ks; and ( 3) f i ndi ng ways t o ensur e
sust ai nabi l i t y at t he pr ovi nci al and l ocal admi ni st r at i ve or gani zat i on l evel s
t o accel er at e and t ake owner shi p of t he HIV/ AIDS pr event i on agenda.
The Di r ect or Gener al ( DG) of t he DDC, as t he secr et ar y of t he NAPAC has
r est r uct ur ed and equi pped t he Nat i onal AIDS Management Cent er ( NAMc)
wi t h mor e peopl e and r esour ces t o be mor e capabl e f or coor di nat i on t he
pl anni ng and i mpl ement at i on as wel l as moni t or i ng and eval uat i on and
pr opose t he needed pol i cy. Dur i ng t he 4
t h
quar t er of t he year 2009, t he
NAMc has coor di nat ed wi t h t he Cent er f or Devel opment of HIV Pr event i on
Appr oach and Mechani sm or gani zi ng mul t i st ake hol der wor kshops t o
devel op accel er at ed HIV pr event i on pl an t o hal ve t he i nci dence of HIV by
2011, as assi gned by t he deci si on of t he NAPAC i n t he meet i ng on 24 Jul y
2009.
Prevent i on
As t ar get popul at i ons ar e i dent i f i ed i n t he Nat i onal AIDS Pl an, t he HIV
pr event i on pr ogr ams i n Thai l and ar e most l y t ar get i ng speci f i c popul at i on
gr oups.
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Most - at - r i sk popul at i on gr oups ar e ver y i mpor t ant and have r ecei ved gr eat er
at t ent i on. Thi s can be seen f r om pol i cy and pl an t o r educe new i nf ect i ons
by hal f by 2011 i n IDU, MSM, f emal e sex wor ker s, pr i soner s and mi gr ant s i n
Thai l and. The nat i onal pr ogr am i s wor ki ng i nt ensi vel y wi t h al l t hese gr oups
usi ng bot h domest i c and i nt er nat i onal f undi ng ( GFATM) . It i s wel l r ecogni zed
t hat t o i ncr ease access t o HIV pr event i on among t hese popul at i on gr oups
needs out r each ser vi ces by ci vi l soci et y or gani zat i ons and l i nkage wi t h
ser vi ces of hospi t al , of whi ch heal t h ser vi ce pr ovi der s have t o under st and
sex/ gender / sexual i t y i ssue i n or der t o make t hei r ser vi ces f r i endl y t o t he
t ar get popul at i ons.
PMTCT i s bei ng i mpl ement ed ef f i ci ent l y i n Thai l and. Tr i pl e t her apy i s now
bei ng used. Ther apy i s t ai l or ed t o t he cl i ent s CD4 cel l count , and Thai l and
has l aunched t he st ayi ng negat i ve st r at egy i n ANC cl i ni cs t hr ough
pr omot i on of coupl e ANC at t endance. Thus, i t can be seen t hat t he pr ogr am
i s gi vi ng i ncr eased i mpor t ance t o t he heal t h of t he mot her . In any case,
i mpl ement at i on of PMTCT i s st i l l seen as over l y f ocused on t he i nf ant at t he
expense of t he i nf ect ed mot her . Thi s i s par t i cul ar l y sensi t i ve i n t he ar ea of
pl anni ng a pr egnancy, car r yi ng a pr egnancy t o t er m, or havi ng an abor t i on
based on f ul l y i nf or med consent and sel f - det er mi nat i on. In addi t i on, HIV
t est i ng at t he ANC cl i ni c i s not whol l y vol unt ar y but i s mor e l i ke pr ovi der -
i ni t i at ed counsel i ng and t est i ng, whi ch i s mor e f ocused on case f i ndi ng. Thi s
r esul t s i n l ess at t ent i on t o vol unt ar y deci si on maki ng and r espect f or t he
pr ef er ence of t he woman. Thus, t her e shoul d be suppor t f or r i ght s
pr ot ect i on i n r epr oduct i ve heal t h car e set t i ngs t oget her wi t h devel opment
of heal t h ser vi ces t hat ar e mor e user - f r i endl y, and pr omot i on of coupl e ANC
t o hel p t he woman communi cat e her pr event i on pr i or i t i es wi t h her par t ner .
Yout h i s an i mpor t ant t ar get gr oup under t he Nat i onal AIDS Pl an f or 2007-
2011, i ncl udi ng t he t ar get of r educi ng new i nf ect i ons by hal f by 2011. Most
of t hi s por t i on of t he nat i onal pr ogr am i s suppor t ed by t he GFATM.
Never t hel ess, t he st r at egy f or yout h behavi or change has not had opt i mal
ef f ect si nce Thai yout h ar e i ncr easi ngl y di ver se i n t er ms of at t i t udes, bel i ef s,
and l i f est yl es. It i s st i l l an i mpor t ant chal l enge f or t he pr ogr am t o t ai l or
st r at egi es f or yout h t o t he var i ous di f f er ent l i f est yl es t hat ar e cur r ent l y i n
f ashi on.
Pr omot i on of compr ehensi ve sexual i t y educat i on i s st i l l a weak poi nt of t he
pr ogr am. The chal l enge her e i s t o f i nd a way t o i nst i t ut i onal i ze
compr ehensi ve sexual i t y educat i on i n t he school syst em t hr ough pol i cy
i mpr ovement s at t he nat i onal and mi ni st er i al l evel . Ther e i s no cor e
cur r i cul um at t he nat i onal l evel t hat i s accept abl e t o t he MoE. The at t i t ude
of t he MoE admi ni st r at or s and t eacher s st i l l i s not accept i ng of t he need f or
compr ehensi ve sexual i t y educat i on. In any case, compr ehensi ve sexual i t y
educat i on al one pr obabl y i s i nsuf f i ci ent t o change at t i t udes and behavi or s
over t he l ong- t er m si nce yout h have di f f er ent ways of l ear ni ng as t hey
mat ur e i nt o adol escence and adul t hood. In addi t i on, t her e ar e many
var i abl es t o consi der such as i ncr eased ease of access t o si nf ul ( r i sky)
t empt at i ons and peer pr essur e.
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Care, support and t reat ment
Thai l and has t he pol i cy t o pr ovi de f ul l cover age of car e and t r eat ment f or
PLHA t hr oughout t he count r y as par t of t he Uni ver sal Cover age. The goal i s
f or ever y Thai t o have heal t h i nsur ance under one syst em or anot her t o
expand cover age of ART. In any event , by vi ewi ng AIDS as j ust anot her
chr oni c condi t i on t hat r equi r es l i f e- l ong t r eat ment coul d l ead t o t he new
chal l enge of pr event i ng HIV among t he i ncr eased number of PLHA who
sur vi ve f or decades because of ART.
Pr egnancy among PLHA i s one ar ea i n whi ch PLHA ar e conf r ont i ng compet i ng
pr event i on pr i or i t i es as, i n one st udy, 60%of i nf ect ed pr egnant women knew
of t hei r ser o st at us bef or e becomi ng pr egnant .
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Thus, t her e i s t he need f or
counsel i ng of al l PLHA f r om t he heal t h pr ovi der and peer PLHA, and gr oup
act i vi t i es t o hel p t he PLHA under st and and make an i nf or med deci si on f or
saf e sex and pr act i ce cont r acept i on t hat i s appr opr i at e. Thi s wi l l l ead t o a
mor e sat i sf act or y physi cal , psycho- emot i onal and soci al l i f e of t he PLHA.
Anot her chal l enge i s t he f act t hat new cl i ent s f or ART ar e di agnosed when
t hei r i mmune syst em i s al r eady qui t e damaged ( CD4 count s ar e under 100) .
Ther e i s a need t o devel op and pr omot e out r each counsel i ng ser vi ces f or t he
gener al popul at i on t hr ough mass medi a campai gns t o r ai se concer n about
HIV pr event i on, pr event i on of r i sk, and t he benef i t of knowi ng one s
ser ost at us. The 5-year pl an t o devel op syst em and i mpr ove qual i t y of
counsel i ng ser vi ces ar e bei ng devel oped by mul t i st akehol der s and expect ed
t o get f undi ng f r om t he NHSO.

It i s r ecogni zed t hat suppor t f or t he pr omot i on of qual i t y of l i f e of PLHA i n
t he communi t y shoul d be i ncr eased by st r engt heni ng t he r ol e of t he
compr ehensi ve cont i nuum of car e, r at her t han j ust conduct i ng gr oup
act i vi t i es and home vi si t s. Thi s woul d i ncl ude devel opi ng model s of
gui del i nes f or col l abor at i ve act i on at t he communi t y l evel by each sect or t o
bui l d t he qual i t y of l i f e of t he PLHA i n t he communi t y. Par al l el wi t h t hi s i s
t he need t o pr omot e communi t y at t i t udes t hat ar e f avor abl e and i ncl usi ve
of t he PLHA. Thi s wi l l hel p r educe t he st i gma and pr ej udi ce suf f er ed by t he
PLHA, and i mpr oves t hei r qual i t y of l i f e as a r esul t .
AIDS and human ri ght s
A pr ovi si on of t he Thai Const i t ut i on ( 2007) pr ovi des f or t he pr ot ect i on of
r i ght s and f r eedoms of t he popul at i on br oadl y, i ncl udi ng t he pr ohi bi t i on of
di scr i mi nat i on or unf ai r t r eat ment of i ndi vi dual s. In addi t i on, t her e ar e
l aws about heal t h secur i t y, nat i onal heal t h l aws, l aws f or l abor pr ot ect i on,
and chi l d r i ght s pr ot ect i on. Ther e ar e gui del i nes f or HIV/ AIDS pr event i on i n
t he wor kpl ace whi ch wer e f or mal i zed on August 21, 2009. The pl an f or
human r i ght s, V. 2 f or 2009- 2013 r ecei ved Cabi net appr oval on Oct ober 20,
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Repor t of t he commi t t ee t o moni t or pol i cy and i mpl ement at i on of PMTCT by ci vi l soci et y
i n 2009. The f ul l r epor t i s par t of t he compar at i ve st udy of pol i cy and i mpl ement at i on of
r epr oduct i ve heal t h i n 9 count r i es Ar gent i na, Bel i ze, Br azi l , Indonesi a, Kenya, Per u, Sout h
Af r i ca, Thai l and, Uganda i mpl ement ed by GESTOS, Br azi l suppor t ed by t he For d Foundat i on.

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2009. In addi t i on, t he Nat i onal AIDS Pl an f or 2007- 11 speci f i ed t he
pr ot ect i on of AIDS r i ght s i n st r at egy 3, and i s suppor t ed i n var i ous measur es
i ncl udi ng di ssemi nat i on of i nf or mat i on on human r i ght s. Al l of t hi s r ef l ect s
Thai l and s l egal and pol i cy st r at egy t o cr eat e an envi r onment t hat r espect s
r i ght s, especi al l y t hose of PLHA.
PLHA r i ght s pr ot ect i on i s i mpl ement ed by t he gover nment and ci vi l soci et y.
The gover nment st r at egy i s i mpl ement ed t hr ough t he Depar t ment f or t he
Pr ot ect i on of Ri ght s and Li ber t i es of t he Mi ni st r y of Just i ce and who
par t i ci pat e as par t of t he r i ght s pr ot ect i on net wor k, and consi der
compl ai nt s of r i ght s vi ol at i ons i n col l abor at i on wi t h PLHA r epr esent at i ves.
Ci vi l soci et y emphasi zes t hei r r ol e i n campai gni ng and pr omot i ng
under st andi ng of r i ght s, and r ecommendi ng pol i cy act i on t o i mpr ove
pr ot ect i ons such as t he Foundat i on f or AIDS Ri ght s whi ch pr oduced a r epor t
of a st udy r evi ewi ng l aws and pol i ci es on human r i ght s and AIDS r i ght s, and
t he r epor t of t he si t uat i on of human r i ght s r el at ed t o HIV/ AIDS i n Thai l and
( 2007 and 2008) . The Thai Net wor k of PLHA ( TNP+) conduct ed a st udy of
st i gma and di scr i mi nat i on t owar d PLHA i n 2009, whi l e t he Thai NGO
Coal i t i on on AIDS ( TNCA) wi t h coor di nat i on by Raks Thai Foundat i on
pr oduced a r epor t anal yzi ng pol i cy as a r esponse t o AIDS seen t hr ough t he
l ens of sexual and r epr oduct i ve heal t h r i ght s.
Even t hough Thai l and has r at her good pol i ci es i n pl ace, t hese ar e not al ways
i mpl ement ed i n pr act i ce. Human r i ght s r el at ed t o AIDS st i l l don t r ecei ve
opt i mal pr i or i t y, and i mpl ement at i on at t he per i pher al l evel i s of t en not
consi st ent wi t h nat i onal pol i cy. Ther e i s st i l l i gnor ance about t he r i ght s
pol i ci es and t hei r r el at i onshi p t o AIDS.

Orphans and chi l dren af f ect ed by AIDS
Pol i cy and measur es t o hel p or phans and chi l dr en af f ect ed by AIDS ar e st i l l
not as cl ear as t hey coul d be. Thi s i s because of a l ack of st r at egi c
i nf or mat i on t o under st and t he f ul l si t uat i on and pr obl ems of or phans and
chi l dr en af f ect ed by AIDS. Most of t he assi st ance i s st i l l i n t he f or m of
r ehabi l i t at i on such as heal t h car e and ARV t r eat ment f or chi l dr en i nf ect ed
by t hei r mot her s. But t hi s i s onl y f or t hose chi l dr en and f ami l i es t hat ar e
open about t hei r ser ost at us. Soci al and psycho- emot i onal suppor t i s st i l l not
adequat e, and i s most l y conduct ed by NGOs. Some pr oj ect s ar e good-
pr act i ce model s and can be expanded, such as t he ECAT pr oj ect and t he Ar t
Ther apy Pr oj ect .
Al t hough t he Mi ni st r y of Soci al Devel opment and Secur i t y has t he pol i cy t o
encour age t he f ami l y and communi t y t o suppor t chi l dr en af f ect ed by HIV,
t he or phanages ar e st i l l needed f or some chi l dr en. It i s al so r ecogni zed t he
needs t o st andar di ze t he qual i t y of bot h publ i c and pr i vat e or phanages.
The cases of HIV+ chi l dr en who ar e becomi ng adol escent s ar e anot her
chal l enge t hat needs sol ut i ons. Thi s i s because some PLHA ar e encount er i ng
di f f i cul t y i n adj ust i ng t o t he changes of adol escence and l eadi ng a qual i t y
l i f e. Ther e ar e i ssues r el at ed t o ART compl i ance and i ssues of sex behavi or ,
si nce soci et y may f eel t hat PLHA ar e spr eader s of di sease and t her ef or e
shoul d not have sexual r el at i onshi ps or be l i mi t ed t o PLHA par t ner s. Ther e
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needs t o be gr eat er suppor t f or communi t i es t o l ook af t er or phans and ot her
chi l dr en af f ect ed by AIDS, and r educed communi t y st i gma, and a gr eat er
ar r ay of yout h- f r i endl y ser vi ces.
Resources
A st r engt h of t he Thai pr ogr am i n i t s AIDS pr event i on and cont r ol pr ogr am i s
t hat most of t he budget ( 80 t o 90%) i s domest i c. Thi s r ef l ect s t he
i mpor t ance t hat Thai l and gi ves t o AIDS, and i t s abi l i t y t o be sel f - r el i ant . At
t he same t i me, a weakness i s t hat t he al l ocat i on of r esour ces i s not al ways
bal anced because so much has t o go f or t r eat ment ( 69- 76%) . By cont r ast ,
t he budget f or pr event i on was onl y 14% of t he t ot al i n 2009, and most was
f r om ext er nal sour ces. About one- t hi r d was f or behavi or change whi l e 3%
was f or condoms.
Dependence on ext er nal sour ces of budget i s a concer n of ci vi l soci et y whi ch
sees t hat t her e i s t oo much dependence on t he GFATM sour ce. Ther e i s a
need t o begi n t o expl or e al t er nat i ves f or a post - GFATM pr ogr am so t hat
l ocal i t i es can gener at e t hei r own sour ces of suppor t t o cont i nue essent i al
AIDS pr ogr am act i vi t i es. It can al so be seen t hat t her e shoul d be some
consi der at i on of i ncr easi ng t he pr opor t i on of r esour ces f or pr event i on, si nce
pr event i on of a si ngl e new i nf ect i on conf er s t r emendous f ut ur e savi ngs i n
t he cost of t r eat ment and car e.

9
4. UNGASS Indi cat or Dat a i n an Overvi ew Tabl e
Resul t s
Core i ndi cat ors
2004 2006 2008 2010
Remarks
NATIONAL COMMITMENT AND ACTION
1. Domest ic and int ernat ional
AI DS spending by cat egories
and financing sources
6,728
million
Baht
(2007)
7,208
million
Baht
(2009)
Compile secondary
dat a on act ual
expendit ur e on
HI V/ AI DS f r om
f inancing agent s.
I n case of non
available dat a, t he
imput at ion based
on PQ approaches
(P refers t o
price/ unit cost , Q
refers t o services
rendered)
NATIONAL PROGRAMS
3. Percent age of donat ed blood
unit s screened for HI V in a
qualit y assured manner
99.9
(2003)
100.0
(2005)
99.79
(2007)
100.0
(2009)
Dat a from Nat ional
Blood Cent er and
Regional Blood
Cent ers of Thai Red
Cross Societ y
including 371 blood
banks of 942
government and
privat e hospit als
Donat ed blood was
100% screened
4. Percent age of adult s and
children wit h advanced HI V
infect ion receiving
ant iret roviral t herapy
41.0
(2006)
52.9
(2007)
77.76
Adult
75.43
Pediat ric
85.46
(2009)
67.14
Adult
66.49
Pediat ric
86.06
(2008)
According t o t he
nat ional prot ocol, ART
will be provided t o
eit her sympt omat ic or
asympt omat ic PLHA
wit h CD4 lower t han
200 cell/ cu. mm. Thus,
denominat or also
included asympt omat ic
PLHA wit h CD4 lower
t han 200 cell/ cu.mm.
Denominat ors Adult : -
using Asian Epidemic
Model and Pediat ric:
using spect rum
5. Percent age of HI V-posit ive
pregnant women who
received ant iret roviral t o
reduce t he risk of mot her-
t o-child t ransmission
89.77
(2005)
95.90
(2007)
90.10
(2006)
94.71
(2009)
93.31
(2008)
10
Resul t s
Core i ndi cat ors
2004 2006 2008 2010
Remarks
6. Percent age of est imat ed
HI V-posit ive incident TB
cases t hat received
t reat ment for TB and HI V
32.60
(2007)
25.82
(2009)
x Numerat or: TB
pat ient s wit h HI V
posit ive from
Tuberculosis Pat ient s
Regist er
x Denominat or: t he
est imat ed number
HI V/ TB pat ient s in
Thailand which was
calculat ed by using
WHO est imat es on TB
incidence
(142/ 100000)
x HI V infect ion rat e in
TB pat ient (17%),
yielding t o t he
est imat ed number of
16, 077 new TB/ HI V
pat ient s in 2009.
x Tot al populat ion in
2009 was 66.598
million
7. Percent age of women and
men aged 15-49 who
received an HI V t est in t he
last 12 mont hs and who
know t heir result s
19.12
(2006)
19.12
(2006)
Dat a from t he
Nat ional Sexual
Behavior Survey of
Thailand 2006.
Sample are
male/ female aged 18-
49
8. Percent age of most -at -risk
populat ions t hat have
received an HI V t est in t he
last 12 mont hs and who
know t heir result s
FSW
52.60
MSM
34.9
I DU
NA
(2007)
SW
35.81
FSW
36.03
MSW
35.20
MSM
21.33
(2007)
I DU
59.7
(2008)
BSS among FSW
using venue based
sampling in 8
provinces
I BBS for MSW, MSM
conduct ed in 3
provinces (Bangkok,
Chiangmai and
Phuket )
I BBS among I DU
using RDS in
Bangkok, 2008
(present ed in t his
t able). But dat a in
Chiang Mai was
18.2%.
9. Percent age of most -at -risk
populat ions reached wit h
HI V prevent ion programs.
NA x Dat a is not available.
x Thailand will applied
st andard definit ion for
measuring prevent ion
coverage in I BBS
2010.
11
Resul t s
Core i ndi cat ors
2004 2006 2008 2010
Remarks
10. Percent age of orphaned and
vulnerable children aged 0
17 whose households
received free basic ext ernal
support in caring for t he
child
Not
Applicable
Not
applicable
HI V Prevalence
among pregnant
women in Thailand
less t han 5% (0.72%
in 2008 and 0.74%
in 2009). Thailand
does not require
report ing t his
indicat or.
Mult iple I ndicat ors
Clust er survey (MI CS)
conduct ed in 2006
revealed 21.4% of all
orphaned and
vulnerable children
aged 0-17 receiving
at least one t ype of
basic ext ernal
support .
11. Percent age of schools t hat
provided life skills-based HI V
educat ion in t he last
academic year
NA
(2007)
0
(2009)
x Life skill-based HI V
educat ion in schools
in Thailand has been
implement ed by 3
approaches under
t he Minist ry of
Educat ion:
1. I nt egrat ed int o
t echnical subj ect s at
least 5 hours /
academic year in
primary schools
2. Life skills and sexual
educat ion at least 10-
16 hours/ academic
year in secondary and
vocat ional schools
3. I nt ensive sexual
educat ion at least 16
hours/ academic year
mainly in vocat ional
schools wit h 68%
coverage for only
vocat ional schools
x AI DS and sex -relat ed
campaigns/ act ivit ies
are conduct ed
biannually.
KNOWLEDGE AND BEHAVIOUR
12. Current school at t endance
among orphans and among
non-orphans aged 1014
95.50
OVC
96.4
Non-OVC
(2006)
95.50
OVC
96.4
Non-OVC
(2006)
MI CS collect ed
bet ween December
2005 February 2006
12
Resul t s
Core i ndi cat ors
2004 2006 2008 2010
Remarks
13. Percent age of young women
and men aged 1524 who
bot h correct ly ident ify ways
of prevent ing t he sexual
t ransmission of HI V and who
rej ect maj or misconcept ions
about HI V t ransmission
18.67
(2003)
31.15
(2005)
37.42
(2006)
37.42
(2006)
2008, 2010 UNGASS
report used dat a from
t he Nat ional Sexual
Behavior Survey of
Thailand 2006.
Sample group:
male/ female, aged
18-24
2004, 2006 UNGASS
report used dat a from
t he survey on
vocat ional st udent s
14. Percent age of most -at -risk
populat ions who bot h
correct ly ident ify ways of
prevent ing t he sexual
t ransmission of HI V and who
rej ect maj or misconcept ions
about HI V t ransmission
FSW
28.4
MSM
25.3
I DU
49.10
(2007)
SW
38.26
FSW
41.33
MSW
29.33
MSM
25.53
I DU
NA
(2009)
BSS among FSW
using venue based
sampling in 8
provinces
I BBS for MSW, MSM
in 3 provinces
(Bangkok, Chiangmai
and Phuket )
BSS among I DU
conduct ed in 2007 in
3 provinces.
15. Percent age of young women
and men aged 1524 who
have had sexual int ercourse
effort t he age of 15
6.39
(2003)
12.10
(2005)
4.82
(2006)
4.82
(2006)
2008, 2010 UNGASS
report used dat a from
t he Nat ional Sexual
Behavior Survey of
Thailand 2006.
Sample group:
male/ female, aged
18-24
2004, 2006 UNGASS
report used dat a from
t he survey on
vocat ional st udent s.
16. Percent age of women and
men aged 1549 who have
had sexual int ercourse wit h
more t han one part ner in
t he last 12 mont hs
9.39
(2006)
9.39
(2006)
Dat a from t he
Nat ional Sexual
Behavior Survey of
Thailand 2006.
Sample group is male
and female yout hs,
aged 18-49
17. Percent age of women and
men aged 1549 who had
more t han one sexual
part ner in t he past 12
mont hs report ing t he use of
a condom during t heir last
sexual int ercourse
50.88
(2006)
50.88
(2006)
Dat a from t he
Nat ional Sexual
Behavior Survey of
Thailand 2006.
Sample group is male
and female yout hs,
aged 18-49
13
Resul t s
Core i ndi cat ors
2004 2006 2008 2010
Remarks
18. Percent age of female and
male sex workers report ing
t he use of a condom wit h
t heir most recent client
FSW
96.2
(2007)
FSW
92.2
(2009)
MSW
NA
BSS among FSW used
dat a from 54
provinces
Dat a among MSW is
not report ed since
quest ions used t o
const ruct t his
indicat or are
difference from
st andard definit ion
suggest ed in t he
UNGASS guide. But
t his indicat or will be
available st art ing
from 2010 onward.
19. Percent age of men report ing
t he use of a condom t he last
t ime t hey had anal sex wit h
a male part ner
NA NA Dat a in 2007, 2009
I BBS among MSM is
not report ed since
quest ions used t o
const ruct t his
indicat or are
difference from
st andard definit ion
suggest ed in t he
UNGASS guide. But
t his indicat or will be
available st art ing
from 2010 onward.
20. Percent age of inj ect ing drug
users report ing t he use of a
condom t he last t ime t hey
had sexual int ercourse
35.00
(2007)
41.98
(2008)
2007 dat a from
program monit oring
from Bangkok
I BBS using RDS
conduct ed in Bangkok
in 2008
21. Percent age of inj ect ing drug
users report ing t he use of
st erile inj ect ing equipment
t he last t ime t hey inj ect ed
NA 63.16
(2008)
I BBS using RDS conduct ed
in Bangkok in 2008
IMPACT
22. Percent age of young women
and men aged 1524 who
are HI V infect ed
0.95
(2003)
0.45
(2005)
0.64
(2007)
0.58
(2009)
2003-2009 dat a used
HI V Prevalence
among ANC client s
aged 15-24 from
sent inel sero
surveillance
I n 2009, HI V
prevalence among
milit ary conscript s
was 0.50
14
Resul t s
Core i ndi cat ors
2004 2006 2008 2010
Remarks
23. Percent age of most -at -risk
populat ions who are HI V
infect ed
FSW
6.70
MSM
NA
I DU
46.8
(2003)
FSW
5.15
MSM
N/ A
I DU
37.64
(2005)
FSW
5.00
MSM
24.6
I DU
28.78
(2007)
SW
3.17
FSW
2.79
MSW
14.17
MSM
13.53
I DU
38.67
(2009)
Dat a on FSW used
HSS conduct ed in
venues based sent inel
sit es. However I BBS
in Bangkok revealed
19% and 10% Chiang
Rai using RDS.
MSW and MSM (MSM
and TG) used I BBS,
dat a from 3 t ourist
provinces; Bangkok,
Chiang Mai and
Phuket
I DU used HSS
conduct ed in
met hadone clinics.
However Thailand has
I BBS using RDS t hat
showed HI V
prevalence among
I DU as follow; Tot al
23.3% in Bangkok
and 10% Chiang Mai
24. Percent age of adult s and
children wit h HI V known t o
be on t reat ment 12 mont hs
aft er init iat ion of
ant iret roviral t herapy

84.9
(2007)
85.14
Adult
84.89
Pediat ric
90.02
(2008)
25. Percent age of infant s born
t o HI V-infect ed mot hers who
are infect ion

NA x Dat a from spect rum
is not available
x Evaluat ion conduct ed
by MOPH in 2007
found level of
t ransmission of HI V
from mot her t o infant
was 2.9% based on
laborat ory diagnost ic.
I f dead infant s are
included in t he
analysis t ransmission
rat e was 5.6%.

15
II. Overvi ew of t he AIDS Epi demi c i n Thai l and
Int roduct i on
The spr ead of HIV i n Thai l and cont i nues af t er t he f i r st out br eak mor e t han
20 year s ago. Fr om t he f i r st AIDS case r epor t i n 1984, t he mai n dr i vi ng f or ce
of t he epi demi c has been unsaf e sex, and t hi s has di spr opor t i onat el y
af f ect ed women and men of r epr oduct i ve age. Even t hough Thai l and has
had a nat i onal AIDS pr ogr am ( NAP) si nce 1997 whi ch hel ped t he count r y
succeed i n r api dl y sl owi ng t he spr ead of t he vi r us dur i ng t he decade t hat
f ol l owed, HIV cont i nued t o spr ead dur i ng t he f i r st decade of t he new
mi l l enni um among t he gener al popul at i on, wi t h t r oubl i ng t r ends i n t he
hi ghest r i sk and/ or har d- t o- r each gr oups.
Changes i n Thai soci et y i n t he mi dst of soci o- economi c chal l enges combi ned
wi t h advances i n communi cat i ons t echnol ogy i n accor dance wi t h t he t r ends
of gl obal i zat i on means t hat t he t r adi t i onal met hods of behavi or change
communi cat i on and HIV cont r ol mi ght not wor k as ef f ect i vel y as i n t he past .
Indeed, some of t hese moder ni zi ng t r ends may act ual l y i ncr ease HIV r i sk f or
some of t he yout h and adol escent s popul at i ons. Dat a on t he cur r ent st at us
of t he epi demi c i s gi vi ng a war ni ng si gnal t hat t he HIV f i r e coul d r e- i gni t e
i n Thai l and unl ess pr event i on act i vi t i es ar e i nt ensi f i ed and aggr essi vel y
r ol l ed- out t o achi eve sust ai nabl e cover age.
In br i ef , t he f ol l owi ng have gi ven r i se t o t he concer n r egar di ng t he cur r ent
st at us of HIV/ AIDS:
1. Dat a f r om t he HIV sur vei l l ance syst em show t hat HIV i s not decl i ni ng
i n some sent i nel popul at i ons.
2. The emer gence of f act or s whi ch i ncr ease vul ner abi l i t y of yout h due
t o r api d soci o- cul t ur al change and changi ng l i f est yl es.
3. Tr ends f r om t he anal ysi s of t he si t uat i on of t he epi demi c f or t he
pur pose of pr i or i t i zi ng l ocat i ons and popul at i ons f or i nt ensi f i ed
pr event i on.
1. Absence of a sust ai ned decl i ne i n HIV and warni ng si gns t hat an
i ncreasi ng t rend may ret urn
The epi demi ol ogi cal dat a combi ned wi t h dat a f r om ad hoc ser osur veys
i ndi cat e a t r end t owar d sust ai ned spr ead of HIV wi t h t he possi bi l i t y of a
r ever se t o an i ncr easi ng t r end i n some most - at - r i sk gr oups such as sex
wor ker s, MSM, and IDU. These devel opment s pose a t hr eat t o Thai l and s
abi l i t y t o achi eve i t s t ar get s f or r educt i on of new i nf ect i ons as speci f i ed i n
t he NAP f or 2007- 2011. The NAPAC had set a t ar get of hal vi ng t he number
of new HIV i nf ect i ons f r om t he pr oj ect ed t ot al ; r educe t he pr eval ence of
HIV among pr egnant women and Thai mi l i t ar y r ecr ui t s by at l east 0. 05
per cent age poi nt s per year .
16
1. 1 HIV t rends i n t he general popul at i on
HIV pr eval ence has decl i ned i n t he gener al popul at i on as i ndi cat ed by HIV
sur vei l l ance among mi l i t ar y r ecr ui t s and pr egnant women appear i ng f or ANC.
The combi ned ef f or t s of al l sect or s under t he NAP have r esul t ed i n t hese
successf ul decl i nes. However , t he decl i ne of HIV has r eached a pl at eau i n
t he past 4 t o 6 year s.
Among mi l i t ar y r ecr ui t s, who can be consi der ed t o be appr oxi mat el y
r epr esent at i ve of Thai mal e yout h age 18- 24 ( aver age age of 21 year s) , HIV
pr eval ence i ni t i al l y i ncr eased r api dl y f r om 0. 5%i n 1989 t o 4. 0%i n 1993, and
t hen decl i ned unt i l i t r eached a pl at eau. Dur i ng t he per i od f r om 2005 t o
2009, t he HIV pr eval ence among t hi s popul at i on had r emai ned const ant at
0. 5%, and i s not decl i ni ng i n accor dance wi t h t he t ar get s speci f i ed i n t he
NAP ( Fi gur e 1) . In addi t i on, HIV i nci dence dur i ng t he same per i od showed a
sl i ght i ncr easi ng t r end, f r om 1. 4 per 1, 000 per year i n 2005 t o 2. 5 per 1, 000
per year i n 2009 ( Fi gur e 2) . These t r ends ar e consi st ent acr oss r egi ons.
0
0. 5
1
1. 5
2
2. 5
3
3. 5
4
4. 5
'89 '91 '93 '95 '97 '99 '01 '03 '05 '07 '09
Sour ces: AFRIMS
HIV Pr eval ence (%)
Fi gur e 1: HIV pr eval ence among mi l i t ar y r ecr ui t s:
1989-2009
Resul t s f r om HIV sur vei l l ance among ANC cl i ent s i n gover nment hospi t al s
t hr oughout t he count r y show t hat t he pr ovi nci al medi an pr eval ence of HIV
i ni t i al l y i ncr eased r api dl y f r om 0. 68% i n 1991 t o 2. 3% i n 1995. Ef f ect i ve
pr event i on act i vi t i es f r om 1993 st ar t ed t o show r esul t s by t he r ever sal of
t hi s i ncr easi ng t r end af t er 1995. However , t he decl i ne i n pr eval ence r eached
a pl at eau i n 2005 and has r emai ned t her e t o t he pr esent ( 0. 70% and 0. 65%
f or 2008 and 2009 r espect i vel y ( Fi gur e 3) . When l ooki ng at one- year
i nci dence of i nf ect i on among pregnant women, HIV act ual l y i ncreased f rom
appr oxi mat el y 0. 5 t o 1. 8 per 1, 000 per year bet ween 2005 and 2008
( Fi gur e 4) .
Figure 2: Inci dence of HIV: mi li t ary recrui t s: 2005-2009
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
2009
HIV i ncidence (%per year)
0. 14
(0. 09-0. 20)
0. 19
(0. 14-0. 24)
0. 20
(0. 15-0. 26)
0. 26
(0. 20- 0. 32)
0. 25
(0. 17-0. 33)
2008 2007 2006 2005
Sour ces: AFRIMS, BOE, and TUC
17
When exami ni ng pr eval ence among ANC cl i ent s by age gr oup i n 2009, HIV i s
hi ghest i n t he gr oup age over 30 ( 1. 02%) . However , HIV pr eval ence among
t he gr oup under 30 year s i ncr eased si nce 2008, especi al l y among t hose under
age 20, whose pr eval ence i ncr eased st eadi l y si nce 2007 and at an
accel er at i ng r at e ( f r om 0 i n 2007 t o 0. 20 and 0. 46 per year r espect i vel y) . HIV
pr eval ence among pr egnant women age over 30 has r emai ned const ant si nce
2006 at a l evel of 1. 0% ( Fi gur e 5) . When l ooki ng at HIV pr eval ence by
gr avi da, HIV i s hi ghest at gr avi da 3, whi ch r ef l ect s t he hi gher pr eval ence of
HIV among women over 30 year s. Tr ends i n HIV among women of gr avi da 1
and 2 ar e gener al l y const ant f r om 2007 t o 2009 ( Fi gur e 6) .
When exami ni ng HIV t r ends among mi l i t ar y r ecr ui t s and ANC cl i ent s by
r egi on, i t can be seen t hat , st ar t i ng i n 2001, t her e wer e sust ai ned decl i nes of
HIV i n each r egi on, especi al l y i n t he upper nor t h and cent r al r egi ons.
However , i t i s not ewor t hy t hat , i n t he past f i ve year s, t hat t hese decl i nes
have r eached a pl at eau wi t h a sl i ght i ncr easi ng t r end si nce 2007 bot h i n t he
r ecr ui t s and pr egnant women. In 2009, t he pr eval ence of HIV among t he
Fi gure 4: HIV i nci dence among ANC cl i ent s:
2005-2009
0
0. 05
0. 1
0. 15
0. 2
0. 25
2008
HIV incidence (%per year)
Sources: HIV surveillance, BOE, Medical Sciences Department, and the TUC
0.05
(0.03-0.08)
0.09
(0.05-0.12)
0.15
(0.10-0.19)
0.18
(0.12-0.23)
2007 2006 2005
0
0. 5
1
1. 5
2
2. 5
3
95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09
< 20 y 20-24 y 25-29 y more than 30 y
Fi gure 5: HIV preval ence among ANC cl i ent s by age group:
2005-2009
Source: HIV surveillance, BOE
Provinci al Medi an HIV Prevalence (%)
Fi gur e 3: HIV preval ence i n ANC cl i ent s: 1991-2009
0
0.5
1
1.5
2
2.5
91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09
Provi ncial Medi an HI V Preval ence (%)
Source: HIV survei llance, BOE
0
0.5
1
1.5
2
2.5
'97 '99 ' 01 '03 ' 05 '07 '09
Gravida 1
Gravida 2
Gravida 3
Fi gur e 6: HIV pr eval ence among ANC cl i ent s by gr avi da:
1995 - 2009
Source: HIV surveillance, BOE
Provincial Median HIV Prevalence (%)
18
r ecr ui t s was hi ghest i n Bangkok ( 0. 6%) ; i n t he ot her r egi ons HIV i ncr eased
f r om 0. 4 t o 0. 5 i n 2008 and 2009 r espect i vel y. For pr egnant women, HIV
pr eval ence was hi ghest i n t he upper nor t h ( 1. 01%) f ol l owed by 0. 93% i n t he
cent r al , 0. 90% i n Bangkok, 0. 80% i n t he nor t heast , and 0. 7% i n t he sout h
( Fi gur e 7). Ther e wer e 20 pr ovi nces wi t h ANC HIV above 1. 0% and si x
pr ovi nces wi t h a l evel of over 1. 5%.
Dat a whi ch conf i r m t he wor r i some l evel s and t r ends of HIV come f r om STI
dat a i n mi l i t ar y r ecr ui t s i n t he second r ound of t he dr af t i n 2008
( November ) . At t hat t i me, t he pr eval ence of non- speci f i c ur et hr i t i s was
6. 86%, gonor r hea 0. 86% and syphi l i s 0. 09%. The l evel of i nf ect i on was
hi ghest i n t he upper nor t h and east ( par t of t he cent r al r egi on) i n whi ch t he
r at es wer e 13. 1%and 12. 5%r espect i vel y.
2
Fi gur e 7: HIV pr eval ence among mi l i t ar y r ecr ui t s and ANC cl i ent s by r egi on
1. Bangkok and cent r al


2. Nor t h
2
Facul t y of Medi ci ne, Phr amongkut kl ao, Bur eau of AIDS, TB, and STIs, Depar t ment of
Di sease Cont r ol , and t he TUC
0
0 . 5
1
1 . 5
2
2 . 5
3
3 . 5
95 99 '03 '07
Bangkok
Central
'
0
0.5
1
1.5
2
2.5
3
3.5
91 93 95 97 99 '01 '03 '05 '07 '09
Bangkok
Central
'
0
2
4
6
8
10
12
14
91 93 95 97 99 '01 '03 '05 '07 '09
Upper north
Lower north
0
2
4
6
8
10
12
14
91 93 95 97 99 '01 '03 '05 '07 '09
Upper north
Lower north
% %
%
%
19
3. Nor t heast ( Isan)
4. Sout h
The popul at i on of bl ood donor s at t he Red Cr oss cent r al bl ood bank ar e
somewhat r epr esent at i ve of t he gener al popul at i on who f eel t hey have no
r i sk f or HIV ( because of t he sel f - def er r al scr eeni ng pr ocess bef or e bl ood i s
gi ven) . Over al l , st ar t i ng i n 1993, HIV pr eval ence among bl ood donor s
decr eased shar pl y t hough, f r om 2004 t o t he pr esent t her e i s di f f er ent i al s
bet ween sex and whet her t he donor i s new or r et ur ni ng. HIV pr eval ence
among new mal e donor s was i ni t i al l y qui t e hi gher t han t he ot her sub- gr oups
and decl i ned f r om 1. 60%i n 1993 t o 0. 33%i n 2002 ( Fi gur e 8) . However , af t er
t hat year , HIV st ar t ed t o cl i mb agai n, and r eached a pl at eau at about 0. 45%
- - a l evel si mi l ar t o t hat f or mi l i t ar y r ecr ui t s. The l evel of HIV among t he
new mal e donor s exceeded t he l evel f or r et ur ni ng ( or member ) donor s by
2. 5 t o 6- f ol d. For f emal e donor s, even t hough t he HIV pr eval ence i s
gener al l y l ower t han t he mal es, HIV pr eval ence among new donor s
exceeded member donor s by 2 t o 7. 7- f ol d.
When anal yzi ng t hese t r ends and pat t er ns i t i s not ewor t hy t hat t her e ar e
bot h mal es and f emal es who bel i eve t hey ar e at l ow/ no r i sk f or HIV when,
0
0.5
1
1.5
2
2.5
3
3.5
91 93 95 97 99 '01 '03 '05 '07 '09
Northeast
0
0.5
1
1.5
2
2.5
3
3.5
91 93 95 97 99 '01 '03 '05 '07 '09
Upper northest
Lower northeast
0
0.5
1
1.5
2
2.5
3
3.5
91 93 95 97 99 '01 '03 '05 '07 '09
South
0
0.5
1
1.5
2
2.5
3
3.5
91 93 95 97 99 '01 '03 '05 '07 '09
Upper south
Lower south
Military recruits
ANC clients
%
%
%
%
Sour ces: HIV sur vei l l ance dat a f r om t he Ar med For ces Resear ch Inst i t ut e of Medi cal Sci ence ( AFRIMS) ,
The Depar t ment of t he Ar my and t he Bur eau of Epi demi ol ogy.
20
i n f act t hey st i l l have r i sk. Whet her t hey per cei ve t hat r i sk accur at el y
depends on t he si t uat i ons t hey f i nd t hemsel ves i n.

Anal ysi s of bl ood donor HIV pr eval ence by age gr oup i s shown i n Fi gur e 9.
HIV i s hi ghest i n t he 21- 30 year age gr oup, f ol l owed by age 31- 40 year s.
Ther e i s a sl i ght decl i ni ng t r end i n bot h gr oups st ar t i ng i n 2004. Among
t hose under 20, t he l evel of HIV i s qui t e l ow but i s not decl i ni ng, wi t h a
sl i ght t ur n upwar d i n 2009. These dat a suggest t hat mor e HIV can be
expect ed among t he yout h and adol escent s i f mor e ef f ect i ve i nt er vent i on i s
not i mpl ement ed.
1. 2 Trends i n HIV among most -at -ri sk/ hard-t o-reach popul at i ons
Per sons wi t h most - at - r i sk of HIV t hose ar e i ncl uded i n t he MOPH HIV sent i nel
sur vei l l ance i ncl ude f emal e sex wor ker s i n br ot hel s and ent er t ai nment
est abl i shment s, IDU, mal e STI pat i ent s, and document ed mi gr ant wor ker s.
The HIV sent i nel sur vei l l ance ( HSS) has been i n oper at i on si nce 1989.
Because of soci al changes, t he HSS has expanded t he sent i nel popul at i ons t o
i ncl ude har d- t o- r each popul at i ons of MSM and f r ee- l ance sex wor ker s ( st r eet
wal ker s) . Dat a f r om t he HSS and ser osur veys shows t hat HIV among t he
t r adi t i onal l y most - at - r i sk and t he har d- t o- r each i s st i l l at ver y hi gh l evel s.
These dat a emphasi ze t he i mpor t ance of achi evi ng gr eat er cover age of
t hese gr oups wi t h pr event i on ser vi ces t o mor e ef f ect i vel y cont r ol t he spr ead
of HIV.
1. 2. 1 Si t uat i on of HIV among sex workers
Femal e, br ot hel - based sex wor ker s ( SWs) ar e assumed t o be one of t he
hi ghest r i sk popul at i ons f or HIV. In 1993, t he pr eval ence of HIV i n t hi s gr oup
had r eached 28%( Fi gur e 10) . Fol l owi ng massi ve ef f or t s by mul t i pl e sect or s
and par t ner s i n t he NAP, t hr ough mass communi cat i on, i ndi vi dual out r each,
and condom pr omot i on, t he pr eval ence of HIV st ar t ed t o decl i ne i n bot h
br ot hel - based ( di r ect est abl i shment SWs DSW) and SWs who wor ked out of
ent er t ai nment est abl i shment s ( i ndi r ect SWs or ISW) . Never t hel ess, i t i s
not ewor t hy t hat af t er 2004, t he decl i ned of HIV pr eval ence sl owed t o near l y
a pl at eau as of 2009 at l evel s of 2. 76% and 1. 66% f or DSW and ISW
r espect i vel y. When compar i ng by r egi on, t he HSS shows decl i nes i n al l
r egi ons, wi t h t he l at est l evel f or DSW i n t he cent r al r egi on, i ncl udi ng
Bangkok at 5. 26%, f ol l owed by t he nor t h ( 3. 70%) , sout h ( 2. 76%) , and
nor t heast ( 1. 60) . Never t hel ess, i t i s not ewor t hy t hat t he decl i ne among
Figure 9: HIV prevalence among blood donors at the national
blood bank by age group. 2001-2009
0
0.02
0.04
0.06
0.08
0.1
0.12
'01 '02 '03 '04 '05 '06 '07 '08 '09
< 20 y 21-30 y
31-40 y 41-50 y
51-60 y
Source: National Blood Bank. Thai Red Cross
Fi gur e 8 HIV pr e val e nce amon g bl ood dono r s cl assi f ie d by
se x a nd t ype of donor s, 1991- 2009
0
0.4
0.8
1.2
1.6
2
'91 '93 '95 '97 '99 '01 '03 '05 '07 '09
Mal e- Ne w Femal e- New
Mal e- Membe r Femal e- Memb er
Sourc e: Nat i onal Bl ood Bank, Thai Red Cr oss
HIV p r ev al ence ( %)
21
0
0.2
0.4
0.6
0.8
1
1.2
2006 2008 2004 2005
HIV incidence (% per year)
0.34
(0.18-0.50)
0.42
(0.21-0.62)
0.73
(0.47-0.99)
0.66
(0.40-0.93)
Sources: HSS of the BOE, DDC and the TUC
Figure 11 HIV incidence per year: Indirect SW. 2004-2008
0.24
(0.12-0.37)
2007
ISW i n t he sout h was negl i gi bl e and wi t h t he hi ghest pr eval ence f or ISW
among r egi ons ( 2. 23%) f ol l owed by t he cent r al , i ncl udi ng Bangkok, ( 1. 98%) ,
t he nor t heast ( 1. 75%) , and t he nor t h ( 1. 00%) .
For mal e sex wor ker s, t he l evel of HIV i s st i l l hi gh and not yet decl i ni ng f r om
a l evel of 11. 2%i n 2009 ( Fi gur e 10) .
As Thai soci et y has i ncr eased i n compl exi t y, so have t he var i ous f or mat s f or
i ndi r ect commer ci al sex. Even t hough HIV among ISW has decl i ned, HIV
i nci dence ( among t hose i nf ect ed l ess t han one year ) bet ween 2004 and 2008
i ncr eased f r om 2. 4 per 1, 000 per year t o 7. 3 and 6. 6 per 1, 000 per year i n
2007 and 2008 r espect i vel y ( Fi gur e 11) .

In addi t i on, t he f or mat s of commer ci al sex ar e expanded i ncl udi ng st r eet
wal ker s, SWs sol i ci t i ng i n publ i c ar eas, t hr ough net wor ks of phone cont act s,
t he Int er net , et c. Fr om a r esear ch st udy i n 2008 i n Bangkok and Chi ang Rai
among ISWs, i t was f ound t hat HIV pr eval ence was 20%and 10%r espect i vel y.
Pr eval ence of non- speci f i c ur et hr i t i s ( NSU) was 9% i n bot h pr ovi nci al
sampl es, and gonor r hea was 2%and 1%r espect i vel y ( Tabl e 1) . The net wor k
of ISW i s expandi ng r api dl y at pr esent and i s a gr oup t hat i s har d t o r each.
Figure 10: HIV prevalence among female and male SWs, and male
STI patients. 1989-2009
year
0
5
10
15
20
25
30
35
40
89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '52
direct SW
indirect SW
male STI patient
male SW
%
%
Source: HSS of the BOE, DDC
22
Unl ess ef f ect i ve pr event i on i s i mpl ement ed wi t h t hi s gr oup, t hen HIV coul d
spr ead f ur t her i nt o t he gener al popul at i on of men and women.
Tabl e 1: Resul t s of pr eval ence sur vey of HIV and STIs among ISW ( non-
venue- based SW) i n Bangkok and Chi ang Rai i n 2007
Bangkok ( n=707) Chi ang Rai ( n=366) Inf ect i on t ype
Venue-
based SWs
( n=164)
Non- venue-
based SWs
( n=519)
Venue-
based
SWs
( n=267)
Non- venue-
based SWs
(n=87)
HIV 2. 5% 20 % 2. 6% 10%
Gonor r hea - 1% - 2%
NSU - 9% - 9%
Sour ce: Bur eau of Epi demi ol ogy, DDC, MOPH and TUC
As a consequence of gover nment r ef or m and publ i c heal t h r e- st r uct ur i ng i n
2002, STI case management was i nt egr at ed wi t h t he gener al heal t h ser vi ces
of hospi t al s. Thi s had t he ef f ect of r educi ng ut i l i zat i on of STI ser vi ces by
SWs and t he r esul t i ng cl osur e of many STI cl i ni cs i n many pr ovi nces. Despi t e
t he heal t h r ef or m i nnovat i ons i n t he past 2- 3 year s, ser vi ces have not yet
r eached opt i mal l evel s of cover age, and t her e ar e st af f l i mi t at i ons i n
pr ovi di ng di agnosi s, t r eat ment and counsel i ng out si de t he cl i ni c set t i ng, and
t hi s f ur t her r educes access t o pr event i on ser vi ces.
STI sur vei l l ance among SWs dur i ng 1999- 2008 f ound t hat HIV pr eval ence di d
not decl i ne, and sl i ght l y i ncr eased i n ISW ( f r om 1. 5%i n 2007 t o 1. 8%i n 2008
( Fi gur e 12) . Resul t s f r om t he Int egr at ed Bi ol ogi cal and Behavi or al
Sur vei l l ance ( IBBS) i n f i ve pr ovi nces i n 2006 among SWs f ound t hat 10. 1%of
SWs wer e i nf ect ed wi t h NSU, especi al l y among t he SWs age 15- 19 year s
( 19. 2%) , t hose age 20- 24 ( 13%) ; and t hose age 24+ year s ( 7. 2%) . In a
subsequent r ound of t he IBBS i n 11 pr ovi nces i n 2007 f ound t hat t he
pr eval ence of NSU i ncr eased sl i ght l y t o 11. 3% wi t h a si mi l ar age gr oup
di f f er ent i al . However , t he i ncr eases wer e shar pest f or SWs age 15- 19 and
20- 24, whose NSU pr eval ence i ncr eased f r om 19. 2 t o 21. 3 and 13. 0 t 16. 1
r espect i vel y ( Tabl e 2) . The pr eval ence of gonor r hea was ver y l ow but st abl e
at 1. 6%and 1. 2%i n 2006 and 2007 r espect i vel y.
23
0
1
2
3
4
5
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8

direct SW
indirect SW
Fi gur e 12: Syphi l i s sur vei l l ance among DSW and ISW dur i ng 1999- 2008

Tabl e 2 Pr eval ence of NSU i n SWs by age gr oup f r om t he IBBS dur i ng 2006- 7

Age gr oup ( year s) 2006 ( 5
pr ovi nces)
2007 ( 11
pr ovi nces)
15- 19 19. 2% 21. 3%
20- 24 13. 0% 16. 4%
> 24 7. 2% 7. 3%
Tot al 10. 1% 11. 3%
Sour ces: BOE, DDC, MOPH; and t he TUC
Resul t s f r om behavi or al sur vei l l ance sur veys ( BSS) among DSW f ound t hat
most used condoms f or al l sex epi sodes wi t h cl i ent s, but use decl i nes wi t h
ot her t ypes of par t ner s. Use i s l owest wi t h husband or co- habi t i ng par t ner .
Dur i ng 2006- 8 t he l evel of al ways condom use was 93. 7%, 89. 8%, and
40. 8% f or cl i ent s, ot her par t ner s, and husband/ co- hab r espect i vel y.
Cover age of VCT i n t he pr i or si x mont hs was under 50%. The BSS f ound
l evel s of use of i nj ect i on dr ugs t o be i ncr easi ng f r om 0%i n 2004 t o 1. 2%and
0. 8% i n 2007 and 2008 r espect i vel y. Regul ar par t ner s or husbands who
i nj ect ar e at si mi l ar l evel s as f or t he SWs. Thi s pr esent s a dual r i sk f or SWs
t o cont r act / t r ansmi t HIV ( Tabl e 3) . In addi t i on i t was f ound t hat , f r om f i ve
knowl edge/ at t i t ude quest i ons accor di ng t o UNGASS st andar ds; dur i ng 2004
t o 2008 cor r ect r esponse was l ow and not i ncr easi ng at a l evel of 39% i n
2008. The dat a t hus f ar show t he ur gent need t o i ncr eased cover age of t hi s
popul at i on wi t h ef f ect i ve pr event i on, knowl edge, and under st andi ng i n
or der t o r educe r i sk behavi or f or HIV.

Source: HSS, BOE, DDC
24
69
67
65
76
57
49
0
10
20
30
40
50
60
70
80
90
100
Condom use with a sex worker
%
factory workers
army recruits
general population
M5 HS
2nd year vocational
M2 HS
Tabl e 3: Sel ect ed behavi or s of SWs i n Thai l and: 2004- 2008
Behavi or 2004 2005 2006 2007 2008
Use of condom ever y t i me wi t h di f f er ent t ypes of par t ner s i n t he past
mont h
Cl i ent
Husband or co- habi t i ng par t ner
Ot her sex par t ner
93. 4
35. 8
82. 4
91. 5
32. 3
83. 3
86. 2
27. 5
83. 3
94. 0
30. 4
80. 4
93. 7
40. 8
89. 8
Use of i nj ect i on dr ugs i n t he past mont h
Used i nj ect i on dr ugs
Husband/ co- habi t i ng par t ner
used i nj ect i on dr ugs
0. 0
0. 3
0. 6
0. 7
0. 7
2. 1
1. 2
1. 2
0. 8
0. 7
Recei ved an HIV t est i n past 6 mont hs
Ever had an HIV t est
Know t he r esul t s
60. 6
48. 5
48. 9
44. 8
47. 0
NA
52. 8
53. 8
48. 0
NA
Sour ce: Sur vei l l ance of HIV r i sk behavi or . BOE, DDC, MOPH
It i s not ewor t hy t hat t he r esul t s of t he 2008 r ound of t he BSS wi t h SWs,
al ways condom use ( al l par t ner s) was onl y 75. 8% among DSW, 69. 2%
among mi l i t ar y r ecr ui t s, and 66. 95 among gener al popul at i on mal es. Among
school st udent s, al ways condom use wi t h a SW r anged f r om 65. 2%, 57. 0%
and 49. 2%f or M5 hi gh school , 2
nd
year vocat i onal school , and M2 hi gh school
st udent s ( Fi gur e 13) . These r esul t s may suggest def i ci enci es i n knowl edge
and concer n about t he need t o use condoms f or al l commer ci al sex.
Fi gur e 13: Per cent condom use wi t h sex wor ker s i n 2008
Sour ce: HIV BSS conduct ed by t he BOE, DDC, MOPH
25
1. 2. 2 Si t uat i on of HIV among men who have sex wi t h men (MSM)
The spr ead of HIV among MSM occur r ed r api dl y i n t he past and shows
i ndi cat i ons of i ncr easi ng. At pr esent , i t i s f ound t hat pr eval ence of MSM
behavi or i s i ncr easi ng or t hat MSM ar e becomi ng mor e open about t hei r
sexual or i ent at i on. The i ncr ease i s gr eat er as age i ncr eases. Fr om sur veys
of young men i n 24 pr ovi nces i t was f ound t hat MSM behavi or was 0. 3 among
upper hi gh school s st udent s, 2 t o 3% among vocat i onal school st udent s and
4. 7%among mi l i t ar y r ecr ui t s.
HIV pr eval ence among MSM i s hi gher i n l ar ge ur ban ar eas wi t h hi gher SES,
mor e t our i sm and ent er t ai nment est abl i shment s ( e. g. , Bangkok, Chi ang Mai ,
and Phuket ) . MSM HIV i n 2007 r anged f r om 17% t o 31% i n t hese pr ovi nces
compar ed t o 5% i n t he smal l er , l ess cosmopol i t an pr ovi nces of Udor n and
Pat al ung i n 2008 ( Fi gur e 14) .
Fi gur e 14: HIV pr eval ence f r om t he sur vey of MSM i n sent i nel pr ovi nces
dur i ng 2003- 2008
28.3
15.3
20
4.7
5.5
17.3
5.5
16.9
30.7
0
10
20
30
40
Bangkok Chiang Mai Phuket Udorn Patalung
H
I
V

P
r
e
v
a
l
e
n
c
e

(
%
)
2546 2548 2550 2551
The t r end i n HIV i nf ect i on among MSM i s i ncr easi ng f or al l year s and age
gr oups. MSM age 29+ year s have t he hi ghest pr eval ence. Fr om t he HSS, t he
sent i nel popul at i on i n Bangkok had a l evel of HIV of 17. 3%i n 2003 and 30. 7%
i n 2007. In Chi ang Mai , t he compar abl e r at es wer e 15. 3%i n 2005 and 16. 9%
i n 2007. In Phuket , t he r at es wer e 5. 5%i n 2005 and 20. 0%i n 2007.
MSM condom use f or pr event i on of HIV i s r at her l ow as measur ed by t he
sur vey i n 2007 whi ch f ound t hat al ways use i n t he t hr ee mont hs pr i or t o t he
i nt er vi ew was 66%f or Bangkok MSM, 44%f or Phuket MSM, and 36%f or Chi ang
Mai MSM. In addi t i on, i n 2008 sur veys of MSM i n Udor n and Pat al ung, al ways
condom use i n t he past t hr ee mont hs was 56. 3%and 57. 0%r espect i vel y.
Tourism provinces
Sources: BOE, DDC; and the TUC
26
1. 2. 3 HIV si t uat i on among i nj ect i on drug users (IDU)
The l evel of HIV among IDU r emai ns hi gh and shows no si gn of decl i ne. In
addi t i on, t her e i s i ncr easi ng dr ug addi ct i on i ncl udi ng met hamphet ami nes i n
yout h and adol escent s. Fr om t he HSS of t he BOE, t he pr eval ence of HIV
among IDU at t endi ng det oxi f i cat i on cl i ni cs t hr oughout Thai l and i s wi t hi n a
r ange of 30 t o 40%( Fi gur e 15) . In a sur vey usi ng r espondent dr i ven sampl i ng
i n t wo pr ovi nces ( Chi ang Mai and Bangkok) i t was f ound t hat t he HIV
pr eval ence was 10. 8% ad 23. 3% r espect i vel y among IDU, among whom onl y
13. 8%and 70. 2%had ever at t ended a det oxi f i cat i on cent er .
Ri sk behavi or sur veys of IDU i n Chi ang Mai , Songkl a and Samut Pr akan, most
of whom wer e cl i ent s at t he l ocal det oxi f i cat i on cl i ni c, or out r each cont act s
f ound t hat age at f i r st dr ug use was appr oxi mat el y 16 year s, t he most
common dr ug used was her oi n f ol l owi ng by Dor mi cum, and
met hamphet ami nes ( met h) . The per cent i nj ect i ng dr ugs wi t h a used
needl e and l et t i ng someone el se use one s own needl e i n t he past mont h
wer e 53. 2% and 38. 7% r espect i vel y i n Songkl a, 36. 1% and 24. 2% i n Chi ang
Mai , and 26. 1%and 18. 0%i n Samut Pr akan.
In addi t i on t o t he r i sk f r om needl e shar i ng, t he sur vey f ound t hat many IDU
have unsaf e sex: onl y 35%r epor t ed usi ng a condom at l ast sex. Spr ead of
dr ug use can i ncr ease spr ead of HIV i n mul t i pl e ways. The i nf l uence of a
r api dl y changi ng soci et y has caused many yout h and adol escent s t o t ur n t o
dr ugs such as her oi n, met h, Ecst asy, mar i j uana, al cohol , et c. The BSS f ound
t hat bot h mal e and f emal e hi gh school and vocat i onal st udent s i n al l gr ades
have used addi ct i ve dr ugs i n t he past . The most common dr ug used was
mar i j uana, f ol l owi ng by met h ( Tabl e 4) .
year
0
10
20
30
40
50
60
89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '52
%
Figure 15: HIV prevalence among IDU: 1989-2009
%
Source: HSS, BOE, DDC
27
Tabl e 4 Dr ug use i n yout h and adol escent s: 2008
M2 hi gh school M5 hi gh school vocat i onal Drug used
mal e f emal e mal e f emal e mal e f emal e
Her oi n 0. 6 0. 1 0. 5 0. 5 1. 0 0. 1
met h 1. 7 0. 4 5. 3 0. 1 12. 8 2. 3
Mar i j uana 4. 1 0. 4 12. 3 1. 0 24. 0 2. 9
K 0. 4 0. 1 0. 3 0. 1 0. 6 0. 1
ecst asy 0. 6 0. 1 0. 6 0. 7 1. 1 0. 2
Sour ce: BSS t hr ough hand- hel d comput er dat a- ent r y. 2008. BOE, DDC
1. 2. 4 HIV si t uat i on among mi grant workers and f i shi ng boat crew
Fr om t he r esul t s of t he HSS, mi gr ant wor ker s show i ncr easi ng HIV i nf ect i on
f r om 0. 84%i n 2007 t o 1. 20%i n 2008. For f i shi ng boat cr ew, t he pr eval ence
l evel s ar e 1. 25% and 2. 50% r espect i vel y, f ol l owi ng decl i nes dur i ng 1997 t o
2006.
Sour ce: HSS, BOE, DDC, MOPH
2. Fact ors f aci l i t at i ng t he spread of HIV among chi l dren and yout h as a
resul t of changes i n soci et y, cul t ure and l i f est yl es
The spr ead of HIV i n Thai l and has been goi ng on f or over 20 year s. The
pr i nci pal dr i vi ng f or ce of spr ead has been unsaf e sexual behavi or , t hus
di spr opor t i onat el y af f ect ed women and men of r epr oduct i ve age. Despi t e
maj or advances and success i n pr event i on, t he Thai NAP has not yet been
abl e t o er adi cat e new i nf ect i on. Indeed, r api d changes i n soci et y, cul t ur e
and l i f est yl es coul d l ead t o i ncr eased r i sk of HIV among yout h and
adol escent s i n t he year s ahead. The advanci ng t echnol ogy i n
Figure 16: Prevalence of HIV among migrant workers and fishing boat crew
Thailand: 1997 - 2008
0
2
4
6
8
10
12
14
16
97 99 00 01 02 03 04 05 06 07 08 09
Migrants
Boat crew
%
28
communi cat i ons may be f aci l i t at i ng r i sk as wel l . New and ef f ect i ve
pr event i on i nt er vent i ons ar e needed t o addr ess t hese t r ends.
2. 1 Yout h sexual norms
Past sur veys have f ound si mi l ar r esul t s r egar di ng adol escent val ues and
i ncr easi ng accept ance of pr e- mar i t al sex. Fr om a sur vey i n 2007 i n 11
pr ovi nces among yout h age 15 t o 22 year s i t was f ound t hat 48. 8% f i nd t he
i dea of sex among unmar r i ed adol escent s as accept abl e. In addi t i on, 67. 2%
of r espondent s f el t t hat t he deci si on t o have sex was t he i ndi vi dual s
choi ce. Ful l y 39. 1%havi ng mul t i pl e sex par t ner s dur i ng adol escence was not
unusual . These f i ndi ngs ar e consi st ent wi t h a nat i onal st udy of i n- school
chi l dr en and yout h i n 2006- 7 conduct ed by t he Ramaj i t t i Inst i t ut e whi ch
f ound t hat 30% of vocat i onal st udent s and 56% of col l ege st udent s t hought
t he l i vi ng t oget her bef or e mar r i age i s accept abl e.
Rounds of t he BSS among mal e and f emal e st udent s i n 24 pr ovi nces
conduct ed by t he BOE of t he DDC, f ound t hat a hi gh pr opor t i on of
r espondent s r epor t ed a hi st or y of sex, and t he t r end i s i ncr easi ng. The
2008 BSS r ound f ound t hat 3% of l ower secondar y school st udent s ( aver age
age of 13 year s) , 15% t o 24% of upper secondar y school st udent s ( aver age
age of 16) , and 37%t o 43%of vocat i onal school st udent s ( aver age age of 17
year s) had ever had sex.
Sexual debut under age 15 i s r i si ng. St udi es of vocat i onal st udent s and
mi l i t ar y r ecr ui t s f r om 2005 t o 2007 showed an i ncr ease f r om 0. 3%t o 0. 8%i n
mal es and 0. 2%t o 0. 6%i n f emal es i n vocat i onal school , and f r om 9%t o 14%
among mi l i t ar y r ecr ui t s.
Ot her dat a whi ch subst ant i at e t he l evel of yout h sex i ncl ude an i ncr ease i n
t een pr egnancy dur i ng 2005 t o 2008. In 2008 i t was est i mat ed t hat t her e
wer e 77, 092 t een pr egnanci es or 211 per day; and i ncr ease f r om 68, 385 i n
2007. Ear l y- age pr egnancy l eads t o coupl es bei ng par ent s bef or e t hey ar e
r eady t o, causi ng economi c har dshi p and, i n some cases, t o commer ci al sex.
3
The sur vey of yout h under t he Chi l d Wat ch pr oj ect f ound t hat 18%t o 20%i n
Bangkok, t he cent r al and nor t h r egi ons had had sex; i t was l owest i n t he
sout h at 11. 6%( Fi gur e 17) .
3
Source: Dr. Amorwich Narkathap. Director of Ramajitti Institute; and Child Watch. Reported in The Nation
12/26/08.

29
Fi gur e 17: Hi st or y of sex of yout h i n hi gh school and col l ege i n 2008
2. 2 Copyi ng ot hers behavi or and ef f ect on promi scui t y i n yout h
A cer t ai n segment of yout h st i l l l ack knowl edge and cor r ect under st andi ng
about saf e sex. In addi t i on, some of t hei r r i sk may come f r om copyi ng t he
behavi or of ot her s, such as t endency t owar d pr omi scui t y. In t he 2008
r ound of t he HIV BSS among school - based yout h age 16 t o 18 year s by t he
BOE, i t was f ound t hat over 50% of mal es had ever had sex whi l e 20% of
f emal es had mor e t han one sex par t ner i n t he past year .
2. 3 Sex f or money or i n-ki nd payment among yout h i s i ncreasi ng
A segment of yout h has sex f or some sor t of mat er i al compensat i on whi ch
coul d be an out gr owt h of economi c di f f i cul t y or t he mat er i al i st i c val ues of
t he soci o- cul t ur al envi r onment at pr esent . The HIV BSS by t he BOE of t he
DCC among school - based yout h f r om 2005 t o 2008 f ound t hat sex f or
money/ mat er i al was i ncr easi ng and i ncr eases wi t h age. In 2008, 0. 6%, 1. 3%,
and 3. 2% of mal e M2 hi gh school st udent s, M5 st udent s and vocat i onal
st udent s r espect i vel y r epor t ed havi ng sex f or money/ mat er i al compar ed
wi t h 0. 1%, 0. 5%, and 1. 7%of f emal es r espect i vel y.
2. 4 Same-sex mal e ri sk behavi or
At pr esent , t her e ar e i ncr easi ng di ver se sex l i f est yl es, and gr eat er openness
and accept ance of t hese. Thi s has r api dl y i ncr eased t he soci al net wor k of
t hose wi t h di f f er ent sex pr ef er ences. Men who pr ef er t o have sex wi t h men
have been st udi ed i n sur vei l l ance sur veys among gener al popul at i on mal es,
mal e f act or y wor ker s, mi l i t ar y r ecr ui t s, M2 and M5 hi gh school st udent s and
vocat i onal school st udent s. Same- sex mal e sex i ncr eases wi t h age. In 2008
0. 4% of mal e st udent s age 12 t o 13 had had sex wi t h anot her mal e i n t he
past year ; 2. 1%t o 3. 0%among t hose age 16 t o 18, and 4. 7%among mi l i t ar y
Percent of youth who said they have had sex:

Child Watch 76 provinces
19.4
18.0
18.7
11.6
19.8
13.8 13.8
0
10
20
30
.
BKK

Upper
Nor t h
Lower
Nor t h
Sout h
Cent r al
East
Nor t heast
Sour ce: Sur vey of behavi or of i n- school chi l dr en and yout h.
Chi l d Wat ch. Ramaj i t t i Inst i t ut e
30
r ecr ui t s. Appr oxi mat el y 3. 8%of gener al popul at i on mal es and mal e f act or y
wor ker s r epor t ed havi ng sex wi t h anot her man.
2. 5 Lack of ski l l s, knowl edge and mot i vat i on f or use of condoms t o
prevent HIV
Even t hough knowl edge sur veys show hi gh l evel s of awar eness of saf e sex,
and t he ef f ect i veness of condoms t o pr event HIV and STI, t her e i s st i l l a l ack
of pr oper concer n and ski l l i n condom use, or i n negot i at i ng condom use
when appr opr i at e. Thi s coul d be par t of t he expl anat i on f or non- condom
use dur i ng commer ci al sex or wi t h ot her non- mar i t al par t ner s. Onl y 50%t o
70% of mal e st udent s, mi l i t ar y r ecr ui t s, and mal e f act or y wor ker s r epor t ed
usi ng a condom ever y t i me t hey had sex wi t h a sex wor ker . Onl y one i n f our
or 20%t o 40%of mal e and f emal e st udent s used a condom ever y t i me t hey
had sex wi t h t hei r gi r l f r i end or boyf r i end r espect i vel y ( Fi gur e 18) .
In an envi r onment wher e HIV i s i ncr easi ng among MSM, combi ned wi t h
i ncr eased openness about sexual or i ent at i on, t he sur vey dat a show
per si st ent l y l ow l evel s of condom use si nce 2004, wi t h onl y sl i ght i ncr eases
t o 50%use as of 2008.
Fi gur e 18: Condom use among yout h: 2008
Secondar y evi dence f or i ncr easi ng unsaf e sex comes f r om t r ends i n STI dat a
f r om t he net wor k of STI cl i ni cs t hr ough t he STI Gr oup of t he DDC of t he
MOPH. STI cases ar e most numer ous i n t he 20 t o 24 year s age gr oup,
f ol l owed by 15 t o 19 year s, wi t h i ncr easi ng t r ends dur i ng 2000 t o 2007
( Fi gur e 19) .
"Always" use condom by type of sex partner in past year
49 48
42
26
65
45
27
20
57
52
23
16
69
55
0
20
40
60
80
100
males: with SWs males: with other
males
males: with girlfriend female:with boyfriend
%
M2 HS M5 HS vocational army recruit
31
2. 6 Chi l dren and yout h dri nk more, and t hi s creat es pot ent i al ri sk f or
unsaf e sex
Mal e st udent s have mor e pr e- mar i t al sex t han f emal es and ar e l ess awar e of
t hei r HIV ser ost at us. Al so, t hey ar e l ess i nt er est ed i n r ecei vi ng i nf or mat i on
about STIs and AIDS, per haps because t hey do not want t o admi t t hat t hey
ar e sexual l y act i ve our of f ear of soci al r ej ect i on. Al so, many st udi es have
shown t hat unsaf e sex i s mor e l i kel y when one i s dr unk. Al so, yout h who
dr i nk al so use t he Int er net t o vi ew por nogr aphy because of easy access and
l ack of ext er nal cont r ol s.
Fr om sur veys conduct ed by t he WHO i n 2001, i t can be seen t hat t he
pr opor t i on of yout h whose age at f i r st consumpt i on of al cohol i s under 15
year s i s i ncr easi ng. Ther e i s a gr eat er chance of al cohol addi ct i on and
unsaf e sex. In a sur vey of 2
nd
year hi gh school st udent s ( mean age of 12) i t
was f ound t hat 34% t o 36% of mal es and 18% t o 25% of f emal es had ever
consumed al cohol i c bever ages, wi t h a const ant t r end over t i me ( 2005- 2008) .
Mor e i n- dept h sur veys ar e needed t o st udy t he cont ext of t he dr i nki ng, t he
t ype of al cohol consumed, and access of yout h t o al cohol i n or der t o
devel op appr opr i at e and ef f ect i ve cont r ol and pr event i on measur es.
2. 7 Chi l dren and yout h l ack knowl edge and concern about prot ect i ng
onesel f f rom HIV
Fr om t he HIV BSS among mal e and f emal e st udent s at t he M2, M5, and 2
nd
year vocat i onal school l evel i n 2008, t he knowl edge scor e based on UNGASS
i ndi cat or s was l ow ( bot h sexes) . The per cent who coul d answer al l f i ve
0
10
20
30
40
50
60
70
80
2000 2001 2002 2003 2004 2005 2006 2007
age 20-24 age 15-19 age < 15 All
Source: STI Group, Bureau of AIDS, DDC
STI reports per 100,000 age-specific mid year population
Figure 19: Trends in STI among the population under 25 years
during 2000-2008
32
knowl edge quest i ons cor r ect l y was under 50%; M2 st udent s had l ower
cor r ect knowl edge t han M5 st udent s, and 2
nd
year vocat i onal st udent s ( Tabl e
5) . The quest i ons wi t h t he l east cor r ect r esponse wer e Shar i ng meal s wi t h
a PLHA can t r ansmi t HIV and HIV can be spr ead by mosqui t oes.
Tabl e 5 Per cent age of Thai st udent s who coul d cor r ect l y answer UNGASS
AIDS knowl edge quest i ons by gr ade of st udent , sex and year : 2005 - 2008

2005 2006 2007 2008
Mal e
Hi gh school M2 13. 5 16. 05 12. 6 16. 6
Hi gh school M5 31. 0 30. 3 22. 6 32. 2
Vocat i onal year 2 22. 7 22. 7 21. 7 24. 7
Femal e
Hi gh school M2 15. 60 12. 7 13. 7 19. 1
Hi gh school M5 31. 3 32. 1 28. 3 35. 3
Vocat i onal year 2 24. 1 25. 7 24. 6 25. 9
Not e: The f i ve UNGASS knowl edge quest i ons i ncl ude: condoms pr event AIDS; havi ng an
HIV- negat i ve sex par t ner pr event s AIDS; mosqui t oes spr ead HIV; eat i ng wi t h a PLHA spr eads
HIV; someone who l ooks heal t h can be HIV+.
Sour ce: HIV BSS, BOE, DDC
3. Anal ysi s of t he epi demi ol ogi cal si t uat i on t o pri ori t i ze si t es and
popul at i ons f or prevent i on act i vi t i es
3. 1 Gui del i nes f or use of dat a t o pri ori t i ze l ocat i ons f or conf ront i ng t he
epi demi c
Appr opr i at e measur es need t o be t aken t o ef f ect i vel y al l ocat e HIV-
pr event i on r esour ces so t hat t her e i s a cost - ef f ect i ve i mpact on t he over al l
epi demi c. Anal yzi ng t he avai l abl e epi demi ol ogi cal dat a combi ned wi t h an
under st andi ng of t he dynami cs of t r ansmi ssi on can hel p pr ogr ams make t he
best r esour ce- al l ocat i on deci si ons.
HIV spr ead i n Thai l and has t he f ol l owi ng char act er i st i cs: ( 1) At pr esent ,
most t r ansmi ssi on i s het er osexual ; ( 2) Ther e ar e gr oups wi t h hi gher
pr eval ence and i nci dence t han ot her s i ncl udi ng MSM and IDU; ( 3) Yout h have
hi gh r i sk behavi or ( condom use wi t h SWs i s l ow) . Thus, i mpor t ant measur es
f or pr event i on of HIV i ncl ude i ncr eased condom use i n var i ous gr oups and
r educed needl e shar i ng among IDU.
For IDU, t he pr i or i t y ar ea shoul d be Bangkok because, i n ot her ar eas, mor e
IDU have swi t ched t o amphet ami nes. For MSM, t her e i s a l i mi t ed geogr aphi c
r ange of dat a; however pr i or i t y can be gi ven t o pr ovi nces wi t h l ar ge t our i st
popul at i ons. For yout h and ot her popul at i ons, each needs t o be assessed
accor di ng t o i t s HIV pr eval ence l evel , combi ned wi t h consi der at i on of t he
f ol l owi ng:
33
( 1) Even t hough some yout h have i ncr easi ng r i sk, such as younger age
at f i r st sex, mor e t een sex, t he i mpor t ant f act or t o consi der i s
whet her t he yout h s sex par t ner i s hi gh- r i sk or not ( i . e. , DSW or
ISW) .
( 2) Whet her pr egnant women have hi gh or l ow HIV l evel s der i ves at
l east i n par t as t o t hei r par t ner s behavi or f or HIV, and whet her
t he man f r equent l y pur chases sex.
( 3) The pr eval ence of HIV i n t he var i ous sent i nel gr oups has mor e or
l ess i mpl i cat i on f or i nci dence needs t o be t aken i nt o consi der at i on
as wel l ( i . e. , t he ampl i f i er ef f ect ) .
Thus, t he pr i or i t y si t es f or HIV- pr event i on emphasi s i ncl ude pr ovi nces wi t h
at l east one of t he f ol l owi ng char act er i st i cs:
1. Pr eval ence of HIV among DSW i s among t he t op 15 pr ovi nces, or
2. Pr eval ence of HIV among ISW i s among t he t op 15 pr ovi nces, and
has one of t he f ol l owi ng char act er i st i cs:
1) Pr eval ence of HIV of mi l i t ar y r ecr ui t s i s among t he t op 15
pr ovi nces
2) Pr eval ence of HIV of ANC cl i ent s i s among t he t op 15
pr ovi nces
Af t er appl yi ng t he l at est HIV pr eval ence dat a ( 2009, except f or mi l i t ar y
r ecr ui t s) t he f ol l owi ng pr i or i t y ar eas ar e der i ved as shown i n Tabl e 6:
It can be seen t hat 25 pr ovi nces meet t he i ni t i al scr eeni ng cr i t er i a. Af t er
appl yi ng al l cr i t er i a, t her e r emai n 15 pr ovi nces as f ol l ows:
1. Cent r al r egi on: 7 pr ovi nces i ncl udi ng Bangkok, Nakor n Sawan,
Samut Songkr am, Sar abur i , Si ngbur i , and Suphanbur i
2. East er n r egi on: 2 pr ovi nces i ncl udi ng Tr ad and Pr achi nbur i
3. Sout her n r egi on: 3 pr ovi nces i ncl udi ng Pr achuap, Nakor n Sr i
Thammar at and Phuket
4. Nor t h r egi on: 2 pr ovi nces i ncl udi ng Pi t sanul oke and Lampang
5. Nor t heast r egi on: 1 pr ovi nce: Udor n Thani
In any event , t hi s r evi ew of t he dat a i s pr el i mi nar y. The r eadi ness and
f easi bi l i t y of i mpl ement i ng i nt ensi ve pr event i on i n t he l ocat i on, al ong wi t h
t he si ze of t he r i sk popul at i on, and i nt egr at i on of t he t ar get popul at i on
shoul d be t aken i nt o consi der at i on bef or e f i nal sel ect i on i s made.
34
Tabl e 6 Di st r i but i on of HIV pr eval ence among sent i nel popul at i ons; r ank of
15 pr ovi nces wi t h hi ghest pr eval ence
Pr ovi nce Di r ect SW Indi r ect SW ANC cl i ent
Ar my r ecr ui t
( 08)
Meet s
cr i t er i a
r ank % r ank % r ank % r ank %
1
Samut
Songkr am 1 21. 21% 1 7. 29% 4 1. 78% 64 0. 00%
/
2 Lampang 2 16. 00% 11 3. 39% 6 1. 66% 63 0. 10% /
3 Sukot hai 3 10. 81% 61 0. 17% 38 0. 35%
4 Phanga 4 9. 83% 2 5. 33% 62 0. 00% 19 0. 60%
5 Tr ad 5 9. 46% 6 4. 42% 5 1. 77% 64 0. 00% /
6 Si ngbur i 6 6. 74% 9 1. 42% 64 0. 00% /
7 Pat hum Thani 7 6. 67% 38 1. 05% 41 0. 59% 23 0. 50%
8 Lopbur i 8 6. 00% 10 3. 60% 28 0. 85% 3 1. 35% /
9
Pr achuap
Ki r i kan 9 5. 26% 25 1. 81% 11 1. 40% 38 0. 35%
/
10 Nakor n Sawan 10 5. 03% 41 0. 75% 46 0. 53% 4 1. 20% /
11 Chumpor n 11 4. 88% 42 0. 58% 47 0. 25%
12 Bangkok 12 4. 47% 43 0. 34% 23 0. 93% 5 1. 10% /
13 Pi t sanul oke 13 3. 70% 32 1. 43% 12 1. 32% 28 0. 45% /
14 Phuket 14 3. 51% 33 1. 42% 10 1. 40% 2 1. 50% /
15 Suphanbur i 15 3. 26% 18 2. 41% 8 1. 56% 33 0. 40% /
16 Yaost hor n 3 5. 15% 62 0. 00% 23 0. 50%
17 Pr achi nbur i 4 4. 74% 2 2. 84% 10 0. 80% /
18 Ayut haya 5 4. 64% 51 0. 41% 28 0. 45%
19 Nakor n Nayok 7 4. 17% 62 0. 00% 64 0. 00%
20
Nong Bua
Lamphu 8 4. 03% 38 0. 61% 33 0. 40%
21 Sar abur i 30 0. 00% 9 3. 64% 19 1. 04% 1 1. 55% /
22 Roi Et 12 3. 33% 22 0. 95% 23 0. 50%
23 Phi chi t 13 2. 90% 62 0. 00% 33 0. 40%
24 Udor n Thani 19 2. 76% 14 2. 82% 58 0. 24% 13 0. 70% /
25
Nakor n Sr i
Thammar at 22 2. 63% 15 2. 80% 18 1. 08% 13 0. 70%
/
Sour ce: HIV sent i nel sur vei l l ance, BOE, DDC
35
2. Est i mat es of HIV and AIDS duri ng 2007 t o 2011
2. 1 Est i mat i ng t he number of new i nf ect i ons
The comput er pr ogr am Asi an Epi demi c Model ( AEM) i nf or ms t he di scussi on of
t he pr oj ect ed AIDS si t uat i on and used dat a f r om t he MOPH HSS and BSS
among ot her sour ces and was f i r st appl i ed i n 2000. The AEM pr ogr am and
basel i ne dat a has been i mpr oved and up- dat ed t hr ough t he i nt egr at ed
anal ysi s and advocacy t o i mpr ove r esponses (A
2
) , ( a col l abor at i on of t he
East - West Cent er , AIDS Resear ch Uni t of t he Thai Red Cr oss, t he Depar t ment
f or Di sease Cont r ol , Fami l y Heal t h Int er nat i onal ( FHI) , and t he U. S. Agency
f or Int er nat i onal Devel opment ( USAID) .
The r esul t s of t he pr oj ect i on whi ch l ooked at past , pr esent and f ut ur e
spr ead of HIV f ound t hat at t he begi nni ng of t he epi demi c, IDUs wer e t he
f i r st t o exper i ence an out br eak wi t h ver y r api d gr owt h of new i nf ect i ons,
f ol l owed by a sl owi ng down of spr ead due l ar gel y t o a sat ur at i on of t he
r el at i vel y smal l popul at i on of suscept i bl es ( Fi gur e 20) .
Not l ong af t er t he IDU epi demi c began, HIV began t o spr ead r api dl y among
SW and t hei r mal e cl i ent s. Because t he men r epr esent ed a l ar ge and mobi l e
popul at i on, HIV spr ead wi del y t hr oughout t he count r y, bot h i n ur ban and
r ur al ar eas. HIV among t hese popul at i ons peaked dur i ng 1990 t o 1995.
Commer ci al sex gener at ed mor e HIV i nf ect i ons ot her r out es of t r ansmi ssi on
and l ed t o a t hi r d epi demi c among women mar r i ed t o men i nf ect ed t hr ough
commer ci al sex and bi - sexual men i nf ect ed by sex wi t ot her men.
An i mpor t ant f act or af f ect i ng r educed t r ends i n HIV spr ead i ncl ude t he
campai gns t o i ncr ease AIDS awar eness and t he 100% Condom Use Pr ogr am
i mpl ement ed i n commer ci al sex est abl i shment s begi nni ng i n 1992. Thai
behavi or st ar t ed t o change on a mass scal e at t hi s poi nt , l eadi ng t o r educed
i nci dence ( Fi gur e 21) . In any event , ef f or t s t o change behavi or i n ot her
popul at i ons wer e spor adi c, and t her e was l ess i mpact on r educed i nci dence
i n t hese gr oups when compar ed t o sex wor ker s and cl i ent s.
36
Fi gur e 20: Est i mat es of t he number of new cases of HIV by popul at i on and
r i sk f act or : 1985- 2010
In t he i ni t i al r esul t s of t he pr oj ect i ons i t i s not ewor t hy t hat dur i ng 2007-
2011 t he pr opor t i on of new cases by r i sk f act or , women i nf ect ed by a
husband or st eady par t ner and men i nf ect ed sexual l y by anot her man
account f or mor e new i nf ect i ons t han ot her gr oups ( Fi gur e 21) . These dat a
cl ear l y show t he cr i t i cal and vul ner abl e aspect s t hat need pr event i on
at t ent i on at pr esent and i n t he near f ut ur e.
Fi gur e 21: Pr oj ect ed new i nf ect i ons by popul at i on and r i sk f act or :
1988 2010
Source: AIDS Projections Working Group and A
2
Thailand
0%
20%
40%
60%
80%
100%
88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 10
Extramarital
Female from Husband
Sex worker
Male from wife
Male from sex worker
Male sex with male
Injection Drug User

0
20000
40000
60000
80000
100000
120000
85 87 89 91 93 95 97 99 '01 '03 '05 '07 '09
Injection Drug User
Male sex with male
Male from sex worker
Male from wi fe
Sex worker
Female from Husband
Extramarital
Sour ce: AIDS Pr oj ect i ons Wor ki ng Gr oup and
37
2. 1 Proj ect i on of AIDS pat i ent s, ART cl i ent s and AIDS deat hs
Thai l and s ART pr ogr am, wi t h suppor t f r om t he NHSP and t he GFATM, has
gr eat l y i mpr oved access t o ARV dr ugs so t hat at l east 200, 000 PLHA ar e
bei ng t r eat ed. Never t hel ess, by l ooki ng at t he pr oj ect i ons dat a f or sur vi vi ng
PLHA pl us t he newl y i nf ect ed, hol di ng t r ends const ant f r om 2005, i t i s
pr oj ect ed t hat t her e wer e a hal f mi l l i on PLHA i n Thai l and i n 2009, wi t h
281, 139 pr ogr essi ng t o a st age r equi r i ng ART. Over t i me, t he number s of
PLHA pl at eau and decr ease i n accor dance wi t h t he ef f ect i veness of t he
cont r ol pr ogr am ( Tabl e 7 and Fi gur e 22) .
Tabl e 7: Number of PLHA and AIDS pat i ent s as proj ect ed f rom t he AEM
Year
Est i mat i on
2005 2006 2007 2008 2009 2010 2011
New HIV
i nf ect i ons
16, 513 15, 174 13, 936 12, 787 11, 753 10, 853 10, 097
Cumul at i ve new
i nf ect i ons
1, 073, 518 1, 088, 692 1, 102, 628 1, 115, 415 1, 127, 168 1, 138, 020 1, 148, 117
Number of new
AIDS cases
50, 254 50, 814 51, 091 50, 657 49, 049 46, 272 42, 992
Number of new
AIDS deat hs
18, 843 20, 797 24, 830 26, 935 27, 680 28, 123 27, 557
Number of
cumul at i ve AIDS
deat hs
513, 268 534, 065 558, 895 585, 830 613, 510 641, 633 669, 191
Tot al number
l i vi ng wi t h
HIV/ AIDS
562, 243 556, 848 546, 578 532, 522 516, 632 499, 324 481, 770
Number el i gi bl e
t o r ecei ve ART*
207, 544 233, 035 252, 388 266, 369 275, 821 281, 139 283, 612
* Est i mat es f r om t he t r eat ment st andar ds i ssued i n 2006- 7 whi ch speci f y i ni t i at i ng ART
when CD4 count i s under 200
38
Fi gur e 22: Est i mat ed number of PLHA el i gi bl e t o r ecei ve ART and
number r ecei vi ng ART accor di ng t o t he AIDS t r eat ment pol i cy of Thai l and

0
50000
100000
150000
200000
250000
300000
90 92 94 96 98 '00 '02 '04 '06 '08 10 12 14 16 18 20 22 24
Not on ART
On ART

Fr om t he pr oj ect i ons dat a i t can be seen t hat Thai l and st i l l has a l ar ge
number of per sons wi t h HIV and AIDS t hat wi l l need on-goi ng car e. If one
al so t akes i nt o consi der at i on t he f ami l i es t he el der l y and chi l dr en who ar e
i mpact ed by AIDS, t her e i s even a gr eat er need f or mat er i al and human
r esour ces, budget , medi cal suppl i es, and dr ugs, i n suf f i ci ent quant i t y t o
meet t he gr owi ng need.
Ther e i s al so a need t o accel er at e coor di nat i on among gover nment agenci es
and NGOs, ci vi l soci et y, and t he communi t y t o achi eve t he maxi mum
ef f ect i veness of t he over al l pr ogr am.
Summary
In sum, t he dat a f r om t he HSS and ot her sour ces show pat t er n of spr ead of
HIV and t hat spr ead of new i nf ect i ons cont i nues i n cer t ai n subgr oups of t he
gener al popul at i on. Inci dence has not decl i ned i n al l gr oups and i s st i l l hi gh
i n t he most - at - r i sk popul at i ons and/ or i s har d- t o- r each. These popul at i ons
i ncl ude IDU, MSM, and i ndi r ect sex wor ker s. In addi t i on, HIV sur vey and BSS
dat a i n yout h show t hat r api d changes i n soci et y, t he economy, and cul t ur e
encour age some yout h t o engage i n r i sk behavi or f or HIV. As st at ed at t he
out set , t hi s pr ovi des an al ar m war ni ng f or Thai l and t o be al er t f or , and t r y
t o pr event , r epeat ed out br eaks of HIV.




Source: AIDS Projections Working Group and A


2
Thailand
39
Nat i onal AIDS Pr event i on and Al l evi at i on Commi t t ee
Subcommi t t ee f or advanci ng
t he pr event i on pr ogr am ef f or t
Subcommi t t ee f or
Pr event i on and Tr eat ment
AIDS Vacci ne Tr i al s
Nat i onal AIDS Management Cent er
Pr ovi nci al AIDS Pr event i on and
Al l evi at i on Subcommi t t ee
Pr ovi nci al AIDS Management
Cent er s
Subcommi t t ee f or Pr ogr am,
Budget , Moni t or i ng and
Eval uat i on f or HIV/ AIDS
Pr event i on and Al l evi at i on
Coor di nat i on
III. Nat i onal Response t o t he AIDS Epi demi cs
1. Nat i onal AIDS Aut hori t y
The Nat i onal AIDS Pr event i on and Al l evi at i on Commi t t ee ( NAPAC) ,
compr i si ng of t he r epr esent at i on of var i ous sect or s f r om t he gover nment t o
ci vi l soci et y, has been r esponsi bl e f or pol i cy maki ng f or t he nat i onal
HIV/ AIDS pr event i on and al l evi at i on pl an f r om 1997 onwar d. NAPAC i s
chai r ed by t he Pr i me Mi ni st er . The Di r ect or Gener al of t he Depar t ment of
Di sease Cont r ol i s t he secr et ar i at , of whi ch t he Nat i onal AIDS Management
Cent er i s r esponsi bl e as t he secr et ar i at of f i ce of t he NAPAC.
At t he count r y l evel , i t compr i ses of 3 Subcommi t t ee i . e. Subcommi t t ee f or
Pr ogr am, Budget , Moni t or i ng and Eval uat i on f or HIV/ AIDS Pr event i on and
Al l evi at i on Coor di nat i on, Subcommi t t ee f or Advanci ng t he HIV/ AIDS
Pr event i on Pr ogr am Ef f or t and Subcommi t t ee f or Pr event i on and Tr eat ment
AIDS Vacci ne Tr i al . At t he pr ovi nci al l evel , t her e i s a Pr ovi nci al AIDS
Pr event i on and Al l evi at i on Sub- Commi t t ee f or each pr ovi nce. ( Fi gur e 23)
Fi gur e 23: St r uct ur e of Nat i onal AIDS Aut hor i t i es
40
2. Nat i onal Int egrat ed HIV/ AIDS St rat egi c Pl an
Thai l and's cur r ent Nat i onal Pl an f or St r at egi c and Int egr at ed HIV and AIDS
Pr event i on and Al l evi at i on 2007- 2011 ( Nat i onal AIDS Pl an ) was devel oped
t hr ough br oad mul t i sect or col l abor at i on and appr oved by t he NAPAC.
Tar get s set by t he end of t he Nat i onal AIDS Pl an i n 2011 ar e: 1) r educi ng
new HIV i nf ect i ons by at l east hal f ; 2) uni ver sal access t o ART f or t hose i n
need and 3) at l east 80% of PLHAs, f ami l i es and t hose af f ect ed by AIDS
access t o soci al suppor t . It s obj ect i ve i s t o i nt egr at e HIV pr event i on and
al l evi at i on st r at egi es at al l l evel s and t o pr omot e mul t i sect or col l abor at i on
and t o pr ovi de i nt egr at ed ser vi ces f or i dent i f i ed popul at i on gr oups. The
Nat i onal Pl an i dent i f i es f our st r at egi es: 1) i mpr oved management t o
i nt egr at e HIV/ AIDS r esponses i n al l sect or s, 2) i nt egr at i on of pr event i on,
car e, t r eat ment and i mpact mi t i gat i on f or each popul at i on gr oup, 3)
HIV/ AIDS r el at ed r i ght s pr ot ect i on and 4) moni t or i ng and eval uat i on coupl ed
wi t h r esear ch on HIV pr event i on and al l evi at i on and emphasi zes t he
i mpor t ance of suppor t i ve publ i c pol i cy and t he empower ment of peopl e t o
pr ot ect t hemsel ves.
3. Progress of Nat i onal Response t o HIV/ AIDS
Thai l and has exper i enced t hr ee decades of t he HIV/ AIDS epi demi c. To t hi s
day, AIDS i s st i l l havi ng an adver se ef f ect on Thai dai l y l i f e, t he heal t h
syst em, and soci o- economi c wel l - bei ng of t he count r y. Even t hough
Thai l and has demonst r at ed st r ong ef f or t s i n t he bat t l e agai nst AIDS, and has
many achi evement s, t hat does not mean t hat Thai l and i s compl acent about
t he chal l enges ahead and t he need t o cont i nue t o i nt ensi vel y f i ght t he
epi demi c.
The r epor t of t he count r y r esponse t o t he HIV epi demi c i s di vi ded i nt o t wo
sect i ons.
x The f i r st par t i s a r evi ew and exami nat i on of pr ogr ess of
i mpl ement at i on i n accor dance wi t h t he Decl ar at i on of Commi t ment
on HIV/ AIDS t o whi ch Thai l and and 188 count r i es wer e si gnat or i es i n
Jul y 2001. Then t her e i s an exami nat i on and an anal ysi s of gaps wi t h
consi der at i on f r om t he vi ewpoi nt of t he gover nment and ci vi l
soci et y. .
x The second par t i s a di scussi on of pr ogr ess of i mpl ement at i on of
HIV/ AIDS pr event i on and cont r ol over t he past t wo year s, whi ch t he
M&E wor ki ng t eams have assembl ed, synt hesi zed and summar i zed t he
r el evant i nf or mat i on on per f or mance t owar d t he UNGASS i ndi cat or s.
41
Part 1
3. 1 Progress t owards t he Decl arat i on of Commi t ment on
HIV/ AIDS, Uni t ed Nat i ons General Assembl y Speci al Sessi on
on HIV/ AIDS, 27 June 2001
Leadershi p
St r ong l eader shi p at al l l evel s of soci et y i s essent i al f or an ef f ect i ve
r esponse t o t he epi demi c.
Leader shi p by Gover nment s i n combat i ng HIV/ AIDS i s essent i al and t hei r
ef f or t s shoul d be compl ement ed by t he f ul l and act i ve par t i ci pat i on of ci vi l
soci et y, t he busi ness communi t y and t he pr i vat e sect or .
Leader shi p i nvol ves per sonal commi t ment and concr et e act i ons.
Decl ar at i on It em 37-38
x Thai l and l aunched nat i onal AIDS pl ans si nce 1995. The cur r ent
pl an per i od i s 2007- 2011. The pl an was devel oped wi t h f ul l
par t i ci pat i on of al l sect or s, wi t h i nt egr at ed pr event i on and
cont r ol . The pl an speci f i es pr i or i t y t ar get gr oups and has made
assur ances f or r i ght s pr ot ect i on. Most of t he budget f or
i mpl ement at i on i s domest i c.
x Despi t e t he pol i t i cal t ur moi l of t he past 3- 4 year s, Thai l and has
st i l l made pr ogr ess i n AIDS because of i t s st r ong
i mpl ement at i on t eam compr i sed of gover nment and ci vi l
soci et y wor ki ng t oget her wi t h PLHA. Wi t h t he cur r ent pr i me
mi ni st er ( Abhi si t Vej j aj i va) chai r i ng t he NAPAC si nce Jul y 2009,
t he pr ogr am has been gi ven added st r engt h and mot i vat i on,
and gi ven t he goal of accel er at i ng pr event i on t o hal ve new
i nf ect i ons by 2011.
x Wi t h decent r al i zat i on gi vi ng t he l ocal admi ni st r at i ve
or gani zat i ons ( LAO) mor e aut hor i t y, t he r ol e of l ocal
l eader shi p i s cr i t i cal f or t he success of t he Nat i onal AIDS Pl an.
In t hi s r epor t per i od, t her e has been a si gni f i cant i ncr ease i n
t he at t empt s t o engage and bui l d capaci t y of t he LAOS i n
pr i or i t y ar eas f or AIDS pr event i on and cont r ol .
x The Thai l and Busi ness Coal i t i on on AIDS has coor di nat ed wi t h
t he busi ness sect or so t hat busi nesses t ake mor e r esponsi bi l i t y
f or HIV/ AIDS pr event i on and cont r ol not onl y f or t hei r
per sonnel but al so f or t he publ i c. Many busi nesses have j oi ned
42
t he ef f or t i ncl udi ng Kasi kor n Bank, St andar d and Char t er s Bank,
and Chevr on.
Prevent i on
Pr event i on must be t he mai nst ay of our r esponse
Decl ar at i on It em 47, 48
x The cur r ent Nat i onal AIDS Pl an cal l s f or t he hal vi ng of new i nf ect i ons
by t he end of t he pl an per i od, and has set behavi or t ar get s f or t he
pr i or i t y gr oups.
Decl ar at i on It em 49, 50
x In 2009, t he NAPAC pr ocl ai med t hat t her e be AIDS i n t he wor kpl ace
pr ogr ams f or al l wor ksi t es, publ i c and pr i vat e, t hr oughout t he count r y.
x Despi t e t he f act t he most of t he budget f or pr event i on wor k wi t h
mi gr ant s and di spl aced per sons comes f r om ext er nal sour ces, t he
MOPH has ar r anged heal t h i nsur ance f or document ed mi gr ant wor ker s
and has submi t t ed pol i cy r ecommendat i ons t o t he NAPAC on
ext endi ng HIV/ AIDS pr event i on and cont r ol ser vi ces t o t hese
vul ner abl e popul at i ons.
Decl ar at i on It em 51
x The MOPH has i ssued gui del i nes f or uni ver sal pr ecaut i ons f or
al l i t s heal t h f aci l i t i es.
x The nat i onal bl ood bank of t he Thai Red Cr oss scr eens ever y
uni t of donat ed bl ood, and t he MOPH has a pol i cy of ensur i ng
t hat al l l abor at or i es under i t s j ur i sdi ct i on per f or m t o st andar d
i nt er nat i onal or domest i c.
Decl ar at i on It em 52, 53
x The cur r ent Nat i onal AIDS Pl an has speci f i ed cl ear t ar get s f or
al l pr i or i t y gr oups. However , due t o decent r al i zat i on of
budget and i mpl ement at i on t o t he pr ovi nce and LAO l evel , t he
amount of coor di nat ed pr event i on act i vi t y has decl i ned.
x The Thai pr ogr am has r ecei ved budget f or pr event i on wi t h
yout h, MSM, sex wor ker s, IDU, mi gr ant s, and pr i son i nmat es.
In addi t i on t o i ncr easi ng cover age of ser vi ces f or t hese gr oups,
Thai l and i s encour agi ng pr ovi nces and LAOS t o mobi l i ze l ocal
sour ces of f unds t o sust ai n i nt er vent i ons i n a cost - ef f ect i ve
way.
43
Decl ar at i on It em 54
x PMTCT i s bei ng i mpl ement ed ef f i ci ent l y i n Thai l and. Tr i pl e t her apy i s
now bei ng used. Ther apy i s t ai l or ed t o t he cl i ent s CD4 cel l count ,
and Thai l and has l aunched t he st ayi ng negat i ve st r at egy i n ANC
cl i ni cs t hr ough pr omot i on of coupl e ANC at t endance. Thus, i t can be
seen t hat t he pr ogr am i s gi vi ng i ncr eased i mpor t ance t o t he heal t h of
t he mot her . In any case, i mpl ement at i on of PMTCT i s st i l l seen as
over l y f ocused on t he i nf ant at t he expense of t he i nf ect ed mot her .
Thi s i s par t i cul ar l y sensi t i ve i n t he ar ea of pl anni ng f or pr egnancy,
car r yi ng a pr egnancy t o t er m, or havi ng an abor t i on based on f ul l y
i nf or med consent and sel f - det er mi nat i on.
Care, support and t reat ment
Car e, suppor t and t r eat ment ar e f undament al el ement s
of an ef f ect i ve r esponse
Decl ar at i on It em 55, 56, 57
x Al l Thai s have r i ght of access t o ART t hr ough t he Uni ver sal
cover age, soci al secur i t y and ci vi l ser vant medi cal benef i t
scheme.
x Ther e i s a net wor k f or managi ng pedi at r i c AIDS t r eat ment ,
wi t h r ef er r al l i nks among t he di f f er ent l evel s of hospi t al s.
x TNP+ t oget her wi t h NGOs has est abl i shed compr ehensi ve
cont i nuum car e cent er s i n col l abor at i on wi t h di st r i ct hospi t al s
t o pr ovi de ser vi ces t o PLHAs.
x ART st i l l does not f ul l y cover mi gr ant s i n Thai l and who ar e
HIV+. The GFATM i s pr ovi di ng suppor t f or ART f or a por t i on of
t hese mi gr ant s.
x Anot her chal l enge i s t hat new cl i ent s f or ART ar e comi ng t oo
l at e i n t he cour se of t hei r i nf ect i on, when t hei r i mmune
syst em has al r eady suf f er ed sever e damage.
HIV/ AIDS and human ri ght s
Real i zat i on of human r i ght s and f undament al f r eedoms f or
Al l i s essent i al t o r educe vul ner abi l i t y t o HIV/ AIDS
Respect f or t he r i ght s of peopl e l i vi ng wi t h HIV/ AIDS dr i ves
an ef f ect i ve r esponse
44
Decl ar at i on It em 58, 59
x Thai l and has l aws, pol i ci es, or der s, and di r ect i ves f or human
r i ght s pr ot ect i ons, and t hese ext end t o PLHA i n most cases.
x The Foundat i on f or AIDS Ri ght s pr oduced t he r epor t of a st udy
r evi ewi ng l aws and pol i ci es on human r i ght s and AIDS r i ght s,
and t he r epor t of t he si t uat i on of human r i ght s r el at ed t o
HIV/ AIDS i n Thai l and ( 2007 and 2008) . The TPN+ conduct ed a
st udy of st i gma and di scr i mi nat i on t owar d PLHA i n 2009, whi l e
t he NGO Coal i t i on on AIDS pr oduced a r epor t anal yzi ng pol i cy
as a r esponse t o AIDS seen t hr ough t he l ens of sexual and
r epr oduct i ve heal t h r i ght s. Even t hough Thai l and has r at her
good pol i ci es i n pl ace, t hese ar e not al ways i mpl ement ed i n
pr act i ce. Human r i ght s r el at ed t o AIDS st i l l don t r ecei ve
opt i mal pr i or i t y, and i mpl ement at i on at t he per i pher al l evel i s
of t en not consi st ent wi t h t he nat i onal pol i cy
Decl ar at i on It em 60, 61
x Fr om t he vi ew of ci vi l soci et y, suppor t and pr ovi si on of heal t h
ser vi ces t hat ar e consi st ent wi t h a r i ght s per spect i ve i nt er act
wi t h many di f f er ent di mensi ons of t he pr ogr am and whi ch can
i nf r i nge on human and r epr oduct i ve heal t h r i ght s. For
exampl e, t he pr ovi der s of t he PMTCT ser vi ce, HIV VCT, and
user - f r i endl y ser vi ces f or yout h, women and vul ner abl e
popul at i ons, need i mpr oved awar eness of t he need t o r espect
cl i ent r i ght s i ncl udi ng an under st andi ng t he di ver si t y of sex
l i f est yl es, gender and sexual i t y.
Reduci ng vul nerabi l i t y
The vul ner abl e must be gi ven pr i or i t y i n t he r esponse
Empower i ng women i s essent i al f or r educi ng vul ner abi l i t y
Decl ar at i on It em 62, 63, 64
x Dur i ng 2008- 2009 t he AIDS pr event i on accel er at i on sub-
commi t t ee r evi ewed t he suppor t f or di f f er ent agenci es i n t he
publ i c and pr i vat e sect or s.
x Pr event i on act i vi t i es f or yout h and most - at - r i sk gr oups, as
suppor t ed by t he GFATM, use t he st r at egy of r ai si ng AIDS
awar eness and ski l l s bui l di ng t o pr ovi der s f or a bet t er
under st andi ng of sex, gender and sexual i t y. Ot her ser vi ces
i ncl ude condom and l ubr i cant di st r i but i on.
45
x To r educe vul ner abi l i t y of t he f ami l y, t he Nat i onal AIDS Pl an i s
t r yi ng coupl e ANC t o i ncr ease mal e par t i ci pat i on t o addr ess t he
f emi ni zat i on of t he epi demi c ( see Best Pr act i ces) .
Chi l dren orphaned and made vul nerabl e by HIV/ AIDS
Chi l dr en or phaned and af f ect ed by HIV/ AIDS need speci al assi st ance
Decl ar at i on It em 65, 66
x Or phans and non- or phans have equal access t o educat i on.
x Thai l and l acks st r at egi c i nf or mat i on about or phans and chi l dr en
af f ect ed by HIV/ AIDS. Most of t he assi st ance i s i n t he f or m of
wel f ar e, when chi l dr en al so need psycho- soci al suppor t .
x Anot her chal l enge i s when pedi at r i c PLHA age i nt o adol escence.
Ther e i s a need f or ser vi ce pr ovi der s t o under st and t hei r needs
r el at i ng t o r epr oduct i ve heal t h.
Al l evi at i ng soci al and economi c i mpact
To addr ess HIV/ AIDS i s t o i nvest i n sust ai nabl e devel opment
Decl ar at i on It em 68
x In t he nat i onal soci o- economi c devel opment pl an f or 2007-
2011, t her e i s di scussi on of t he i mpact on t he economy and
soci et y. Ther e shoul d be a r evi ew of t hi s i mpact conduct ed i n
2010 t o ser ve as backgr ound dat a f or pl anni ng i n t he next
phase.
Decl ar at i on It em 69
x The gui del i nes f or AIDS pr event i on and management i n t he
wor kpl ace ( 2009) have an i mpor t ant sect i on on r i ght s
pr ot ect i on of wor ker s.
Resear ch and devel opment
Wi t h no cur e f or HIV/ AIDS yet f ound,
f ur t her r esear ch and devel opment i s cr uci al
Decl ar at i on It em 70, 71, 72, 73, 74
x Thai l and has compl et ed a Phase 3 st udy of an AIDS vacci ne.
x Ther e ar e r esear ch st udi es i n t he cl i ni cal , behavi or al , and
devel opment ar eas bei ng i mpl ement ed by many agenci es.
However , t her e i s no over al l summar y or r evi ew of t hese
r esul t s i n or der t o ser ve as a dat abase t o gui de f ut ur e r esear ch.
46
HIV/ AIDS i n conf l i ct and di sast er-af f ect ed regi ons
Conf l i ct s and di sast er s cont r i but e t o t he spr ead of HIV/ AIDS
Decl ar at i on It em 77, 78
x The mi l i t ar y and pol i cy have on- goi ng AIDS pr event i on and
cont r ol pl ans and pr ogr ams.
Resources
The HIV/ AIDS chal l enge cannot be met wi t hout new, addi t i onal
and sust ai ned r esour ces
Decl ar at i on It em 82, 85
x Ful l y 80-90% of t he AIDS budget i s suppor t ed f r om domest i c
sour ces; but t he pr opor t i on t hat goes f or pr event i on i s
r el at i vel y smal l .
x The chal l enge i s how t o mobi l i ze enough r esour ces f or
cont i nui ng t he pr event i on and cont r ol act i vi t i es t hr ough t he
LAOs.
Fol l ow-up
Mai nt ai ni ng t he moment um and moni t or i ng pr ogr ess ar e essent i al
Decl ar at i on It em 94, 95, 96
x The NAPAC has set up 16 wor ki ng gr oups wi t h r epr esent at i ves
f r om t he gover nment , ci vi l soci et y, exper t s and i nt er nat i onal
or gani zat i ons. These gr oups col l abor at ed t o pr oduce t hi s r epor t ,
as wel l as pr oduci ng a f r amewor k f or moni t or i ng and eval uat i on
of t he pr ogr am goi ng f or war d.
47
Part 2:
3. 2 Nat i onal Commi t ment and Act i on
3. 2. 1 Nat i onal AIDS Spendi ng Assessment (NASA)
Thai nat i onal AIDS expendi t ur es i n 2008 t ot al ed 6. 928 bi l l i on baht or 110
baht per capi t a, or 14, 275 baht per si ngl e PLHA ( f r om an est i mat e of
485, 325 PLHA) . Thi s r epr esent ed 0. 08% of t he GDP i n 2008 or 1. 9% of al l
heal t h expendi t ur e. In 2009 AIDS expendi t ur e i ncr eased sl i ght l y t o 114 baht
per capi t a or 14, 417 baht per si ngl e PLHA ( Tabl e 4, Annex 7) .
Tabl e 8: Thai AIDS expendi t ur e ( i n baht ) by t ype of expendi t ur e i n 2008 and
2009
2008 2009
Type of expendi t ure
mi l l i on
baht
% mi l l i on
baht
%
Pr event i on 1, 500 21. 7 987 13. 7
Car e and t r eat ment 4, 560 65. 8 5, 483 76. 1
Assi st ance f or or phans and vul ner abl e chi l dr en
af f ect ed by AIDS
50 0. 7 52 0. 7
Management and st r engt heni ng pl anni ng 397 5. 7 250 3. 5
Compensat i on f or st af f and per sonnel 44 0. 6 208 2. 9
Ri ght s pr ot ect i ons and soci al ser vi ces not
i ncl udi ng suppor t f or chi l dr en/ or phans af f ect ed
by AIDS
219 3. 2 171 2. 4
Impr ovi ng t he envi r onment f or i mpl ement at i on
and communi t y devel opment
2 0. 0 8 0. 1
Resear ch not i ncl udi ng oper at i onal r esear ch 156 2. 3 49 0. 7
Tot al 6, 928 100. 0 7, 208 100. 0
Fr om Tabl e 8 most Thai AIDS expendi t ur e was f or car e and t r eat ment ( 66%
i n 2008 and 76% i n 2009) . Pr event i on expendi t ur e was 22% i n 2008 and
decl i ned t o 14% i n 2009. The ot her component s consume onl y smal l
por t i ons of t he over al l budget .
The sour ces of f undi ng f or AIDS ar e al most al l domest i c ( 85%i n 2008 and 93%
i n 2009) and ar e i n t he f or m of car e and t r eat ment ( 71%i n 2008 and 80%i n
2003) . Funds f r om ext er nal sour ces ar e decl i ni ng, f r om 17%i n 2007, 15%i n
2008 and 7%i n 2009. Appr oxi mat el y one- t hi r d of ext er nal i n budget i n 2009
was t o suppor t per sonnel , f ol l owed by 29%f or pr event i on act i vi t i es, 17%f or
management , and 15%f or car e and t r eat ment .
The Nat i onal Heal t h Secur i t y Pr ogr am ( NHSP) i s t he l ar gest domest i c sour ce
of f unds as i t account s f or hal f of al l expendi t ur es. The gover nment ci vi l
ser vi ce and soci al wel f ar e pr ogr am account ed f or 12%t o 15%each. Al most
al l of t hi s suppor t was f or car e and t r eat ment of PLHA.
When anal yzi ng per capi t a expendi t ur e per si ngl e PLHA i n 2009 wi t h 2007 i t
can be seen t hat per capi t a expendi t ur e i ncr eased mar kedl y f r om $333 i n
2007 t o $415 i n 2009. Thi s i ncr ease i s expl ai ned by t he r educed number of
48
new i nf ect i ons combi ned wi t h an i ncr ease of PLHA on ART or who swi t ched
f r om f i r st - l i ne t o second- l i ne r egi mens due t o vi r al r esi st ance.
Tabl e 9 Det ai l s of car e and t r eat ment expendi t ur es dur i ng 2008- 2009
2008 2009
Expendi t ure component
mi l l i on
baht
% mi l l i on
baht
%
Tot al 4, 560 100 5, 483 100
1 ARV dr ugs 2, 031 45 3, 125 57
2 In- pat i ent car e 942 21 1, 042 19
3 Out - pat i ent car e 420 9 491 9
4 Moni t or i ng t he ef f ect of t r eat ment t hr ough
l ab t est s
697 15 373 7
5 OI pr ophyl axi s 190 4 215 4
6 Nut r i t i onal suppl ement s 141 3 139 3
7 Mai nt enance car e 67 1 75 1
8 Home- based car e 50 1 11 0
9 Ot her , non- speci f i c 20 1 7 0
10 Psycho- emot i onal car e 4 0 5 0
Sour ce: Modi f i ed f r om Tabl e 10 i n Annex 7

Tabl e 9 shows det ai l of expendi t ur es by car e and t r eat ment component . It
can be seen t hat expendi t ur e i n 2009 i ncr eased t o 5. 483 bi l l i on baht , mor e
t han hal f ( 57%) of whi ch was f or ARV dr ugs; 28%was f or OI t r eat ment ( bot h
i n- and out - pat i ent ) ; 7% was f or l abor at or y moni t or i ng, 4% was f or OI
pr ophyl axi s; and 4%f or ot her car e and t r eat ment .
Expendi t ur e f or ARVs i ncr eased f r om 2. 031 bi l l i on baht i n 2008 t o 3. 125
bi l l i on baht i n 2009, or 54%i n a si ngl e year . Thi s was due t o an i ncr ease of
PLHA st ar t i ng f i r st - l i ne t r eat ment ( f r om 96, 119 t o 108, 924 r espect i vel y) and
an i ncr ease of PLHA t aki ng second- l i ne r egi men ARVs f r om 2, 998 t o 5, 572 i n
2008 and 2009, r epr esent i ng an 86% i ncr ease i n one year . Thi s had t he
ef f ect of i ncr easi ng t he cost of ARV dr ugs per PLHA f r om 10, 728 baht t o
16, 162 i n 2008 and 2009.

Tabl e 10 shows det ai l s on pr event i on component expendi t ur es. It can be
seen t hat pr event i on expendi t ur es decr eased f r om 1. 5 bi l l i on baht i n 2008
t o 0. 987 bi l l i on baht i n 2009, f or a 34%decl i ne i n one year . Appr oxi mat el y
one- t hi r d of expendi t ur es f or pr event i on wer e f or pr ot ect i ng t he bl ood bank
suppl y, and one- f i f t h was f or ARVs f or pr event i on such as f or PMTCT and PEP.
Pr event i on of r i sk behavi or consumed about one- f our t h of t he budget i n
2008 and i ncr eased t o 38%i n 2009. Expendi t ur e f or condoms was onl y 3%of
t he t ot al pr event i on cost s.
In sum, Thai AIDS expendi t ur es dr ew pr i mar i l y on domest i c sour ces of f unds
and most of i t was f or car e and t r eat ment of PLHA. Expendi t ur es f or
pr event i on wer e smal l by compar i son and t hese wer e most l y suppor t ed by
ext er nal sour ces, especi al l y t hat f or pr event i on of r i sk behavi or i n pr i or i t y
popul at i ons. Expendi t ur e f or condoms was ver y smal l , and was pr obabl y l ess
49
t han i s needed t o achi eve t he t ar get of hal vi ng t he number of new
i nf ect i ons by 2011.
Tabl e 10: Det ai l s of AIDS Pr event i on Expendi t ur e dur i ng 2008- 2009
2008 2009
Component s of Expendi t ure
mi l l i on baht % mi l l i on
baht
%
Tot al Prevent i on Expendi t ure 1, 500 100 987 100
1 Saf e bl ood suppl y 404 27 343 35
2 PMTCT 136 9 131 13
3 Post - exposur e pr ophyl axi s ( PEP) 6 0 105 11
4 Pr event i on i n school s 118 8 78 8
5 Mass medi a 30 2 48 5
6 HIV VCT 23 2 37 4
7 Har m r educt i on f or IDU 2 0 36 4
8 AIDS i n t he wor kpl ace 48 3 34 3
9 Condom di st r i but i on and mar ket i ng 51 3 23 2
10 Out - of -school yout h pr event i on 100 7 22 2
11 Pr event i on f or vul ner abl e popul at i ons and
ot her speci al gr oups
26 2 20 2
12 Impr oved STI case management 7 0 19 2
13 Pr event i on f or MSM 7 0 8 1
14 Wor ki ng wi t h communi t i es 2 0 7 1
15 Pr event i on f or posi t i ves 5 0 5 1
16 Pr event i on f or sex wor ker s and cl i ent s 10 1 4 0
17 Femal e condoms 0 0 1 0
18 Ot her , unspeci f i ed 525 35 65 7
Sour ce of dat a: Modi f i ed f r om Tabl e 11 i n Annex 7
The i ncr easi ng cost of t r eat ment ( especi al l y ART) i ncr eased 54%i n one year ,
and i s at t r i but abl e t o new cases i ni t i at i ng ART and an i ncr ease of PLHA
swi t chi ng f r om f i r st - t o second- l i ne r egi mens due t o vi r al r esi st ance. The
ARVs i n t he second- l i ne r egi mens ar e 1. 5 t i mes mor e expensi ve t han t hose i n
t he f i r st - l i ne r egi mens. Thus, mor e emphasi s needs t o be gi ven t o
pr event i on t o hel p r educe t he number of new cases of i nf ect i on whi ch wi l l
r educe t he over al l t r eat ment cost s i n t he f ut ur e.
50
3. 2. 2 Nat i onal Composi t e Pol i cy Index
3. 2. 2. 1 Vi ewpoi nt s of government al of f i ci al s
St rat egi c Pl an
Thai l and has est abl i shed t he Nat i onal AIDS Pl an whi ch i nt egr at ed
col l abor at i on f r om key gover nment par t ner s f or 12 year s. Pr esent l y, t he 4
t h
Nat i onal AIDS Pl an 2007- 2011 has been est abl i shed whi ch empl oyed 4
st r at egi es and cl ear l y speci f i ed t ar get popul at i on f or HIV pr event i on. The
pl an di d not assi gn t o al l ocat e budget i n suppor t i ng AIDS pr ogr ams f or key
gover nment par t ner s. However , t he gover nment par t ner s ut i l i zed t he pl an
i n desi gni ng AIDS pr ogr ams f r amewor k and seeki ng suppor t i ve f unds f or t hei r
own. Sour ce of t hei r f undi ng i ncl uded t he Nat i onal Heal t h Secur i t y Of f i ce,
i nt er nat i onal agenci es and l ocal f unds i ncl udi ng sub- di st r i ct heal t h f unds,
l ocal admi ni st r at i ve gover nment and budget of pr ovi nci al st r at egi c pl an.
In addi t i on, count r y i ni t i at ed a si gni f i cant pl an under t he Nat i onal AIDS Pl an
f r amewor k dur i ng 2008- 2009. Thi s i ncl uded t he pl an on HIV pr event i on
among yout hs and most - at - r i sk popul at i ons whi ch was suppor t ed by t he
GFATB and t he accel er at ed pl an i n hal vi ng HIV i nci dence among yout hs and
most - at - r i sk popul at i ons by 2011.
Al t hough Thai l and has f avour abl e pol i ci es t hat pr omot e AIDS pr ogr am ef f or t s,
t her e st i l l ar e uncl ear i n sex educat i on i n school , har m r educt i on pol i cy and
heal t h car e scheme f or mi gr ant s. However , a new pol i cy was i ni t i at ed t o
pr omot e AIDS pr event i on and management i n wor kpl ace bot h gover nment
and pr i vat e sect or s i n August 2009.
Pol i t i cal support s
Dur i ng 2008- 2009, i t was cl ear t hat AIDS pr event i on and management
r ecei ved pol i t i cal suppor t s. The Pr i me Mi ni st er chai r ed t he Nat i onal AIDS
Commi t t ee meet i ng by hi msel f and t o be pr esent er on AIDS campai gn i n
publ i c medi a. It br ought about a mor e at t ent i on on AIDS among key
gover nment par t ner s. The accel er at ed pl an i n hal vi ng HIV i nci dence among
yout hs and most - at - r i sk popul at i on by 2011 was endor sed. Key measur es of
t hi s pl an i ncl uded publ i c communi cat i on, condom pr omot i on and HIV
pr event i on among yout hs and most - at - r i sk popul at i on. Joi nt KPI t o pr omot e
col l abor at i on of al l sect or s was al so speci f i ed. Wor k st r at egi es f ocused on
bui l di ng compet ent net wor ks, encour agi ng l ocal admi ni st r at i ve gover nment
and pr ovi nci al gover nment t o mobi l i ze AIDS wor ks cont i nuousl y and
sust ai nabl y.
51
Prevent i on
Al t hough t he Nat i onal AIDS Pl an speci f i ed cover i ng t ar get popul at i on,
st r at egi es and measur es i n HIV pr event i on, suppor t f unds t o i mpl ement AIDS
pr ogr ams f r om gover nment agency was l i mi t ed. Obst acl es wer e ei t her
budget decr eased by l i mi t at i on of count r y f i nanci al st at us, l aw and pol i cy
not suppor t i ng AIDS wor ks wi t h speci f i c t ar get popul at i on or l ack of
gover nment agency and ci vi l soci et y wor ki ng on HIV pr event i on pr ogr am.
However , pr ogr ess r ef l ect i ng AIDS ef f or t s at t hi s r ound was seen. The wor k
pl an on HIV pr event i on among yout hs and most - at - r i sk popul at i ons
suppor t ed by t he GFATB has i ncr eased HIV i nt er vent i ons cover age and
est abl i shed mechani sm cal l ed pr ovi nci al coor di nat i ng mechani sm ( PCM) t o
mobi l i ze AIDS act i vi t i es i n pr ovi nci al l evel .
Treat ment , support and care
Thai l and has pr ovi ded uni ver sal and equal access t o ant i - r et r ovi r al t her apy
( ART) f or PHLA under t he heal t h car e scheme t hr ough ef f ect i ve
col l abor at i on bet ween gover nment sect or s and ci vi l soci et y i ncl udi ng PLHA
net wor ks.
In t er ms of suppor t and car e f or peopl e af f ect ed by HIV/ AIDS, t her e st i l l ar e
concer ni ng i ssues t hat need t o be addr essed. Ol d peopl e af f ect ed by
HIV/ AIDS t hat ar e not yet come t o at t ent i on f or pol i cy maki ng. Incr ease
st andar d f or bot h gover nment and pr i vat e or phanages r emai ns chal l engi ng.
In addi t i on, l ack of dat abase t o i dent i f y magni t ude of pr obl em and si t uat i on
of or phans and chi l dr en af f ect ed by HIV/ AIDS causes t o def i ci ent syst emat i c
and ef f ect i ve nat i onal pl an.
Moni t ori ng and Eval uat i on
Thai l and cal l s f or devel opi ng an uni f i ed M&E syst em on AIDS pr event i on and
management by speci f yi ng cl ear l y M&E st r uct ur e, est abl i shi ng 16 nat i onal
wor ki ng gr oups, and st r engt heni ng pr ovi nci al M&E syst em.
In 2009, Nat i onal M&E pl an on speci f i c t ar get popul at i ons and pr ogr am ar ea
have been devel oped. However , a cost ed M&E wor k pl an i s st i l l mai n
chal l enge. In t ot al of 17 gover nment agenci es par t i ci pat ed i n t he sur vey, i t
f ound onl y 3 or gani zat i ons had M&E pl an wi t h budget . Whi l e 5 of t hem had
M&E pl an but l ack of r esour ce avai l abl e, and t he r est had no pl an.
Fur t her mor e, t he maj or i t y of gover nment agenci es had no act i on pl an t o
st r engt hen M&E syst em. Int egr at ed super vi si on i s a M&E pr ocess i n or der t o
encour age t he pr ovi nci al AIDS sub- commi t t ee t o ef f ect i vel y i mpl ement AIDS
act i vi t i es and mobi l i ze l ever age l ocal r esour ces.
52
3. 2. 2. 2 Vi ewpoi nt s of ci vi l soci et y
A. Human ri ght s: support f or ri ght s and respect f or humani t y
Fr om t he 2009 r evi ew by t he Foundat i on f or AIDS Ri ght s, i t can be sai d t hat
Thai l and has f avor abl e l aws t hat pr omot e t he pr event i on pr ogr am ef f or t s
i ncl udi ng t he Thai Const i t ut i on ( as r evi sed i n 2007) , cr i mi nal , ci vi l and
commer ci al l aws, t he Nat i onal Heal t h Secur i t y Pr ogr am ( NHSP) , Nat i onal
Heal t h Law, Pat ent Law, Labor Law, and Chi l d Pr ot ect i on Law. Ther e ar e
al so nat i onal gui del i nes f or pr event i on and cont r ol of AIDS i n var i ous t ypes
of wor k si t es, as announced on August 21, 2009. Al l of t hi s shows t hat
Thai l and has l egal st r at egi es and pol i ci es t hat ar e f avor abl e f or AIDS cont r ol
wor k.
Even t hough Thai l and has f avor abl e pol i ci es i n many ar eas, t her e st i l l ar e
obst acl es t hat ar e not bei ng addr essed. The human r i ght s st r at egy i s st i l l not
ver y i nf l uent i al i n t he ar ea of AIDS and, at t he i mpl ement at i on l evel , i t has
not advanced i n a way t hat i s consi st ent wi t h t he changi ng ci r cumst ances.
The r i ght s moni t or i ng st r at egy needs t o be st r engt hened i n t he ar ea of AIDS,
i ncl udi ng syst em st r engt heni ng f or r i ght s pr ot ect i on at t he st r uct ur al and
i mpl ement at i on l evel s so t hat t hey ar e har moni zed.
In t he pr ocess of pr esent i ng t he r epor t of pol i cy anal ysi s of t he r esponse t o
AIDS by t he NAPAC i n 2009, t her e was r ef er ence t o t he chal l enge of
suppor t i ng t he r espect f or humani t y and el i mi nat i on of st i gma and
di scr i mi nat i on by no l onger vi ewi ng or usi ng t he t er m r i sk gr oup or
hi ghest r i sk gr oup . Thi s st i gmat i zes t hose i ndi vi dual s as spr eader s of HIV
and a soci al enemy. Thi s r esul t s i n t hei r bei ng vi ewed unequal l y, and causes
t hem t o suf f er di scr i mi nat i on i n a way t hat pr event s t hem f r om exer ci si ng
f r ee wi l l i n maki ng t hei r l i f e deci si ons i n a saf e and const r uct i ve way.
B. Impl ement at i on of heal t h servi ces
Thai l and has a cl ear pol i cy and i ncr eased suppor t f or pr event i on. Thi s
i ncl udes t he cr eat i on of a subcommi t t ee t o accel er at e HIV pr event i on and
t he pol i cy t o r educe i nci dence by hal f by 2011, and t he addi t i onal f undi ng t o
make t hi s happen f r om t he GFATM Round 8 t o cont i nue act i vi t i es st ar t ed
under pr evi ous r ounds and pr ovi de gr eat er emphasi s t o t he vul ner abl e
popul at i ons of IDU, MSM, SWs, and mi gr ant l abor er s. Repr esent at i ves f r om
t he benef i ci ar y popul at i ons pl ayed a gr eat er r ol e i n st r at egi c pl anni ng or
pol i cy f or mul at i on and i mpl ement at i on at t he nat i onal and pr ovi nci al l evel .
In t he ar ea of PMTCT, t he ART r egi men was i mpr oved t o i ncl ude t r i pl e
t her apy wi t h expansi on f r om pi l ot t o nat i onal cover age st ar t i ng i n Oct ober
2010. The St ayi ng Negat i ve Pr oj ect was l aunched i n MCH cl i ni cs whi ch
advocat ed coupl e counsel i ng. These devel opment s r ef l ect a gr eat er
53
at t ent i on t o t he mot her / wi f e i n t he f ami l y. Qual i t y of l i f e pr omot i on was
al so f eat ur ed al ong wi t h sex and r epr oduct i ve heal t h r i ght s f or PLHA,
st ar t i ng wi t h t hose i ni t i at i ng ART and women appear i ng f or ANC who l ear n
t hat t hey ar e i nf ect ed. Thi s ef f or t i s bei ng expanded t o nat i onal cover age.
Har m r educt i on i nvol ves many sect or s and pl ayer s, i ncl udi ng t he l egal and
j ust i ce syst em. Nat i onal l evel commi t t ees wer e f or med and l ear ned mor e
about t he act ual si t uat i on of vul ner abl e popul at i ons, and t hi s i ncr eased
concer n f or t he need f or ser vi ces. Met hadone mai nt enance t her apy ( MMT)
was added t o t he benef i t s of f er ed by t he NHSP st ar t i ng i n Oct ober 1, 2008.
The NAPHA ext ensi on pr oj ect i mpr oved t r eat ment access f or 2, 000 mi gr ant s,
et hni c mi nor i t i es and undocument ed per sons. HIV VCT, condoms r e- suppl y
and har m r educt i on was i nt r oduced i nt o pr i son popul at i ons on a pi l ot basi s
and t he ser vi ce model i s bei ng r ef i ned. For chi l dr en, t her e i s a commi t t ee
t hat moni t or s t he r i ght s of t he chi l d under t he Mi ni st r y of Soci al Wel f ar e and
Human Secur i t y. The f ocus i s on chi l dr en af f ect ed by AIDS bot h i nf ect ed
and uni nf ect ed. In addi t i on, t her e has been model devel opment by t he We
Under st and gr oup i n col l abor at i on wi t h cl i ni cal and t echni cal medi cal
ser vi ces t o bui l d t he capaci t y of chi l dr en and yout h wi t h HIV so t hat t hey
can act i vel y par t i ci pat e i n AIDS wor k.
One ar ea of chal l enges i s t hat t he PMTCT pr ogr am st i l l over l y emphasi zes
t he heal t h of t he i nf ant . It does not consi der t he woman s body, her
deci si on opt i ons, and pr egnancy pl anni ng, car r yi ng t he pr egnancy, or
choosi ng abor t i on. These deci si ons need t o be based on compr ehensi ve
i nf or mat i on f or t he pr egnant woman and her par t ner . VCT ser vi ces i n MCH
cent er s f or pr egnant women ar e not yet t ot al l y vol unt ar y.
Ther e i s a need f or gr eat er r espect f or t he r epr oduct i ve heal t h r i ght s of t he
woman based on user - f r i endl y sexual heal t h ser vi ces, wi t h pr omot i on of
mor e coupl e- based ser vi ces f or ANC cl i ent s t o hel p women communi cat e
t hei r f eel i ngs and wi shes t o t hei r par t ner .
Pr omot i ng r i ght s of access t o ser vi ces f or undocument ed mi gr ant i s l acki ng
suppor t i ve pol i cy, and t hi s i s an obst acl e t o access t o ser vi ces such as l ack
of a compr ehensi ve har m r educt i on pol i cy. Use of t he l aw on pr ost i t ut i on t o
har ass and ar r est pr ost i t ut es or MSM who car r y condoms as evi dence of
cr i me i s count er pr oduct i ve. Mi gr ant s or et hni c mi nor i t i es or ot her s who ar e
i n Thai l and i l l egal l y ar e al so har d t o r each and can t access t r eat ment si nce
t hey ar e not el i gi bl e f or t he ART pr ogr am under t he NHSO, or because t he
NAPHA ext ensi on quot a of 2, 000 was al r eady f i l l ed. Et hni c mi nor i t i es, or hi l l
54
peopl e, bot h document ed and undocument ed, can t of t en exer ci se t hei r
r i ght s t o ser vi ce under t he NHSO, or t hey r ecei ve di sr espect f ul ser vi ce.
Concer ni ng ser vi ces i n pr i sons i t i s f ound t hat most pr i soner s don t
under st and t hei r r i ght s, and aut hor i t i es usual l y over l ook t hese gaps and
don t want t he pr i soner s t o know what t hey ar e ent i t l ed t o. Tr eat ment i s
sl ow t o ar r i ve and pr i soner s wi t hout t he 13- di gi t ID car d ar e not el i gi bl e f or
subsi di zed car e.
Car e f or chi l dr en af f ect ed by AIDS i n or phanages ( publ i c and pr i vat e) i s
under st andar d i n some cases and can be consi der ed a r i ght s vi ol at i on.
These i ncl ude segr egat i on of sl eepi ng quar t er s, and i nappr opr i at el y usi ng
chi l dr en f or f und- r ai si ng. Ther e shoul d be t r ai ni ng and i nf or mat i on
di ssemi nat i on f or t he r el evant st af f wi t h t he Mi ni st r y of Soci al Wel f ar e as
t he r esponsi bl e agency.
C. Promot i ng knowl edge and educat i on
The DOH of t he MOPH has st udi ed t he cont ent of sex educat i on and
i mpr oved t hi s so t hat i t i s mor e compr ehensi ve, and submi t t ed t hi s t o t he
Mi ni st r y of Educat i on f or i nt egr at i on i nt o t he f or mal school heal t h educat i on
cur r i cul um over a per i od of t i me st ar t i ng i n 2002. The Teenpat h pr oj ect has
t aken sex educat i on f ur t her t o cr eat e a Compr ehensi ve Sex Educat i on ( CSE)
cur r i cul um, however , t he cur r i cul um i s st i l l most l y used as gui dance, and i t
i s up t o t he di scr et i on of t he t eacher whet her and how t o appl y i t . The
Mi ni st r y of Educat i on has st i l l not adopt ed t he CSE appr oach i nt o t he f or mal
cur r i cul um.
Ci vi l soci et y r ecommends t hat t her e be suppor t f or CSE on a cont i nuous
basi s wi t h gr eat er cover age i n t he f or mal and non- f or mal educat i onal
syst ems. The t eacher s capaci t y and at t i t udes need st r engt heni ng. The
subcommi t t ee f or accel er at ed HIV pr event i on has t o consi der measur es t o
advance t hi s as par t of t he human r i ght s appr oach, as an adol escent s r i ght
t o accur at e and pr act i cal i nf or mat i on about sex t hr ough CSE.
D. St ruct ure and st rat egi es f or pol i cy devel opment , pl anni ng and
i mpl ement at i on
Ther e was pr ogr ess i n r ef or mi ng t he st r uct ur e t o i ncr ease st r at egi es f or
accel er at ed act i on of t he NAPAC on Apr i l 4, 2007 t o cr eat e t he
subcommi t t ee f or cont r ol and accel er at i on of AIDS pr event i on whi ch has t he
aut hor i t y t o moni t or consi st ency of i mpl ement at i on wi t h t he gui del i nes such
as mor e i nt egr at ed and t r anspar ent i mpl ement at i on t o i ncr ease cost -
ef f ect i veness. At t he same t i me t her e wer e modi f i cat i ons t o t he st r at egy f or
accel er at ed act i on at t he pr ovi nci al l evel t hr ough t he Pr ovi nci al
Coor di nat i ng Mechani sm whi ch can be consi der ed a new el ement of t he
pr ovi nci al st r uct ur e t o manage nat i onal budget and l ocal r esour ces f or AIDS
pr event i on and cont r ol .
55
Ther e i s a need, at t he nat i onal and pr ovi nci al AIDS commi t t ee l evel s, f or
i ndependent deci si on- maki ng and l ocal par t i ci pat i on f r om var i ous sect or s i n
accor dance wi t h decent r al i zat i on of aut hor i t y t o mor e aggr essi vel y addr ess
t he pr obl ems of AIDS i n a mor e par t i ci pat or y and cost - ef f ect i ve way.
Ci vi l soci et y r ecogni zes t hat t he GFATM assi st ance has gal vani zed pr event i on
i nt er vent i ons at t he communi t y l evel wi t h mor e gr assr oot s agenci es i nvol ved,
however t her e i s i nadequat e shar i ng of exper i ence acr oss t hese agenci es.
Thi s i s par t l y due t o t he st yl e of management of gr ant s by t he Pr i nci pal
Reci pi ent whi ch does not encour age shar i ng among t he sub- r eci pi ent s.
Anot her ar ea of concer n i s t hat t he Thai pr ogr am ( i ncl udi ng ci vi l soci et y) i s
now t oo dependent on t he GFATM assi st ance. Ther ef or e, t he gover nment
and ci vi l soci et y need t o br ai nst or m t oget her on how t o pr oceed i n a post -
GFATM wor l d and how t hat wi l l af f ect i nt er vent i ons, and devi se an
appr opr i at e st r at egy f or mobi l i zi ng f unds t o cont i nue t he success and cost -
ef f ect i ve i mpl ement at i on t hat has occur r ed so f ar .
In addi t i on, t her e needs t o be adequat e sur vei l l ance and moni t or i ng of t he
pr obl ems and i mpact of st i gmat i zat i on and di scr i mi nat i on r egar di ng sex and
AIDS. A subcommi t t ee t o moni t or and er adi cat e st i gma and di scr i mi nat i on
of PLHA and af f ect ed per sons and t hei r f ami l i es woul d be anot her st r at egy
t o hel p t he accel er at ed pr ogr am t o r espond t o t he AIDS pr obl em i n Thai l and.
56
3. 3 HIV/ AIDS Prevent i on
3. 3. 1 Bl ood Saf et y
A. Bl ood screeni ng
About one- t hi r d of donat ed bl ood i n Thai l and comes f r om Red Cr oss
donat i on cent er s. Ever y uni t of donat ed bl ood i s scr eened t hr ough qual i t y
pr ocedur es at ever y st ep, st ar t i ng f r om t he st age of r i sk assessment of t he
donor ( who i s excl uded i f she/ he has r i sk f or HIV) .
Most of bl ood donat i on cent er s i n Thai l and use Chemi l umi nescence s
Immuno Assay ( CMIA) t o scr een HIV. In scr eeni ng donat ed bl ood f or HIV and
hepat i t i s vi r us ( HV) , t he nat i onal bl ood bank st ar t ed usi ng Nucl ei c Aci d
Test i ng ( NAT) t o scr een f or HIV, HCV, and HBV i n 2000 si nce t hi s met hod i s
mor e sensi t i ve t o det ect i ng ear l y i nf ect i on t han ar e r out i ne di agnost i cs.
Ini t i al l y, NAT was appl i ed i n Bangkok and was bei ng expanded t o t he f our
r egi ons i n 2010 at r egi onal bl ood cent er s i n Phuket , Khon Kaen, Nakor n
Rachasi ma, and Chi ang Mai . On Febr uar y 2, 2010, t he Cabi net appr oved i n
pr i nci pl e t he nat i onal bl ood ser vi ce pol i cy of 2010 as devel oped by t he Thai
Red Cr oss ( TRC) , and i nst r uct ed t he TRC t o consi der r ecommendat i ons f r om
t he Bur eau of t he Budget and t he Nat i onal Economi c and Soci al
Devel opment Boar d r egar di ng t he expansi on of NAT t o t ot al cover age of t he
count r y, and est abl i shi ng a nat i onal bl ood commi t t ee.
In addi t i on, t her e ar e qual i t y cont r ol s f or t he l abor at or y t o ensur e hi gh
st andar ds of accur acy of l ab wor k and di agnost i c concl usi ons. At pr esent ,
t he MOPH has t he pol i cy f or l abor at or i es under i t s over si ght t o compl y wi t h
st andar ds of excel l ence, whet her t hese st andar ds ar e i nt er nat i onal , such as
ISO 15189, or ar e nat i onal st andar ds, such as t he medi cal t echni ques
st andar ds ( LA) as over seen by t he Techni cal Medi ci ne Counci l . Any l ab t hat
i s cer t i f i ed as pr act i ci ng ei t her t he ISO or LA st andar ds ensur es t hat t hi s i s a
qual i t y l ab. The number of cer t i f i ed l abs i s an i ndi cat or of success of
qual i t y assur ance of t he l abor at or y sect or . The WHO and t he US Cent er f or
AIDS Pr event i on and Cont r ol have encour aged al l count r i es t o cer t i f y t hei r
l abs f or st andar ds of excel l ence i n or der t o guar ant ee t hat what ever
di agnost i c i s per f or med, t he r esul t wi l l be accur at e and of hi gh qual i t y.
B. Resul t s
A sur vey of 371 bl ood donat i on cent er s t hr oughout Thai l and out of 942
hospi t al s conduct ed by t he TRC f ound t hat ever y uni t of bl ood was scr eened
f or HIV t hr ough a qual i t y cont r ol met hod. The number of donat ed uni t s was
1, 784, 579 i n 2008 and 1, 942, 333 i n 2009.
57
Concer ni ng pr eval ence of HIV among bl ood donor s, t he dat a f r om 2008- 2009
show t hat HIV among f i r st - t i me donor s was hi gher t han t hat f or r et ur ni ng or
member donor s ( 0. 28%ver sus 0. 05%r espect i vel y) . Fi r st - t i me mal e donor s
had hi gher HIV pr eval ence t han f emal es ( 0. 43%ver sus 0. 16%r espect i vel y) .
C. Probl ems and chal l enges f or 2008-2009
x Some have obj ect ed t o t he scr eeni ng quest i on t hat asks i f t he per son has
had sex wi t h a same- sex par t ner , whi ch i s an excl usi on cr i t er i on. It i s
f el t t hat t hi s quest i on r ei nf or ces t he st i gma of gays as bei ng spr eader s of
HIV. The bl ood donat i on cent er s def end t he scr eeni ng quest i on by sayi ng
i t i s not a vi ol at i on of r i ght s because i t i s a r easonabl e met hod t o scr een
f or hi gher r i sk of HIV. In any event , a meet i ng of exper t s was cal l ed t o
r evi ew t he scr eeni ng quest i onnai r e. The wor di ng was modi f i ed t o
r educe st i gmat i zat i on of a par t i cul ar gr oup.
x Ther e i s no si ngl e or coor di nat ed dat abase on bl ood saf et y pr ogr am at
t he nat i onal l evel , whi ch woul d be usef ul t o moni t or t he pr ogr am and
al so t he HIV pr eval ence among f r equent bl ood donor s, consi der ed as l ow
r i sk popul at i on.
D. Pl an f or addressi ng t he probl ems and chal l enges
x The nat i onal moni t or i ng and eval uat i on t echni cal wor ki ng gr oup on bl ood
saf et y i s expect ed t o est abl i sh t he nat i onal r out i ne heal t h i nf or mat i on
syst em f or bl ood saf et y pr ogr am.
E. Best pract i ce
x Evi dence based proposal f or bl ood screeni ng pol i cy
TRC has i ni t i at ed t he st udy on usi ng Nucl ei c Aci d Test i ng ( NAT) t o scr een
donat ed bl ood si nce 2004. One r eact i ve case was f ound af t er 40, 000
bl ood uni t wer e scr eened, whi ch can pr event 4 bl ood r eci pi ent s t o get
HIV i nf ect i on. TRC cont i nues usi ng NAT f or bl ood scr eeni ng based on t he
r ecommendat i on of t he U. S. aut hor i t y; t hat NAT shoul d be used wher e
one r eact i ve case i s f ound i n 1, 000, 000 bl ood uni t s.
In 2009, out of 539, 093 bl ood uni t s, t her e wer e 6 r eact i ve cases by NAT,
whi ch wer e negat i ve by ser ol ogy t est . The cal cul at i on f or NAT i n
1, 800, 000 bl ood uni t s wi l l det ect 20 r eact i ve cases, whi ch means 80
bl ood r eci pi ent s wi l l be pr event ed f r om HIV i nf ect i on.
Based on t hi s evi dence, t he cabi net has appr oved t he pr i nci pl e t o use
NAT f or r out i ne bl ood scr eeni ng of t he count r y.
58
x Mobi l e dat abase t o screen HIV and HBV posi t i ve bl ood donors
Bef or e 1997, t her e wer e many HIV or HBV posi t i ve peopl e r epeat ed bl ood
donat i on. One HIV posi t i ve per son donat ed bl ood f or 7 t i mes. Ther e wer e
6 HBV posi t i ve per sons donat ed 8 t i mes.
Si nce 1998, TRC has t r i ed ent er i ng and updat i ng dat a on scr eeni ng
donat ed bl ood bef or e and af t er mobi l e bl ood donat i on act i vi t i es t o be
used t o det ect t hose who ar e HIV or HBV posi t i ve by usi ng bar code
syst em i nst al l ed i n not ebooks.
In 2008- 2009, af t er usi ng t hi s met hod, t her e wer e onl y 2 HBV posi t i ve
per sons donat e bl ood f or t he second t i me, whi ch was because t her e
wer e many bl ood donor s t hat t hey ar e not scr eened.
3. 3. 2 Prevent i on of Mot her-t o-Chi l d HIV Transmi ssi on
A. Si t uat i on of t he HIV epi demi c among pregnant women and prevent i on
of t ransmi ssi on t o t he i nf ant
Tr ansmi ssi on of HIV f r om mot her t o chi l d i s a pr i nci pal cause of pedi at r i c
i nf ect i on. If no pr event i on i nt er vent i ons ar e t aken, t hen appr oxi mat el y 25%
t o 40%of i nf ant s woul d acqui r e HIV f r om t hei r mot her s. Thai l and began t o
t r ack HIV among pr egnant women i n 1989 f r om t he HIV sent i nel sur vei l l ance
syst em i mpl ement ed by t he Bur eau of Epi demi ol ogy ( BOE) . It was f ound
t hat t he medi an pr eval ence of HIV peaked i n 1995 and has shown a decl i ni ng
t r end si nce t hen. In 2008 and 2009 t he pr eval ence of HIV among pr egnant
women was 0. 74 and 0. 72
4
r espect i vel y.
As of 2001, t he Depar t ment of Heal t h ( DOH) was i mpl ement i ng i t s pr ovi nci al
hospi t al i nf or mat i on moni t or i ng syst em i n 900 gover nment hospi t al s ( PHIMS) ;
i t f ound l evel s of HIV i nf ect i on among pr egnant women t hat wer e consi st ent
wi t h t hose of t he BOE sent i nel sur vei l l ance ( Fi gur e 24) . But i t i s
not ewor t hy t hat t he 5% of pr egnant women who di d not r ecei ve ant e- nat al
car e ( ANC) had si gni f i cant l y hi gher HIV pr eval ence t han t hose who r ecei ved
ANC, namel y 5. 8%i n 2001 and 3. 3%i n 2009.
4
Resul t s of HIV Ser o- sur vei l l ance, Thai l and 1989- 2009. Sour ce: AIDS Gr oup, BOE,
Depar t ment of Di sease Cont r ol . Avai l abl e at ht t p: / / epi d. moph. go. t h/
59
Eval uat i on of PMTCT at t he nat i onal l evel by t he MOPH
5
dur i ng 2007 f ound
t hat t he l evel of t r ansmi ssi on of HIV f r om mot her t o i nf ant was 2. 9% based
on al l l ab di agnost i cs. However , i f dead i nf ant s ar e i ncl uded i n t he
anal ysi s, t he t r ansmi ssi on r at e cl i mbs t o 5. 6%. The r eason f or t he
per si st ent l y hi gh r at e of MTCT i s t hat 56% of pr egnant women ar e not
r ecei vi ng CD4 cel l count s. Thus, t hese women ar e not r ecei vi ng a pr oper
r egi men of ART as r ecommended by t he MOPH. In addi t i on, onl y 54% of
i nf ant s r ecei ved HIV di agnost i c exams.
The DOH has r epor t ed t hat t he cover age of ANC has r eached 95%,
6
but onl y
39%
7
had t hei r f i r st ANC vi si t bef or e 12 weeks of gest at i on. Al so, HIV-
posi t i ve women have a l ower r at e of r ecei vi ng ANC ( 87%
8
) t han pr egnant
women i n gener al . The medi an gest at i onal age of HIV+ women was 19
weeks wi t h near l y one i n f our havi ng t hei r f i r st ANC vi si t af t er 28 weeks of
5
Nai wat anakul T, Punsuwan N, Kul l er k N, et al . Reduct i on i n HIV t r ansmi ssi on r i sk f ol l owi ng
r ecommendat i ons f or CD4 t est i ng t o gui de sel ect i on of pr event i on of mot her - t o- chi l d
( PMTCT) r egi mens, Thai l and, 2006-2007. In: 5t h IAS Conf er ence on HIV Pat hogenesi s and
Tr eat ment . Capet own, Sout h Af r i ca
6
Repor t of t he eval uat i on of heal t h pr omot i on act i vi t i es i n t he 9
t h
Nat i onal Economi c and
Soci al Devel opment Pl an ( Febr uar y 2006) ; Publ i shed by t he Vet er ans Pr i nt i ng
Or gani zat i on.
7
Ad hoc r epor t of t he Sai Yai Rak Haeng Khr awp Khr ua Pr oj ect , DOH Avai l abl e at
ht t p: / / www. sai yai r akhospi t al . com/ newdemo/ admi n/ user _r epor t . ht ml . ( Last accessed
Dec 23, 09) .
8
Ibi d 3
Sources: Sentinel surveillance BOE; PHIMS from the DOH
0
1
2
3
4
5
6
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8
9
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9
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3
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4
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9
Sent i nel PHI M S- ANC PHI M S- No ANC
Fi gur e 24: Pr eval ence of HIV among pr egnant women dur i ng 1989- 2008
60
pr egnancy.
9
Those HIV+ pr egnant women who r ecei ved ANC had a CD4
count of over 350 cel l s/ cubi c mm
10
. Most of t he i nf ect ed pr egnant women
r ecei ved ART i n accor dance wi t h t he gui del i nes. In 2007, t hese women
came f or del i ver y accor di ng t o appoi nt ment and had a medi an gest at i onal
age at del i ver y of 39 weeks.
11
B. Impl ement at i on of PMTCT
The most ef f ect i ve way t o achi eve PMTCT i s by pr ovi di ng compr ehensi ve
ser vi ces f r om t he t i me of f i r st ANC vi si t , admi ni st er i ng an ef f ect i ve r egi men
of ARV whi ch i s appr opr i at e t o t he i mmunol ogi cal pr of i l e of t he mot her , and
t he use of i nf ant f or mul a i nst ead of br east mi l k f or nur si ng t he i nf ant .
Thai l and has del i ver ed HIV VCT f or pr egnant women si nce 1993. In 2000,
t he MOPH announced t he pol i cy t o r educe MTCT f or t he f i r st t i me. Over
t i me, as new r egi mens wer e devel oped, t he pol i cy and i mpl ement at i on
gui del i nes wer e modi f i ed. At pr esent t he 2006 pol i cy and gui del i nes ar e i n
f or ce and i ncl ude t he f ol l owi ng:
x Al l pr egnant women wi l l r ecei ve HIV VCT
x HIV+ pr egnant women wi l l r ecei ve ARV dur i ng pr egnancy and del i ver y
t o r educe MTCT of HIV.
x HIV+ pr egnant women wi l l r ecei ve CD4 count s dur i ng pr egnancy, and
r ecei ve t r i pl e- t her apy ART as appr opr i at e.
x HIV+ pr egnant women wi l l r ecei ve ART t o r educe r esi st ance t o
Nevi r api ne.
x Inf ant s of HIV+ mot her s wi l l r ecei ve ART, and wi l l r ecei ve i nf ant
f or mul a, as wel l as moni t or i ng of i mmuni t y agai nst HIV.
x The mot her and chi l d and t he HIV+ f at her wi l l r ecei ve on- goi ng
moni t or i ng and car e as appr opr i at e.
B. 1 Pol i cy and pl an/ program i n response t o t he probl em of MTCT
1) Prevent i ng t he marri ed coupl e f rom acqui ri ng HIV
Past pol i cy and pr act i ces have emphasi zed scr eeni ng of pr egnant women f or
HIV, and t hen pr ovi di ng ART f or PMTCT. Thi s i s a somewhat secondar y
appr oach t o pr event i on. Dur i ng 2008- 2009 t he DOH i ni t i at ed a new
pr ogr am t hat i s a mor e pr o- act i ve pr event i on st r at egy by emphasi zi ng t he
pr event i on of HIV among t he negat i ve mar r i ed coupl e, and pr event i ng
unwant ed pr egnancy among HIV+ women. The DOH col l abor at ed wi t h UNFPA
i n a pr oj ect t o i ncr ease par t i ci pat i on of t he husband i n r epr oduct i ve heal t h
( RH) , car e of hi s pr egnant wi f e, and act i ons t o keep bot h husband and wi f e
f r ee of HIV. The DOH al so col l abor at ed wi t h t he TUC t o devel op a model of
coupl e counsel i ng f or pr egnant women and t hei r par t ner s, and pr oj ect s t o
i ncr ease knowl edge among ser vi ce pr ovi der s who wor k wi t h t he PLHA i n
ar eas of RH, f ami l y pl anni ng, appr opr i at e cont r acept i ve choi ces f or t he
9
Bur eau of Heal t h Pr omot i on, DOH, BOE, DDC, TUC. Paper pr esent ed at t he meet i ng on
r esul t s of eval uat i on of PMTCT on Febr uar y 2, 2009 at t he Rama Gar dens Hot el , Bangkok.
Ref PATCG 076.
10
Ibi d 7
11
Ibi d 7
61
PLHA t o r educe unwant ed or hi gh- r i sk- of - t r ansmi ssi on pr egnancy ( see best
pr act i ces sect i on) .
2) Use of HAART
The WHO has speci f i ed t he t ar get t hat t her e be no MTCT as of 2015
12
by
expandi ng cover age of PMTCT. To achi eve t hi s, Thai l and has i nst i t ut ed
gui del i nes t hat heal t h f aci l i t i es must use t he most ef f ect i ve ART r egi mens t o
r educe MTCT, and whi ch ar e saf e t o bot h mot her and chi l d wi t h mi ni mal
chance of r esi st ance t o non- nucl eosi de r ever se t r anscr i pt ase i nhi bi t or s
( NNRTI) . The r egi men shoul d be accessi bl e, si mpl e t o appl y, and f easi bl e.
The PMTCT gui del i nes used i n Thai l and dur i ng 2004- 2009 r ecommend AZT+ a
si ngl e- dose of Nevi r api ne ( SD NVP) f or pr egnant women wi t h CD4 count s
above 200.
13
Af t er del i ver y, t he women r ecei ve AZT + 3TC f or seven days t o
pr event r esi st ance t o NNRTI. Never t hel ess, t hi s r egi men i s not abl e t o
el i mi nat e t he pr obl em of r esi st ance t o NNRTI i n bot h post - par t um mot her s
and i nf ect ed i nf ant s. In addi t i on, t he ef f ect i veness i n PMTCT f r om t hi s
r egi men i s st i l l not t he best one avai l abl e. Usi ng AZT+SD NVP yi el ds a MTCT
r at e of 1. 9%
14
wher eas t he HAART r egi mens used i n ot her count r i es have
r educed MTCT t o bel ow 1%.
15
Thus, t o achi eve t he pr el i mi nar y t ar get s, t he MOPH has col l abor at ed wi t h
t he Thai l and AIDS Associ at i on and Heal t h Int er vent i on and Technol ogy
Assessment Pr ogr am ( HITAP) wi t h budget f r om t he Nat i onal Heal t h Secur i t y
Of f i ce ( NHSO) t o i mpl ement a pi l ot HAART pr ogr am among al l pr egnant
women i n f our pr ovi nces t o assess t he f easi bi l i t y of a nat i onal HAART
pr ogr am f or pr egnant women. These f our pr ovi nces i ncl ude Sr i saket ,
Nakor n Sawan, Sr a Kaew, and Sat un. In addi t i on, t her e has been an
economi c anal ysi s t o det er mi ne t he most cost - ef f ect i ve r egi men i n t he
cont ext of Thai l and f or pr egnant women wi t h CD4 count s above 250. The
r esul t s of t he anal ysi s f ound t he use of HAART was mor e cost - ef f ect i ve t han
usi ng AZT+SD NVP i n pr egnant women wi t h CD4 count s above 250 and i s
f easi bl e f or i mpl ement at i on i n t he f i el d set t i ng.
16
Based on t hese f i ndi ngs,
t he NHSO wi l l suppor t t he budget and dr ugs f or HAART i n coor di nat i on wi t h
12
Gui dance on gl obal scal e- up of t he pr event i on of mot her - t o- chi l d t r ansmi ssi on of HIV.
Towar ds uni ver sal access f or women, i nf ant s and young chi l dr en and el i mi nat i ng HIV and
AIDS among chi l dr en. Int er - Agency Task Team on Pr event i on of HIV Inf ect i on i n Pr egnant
women, mot her s and t hei r chi l dr en. WHO 2007
13
DOH. Gui del i nes f or PMTCT and car e f or mot her s, i nf ant s, and t he f ami l y l i vi ng wi t h HIV.
MOPH. 2007.
14
Lal l emant M, Jour dai n G, Le Coeur S, et al . Si ngl e- dose per i nat al nevi r api ne pl us
st andar d zi dovudi ne t o pr event mot her -t o- chi l d t r ansmi ssi on of HIV- 1 i n Thai l and. The New
Engl and j our nal of medi ci ne 2004; 351(3) : 217- 28.
15
Pal ombi L, Mar azzi MC, Voet ber g A, Magi d NA. Tr eat ment accel er at i on pr ogr am and t he
exper i ence of t he DREAM pr ogr am i n pr event i on of mot her - t o-chi l d t r ansmi ssi on of HIV.
AIDS ( London, Engl and) 2007; 21 Suppl 4: S65- 71.
16
Pr oj ect t o eval uat e t he cost - ef f ect i veness and f easi bi l i t y of usi ng HAART as a st andar d
pr ot ocol f or PMTCT i n Thai l and. Pr esent ed t o t he Commi t t ee t o Devel op Ser vi ces f or
Peopl e Li vi ng wi t h HIV/ AIDS (PLHA) on November 6, 2009 by t he Heal t h Int er vent i on and
Technol ogy Assessment Pr ogr am ( HITAP) .
62
t he DOH t o pl an f or t he r ol l - out of t hi s ser vi ce f or al l HIV+ pr egnant women
as of Fi scal Year 2011.
17
B. 2 Invol vement of ci vi l soci et y
Over 1, 000 gr oups of PLHA vol unt eer s t hr oughout t he count r y have modi f i ed
t hei r r ol e f r om bei ng ser vi ce r eci pi ent s t o become ser vi ce pr ovi der s. They
have r e- gr ouped i nt o i mpl ement at i on uni t s under t he pr i nci pl e of f r i endl y
r ehabi l i t at i on. The st r uct ur e of act i vi t i es i s i n t he f or m of a f oundat i on
compr i sed of a st eer i ng commi t t ee at t he r egi onal and nat i onal l evel s.
Ther e ar e coor di nat or s and f i el d st af f who ar e sel ect ed as r epr esent at i ves
f r om t he var i ous pr ovi nces. Ther e ar e seven r egi onal commi t t ees. At t he
nat i onal l evel t he commi t t ee i s compr i sed of r epr esent at i ves f r om each
r egi on and has t he f ol l owi ng t ar get s:
1. Ever y PLHA, chi l d and adul t , r ecei ves st andar d car e and t r eat ment ,
equi t abl y and cont i nuousl y i n a sust ai nabl e way.
2. PLHA and t hose af f ect ed ar e abl e t o l i ve har moni ousl y i n t he communi t y,
and i n communi t i es whi ch have knowl edge about sel f - pr event i on and
accept l i vi ng wi t h PLHA and wor ki ng t oget her t o addr ess AIDS pr obl ems.
3. The member s of t he PLHA gr oups under st and about t hei r r i ght s and
st r at egi es f or t he pr ot ect i on of r i ght s r el at ed t o AIDS.
4. The member s of t he PLHA gr oups and net wor ks at al l l evel s ar e st r ong,
and have t he pot ent i al t o i mpl ement t he t asks t o addr ess pr obl ems
t oget her , i n t he same di r ect i on, st r at egy of i mpl ement at i on,
coor di nat i on, and t r anspar ency whi ch can be ext er nal l y ver i f i ed.
C. Resul t s of i mpl ement at i on
The Bur eau f or Heal t h Pr omot i on, DOH, i n col l abor at i on wi t h t he BOE and
TUC conduct ed a st udy t o eval uat e t he i mpl ement at i on of t hese act i vi t i es.
In summar y, t he st udy f ound t hat PMTCT ser vi ces ar e achi evi ng t he r equi si t e
cover age i n t er ms of counsel i ng, cl i ent sat i sf act i on t owar d t he counsel i ng,
and pr ovi si on of ART f or PMTCT. However t he ARV dr ugs bei ng pr ovi ded ar e
not ent i r el y i n accor dance wi t h t he pol i cy. Al so, HIV di agnosi s i n i nf ant s of
HIV+ mot her s i s st i l l l ow, and t he l evel of MTCT i s st i l l t oo hi gh, especi al l y i n
t hose whose CD4 l evel i s not known.
Fr om a st udy of 911 cases, of whom 187 wer e HIV+ pr egnant women who
del i ver ed dur i ng Oct ober 2006 and December 2007 i n 27 hospi t al s of 12
pr ovi nces f r om each r egi on, i t was f ound t hat 96%wer e Thai nat i onal s wi t h
aver age age of 28 year s. Ful l y 89% wer e cur r ent l y mar r i ed, 45% had been
mar r i ed mor e t han once, had an aver age of t wo chi l dr en, and most wer e
el i gi bl e f or benef i t s under t he NHSP or t hr ough t he gover nment ci vi l ser vi ce.
Ful l y 19%wer e not el i gi bl e f or any subsi di zed heal t h ser vi ce.
17
Summar y of t he meet i ng of t he Subcommi t t ee on Devel opi ng t he Syst em of Ser vi ces f or
PLHA, No. 7/ 2009 on November 6, 2009 at 13: 30-16: 30 i n t he 5
t h
Fl oor meet i ng r oom of t he
Of f i ce of t he Per manent Secr et ar y, MOPH.
63
x HIV counsel i ng and t est i ng, PMTCT and cont i nuum of care af t er bi rt h
del i very
A t ot al of 66% of t he sampl e wer e not awar e of t hei r ser ost at us bef or e.
Ful l y 81%di d not know t hei r ser ost at us bef or e r ecei vi ng pr e- t est counsel i ng
and 93% r ecei ved post - t est counsel i ng. Ful l y 88% wer e sat i sf i ed wi t h t he
counsel i ng ser vi ce, 78% wer e sat i sf i ed wi t h t he l evel of conf i dent i al i t y of
t he cl i ent s ser ost at us, and had r at her hi gh HIV/ AIDS knowl edge scor es. A
t ot al of 90% r ecei ved counsel i ng on PMTCT and on- goi ng car e. However ,
onl y 51%of t he husbands r ecei ved an HIV t est and 61%of husbands who di d
have a t est wer e f ound t o be HIV+. The r eason f or t he l ow t est r at e among
husbands was t hat many of t he women had not yet r eveal ed t hei r ser ost at us
t o t hei r par t ner .
x Use of i nf ant f ormul a t o repl ace breast mi l k
Al l i nf ect ed mot her s who wer e i nt er vi ewed used i nf ant f or mul a i nst ead of
br east mi l k. The onl y pr obl em wi t h obt ai ni ng t he i nf ant f or mul a i s t he cost
of t r anspor t at i on. Fr om r evi ewi ng t he hi st or y of 911 cases, 10% had
di ar r hea. A t ot al of 17% of t he mot her s sai d t hat t hey had pr obl ems of
f i ndi ng a cl ean sour ce of wat er t o mi x wi t h t he i nf ant f or mul a powder , but
al most al l boi l ed t he wat er bef or e mi xi ng.
x Coverage of PMTCT
x CD4 count s: Fr om a r evi ew of r ecor ds of t he 911 HIV+ mot her s i t was
f ound t hat onl y 10%, 43%, and 35% had CD4 count s t aken bef or e
pr egnancy, dur i ng pr egnancy and af t er del i ver y r espect i vel y. Most of
t he women who had t est s had CD4 count s over 200.
x Recei vi ng ART: Most of t he HIV+ mot her s r ecei ved ART, and al most
al l t he newbor ns r ecei ved a compl et e dose of ARV. Never t hel ess,
onl y 36% r ecei ved ART t hat was appr opr i at e t o t hei r CD4 l evel or i n
accor dance wi t h t he gui del i nes. Most mot her s and i nf ant s r ecei ved
AZT+NVP wi t hout knowi ng t he l evel of CD4. Gi vi ng t he t ai l r egi men
t o r educe vi r al r esi st ance t o NVP was conduct ed f or 51%.
x Di agnosi s of t he st at us of HIV i nf ect i on among i nf ant s of HIV+
mot her s: Ful l y 56% of t he chi l dr en wer e t est ed t o det er mi ne t hei r
st at us of i nf ect i on, most usi ng PCR.
x Rat e of MTCT Over al l , of t he mot her s who r ecei ved t r i pl e t her apy,
t he r at e of MTCT was 1. 9%; f or t hose r ecei vi ng AZT+ SD NVP t he MTCT
r at e was 3. 5%; and f or t hose who knew t hei r CD4 l evel and r ecei ved
ART i n accor dance wi t h t he pol i cy t he MTCT r at e was 1. 7%.
64
x Knowl edge and pract i ce of servi ce provi ders accordi ng PMTCT pol i cy
The PMTCT ser vi ce pr ovi der s wor ked i n mul t i - di sci pl i nar y t eams. Al most al l
t he ser vi ce pr ovi der s i n hospi t al s wer e abl e t o descr i be t he pol i cy and
gui del i nes cor r ect l y. Never t hel ess, t he PMTCT ser vi ce i nvol ves many
di f f er ent uni t s. The l i nks bet ween t he ser vi ce uni t s and poi nt s of r ef er r al
f or dat a shar i ng i s not yet syst emat i c, especi al l y i n t he l ar ger hospi t al s.
D. Probl ems and chal l enges f or 2008-2009
x An i mpor t ant t r end t hat has r ecei ved mor e at t ent i on i n Thai l and t hese
t wo year s i ncl udes coupl e pr event i on and r educt i on of unwant ed pr egnancy
among HIV+ women. Thi s i s bei ng done t hr ough gr eat er i nvol vement of t he
mal e par t ner i n t he coupl e s r epr oduct i ve heal t h, i n car e f or t he pr egnant
wi f e, and st ayi ng negat i ve as a coupl e. Coupl e counsel i ng has been
expanded i n ANC cl i ni cs and t he chal l enge now i s t o achi eve maxi mum
cover age at a t i me when r out i ne ANC ser vi ces ar e al r eady a heavy l oad f or
t he st af f .
x Even t hough cover age wi t h ART f or PMTCT i s r at her hi gh, t he chal l enge i s
t o i ncr ease CD4 cel l count scr eeni ng t o i nf or m t r eat ment deci si ons,
especi al l y t he deci si on t o pr ovi de HAART t o al l el i gi bl e i n Fi scal Year 2011.
x Ther e ar e st i l l chal l enges of pr ovi di ng on- goi ng car e i ncl udi ng
di agnosi ng ser ost at us among t he i nf ant whi ch cur r ent l y i s l ess t han opt i mal
and ser vi ces f or t he mot her s who have CD4 count s over 200, and counsel i ng
and HIV t est s f or HIV+ par t ner s of pr egnant women.
x Eval uat i on by t he DOH and par t ner s showed t hat t her e i s st i l l a need t o
devel op t he qual i t y of counsel i ng and di agnosi s of ser ost at us i n t he ANC
cl i ni c set t i ng. Ther e ar e st i l l pr egnant women who ar e not r ecei vi ng pr e-
t est or post - t est counsel i ng, and t her e i s l ess t han opt i mal sat i sf act i on wi t h
conf i dent i al i t y of t est r esul t s.
x Anot her i ssue f or consi der at i on i s l ocat i ng pr egnant women who ar e not
comi ng f or ANC. Even t hough t hi s number i s l ow (l ess t han 5% of del i ver i ng
women) t hese women have hi gher - t han- aver age HIV ( 3. 3% i n 2009) . So
t her e i s a need t o under st and who t hese women ar e i n or der t o pr ovi de
appr opr i at e pr event i on ser vi ces.
E. Pl an f or addressi ng t he probl ems and chal l enges
x Revi ew t he VCT syst em f or pr egnant women, and appl y i mpr ovement s t o
bui l d st af f capaci t y i n hospi t al s i n t er ms of bot h ANC and f ami l y pl anni ng
ser vi ces. Impr ove t he l i nkages and col l abor at i ve wor k wi t h t he ci vi l soci et y
sect or , and devel op t he capaci t y of NGOs t o del i ver communi t y
i nt er vent i ons i n t he ar ea of i nt egr at ed r epr oduct i ve heal t h and PMTCT.
x Impr ove ser vi ces i n t he hospi t al , especi al l y l ar ge hospi t al s, so t hat t her e
ar e l i nks bet ween ser vi ces and r ef er r al of i nf or mat i on among t he r el evant
65
ser vi ce uni t s. Maxi mi ze t he cover age of CD4 cel l scr eeni ng dur i ng
pr egnancy, use of HAART, and di agnosi ng ser ost at us of i nf ant s of HIV+
mot her s usi ng qual i t y PCR di agnost i cs.
x St udy t he char act er i st i cs of HIV+ women who do not r ecei ve ANC and t he
f act or s behi nd t hi s, and why t hey have hi gher i nf ect i on l evel s. Appl y t hi s
knowl edge t o new measur es t o i mpr ove pr event i on ser vi ces f or t hi s gr oup of
t he popul at i on.
F. Best pract i ces
1. Servi ces and l ab qual i t y under t he proj ect : Use of t he Mul t i pl ex
Nest ed DNA-PCR met hod f or di agnosi ng serost at us among i nf ant s of
HIV+ mot hers
As t he r ef er ence l abor at or y of t he MOPH, t he Medi cal Sci ences Depar t ment
( MSD) has i mpl ement ed and r ef i ned a net wor k of l abs wi t h PCR capabi l i t y,
st ar t i ng i n 1994. Thi s net wor k has exami ned over 25, 000 speci mens. The
l ocal l y- pr oduced r eagent s ar e 5 t o 10 t i mes l ess expensi ve t han t hose f r om
abr oad and have passed qual i t y assur ance t est s among Thai subj ect s,
i ncl udi ng chi l dr en bor n t o HIV+ mot her s. Al l r egi ons of t he count r y now
have access t o t hi s ser vi ce t hr ough t he MSD net wor k of 14 l abor at or i es
whi ch have a t ar get capaci t y of 8, 000 t o 12, 000 speci mens exami ned per
year . Member s of t hi s net wor k have been t r ai ned and r e- t r ai ned t hr ough
annual r e- f r esher cour ses and al l have ext ensi ve l abor at or y exper i ence i n
di agnost i cs.
The qual i t y assur ance syst em i nvol ves cont r ol s f or t he qual i t y of r eagent s
f or t he Mi ni bat ch HIV- 1 DNA- PCR, bal anci ng demand and suppl y f or
di agnosi s. Ther e ar e t wo l ab gr oups t hat do pedi at r i c HIV- 1 di agnosi s: One
i s t he net wor k of 14 l abs i n t he MSD net wor k, whi ch use t he HIV- 1 di agnosi s
usi ng t he Mul t i pl ex Nest ed DNA- PCR ( In- house) met hod; and t he Facul t y of
Techni cal Medi ci ne of Chi ang Mai Uni ver si t y whi ch uses t he on- si t e or dr i ed
bl ood spot s ( DBS) met hod.
2. Devel opment of a model of HIV prevent i on f or pregnant women i n t he
Heal t h-promot i ng Hospi t al 6, Khon Kaen Provi nce
Dur i ng 2005- 6 t he Heal t h- pr omot i ng Hospi t al 6 j oi ned a r esear ch pr oj ect of
t he DOH i n col l abor at i on wi t h ot her heal t h- pr omot i ng hospi t al s ( 1, 4, 7, 8,
and 10) . The HIV Pr event i on f or HIV- Negat i ve Pr egnant Women i n MCH
Hospi t al s i n Thai l and pr oj ect was i mpl ement ed under cooper at i on bet ween
t he DOH and UNFPA. The pur pose of t he pr oj ect was t o def i ne t he model f or
mi ni mum essent i al qual i t y ser vi ces at t he hospi t al l evel . The st udy i nvol ved
par t i ci pat or y l ear ni ng, devel opment , eval uat i on, i nt egr at i on, and
modi f i cat i on at var i ous st ages dur i ng i mpl ement at i on. Ther e was
66
cont i nuous coor di nat i on bet ween t he var i ous cl i ni cs i ncl udi ng t he
counsel or s, t he ANC cl i ni c, t he del i ver y r oom, t he post - par t um cl i ni c, t he
wel l - baby cl i ni c, and t he f ami l y pl anni ng cl i ni c. The r esear ch devel oped a
number of i nnovat i ons i n counsel i ng ser vi ces r el at ed t o coupl e counsel i ng,
di scl osur e of ser ost at us among di scor dant coupl es, and t he f ol l owi ng:
x New Ideas, bel i ef s and val ues: Ser vi ce pr ovi der s wer e abl e t o cr eat e
i nt er est and mot i vat i on i n husbands t o j oi n t he hospi t al act i vi t i es. Af t er
par t i ci pat i ng, t hese men had a gr eat er appr eci at i on f or t hei r r ol e i n
pr ovi di ng car e f or t he wi f e and i nf ant .
x Behavi oral i nnovat i ons: The ser vi ce pr ovi der s acqui r ed new ski l l s and
t echni ques i n communi cat i on t o hel p ser vi ce r eci pi ent s t o per suade t hei r
husbands t o j oi n t he ANC vi si t s wi t h t hem, r esul t i ng i n mor e coupl e
at t endance.
x Servi ce i nnovat i ons: Coupl e ANC and post - t est gr oup counsel i ng f or
HIV- negat i ve coupl es.
x Innovat i ons i n counsel i ng: Coupl e counsel i ng and di scl osur e of
di scor dant ser ost at us.

3. 3. 3 HIV Prevent i on among Reproduct i ve Age Group
A. Si t uat i on of HIV among t he popul at i on of reproduct i ve age (PRA)
The popul at i on of r epr oduct i ve age i n t hi s r epor t r ef er s t o t he popul at i on
bet ween ages 15 t o 49. The AIDS Epi demi c Model has pr oj ect ed t hat mor e
t han one- t hi r d ( 38%) of new HIV i nf ect i ons i n 2010 wi l l occur among mar r i ed
coupl es or l over s, and 7%wi l l be f r om pr omi scuous sex.
18
B. Impl ement at i on of HIV prevent i on among PRA
B.1 Pol i cy and pl ans/ programs t o address t he probl em of AIDS i n PRA
1) Nat i onal AIDS Pl an f or 2007-2014
Mar r i ed coupl es and l over s ar e an i mpor t ant t ar get popul at i on t hat needs t o
r educe i t s i nci dence of HIV by hal f by 2011. Recommended measur es t o
achi eve t hi s i ncl ude coupl e HIV VCT, counsel i ng f or di scl osur e of one s
ser ost at us, i ncr ease concer n, pr omot e const r uct i ve at t i t udes, and r educe
sex- r el at ed pr obl ems by campai gns t hr ough var i ous channel s whi ch t he
popul at i on of r epr oduct i ve age access. In addi t i on, t hese measur es i ncl ude
pr omot i on of HIV pr event i on behavi or and condom use t hr ough i nt egr at ed
ser vi ces f or ANC and ot her heal t h ser vi ces. Anot her measur e i ncl udes
pr omot i ng non- di scr i mi nat i on of women wi t h HIV i nf ect i on. For t he gener al
18
Thai Wor ki ng Gr oup and A
2
Thai l and, The Asi an Epi demi c Model ( AEM) Pr oj ect i ons f or
HIV/ AIDS i n Thai l and: 2005- 2025

67
popul at i on who do not know t hei r ser ost at us but come f or ot her ser vi ces i n
t he heal t h syst em, t hey need t o be hel ped t o assess t hei r r i sk f or HIV and
get t est ed i f appr opr i at e, and shoul d be encour aged t o use condoms, whi l e
al ways t r yi ng t o de- st i gmat i ze and el i mi nat e a sense of di scr i mi nat i on.
2) AIDS prevent i on and management i n t he workpl ace
The Mi ni st r y of Labor ( MOL) t hr ough t he Depar t ment f or Labor Wel f ar e and
Pr ot ect i on ( DLWP) pr ocl ai med t hei r posi t i on on AIDS i n t he wor kpl ace i n
2005 t o i ncr ease t he r ol e of t he wor ksi t e i n pr event i on and management of
AIDS act i vi t i es i n accor dance wi t h t he ILO Code of Pr act i ce on HIV/ AIDS i n
t he Wor l d of Wor k t hr ough t he devel opment and appl i cat i on of st andar ds
( ASO Thai l and: AIDS - r esponse St andar d Or gani zat i on) . Thi s was seen as a
t ool t o advance, eval uat e, and cont r ol AIDS act i vi t i es and t o cer t i f y wor k
si t es t hat i mpl ement accor di ng t o t he st andar ds.
Wi t h suppor t f r om t he GFATM, t he DLWP and t he Thai l and Busi ness Coal i t i on
on AIDS ( TBCA) devel oped a pl an t o have al l wor ksi t es i mpl ement t he ASO
Thai l and st andar ds, and i ncl ude t hi s as a t ar get f or empl oyer s i n t he
Nat i onal AIDS Pl an f or 2007- 2011. At t he same t i me, t he st andar ds concept
was expanded t o i ncl ude t uber cul osi s as t he AIDS and TB r esponse St andar d
Or gani zat i on or ASO- T.
To t ur n t hi s i nt o concr et e st eps, t he NAPAC, i n i t s meet i ng on Sept ember 28,
2005 di r ect ed t he MOL t o dr af t i mpl ement at i on gui del i nes f or AIDS
pr event i on and management i n t he wor kpl ace based on t he MOL
pr ocl amat i on. The NAPAC t hen est abl i shed or der 1/ 2549 t o set up a
wor ki ng gr oup consi st i ng of r epr esent at i ves f r om t he gover nment and ci vi l
soci et y t o r evi se and dr af t t hese gui del i nes whi ch wer e appr oved by t he
NAPAC on Jul y 24, 2009, and i ssued publ i cl y on August 21, 2009 wi t h t he
f ol l owi ng key poi nt s:
1) These ar e gui del i nes f or al l publ i c and pr i vat e wor ksi t es
2) The wor ksi t e must est abl i sh st andar ds f or pr event i on and AIDS
management i n t he wor kpl ace whi ch ar e consi st ent wi t h t he nat i onal
st andar ds at l east i n t wo di mensi ons: ( 1) AIDS i n t he wor kpl ace; ( 2)
i mpl ement at i on pl an.
3) Speci f y t he r ol e of t he empl oyer , wor ki ng gr oup and l abor uni on, and
t he r ol e of gover nment agenci es f or i mpl ement at i on, moni t or i ng and
eval uat i on, over si ght and cor r ect i on of pr obl ems, and r evi ew r esul t s
of i mpl ement at i on.
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C. Progress duri ng 2008-9
1) Prevent i on of HIV i n marri ed coupl es or ot her i nt i mat e rel at i onshi ps
The DOH i n col l abor at i on wi t h t he TUC has devel oped a syst em of coupl e
HIV VCT as par t of t he r out i ne ANC ser vi ce as f ol l ows:
x Devel opment of a model and gui del i nes f or coupl e counsel i ng f or HIV
VCT, and devel op a t r ai ni ng cur r i cul um, pr oduce vi deo medi a t o
demonst r at e t he model and counsel i ng met hod, and conduct t r ai ni ng f or
nur ses and counsel i ng st af f i n f i ve pi l ot pr ovi nces.
x Del i ver coupl e counsel i ng ser vi ces f or HIV VCT f or new ANC cl i ent s
and t hei r husbands i n 17 hospi t al s of f i ve pi l ot pr ovi nces, and eval uat e t he
out come i n pr epar at i on f or expansi on.
2) Prevent i on of HIV i n government ci vi l servant s
Ai r For ce Ther e ar e commi t t ee and subcommi t t ees f or pr event i on and
cont r ol of AIDS i n t he Ai r For ce wi t h a pl an of act i on consi st ent wi t h t he
Nat i onal AIDS pl an and compr ehensi ve f or cont i nuous pr ovi si on of pr event i on
and cur at i ve ser vi ces, i ncl udi ng knowl edge campai gns, condom pr omot i on,
medi cal suppl i es f or Ai r For ce cl i ni cal st af f t o pr event t r ansmi ssi on f r om
cont act wi t h t oxi c f l ui ds, and HIV scr eeni ng of bl ood donor s.
Nat i onal Pol i ce For ce Suppor t heal t h and pr event i on of HIV f or pol i ce,
t hei r f ami l i es and ot her popul at i ons under t hei r j ur i sdi ct i on. Ther e i s a
pol i cy and pl an f or pr event i on and cont r ol of AIDS wi t h suppor t f r om t he
Nat i onal Pol i ce Headquar t er s. Impl ement at i on of t he pl an i ncl udes HIV VCT,
compr ehensi ve t r eat ment f or AIDS, t r ai ni ng and knowl edge pr omot i on on
AIDS by t r ai ni ng pol i ce r esour ce per sons so t hat t hey can pr ovi de t r ai ni ng on
a cont i nuous basi s t o t he pol i ce f or ce.
3) Prevent i on of HIV i n t he workpl ace
Si nce 2005, t he MOL t hr ough t he DLWP announced t he posi t i on of t he MOL
t o suppor t AIDS pr event i on and cont r ol pl ans i n t he wor kpl ace. The TBCA
wor ked wi t h t he DLWP and t he DDC t o devel op st andar ds f or managi ng AIDS
pr ogr ams i n t he wor kpl ace ( ASO- Thai l and) and suppor t ed t he devel opment
of a net wor k of wor ki ng gr oups at t he pr ovi nci al l evel t o i mpl ement t he
st andar ds i n al l wor ksi t es, and conduct moni t or i ng t o ensur e compl i ance.
Compl yi ng wor ksi t es ar e t o be acknowl edged and cer t i f i ed, as st at ed i n t he
NAC pr ocl amat i on of August , 2009.
4) Prevent i on of HIV among non-f ormal worksi t es
In 2008- 2009 t he BATS, DLWP, pr ovi nci al chi ef medi cal of f i ce, l ocal
admi ni st r at i ve or gani zat i ons, communi t i es, and ot her r el at ed or gani zat i ons
69
est abl i shed a net wor k of wor ki ng gr oups f or HIV/ AIDS pr event i on and cont r ol
wi t h an emphasi s on sust ai nabi l i t y by cr eat i ng vol unt eer peer l eader s among
t he mi gr ant l abor f or ce t o ser ve as r esour ce per sons t o del i ver knowl edge,
counsel i ng, and suppor t f or heal t hy behavi or . They conduct act i vi t i es t o
expand successf ul component s such as t he t r adi t i onal ar t i st s i ni t i at i ve
whi ch i nt egr at es pr event i on messages t hr ough l i f est yl e i nt er vent i ons, as
pi l ot ed i n Chi ang Rai and Khon Kaen.
D. Resul t s of i mpl ement at i on
HIV prevent i on i n t he workpl ace
Knowl edge, at t i t udes and behavi or s of t he empl oyees have been i mpact ed
as a r esul t of t he act i vi t i es. Wor kpl ace pol i ci es have al so been posi t i vel y
i nf l uenced. Dat a f r om wor ksi t e sur veys and r epor t s of t he TBCA f ound t hat
11, 208 wor ksi t es had par t i ci pat ed i n t he pr ogr am, benef i t i ng 2, 866, 508
empl oyees wi t h posi t i ve i mpr ovement s i n pol i cy, behavi or s f or pr event i on,
and bet t er at t i t udes as shown i n t he t abl e bel ow.
Tabl e 11: At t i t udes of wor ker s t owar d PLHA f r i ends who wer e t r ai ned
Degree of cont act wi t h PLHA
t hat i s accept abl e
Basel i ne
( n=10, 000)
Year 2
( n=16, 861)
Year 3
( n=31, 896)
Year 4
( n= 27, 578)
Year 5
( n= 12, 242)
Can shar e a wor k r oom wi t h 84% 99 % 99 % 99 % 99 %
Can shar e a phone wi t h 69% 98 % 98 % 98 % 99 %
Can shar e a bat hr oom wi t h 62% 97 % 97 % 97 % 96 %
Can shar e t he same set of f ood 59% 94 % 93 % 95 % 97 %
Can have physi cal cont act wi t h 59% 93 % 93 % 95 % 97 %
Can car e f or a cl ose f r i end wi t h
AIDS
58% 92 % 94 % 96 % 98 %
Tabl e 12: Tr ends i n behavi or change of wor ker s af t er compl et i on of t he t r ai ni ng
Pr e Post Di f f er ence
Concer n t hat HIV/ AIDS coul d ent er my l i f e 76 % 92 % 16 %
Concer n t hat I may have r i sk 27 % 73 % 46 %
Concer n t hat someone cl ose t o me i s at
r i sk
37 % 80 % 43 %
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Tabl e 13: Resul t s of condom pr omot i on
Tar get Resul t
Inst al l condom vendi ng machi nes 3, 050 2, 151
Number of condoms di st r i but ed 300, 000 400, 011
Number of f r ee condoms di st r i but ed 8, 550, 000 6, 861, 550
Tabl e 14: Condom use r at e of wor ker s i ncr eased ever y year
Per cent who used a condom f or ever y sex wi t h l over

TBCA
Basel i ne Sur vey 2003
( n=9, 760)
Popul at i on Counci l
Sur vey 2004
Popul at i on Counci l
Sur vey 2005
TBCA
Sur vey 2008
( n=9, 088)
16. 0% 34. 0% 48. 6% 65. 5 %
Tabl e 15: AIDS act i vi t i es i n t he wor kpl ace
Pr e Post
Pol i cy t o hel p PLHA 14. 7 % 98. 7 %
Pr omot e condoms among t he wor kf or ce 15. 1 % 97. 2 %
Conduct campai gns i n t he wor ksi t e 9. 0 % 96. 4 %
Col l abor at e wi t h ot her s on AIDS act i vi t i es 5. 9 % 94. 0 %
Peer l eader s of t he company conduct AIDS act i vi t i es 1. 9 % 89. 6 %
Peer l eader s can conduct t r ai ni ng wi t hout hel p f r om NGOs No dat a 29. 4 %

Tabl e 16: Changes i n pol i cy of t he wor ksi t e
Pol i cy
Basel i ne
( n=2, 169)
Year
( n=2, 045)
Year 2
( n=1, 703)
Year 3
( n=2, 013)
Year 4
( n=1, 884)
Do not r equi r e HIV scr eeni ng of new
empl oyees
89 % 94 % 96 % 96 % 98 %
Do not r equi r e exi st i ng st af f t o have an
HIV check
89 % 95 % 97 % 98 % 99 %
Do not f i r e per sons because of HIV
i nf ect i on
47 % 72 % 81 % 76 % 90 %
Ter mi nat e empl oyment of PLHA 5 % 3 % 0. 7 % 0. 7% 0. 6%
Not sur e whet her t er mi nat e or not 47 % 25 % 18 % 23 % 9 %
Gi ve educat i on t o t he empl oyees 34 % 91 % 96 % 93 % 90 %
Tabl e 17: Number of wor ksi t es cer t i f i ed as compl yi ng wi t h ASO Thai l and st andar ds
Cert i f i ed f or Year 1 Year 2 Year 3 Year 4 Tot al
ASO THAILAND Gol d Level 478 746 535 549 2, 308
ASO THAILAND Si l ver Level 793 709 851 1, 004 3, 357
Tot al 1, 271 1, 455 1, 386 1, 553 5, 665
HIV prevent i on i mpl ement at i on among t he pol i ce f orce
Tr ai ni ng f or r esour ce per sons i n HIV pr event i on, dr ug addi ct i on, and t obacco
was conduct ed f or 153 per sons i n 2008, and 494 i n 2009. The r esul t s of a
pr e- post assessment showed t hat knowl edge i ncr eased ( t o 91%) , t her e was
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sat i sf act i on wi t h t he t r ai ni ng cont ent and t r ai ner ( 92%and 97%) and 87% t o
94%t hought t he t r ai ni ng f or usef ul f or cur r ent wor k.
E. Probl ems and chal l enges
Chal l enges among general reproduct i ve age group
Thai soci et y st i l l t hi nks t hat HIV i nf ect i on i s l i mi t ed t o r i sk gr oups, and
condom use i n a l ove r el at i onshi p i s l ower r at e. They vi ew t hat use of
condoms means l ack of t r ust .
Chal l enges f or workers i n t he i nf ormal workf orce
Appl i cat i on of t he nat i onal gui del i nes f or pr event i on and management of
AIDS i n t he wor kpl ace needs t o f ul l y cover al l wor ker s i n bot h publ i c and
pr i vat e wor ksi t es.
F. Pl an f or addressi ng t he probl ems and chal l enges
x Suppor t publ i c medi a campai gns t o r ai se concer n about t he pr obl em of
AIDS and pr event i on of HIV i n t he gener al popul at i on, and modi f y at t i t udes
of soci et y about condoms so t hat t hey ar e seen as pr omot i ng sexual heal t h
r at her t han pr event i ng di sease.
x Suppor t t he gener al popul at i on t o seek HIV VCT and pr omot e coupl e
counsel i ng.
x Devel op st andar ds f or managi ng AIDS pr ogr ams i n wor ksi t es (ASO Thai l and)
t hat ar e consi st ent wi t h t he cont ext of t he smal l -scal e wor ksi t es and non-
f or mal wor ksi t es.
x Advance t he devel opment of t ool s f or eval uat i ng and moni t or i ng
pr ogr ams, and accept ance of t hese t ool s, at t he r egi onal l evel ( ASEAN and
APEC) as a st r at egy t o accel er at e i mpl ement at i on of Gui del i nes on Essent i al
Wor kpl ace Act i on f or Ent er pr i ses on t he pr event i on and Management of HIV
and AIDS i n ASEAN member St at es and t he APEC Gui del i nes f or Cr eat i ng an
Enabl i ng Envi r onment f or Empl oyer t o i mpl ement ef f ect i ve wor kpl ace
pr act i ce f or Peopl e l i vi ng wi t h HIV/ AIDS. Thi s wi l l hel p encour age wor ksi t es
wi t h r egi onal oper at i ons t o i nvest i n Thai l and t o hel p achi eve ASO- Thai l and
st andar ds as a soci al l y- r esponsi bl e act i on t hat di f f uses down t hr ough t he
chai n of sub- cont r act or s.
x Devel op st r at egi es t o accel er at e nat i onal act i on f or AIDS i n t he
wor kpl ace pr ogr ams.

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F. Best pract i ces
1) Prevent i ng HIV among pregnant women t hrough mal e part i ci pat i on:
Coupl e ANC
Thi s pr oj ect i s i mpl ement ed by t he Repr oduct i ve Heal t h Di vi si on of t he DOH
i n col l abor at i on wi t h var i ous par t ner s and t he Facul t y of Nur si ng of Bur apha
Uni ver si t y. ( See det ai l s i n sessi on Best Pr act i ce)
2) Cont i nui t y and ext ensi on of i mpl ement at i on by usi ng ASO- Thai l and
st andards
In 2005, t he MOL, t hr ough t he DLWP pr ocl ai med t he posi t i on t o pr event and
manage AIDS i n t he wor kpl ace t o encour age wor ksi t es t o pl ay a r ol e i n
pr event i on of AIDS i n accor dance wi t h t he ILO Code of Pr act i ce on HIV/ AIDS i n
t he Wor l d of Wor k by usi ng AIDS - r esponse St andar d Or gani zat i on st andar ds
as a t ool f or accel er at i ng t he wor k and eval uat i ng out comes and cer t i f yi ng
t he wor ksi t e as compl i ant .
Act i vi t i es wer e i mpl ement ed concr et el y and, at t he same t i me, t he
st andar ds wer e expanded t o i ncl ude t uber cul osi s cont r ol and management
as t he AIDS and TB r esponse St andar d Or gani zat i on, or ASO- T Thai l and.
The accompl i shment s of i mpl ement i ng t hese st andar ds ar e at t r i but abl e t o
t he development process accor di ng t o t he f ol l owi ng t wo pr i nci pl es:
1) Appl yi ng t he concept of heal t h behavi or cal l ed t he BASNEF Model t o
modi f y bel i ef s and behavi or as f ol l ows:
x Modi f y bel i ef s and at t i t udes ( BA) t hr ough a pr ocess of par t i ci pat or y
l ear ni ng f or empl oyer s and empl oyees.
x Access i nf l uent i al per sons who can i nf l uence behavi or al subj ect i ve nor ms
( SN) by bui l di ng awar eness and under st andi ng of t he empl oyer , cadr es of
peer l eader r esour ce per sons, associ at i ons of empl oyer s, l abor uni ons,
wor ksi t e manager s, and DLWP.
x Cr eat e a suppor t i ve envi r onment f or behavi or change ( EF enabl i ng
f act or s) whi ch consi st of spr eadi ng a movement of mobi l i zat i on on AIDS
act i vi t i es l ed by t he ILO, announcement s by t he MOL on AIDS, cr eat e a soci al
movement f or i ncr eased r esponsi bi l i t y f or AIDS, cr eat e t ool s on concr et e
i mpl ement at i on of t he st andar ds ( ASO Thai l and and ASO- T) as a st r at egy t o
assess compl i ance wi t h t he pol i cy, bui l d mot i vat i on by publ i cl y r ecogni zi ng
st ar per f or mer s and best pr act i ces, pr ovi de ser vi ces t hat ar e conveni ent and
adequat e by bui l di ng l ocal NGOs wi t h r esponsi bi l i t y f or pr ovi di ng ser vi ces,
conduct out r each educat i on and use f l exi bi l i t y i n wor ki ng wi t h t ar get gr oups,
i ncl udi ng havi ng t he empl oyer i nst al l condom vendi ng machi nes t o i ncr ease
empl oyee access t o af f or dabl e condoms.
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2) Pr omot i ng t he wor k concept of bei ng a st akehol der i n a par t ner shi p
bet ween t he gover nment , t he DDC, t he TBCA, t he Net wor k of 36
Devel opment NGOs, t he AIDS Ri ght s Foundat i on, t he Associ at i on of
Empl oyer s, l abor or gani zat i on, i ncl udi ng i nt egr at ed net wor ki ng wi t h t he
gover nment , l ocal admi ni st r at i ve or gani zat i ons i n mobi l i zi ng f undi ng and
l ocal r esour ces t o accel er at e i mpl ement at i on i n a net wor ki ng f ashi on, wi t h
f ul l coor di nat i on wi t h t he communi t y i n a way t hat i s sust ai nabl e.
3. 3. 4 HIV Prevent i on among Yout hs
A. Si t uat i on of HIV i n Yout h
Thai l and does not i ncl ude a yout h cat egor y as one of i t s sent i nel
popul at i ons i n HIV sur vei l l ance. However , t he per cent of HIV among ANC
cl i ent s age 15 t o 24 year s, and among mi l i t ar y r ecr ui t s can be used as pr oxy
popul at i ons t o t r ack t he t r ends. Al so, t he r ecent out br eaks among MSM
show t hat HIV has t he pot ent i al t o er upt suddenl y.
In addi t i on, scr eeni ng of STI among ar my r ecr ui t s i n November 2008 f ound
t hat t he pr eval ence of non- speci f i c ur et hr i t i s was 6. 9%, gonor r hea was 0. 9%,
and syphi l i s was 0. 1%. Al so, dat a f r om t he behavi or al sur vei l l ance sur vey
( BSS) war n t hat t her e i s t he pot ent i al f or epi demi cs among yout h unl ess
ef f ect i ve pr event i on measur es ar e i mpl ement ed t o addr ess t he f ol l owi ng:
1) Yout h norms and sex behavi or
Incr easi ngl y, yout h vi ew sex bef or e mar r i age as nor mal . A sur vey among
t he Thai AIDS Yout h Net wor k i n 2007 i n el even pr ovi nces f ound t hat , among
yout h age 15- 22 year s, 48. 8% f i nd non- mar i t al sex accept abl e. In addi t i on,
67. 2% vi ew sex as a per son s r i ght , and 39. 1% f el t t hat havi ng sex wi t h
di f f er ent par t ner s dur i ng adol escence was nor mal . These f i ndi ngs ar e
consi st ent wi t h Ramaj i t t i Inst i t ut e dat a f r om 2006- 7 among school and
uni ver si t y yout h t hat 30% of vocat i onal school yout h and 56% of col l ege-
based yout h accept t he i dea of pr e- mar i t al cohabi t at i on.
Mor e yout h ar e havi ng sex. A sur vey of hi gh school ( HS) st udent s i n 24
pr ovi nces conduct ed by t he BoE of t he DDC i n 2008 f ound t hat t he
pr opor t i on of t he sampl e t hat was sexual l y act i ve was 3. 0%, 15. 2%, and 37%-
43% f or l ower HS ( mean age 13) , upper HS ( mean age 16) , and vocat i onal
school ( mean age 17) r espect i vel y.
Yout h and sex wi t h mul t i pl e par t ner s
Dat a f r om t he 2008 sur vey f ound t hat mor e t han hal f of mal e st udent s had
had sex, and one i n f i ve f emal e st udent s had mor e t han one sex par t ner i n
t he pr evi ous year . A st udy of f i r st - of f ender s i n j uveni l e det ent i on homes i n
2009 f ound t hat , among yout h age 15- 18 year s, 64. 1%had had sex wi t h mor e
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t han one par t ner , and condom use f or ever y sex epi sode was ver y l ow at
15. 9%.
2) Knowl edge and concern regardi ng condom use
Condom use l evel s among adol escent s i s st i l l l ow
Fr om 20%- 40%of st udent s use a condom ever y t i me t hey have sex wi t h t hei r
l over . Al ways condom use i n t he past year among mal e st udent s and ar my
r ecr ui t s who had sex wi t h anot her man shows an i ncr easi ng t r end f r om 28%
i n 2005 t o 50%i n 2008, but t hi s l evel i s st i l l consi der ed t o be ver y l ow.
AIDS Knowl edge i s l ow
The nat i onal sur vey of sex behavi or i n 2006 f ound t hat , among yout h age 18-
24 year s, onl y 28. 4%wer e abl e t o answer al l knowl edge quest i ons cor r ect l y.
The 2008 r ound of t he BSS among M2 HS st udent s f ound t hat 15. 6%and 9. 1%
wer e abl e t o answer t he 5 UNGASS i ndi cat or s cor r ect l y by mal es and
f emal es r espect i vel y. For M5 st udent s t he cor r espondi ng r at e was 35. 3%,
and f or vocat i onal school st udent s was 25%.
4) Chi l dren and yout h can access pornographi c mat eri al easi l y.
x The 2008 sur vey by t he Ramaj i t t i Inst i t ut e f ound t hat chi l dr en ar e usi ng
medi a mor e or near l y hal f t hei r waki ng day ( 6 t o 7 hour s) . The sur vey of
gener al HS and vocat i onal st udent s age 16- 17 year s f ound t hat 69. 3% of
mal e M5 st udent s had l ooked at por n on t he Int er net , whi l e 82. 4% had
l ooked at por n books, or por n vi deo. Ful l y 27. 3%of f emal e M5 st udent s had
l ogged ont o a por n web page, and 54. 3%had seen a por n book or vi deo.
5) More chi l dren and yout h are consumi ng al cohol i c beverages
Among yout h wi t h an STI, 43% of cases occur among yout h who dr i nk.
In addi t i on, t hose yout h wi t h a hi st or y of al cohol consumpt i on al so r epor t
l oggi ng ont o por n websi t es and wat ch por n vi deo.
B. HIV prevent i on among yout h
B. 1 Pol i cy and pl ans/ programs on AIDS i n yout h
1) The Nat i onal AIDS Pl an f or 2007-2011
Yout h ar e one of t he t ar get popul at i ons i n t he Nat i onal AIDS pl an, and ar e
an NAPAC pr i or i t y gr oup i ncl uded i n t he r esol ut i on of Jul y 2009 t o r educe
HIV i nci dence by hal f by 2011.
The i mpl ement at i on of measur es t o r espond t o t he pol i cy and pl ans i ncl ude
AIDS and sex educat i on and l i f e ski l l s i n AIDS pr event i on, suppor t f or a soci al
envi r onment wi t h posi t i ve i nf or mat i on about sex and AIDS pr event i on,
suppor t f or access t o heal t h ser vi ces and pr event i on suppl i es, i ncr eased
yout h par t i ci pat i on i n deci si on maki ng and i mpl ement at i on of AIDS
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pr event i on, and suppor t i ve col l abor at i on of var i ous sect or s i ncl udi ng t he
l ocal admi ni st r at i ve or gani zat i ons ( LAOs) .
2) Pol i cy and st rat egy on reproduct i ve heal t h (RH)
In addi t i on t o t he NAP st r at egy, t he nat i onal RH st r at egi c pl an f or 2010- 2014
by t he DOH al so suppor t s many of t he same goal s i n addi t i on t o pr event i on
of t een pr egnancy. The st r at egy al so ai ms t o pr event and r educe t he
pr obl em of di sadvant aged chi l dr en by f ocusi ng on yout h and adol escent s
t hr ough coor di nat i on and col l abor at i on among agenci es at t he nat i onal ,
zonal , pr ovi nci al , and communi t y l evel s wi t h concr et e di r ect i ves f or publ i c
and pr i vat e agenci es i ncl udi ng t he LAOs, and i ncl udi ng t ar get s on STIs, HIV
and t een pr egnancy, t hr ough yout h- f r i endl y ser vi ces i n var i ous set t i ngs,
especi al l y hospi t al s.
The pr ovi nci al RH pl an t o r educe STI/ HIV and t een pr egnancy i ncl uded a
pi l ot pr ogr am i n t hr ee pr ovi nces i n 2009, expansi on t o 10 pr ovi nces i n 2010,
and pl ans t o expand t o al l pr ovi nces by 2014.
B. 2 Impl ement at i on
1. Capaci t y devel opment f or yout h peer l eaders
Yout h i n school : A col l abor at i ve act i vi t y was conduct ed bet ween t he MOPH,
t he Mi ni st r y of Educat i on ( MOE) and PATH. BATS and t he MOE devel oped a
syst em of peer l eader s f or AIDS pr event i on i n school s by i nt egr at i ng AIDS,
STIs, t obacco and al cohol i nt o t he t r ai ni ng of peer s so t hat t hey can advi se
t hei r f el l ow st udent s t hr ough di r ect communi cat i on and act i vi t i es. Thi s
act i vi t y began i n 2006 and cont i nued unt i l 2009. A t ot al of 98 educat i onal
i nst i t ut i ons par t i ci pat ed i n 35 pr ovi nces, i ncl udi ng 45 hi gh school s, 23
vocat i onal school s, and 30 col l eges. In addi t i on, yout h par t i ci pat i on was
advocat ed by hol di ng web page desi gn cont est s, cont est s t o compose an
AIDS campai gn songs and sl ogans, pr oduct i on of gui del i nes f or
communi cat i ng about AIDS and sex f or par ent s t o get t hem mor e i nvol ved i n
gui di ng t hei r chi l dr en, and E- l ear ni ng pr ogr ams f or yout h and t he gener al
popul at i on.
In addi t i on, al l i es and net wor ks, such as t he syst em of col l eges and t he
Mi ni st r y f or Soci al Wel f ar e have conduct ed act i vi t i es t o suppor t HIV/ AIDS
knowl edge and pr event i on.
Yout h i n t he communi t y: BATS col l abor at ed wi t h NGOs, di sease cont r ol
of f i ces, and t he pr ovi nci al chi ef medi cal of f i ces, t o devel op a syst em of
yout h peer l eader s f or HIV pr event i on at t he communi t y l evel i n 30
pr ovi nces begi nni ng i n 2004 and expandi ng i nt o 43 pr ovi nces by 2009. The
76
peer s par t i ci pat e i n l ocal pl anni ng and i mpl ement at i on of communi t y AIDS
pr event i on act i vi t i es.
Ther e ar e l i nks among school - based net wor ks and t he communi t y by j oi nt
AIDS pr event i on act i vi t i es, and suppor t f or chi l dr en and yout h t o conduct
f r i ends- hel p- f r i ends act i vi t i es, devel opment of adul t and yout h peer
l eader s so t hat t hey can ser ve as r esour ce per sons i n AIDS awar eness r ai si ng,
sex educat i on and RH, and as advocat e f or budget f or chi l d and yout h
f aci l i t i es such as a user - f r i endl y cent er f or heal t h ser vi ces i n t he vi l l age.
Chi l d and yout h counci l s: Ther e has been suppor t f or t he i nvol vement of
chi l d and yout h counci l s by bui l di ng capaci t y of member s at t he pr ovi nci al
l evel . The DOH has i mpl ement ed a pr ogr am among counci l member s t o r ai se
concer n, knowl edge, under st andi ng and mot i vat i on whi ch i s i n accor dance
wi t h RH goal s and i ncr ease yout h par t i ci pat i on i n RH, bot h i n and out - of -
school . At pr esent , 53 pr ovi nces have been cover ed.
2. Teachi ng and l earni ng AIDS and sex educat i on i n t he school s
Hi gh school s and vocat i onal school s: In 2009, t her e was a modi f i cat i on t o
t he i mpl ement at i on st r at egy f or yout h i n vi ew of t he f act t hat t he
eval uat i on of out comes of t he GFATM suppor t dur i ng 2003- 2008 f ound onl y
knowl edge gai ns among yout h i n t ar get ar eas, but pr event i on ski l l s f or saf e
behavi or wer e not yet opt i mal . Thus, t he new st r at egy emphasi zes ski l l s
bui l di ng f or yout h whi ch ar e consi st ent wi t h at t i t udes, bel i ef s and l i f est yl es
of t he yout h. The new t ar get i s t o cover 2. 4 mi l l i on yout h bet ween 12 and
24 year s i n 43 pr ovi nces.
The NGO PATH pl ays a r ol e i n pr omot i ng sex and AIDS educat i on i n hi gh
school s and vocat i onal school s t hr ough devel opment of a cur r i cul um,
educat i onal medi a, t r ai ni ng f or t eacher s, manager s, and educat i onal
super vi sor s. So f ar 68% of vocat i onal col l eges have been cover ed by t hi s
pr ogr am.
Uni ver si t y l evel : The DOH suppor t s RH i nst r uct i on at t he col l ege l evel
t hr ough t he net wor k of Rachapat t eacher s col l eges by suppor t i ng t he
school s t o i mpl ement an RH cur r i cul um t hr ough t he r el evant cour se
pr ogr ams. Thi s i s t o ensur e t hat col l ege st udent s have access t o i nf or mat i on
on RH, and can appl y t hi s i n t hei r wor k wi t h adol escent s. So f ar 13 br anches
of Rachapat Uni ver si t y ar e par t i ci pat i ng, and t her e ar e pl ans t o expand t o
al l br anches.
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3. Support f or Yout h Fri endl y Heal t h Servi ces
The MOPH has set t he t ar get f or 2014 t hat 80% of i t s hospi t al s wi l l have
Yout h Fr i endl y Heal t h Ser vi ces ( YFHS) based on YFHS st andar ds. At t he end
of 2009, about 10%of MOPH hospi t al s at al l l evel s wer e par t i ci pat i ng. MOPH
i s al so col l abor at i ng wi t h par t ner s t o suppor t YFHS i n a var i et y of ser vi ce
si t es i n 43 pr ovi nces usi ng t he GFATM budget .
At t he same t i me, PATH i s appl yi ng t he model Lovecar e appr oach f or
adol escent s i n pr i vat e cl i ni cs and heal t h cent er s i n Bangkok. It i s pl anned
t hat t her e wi l l be expansi on of t hi s model t o 43 pr ovi nces whi ch i ncl udes
counsel i ng, HIV VCT, di agnosi s and t r eat ment of STIs, cont r acept i on,
condom di st r i but i on, scr eeni ng f or cer vi cal cancer , and r ef er r al .
In addi t i on, t her e ar e net wor ks of gover nment and NGO agenci es
i mpl ement i ng YFHS such as t he ser vi ces at Ramat hi bodi , Si r i r aj ,
Phr amongkut kl ao Hospi t al s, and i nt egr at i on of t hese concept s wi t h
chi l dr en s cl i ni cs i n t he pr ovi nces.
C. Probl ems and chal l enges
Some of t he chal l enges ci t ed i n t he pr evi ous r epor t per i od st i l l appl y t o t he
cur r ent r epor t per i od. These i ncl ude soci et al at t i t udes about sex educat i on
i n whi ch most adul t s st i l l cannot accept sex educat i on f or yout h, and t hi s i s
a bar r i er t o f or mal i zi ng AIDS and sex l i f e ski l l s t eachi ng f or yout h i n school .
Thi s al so i mpact s on l i mi t i ng access of yout h t o condoms. Anot her chal l enge
i s coor di nat i on among t he var i ous agenci es whi ch means t hat i ssues ar e st i l l
bei ng addr essed i n separ at e, i sol at ed pi ece- meal f ashi on. Al so, mobi l i zi ng
r esour ces i n t he per i pher al ar eas, especi al l y among LAOs, st i l l needs
consi der at i on t o i mpr ove under st andi ng and appr eci at i on of t he i mpor t ance
of HIV pr event i on i n yout h.
Legal chal l enges: Dur i ng t hi s r epor t per i od, t her e has been an i ncr eased
f ocus on YFHS, t o hel p yout h accur at el y assess t hei r HIV r i sk, t o make
choi ces about get t i ng t est ed, and deci di ng t o di agnose and t r eat STIs. A
l i mi t at i on i s t hat yout h under 18 year s must have par ent al consent f or
ser vi ces, and yout h do not want t o r eveal t hei r need f or t hi s t o t he par ent s
or guar di ans.
A di f f i cul t y i n wor ki ng wi t h yout h i s deal i ng wi t h soci al f act or s whi ch
i ncr ease r i sk. Al so, knowl edge and i nf or mat i on campai gns i n t he past wer e
not pl anned wel l and wer e shor t - t er m, not st r ong enough, di d not i mpr ess
t he adol escent s, l acked cont i nui t y and di d not l i nk wi t h act i vi t i es bei ng
i mpl ement ed i n t he l ocal i t y.
78
D. Pl an t o address t he probl ems and chal l enges
x An ur gent need i s t o have t he r esponsi bl e agenci es at t he cent r al l evel t o
al i gn t he st r at egi c pl ans f or st andar ds and pr ogr ams t o mobi l i ze r esour ces,
so t hat t her e ar e cl ear t echni cal di r ect i ons f or cost - ef f ect i ve and concr et e
i mpl ement at i on.
x Ther e i s a need f or pol i cy at t he nat i onal and mi ni st er i al l evel f or AIDS
and l i f e ski l l s educat i on, and devel opment of a cor e cur r i cul um t hat i s
i mpl ement ed i n school s t hr oughout t he count r y i n t he amount of 30 hour s
per academi c year . Ther e i s a need t o devel op st andar ds f or t hi s
i mpl ement at i on so t hat each school has assi gned and t r ai ned t eacher s t o
del i ver t he i nst r uct i on. Ther e shoul d be pol i cy suppor t f r om educat i onal
admi ni st r at or s at t he zonal l evel and school l evel s, and i n t he ar ea of
t echni cal suppor t f r om t he net wor k of publ i c, educat i on, heal t h, NGO and
i nt er nat i onal agency sect or s.
x Ther e shoul d be a syst emat i c and cont i nuous pl an f or campai gns by
devel opi ng cont ent t hat i s appr opr i at e f or yout h at var i ous ages. Thi s
shoul d i ncl ude t he use of mul t i pl e communi cat i on channel s t o maxi mi ze
cover age cost - ef f ect i vel y, and col l abor at e wi t h mass medi a t o pr omot e
at t i t udes whi ch f aci l i t at e t he i mpl ement at i on on a cont i nuous basi s.
E. Best pract i ces
Innovat i on i n t he area of yout h f ri endl y servi ces by PATH
PATH has i mpl ement ed t he Love car e Pr oj ect whi ch pr ovi des YFHS f or
yout h age 12 t o 25 year s so t hat yout h can access suppor t ser vi ces,
pr event i on, and t r eat ment f or sexual and RH pr obl ems. The pr oj ect i s
suppor t ed by t he NHSP, UNFPA and t he Heal t h Pr omot i on Bur eau. In i t s f i r st
year of i mpl ement at i on, t he pr oj ect was successf ul i n set t i ng up cl i ni cal
ser vi ces, conduct i ng publ i c awar eness r ai si ng about t he pr oj ect , out r each
and t wo- way communi cat i on t o i ncr ease concer n of t he t ar get gr oup of t he
need t o assess t hei r r i sk and seek cl i ni cal ser vi ces.
Dur i ng Jul y 2008 t o Jul y 2009 a t ot al of 16, 832 per sons r ecei ved ser vi ces
t hr ough out r each, mobi l e, cal l cent er and pr oj ect websi t e i nt er act i on. A
t ot al of 9, 702 yout h sought ser vi ces at t he net wor k of 14 cl i ni cs i n t he
pr oj ect . Over hal f r equest ed STI di agnosi s. A t ot al of 5, 544 r ecei ved HIV
VCT wi t h 3. 0% t est i ng posi t i ve. The HIV+ r at e among t hose under 25 year s
was 1. 6%, or about 2. 5 t i mes hi gher t han t hat f or t he gener al popul at i on i n
t hat age gr oup. Those t est i ng posi t i ve wer e counsel ed and r ef er r ed t o t he
appr opr i at e heal t h out l et f or f ol l ow- up car e.
Thi s i nnovat i ve pr oj ect i s a good exampl e of publ i c- pr i vat e col l abor at i on. It
al so has pi oneer ed a chat r oom ser vi ce on t he Int er net whi ch act s l i ke an
79
on- l i ne cl i ni c and i s a good channel f or r eachi ng yout h. Al t hough i t i s l abor -
i nt ensi ve, t he pr oj ect has r ecr ui t ed and t r ai ned yout h vol unt eer s f r om
school s t o hel p pr ovi de t he YFHS.
Ther e ar e f our pr i nci pal ser vi ces of Love car e cl i ni cs: HIV, STI and cer vi cal
cancer di agnosi s, and cont r acept i on. Of t he 14 Love car e cl i ni cs, 5, 160
cl i ent s wer e seen dur i ng Jul y 2, 2008 t o June 30, 2009, i ncl udi ng 2, 255
under 25 year s, and 2, 905 age 25 year s or over .
A chal l enge f or i mpl ement at i on i s t he cr eat i on of a moni t or i ng syst em f or
f ol l owi ng up t r eat ment and r ef er r al . Thi s i s especi al l y i mpor t ant f or t hose
t est i ng HIV+ t o ensur e t hey get t r eat ment f or bot h physi cal and psycho-
emot i onal needs. Ther e i s a need t o cont i nual l y moni t or cl i ent sat i sf act i on
and i n- ser vi ce t r ai ni ng needs of st af f t o mai nt ai n ser vi ce qual i t y so t hat al l
yout h have access t o a st r ong net wor k of YFHS.
3. 3. 5 HIV Prevent i on among Sex workers (SW)
A. Number of sex workers
The 2009 annual sur vey of commer ci al sex est abl i shment s ( CSE) and sex
wor ker s ( SW) conduct ed by t he BATS f ound 16, 270 and 73, 917 r espect i vel y,
wi t h 6, 746 mal e 67, 171 FSWs. Thi s r epr esent s a decl i ne f r om 2007. The t op
f i ve most common CSEs wer e kar aoke sal ons, beer bar s, and t r adi t i onal
massage par l or s, saunas, and coyot e bar s. The act ual number of SWs i s
pr obabl y t wo t o t hr ee t i mes hi gher t han t hose enumer at ed f r om t he BATS
sur vey, or appr oxi mat el y 150, 000 t o 250, 000 per sons.

B. HIV si t uat i on among SWs
B.1 HIV i nf ect i on
HIV pr eval ence among FSWs i n CSEs i s st i l l i n decl i ne, f r om 4. 3%i n 2007 t o
2. 8% i n 2009. Ther e was al so a decl i ne f or MSWs, f r om 20. 7% t o 14. 2%
r espect i vel y.
The t r end of HIV among br ot hel - based and non- br ot hel - based SWs i n ot her
CSEs i s decl i ni ng; however t he pr eval ence of HIV among f r ee- l ance sex
wor ker s or ot her SWs out si de t he r out i ne sur vei l l ance syst em i s hi gh and not
necessar i l y decr easi ng. A st udy i n 2007 by t he TUC usi ng t he r espondent -
dr i ve sampl i ng met hod i n Bangkok and Chi ang Rai f ound HIV pr eval ence as
hi gh as 20%among FSWs.
80
0
2
4
6
8
10
12
Direct Indirect Total
o
Sero-surveillance
RDS 2007
ChiangRai
Fi gur e 25 Pr eval ence of HIV among FSWs i n Thai l and: 1989- 2008
3.12
9.3
15.2
23.0
28.0
27.6
28.2
26.1
21.1
16
18.46
16.56
12.34
10.87
7.36
6.8
4.59
5.57
3.2
0
2
4.34 4.46
7.69
8
10.14
8.26
6.67 6.56
5.51
5.03
4.04
3.67
4
3.37
2.27
3.35
2.6
0
5
10
15
20
25
30
1
9
8
9
1
9
9
1
1
9
9
3
1
9
9
5
1
9
9
7
1
9
9
9
2
0
0
1
2
0
0
3
2
0
0
5
2
0
0
7
Brothel-based sex workers Other venue-based sex workers
%
In 1989, HIV
prevalence
among
brothel-based
sex workers in
Chiang Mai
was 44%
Source: Sentinel sero-surveillance, Bureau of Epidemiology, Ministry of Public Health
In 2007, HIV
prevalence among
non venue-based
sex workers using
RDS in Bangkok
was 19%
Fi gur e 26 HIV pr eval ence among a sampl e of FSWs usi ng RDS i n 2007
Bangkok and Chi ang Rai
In addi t i on, sur vei l l ance of r ecent HIV i nf ect i on usi ng t he BED capt ur ed
ELISA t echni que of t he BoE f ound t hat t he pr eval ence of new i nf ect i on
among FSWs i n non- br ot hel based CSEs i ncr eased bet ween 2004 and 2007.
Dat a f or 2008 shows no st at i st i cal l y si gni f i cant decl i ne f or t hi s i ndi cat or .
For MSWs, dat a f r om t he nat i onal sur vei l l ance and t i me- l ocat i on sampl i ng
f ound t hat HIV i s st i l l hi gh and not decl i ni ng f or t he most r ecent year s of
dat a.
0
5
10
15
20
25
Direct Indirect Total
o
Sero-surveillance
RDS 2007
Bangkok
81
B. 2 STI si t uat i on
The si t uat i on and t r ends f or STIs af t er t he i mpl ement at i on of heal t h r ef or m
of 2002, shows si gns of i ncr easi ng, wi t h cor r espondi ng decl i nes i n SW
at t endance at STI cl i ni cs, especi al l y si nce 2003. In 2008, t he pr eval ence of
STIs among SWs was 1. 8%i n f emal es and 15. 2%i n mal es.
Impr oved di agnost i cs have al l owed ear l i er det ect i on of gonor r hea and
Chl amydi a i nf ect i on. Bet ween 0 and 2. 2%of FSWs had gonor r hea, and 5%t o
16%had Chl amydi a. These f i ndi ngs ar e consi st ent wi t h dat a f r om t wo
pr i vat e cl i ni cs i n Bangkok and Pat t aya whi ch f ound t hat i nci dence of
gonor r hea was 18. 7%i n 2007 and 19. 2%i n 2009.
In addi t i on, t he BoE has f ound t hat pr eval ence of syphi l i s among SWs i s al so
i ncr easi ng.
B. 3 Knowl edge and behavi or
The behavi or al sur vei l l ance sur vey ( BSS) of t he BoE i n 2008 assessed AIDS
knowl edge acr oss t he f i ve UNGASS i ndi cat or s. Bot h f emal e and MSWs had
i mpr oved per cent ages answer i ng al l f i ve quest i ons cor r ect l y compar ed t o
2007: 41. 3%f or f emal es and 29. 3%f or mal es. Sex wor ker s over 25 year s of
age had mor e cor r ect r esponse t han t hose under 25 year s.
The BSS i n 2008 f ound 96. 1%, 97. 1% and 88. 8% of FSWs r epor t ed t hat t hey
use condoms wi t h r egul ar , gener al and ot her t ypes of cl i ent s r espect i vel y.
However , onl y 45. 4% sai d t hey used condoms wi t h t hei r l over or par t ner .
Condom use wi t h l ast cust omer decl i ned f r om 96. 2%t o 92. 2%bet ween 2007
and 2009.
B. 4 Access t o heal t h servi ces
A sur vey of r epr oduct i ve heal t h access i n FSWs i n f our ci t i es (Bangkok,
Pat t aya, Chi ang Mai and Songkl a) i n 2007 f ound t hat 68% wer e el i gi bl e f or
NHSP benef i t s, 8% had soci al wel f ar e car ds, and 22. 5% had no heal t h
i nsur ance cover age.
Ser vi ce st at i st i cs f r om t he STI cont r ol pr ogr am cl i ni cs i n 76 pr ovi nces f ound
t hat t he pr opor t i on of cl i ent s at t endi ng t he cl i ni c has decl i ned cont i nuousl y.
BoE sur vei l l ance dat a show t hat t he pr opor t i on of SWs who had an HIV t est
i n t he past 12 mont hs and knew t he r esul t s decl i ned i n FSWs f r om 43. 1%t o
35. 6% bet ween 2007 and 2009, and f r om 54. 2% t o 35. 6% i n MSWs
r espect i vel y.
82
0
10
20
30
40
50
60
2007 2009
FSW
MSW
Source: Bureau of Epidemiology, Ministry of Public Health
Percentage
Fi gur e 27 Pr opor t i on of sex wor ker s havi ng an HIV t est and knowi ng
t he r esul t i n 2007 and 2009 by sex

C. Impl ement at i on of HIV prevent i on among sex workers
C. 1 Knowl edge educat i on
The annual sur vey of CSEs and SWs by t he pr ovi nci al chi ef medi cal of f i ce
and par t ner s, si mul t aneousl y t hr oughout t he count r y i nvol ves vi si t s t o t he
CSEs and pr esent at i ons on STI/ AIDS pr event i on f or t he SWs, condom
pr omot i on, r ai si ng awar eness of t he ser vi ces f or SWs i n t he pr ovi nce, and
mot i vat i on f or t he SWs t o come f or STI/ HIV scr eeni ng.
Ther e i s cont i nual devel opment of medi a, and t ool s t o pr esent t hese, t o
i ncr ease knowl edge and mot i vat i on, and f or use by out r each t eams of t he
gover nment and NGOs. Ther e ar e peer vol unt eer s t o hel p r each SWs t hat
wor k out si de of CSEs. NGOs pl ay an i mpor t ant r ol e i n condom pr omot i on
and di st r i but i on. NGOs such as EMPOWER conduct educat i on i n t he CSE
i t sel f , ot her s, such as SWING, r each f r ee- l ancer s i n Sanam Luang, Khl ong
Lawd and Wong Wi en 22 Kor akada ar eas. The SWs Fr i ends Foundat i on
pr ovi des AIDS educat i on f or mal e and FSWs and t r ansgender s.
C. 2 Promot i on and access t o condoms
The 100% condom use pr ogr am i s an i mpor t ant st r at egy f or pr event i on of
HIV spr ead f or SWs. Ther e was 15. 6 mi l l i on baht al l ocat ed f or t hi s act i vi t y
i ncl udi ng t he pr ocur ement of 16 mi l l i on 49- mm condoms and 11 mi l l i on 52-
mm condoms. Act i vi t i es of NGOs such as SWING have set up condom
83
r evol vi ng f unds t o r educe t he cost of qual i t y condoms f or SWs i n Bangkok
and Pat t aya.
In addi t i on, UNFPA suppor t s t he est abl i shment of a nat i onal condom
commi t t ee and dr af t st r at egy f or compr ehensi ve condom pr ogr ammi ng, and
suppor t s t he t r i al i nt r oduct i on of t he f emal e condom f or use by SWs and t he
gener al popul at i on.
C. 3 Servi ce cl i ni c devel opment
Nat i onal pol i cy st i pul at es t hat each pr ovi nce needs t o have at l east one STI
cl i ni c t o i ncr ease access t o di agnosi s, scr eeni ng and t r eat ment of STIs, and
HIV VCT. In 2009, t her e wer e a t ot al 160 STI cl i ni cs i n 76 pr ovi nces
oper at i ng out of hospi t al s, di sease cont r ol cent er s, t he STI Cl ust er , and
heal t h cent er s of t he Bangkok Met r opol i t an Admi ni st r at i on.
C. 4 Capaci t y bui l di ng of government and NGO st af f
Wi t h f undi ng f r om t he GFATM Round 8, t he PPAT and net wor k member s
conduct ed a t r ai ni ng of NGO st af f so t hat t hey coul d conduct bet t er
out r each educat i on f or SW peer educat or s t o i ncr ease knowl edge and
di st r i but e condoms t o ot her s SWs. The t r ai ni ng al so i ncl uded r el evant
ot her s such as t he pol i ce, t axi dr i ver s, CSE manager s and st af f , and cover ed
t opi cs on AIDS, STIS, and RH.
In addi t i on, t he UNFPA suppor t ed capaci t y bui l di ng f or st af f conduct i ng
out r each by synt hesi zi ng t he l essons f r om a var i et y of out r each pr ogr ams,
and i ncl uded t r ai ni ng on est i mat i ng t he popul at i on of har d- t o- r each SWs,
among ot her t opi cs.
C. 5 Increased part i ci pat i on of SWs and ot her groups
Ci vi l soci et y suppor t s SW par t i ci pat i on t hr ough vol unt eer act i vi t y such as
t hose of EMPOWER and SWING whi ch emphasi ze capaci t y bui l di ng of SWs so
t hat t hey can t ake car e of and i mpr ove t hemsel ves, and hel p peer s gai n
knowl edge and f i nd r ef er r al ser vi ces.
C. 7 Mobi l i zi ng f i nanci al resources
Dur i ng 2008- 9, r esour ces f or i mpl ement at i on i ncr eased, f r om t he domest i c
budget and f r om t he GFATM, Heal t h Ser vi ce Resear ch Inst i t ut e ( HSRI) , TUC
and UNFPA. Bot h t he UN and TUC pr ovi ded t echni cal assi st ance.
C. 8 Bui l di ng a net work f or an al l i ance of workers
The Depar t ment of Di sease Cont r ol ( DDC) col l abor at ed wi t h t he UNFPA t o
convene an annual , nat i onal semi nar t o exchange exper i ence and l essons
l ear ned, and t o bui l d an al l i ance of ser vi ce pr ovi der s f or STI/ HIV and sex
84
ser vi ces wi t h r epr esent at i on i n al l 76 pr ovi nces and ci vi l soci et y. The f i r st
semi nar was i n 2007.
In addi t i on, EMPOWER st i l l mai nt ai ns a net wor k of NGOs who wor k wi t h SWs
under t he suppor t of t he HSRI.
D: Probl ems and chal l enges
1. Devel opment of t he dat a syst em f or eval uat i ng t he si t uat i on
Dat a f r om i mpl ement at i on under t he Gl obal AIDS Pr ogr am ( GAP) f ound t hat
onl y 60% of t hose el i gi bl e f or t r eat ment ar e r ecei vi ng i t , and t hi s i s onl y i n
t he publ i c sect or .
2. Access t o knowl edge and prevent i on
Ther e i s i nadequat e cover age of SWs who wor k on t he st r eet , i n par ks, or
ot her publ i c spaces. Ther e i s ver y l i mi t ed dat a on t hi s sub- gr oup. Ther e i s
al so l i mi t ed dat a and out r each t o t he SWs who ar e f or ei gn mi gr ant s si nce
CSE manager s do not want i t known t hat t hey have i l l egal mi gr ant s wor ki ng
f or t hem.
3. At t i t udes of servi ce provi ders t oward t he SWs
Some ser vi ce pr ovi der s do not f ul l y under st and t he pr i nci pl es of uni ver sal
human r i ght s and AIDS r i ght s. They t end t o vi ew SWs as spr eader s of
di sease, who ar e br eaki ng t he l aw, and ar e si nf ul . Thi s l eads t o ser vi ces
t hat ar e not user - f r i endl y.
4. Laws and regul at i ons whi ch i mpede prevent i on work
These i ncl ude t he l aw on human t r af f i cki ng and t he l aw on pr ost i t ut i on. A
cl ear exampl e of how t hese can be count er - pr oduct i ve i s when t he
owner / manager of a CSE does not cooper at e wi t h heal t h ser vi ce pr ovi der s
who want t o conduct out r each i n t he CSE out of f ear of l egal consequences,
especi al l y i f t hey have i l l egal i mmi gr ant SWs or per sons under age 18.
E: Pl ans t o address t he probl ems and chal l enges
The GFATM Round 8 i s suppor t i ng out r each and i nt egr at ed net wor k
st r engt heni ng f or t he per i od of 2009 t o 2014 i n 43 pr ovi nces i ncl udi ng
Bangkok. Ther e ar e cl ear pl ans, t ar get s and an M&E pl an whi ch shoul d be
usef ul f or ot her pr ovi nces t o consi der f ol l owi ng.
85
F: Best pract i ces
1. Can Do Bar
Probl em, concept , obj ect i ve
Sex wor k i s an occupat i on t hat i s not pr ot ect ed or suppor t ed by Thai l abor
l aw. The st r ong pr of i t - mot i ve of t he CSEs ensur es t hat t her e i s unf ai r
t r eat ment , pr essur e on and expl oi t at i on of SWs. Thi s i ncl udes l ack of
nor mal wor k r i ght s such as a l i mi t ed number of hour s of wor k, sal ar y and
compensat i on, ar bi t r ar y f i nes and f ees, and f ewer l eave days f or i l l ness or
vacat i on t han i n accor dance wi t h l abor l aws. Of t en, t he suppl i es and
equi pment i n t he CSE ar e sub- st andar d such as soap, massage oi l , dance
f l oor , massage r oom, chai r s, or i nappr opr i at e mandat or y uni f or ms. When
danci ng i n a coyot e bar SWs have t o wear hi gh heel shoes, or si t i n f r ont of
t he CSE i n ski mpy cl ot hes even when t he weat her i s col d. Ther e ar e
i nadequat e hazar d pr ot ect i ons i n t he CSEs r egar di ng f i r e, sound, or
ci gar et t e smoke.
Soci et y i n gener al vi ews CSEs as pl aces wher e i l l egal and i mmor al act i vi t i es
occur , wher e di sease i s spr ead and dr ugs ar e used, wher e or gani zed cr i me i s
act i ve, wher e young women ar e abused, wher e si nf ul and dr unk peopl e go,
wher e i t i s danger ous and di sgust i ng. These soci al at t i t udes st i gmat i ze t he
SWs and de- val ue t hem. Thus, saf et y and r i ght s of t hese SWs ar e not
consi der ed as i mpor t ant as t hat f or ot her s.
Concept ual model
Fr om meet i ngs of t he net wor k of SW peer l eader s, f r om r epor t s of deat hs of
SWs due t o unsaf e wor ki ng condi t i ons, and expl oi t at i on of SWs, and l ack of
occupat i onal heal t h, i t was deci ded t o open a bar wi t h a f avor abl e
envi r onment f or SWs. It i s cal l ed t he Can Do Bar and i s l ocat ed i n Chi ang
Mai .
The net wor k col l ect ed donat i ons f r om member s and SWs i n t he amount of
no l ess t han 1, 000 baht per per son unt i l 1 mi l l i on baht was accumul at ed. A
space was f ound, made cl ean, f r esh, wel l - l i t , wi t h appr opr i at e sound
syst em, al l accor di ng t o occupat i onal heal t h st andar ds. A ci r cui t br eaker
was i nst al l ed al ong wi t h f i r e ext i ngui sher , pr i vat e bat hr ooms, and a r oom
f or wor ker r el axat i on.
The Can Do Bar i n Chi ang Mai opened on Sept ember 15, 2006 wi t h t hr ee f ul l -
t i me st af f who ar e pai d a sal ar y. Ther e ar e no f i nes or sal ar y deduct i ons.
Ther e i s soci al i nsur ance, and ever yone has t he r esponsi bi l i t y of ser vi ng
dr i nks, t al ki ng wi t h cust omer s, cl eani ng t he pr emi ses, managi ng f i nances,
and managi ng t he st ock suppl y. An addi t i onal 40 per sons wor k at t he bar on
a f r ee- l ance basi s whi ch means t hey do not r ecei ve a sal ar y but ar e
al l owed t o come and go at wi l l . The sal ar i ed st af f wor k under st andar ds of
86
t he Thai l abor l aw, and t he bar i s r egi st er ed wi t h t he Mi ni st r y of Labor . It s
hour s of oper at i on ar e f r om 6 p. m. t o mi dni ght ever y day of t he week.
The bar i ncome comes f r om sal es of dr i nks, not f r om bar f i nes f or sex. The
pol i cy of t he bar i s t hat sex i s a pr i vat e negot i at i on bet ween t wo adul t s, and
t he bar t akes no par t or i nt er est i n t hat .
The Can Do Bar di st r i but es condoms f or f r ee. St af f i s t r ai ned i n counsel i ng
and can gi ve gui dance on saf e sex. St af f i s al so t r ai ned i n f i r st ai d, use of
bar equi pment , saf e ways of l i f t i ng and movi ng heavy obj ect s, and ot her l i f e
ski l l s.
Achi evement s
The Can Do Bar i s a model est abl i shment t hat i s saf e and f ai r , t hat compl i es
wi t h l abor l aw and soci al wel f ar e gui del i nes.
St af f i s empl oyed. They r ecei ve compensat i on at a f i xed r at e or a wage
whi ch i s hi gher t han t he mi ni mum wage.
St af f wor k 8 hour s per day and have one day of f per week.
St af f has 10 days of pai d vacat i on per year and 13 pai d hol i days.
Over t i me wor k i s avai l abl e on a vol unt ar y basi s and i s compensat ed
accor di ng t o l abor l aw. Ther e ar e no speci al condi t i ons i n whi ch a st af f
per son s sal ar y can be r educed or wi t hhel d, wi t hout except i on.
St af f i s encour aged t o f or m a l abor or gani zat i on or uni oni ze.
St af f i s not f i ne when t aki ng si ck l eave; and r ecei ves soci al wel f ar e.
If t her e i s a l abor di sput e, t hese must be set t l ed i n l abor cour t .
The Can Do Bar has cr eat ed a space f or st af f t o r el ax whi ch i s separ at e
f r om t he bar . St af f can t ake br eaks out si de t he bar wher e i t i s conveni ent
t o do so.
St af f i s gi ven r ef r eshment s f or f r ee t hat ar e avai l abl e f or st af f
t hr oughout t he wor k shi f t .
Ther e i s a separ at e st af f bat hr oom wi t hout any r ul es f or how l ong a st af f
per son can spend i n t he bat hr oom.
The Can Do Bar i s a model space f or exchange of knowl edge, campai gns,
changi ng soci al at t i t udes, publ i c medi a di ssemi nat i on, demonst r at i on of SW
par t i ci pat i on, col l abor at i ve net wor k bui l di ng wi t h ot her bar owner s,
cooper at i on wi t h r el evant gover nment aut hor i t i es, and pr oduct i on of
suppl i es, t ool s and cur r i cul a f or saf er sex and condom use.
2. Mobi l e out reach by Issarachon
The NGO Issar achon has been del i ver i ng AIDS and sex educat i on i n var i ous
l ocat i ons f or st r eet sex wor ker s f or si x year s. Issar achon f i r st get s f ami l i ar
wi t h a l ocat i on and bui l ds t r ust bef or e sendi ng i n t he mobi l e uni t . The SWs
need t o know what Issar achon i s and why t hey ar e t her e. Fi r st , Issar achon
shoul der - bag wor ker s go i nt o publ i c ar eas such as Snam Luang and Khl ong
Lawd i n t he eveni ng. SWs see t hem and ask t hat t hey ar e doi ng and how
of t en t hey come, whet her t hey have f r ee condoms, et c. Af t er bui l di ng
r appor t t hey wor k on bui l di ng t r ust so t hat SWs ar e wi l l i ng t o di scuss t hei r
heal t h pr obl ems and basi c needs.
87
In 2007, a mobi l e uni t was donat ed t o t he pr oj ect whi ch par ks at t he Sanam
Luang and Khl ong Lawd ar ea. The uni t al so goes t o near by pr ovi nces such as
Samut Sakor n i n col l abor at i on wi t h ot her pr oj ect s. The mobi l e van vi si t s an
ar ea 1 or 2 t i mes per week t o gi ve counsel i ng on var i ous t opi cs such as
pr event i on of STI/ HIV. The ser vi ce hour s ar e f r om 3: 00 p. m. t o 11: 00 p. m.
It was f ound t hat vi r t ual l y al l mal e and FSWs sai d t hey wer e abl e t o access
t he pr oj ect ser vi ces i n t hei r l ocal i t y. Al l ar e awar e of t he need t o use
condoms and pr act i ce sel f - car e. The HIV pr eval ence among SWs i n t he
pr oj ect ar ea decl i ned f r om 30%t o 15%.
The ser vi ce st at i st i cs f or t he mobi l e uni t ser vi ce at Sanam Luang and Khl ong
Lawd dur i ng August 15, 2008 t o August 11, 2009 ar e as f ol l ows:
6, 230 f emal e SW vi si t s, or an aver age of 83 per son- cont act s per day
2, 373 mal e SW vi si t s, or an aver age of 32 per son- cont act s per day
463 t r ansgender SW vi si t s, or an aver age of 6 per son- cont act s per day
The oper at i ng budget i s shar ed wi t h ot her or gani zat i ons whi ch have speci al
ski l l s, such as t he EMPOWER under t he AIDS Ser vi ce Or gani zat i ons Net wor k
Pr oj ect , i n or der t o hel p di f f use t he knowl edge and ser vi ces, and t o devi se
new met hods of accessi ng cl i ent s i n need, and t o pr ovi de al t er nat i ves t o
ser vi ces i f t he l ocat i on and hour s of oper at i on of gover nment ser vi ce out l et s
i s not conveni ent . Anot her goal of t he pr oj ect i s t o r educe soci al st i gma
agai nst SWs by encour agi ng member s of t he gener al popul at i on t o hel p wi t h
t he pr oj ect act i vi t i es on a vol unt eer basi s.
3. 3. 6 HIV Prevent i on among Men who have Sex wi t h Men
(MSM)
A. Si t uat i on of HIV among MSM
In Thai l and, t he HIV epi demi c among MSM can be consi der ed sever e. Many
MSM cont i nue t o have hi gh- r i sk behavi or . St ar t i ng f r om t he ser osur vey of
MSM i n Bangkok i n 2003 whi ch f ound a pr eval ence r at e of 17. 3%, HIV
cont i nued t o make i nr oads i n t hi s popul at i on. In Chi ang Mai i n 2005 and
2007 t he l evel of HIV was 15. 3%and 16. 9%r espect i vel y. In Phuket , HIV was
at a l evel of 5. 5%i n 2005 and i ncr eased t o 20. 0%t wo year s l at er .
19
The est i mat i on of new HIV cases f r om t he Asi an Epi demi c Model comput er
pr ogr am f or ecast t hat t he epi demi c of HIV i n MSM wi l l be a dr i ver of t he
19
Pr event i on and cont r ol of HIV i n MSM: Annual t echni cal semi nar of t he NAP 2008 dur i ng
Febr uar y 11-13, 2008, at t he Bi - Tec nat i onal convent i on cent er , Bang Na, Bangkok
88
28.3
15.3
30.7
16.9
20
4.7
5.5
24.7
17.3
5.5
0
5
10
15
20
25
30
35
Bkk Chiang Mai Phuket Udorn Patalung
H
I
V

P
r
e
v
a
l
e
n
c
e

(
%
)
2003 2005 2007 2008 2009
nat i onal epi demi c i n t he f ut ur e. If t he cur r ent t r ends cont i nue, t hen MSM
wi l l compr i se hal f of al l new HIV i nf ect i ons by t he year 2025.
20

It i s est i mat ed t hat 5% t o 10% of mal es bet ween 15- 49 year s wi l l have sex
wi t h ot her men dur i ng 2010 or , appr oxi mat el y 1. 3 t o 2. 5 mi l l i on per sons.
The r esul t s of t he l at est r ound of sent i nel sur vei l l ance f ound t hat HIV
decl i ned i n Bangkok f r om 30. 7% i n 2007 t o 24. 7% i n 2009 ( Fi gur e 28) , and
pr eval ence i n t he popul at i on age 15- 22 year s decl i ned f r om 22. 3%i n 2007 t o
12. 5%i n 2009.
21
As seen i n Fi gur e 3, t he sampl e ser o- pr eval ence was 13. 9%.
Fi gur e 28: Pr eval ence of HIV among MSM by pr ovi nce: HIV sent i nel
sur vei l l ance dur i ng 2003- 2009
Even t hough HIV pr eval ence has decl i ned i n Bangkok, t he si t uat i on i s st i l l of
concer n. Pr ospect i ve st udi es of a sampl e of 1, 292 per sons i n Bangkok over
t hr ee year s f r om Apr i l 2006 t o Januar y 2008, wi t h quar t er l y scr eeni ng f or
HIV, f ound t hat t he i nci dence of HIV was 6. 0%( CI 4. 5- 7. 9%) i n t he f i r st year ,
6. 3% ( CI 4. 3- 7. 9%) i n t he second year , and 5. 7% ( CI 3. 8- 9. 3%) i n t he t hi r d
year .
22

In Bangkok dur i ng 2003 t o 2009, i t was f ound t hat r epor t s of consi st ent
condom use i n t he pr evi ous t hr ee mont hs showed no si gns of i ncr ease.
23
20
The Asi an Epi demi c Model ( AEM) Pr oj ect i ons f or HIV?AIDS i n Thai l and 2005-2025, A2
Anal ysi s and Advocacy, 2008, Fami l y Heal t h Int er nat i onal and Bur eau of AIDS, TB and STIs,
Depar t ment of Di sease Cont r ol , Mi ni st r y of Publ i c Heal t h, Thai l and
21
Ker at i kar n K. , et al . , ( 2010) Tr ends i n HIV pr eval ence and r i sk behavi or among men who
have sex wi t h men ( MSM) i n Bangkok, Thai l and, 2003 t o 2009, submi t t ed t o XVIII Int er nat i onal
AIDS Conf er ence, Jul y 18-23, 2010, Vi enna, Aust r i a
22
van Gr i ensven F, et al . ( 2010) Thr ee year s of f ol l ow- up i n t he Bangkok MSM Cohor t St udy:
Evi dence of an expl osi ve epi demi c of HIV i nf ect i on, submi t t ed t o XVIII Int er nat i onal AIDS
Conf er ence, Jul y 18-23, 2010, Vi enna, Aust r i a
23
Ibi d 3
Source: Bureau of Epidemiology, Department for Disease Control and the TUC
89
In pr ovi nces not consi der ed t o be popul ar t our i st si t es, i t was f ound t hat HIV
pr eval ence i n t he MSM popul at i on i s al so hi gh, despi t e bei ng l ower t han i n
t he pr i mar y t our i st l ocat i ons. For exampl e, sur veys i n Pat al ung and Udor n i n
2008 f ound l evel s of HIV among MSM as hi gh as 5. 5%and 4. 7%r espect i vel y.
B. Act i vi t i es t o prevent HIV among MSM
B. 1 Pol i cy and pl ans/ programs addressi ng t he probl em of HIV/ AIDS i n MSM
1) The Nat i onal AIDS Pl an: 2007-2011
The gr oup of MSM i s t he hi ghest pr i or i t y t ar get gr oup i n t he Nat i onal AIDS
Pl an f or 2007- 2011. The pl an speci f i es a t ar get of r educi ng new cases of HIV
by hal f of t hose pr oj ect ed t o occur . The pl an al so speci f i es t ar get s f or
i ncr easi ng access t o and cover age of ART, al ong wi t h soci al ser vi ces f or
t hose adver sel y i mpact ed.
In t he NAP f or 2007- 11, f our measur es ar e speci f i ed f or addr essi ng HIV
among MSM:
1) Est abl i shi ng cent er s f or management , f undi ng and r e- suppl y of
condoms and l ubr i cant f or MSM.
2) Incr ease cover age of i nf or mat i on and HIV/ STI VCT di agnosi s and
t r eat ment .
3) Bui l d capaci t y and par t i ci pat i on of MSM i n i mpl ement i ng HIV/ STI
pr event i on act i vi t i es, and VCT.
4) Est abl i sh and publ i ci ze a f r i end s cent er and bui l d a net wor k of
f r i ends cent er s t o mobi l i ze gr oup ef f or t of MSM t hr oughout t he count r y.
B. 2 Act i vi t i es by t he government
The Depar t ment of Di sease Cont r ol ( DDC) and t he Bur eau f or AIDS, TB, and
STIs ( BATS) convened a wor ki ng meet i ng t o devel op gui del i nes t o advocat e
f or HIV pr event i on pol i cy i mpr ovement s concer ni ng MSM. The r esul t was
t hat t he DDC pr ovi ded budget f or st r engt heni ng and accel er at i ng HIV/ STI
pr event i on among MSM f or 2010, wi t h an emphasi s on pol i ci es t o f aci l i t at e
wor ki ng wi t h ent er t ai nment and ser vi ce est abl i shment s, and i ncr ease
concer n f or t he need t o i nt ensi f y pr event i on act i vi t i es i n t hi s popul at i on.
In addi t i on, t he BATS car r i ed out numer ous pr oj ect s such as t he Heal t hy
ser vi ce est abl i shment s whi ch emphasi zed di st r i but i on of condoms and
l ubr i cant t o ensur e adequat e suppl i es; t he pr oj ect t o sel ect t he best
ent er t ai nment est abl i shment accor di ng t o pr event i on st andar ds; t he pr oj ect
t o cr eat e cadr es of MSM peer l eader s i n col l eges and uni ver si t i es, i ncl udi ng
t he dr af t i ng of a cur r i cul um f or hi gh school t eacher s on l i f e ski l l s f or MSM
yout h; t he pr oj ect f or HIV pr event i on t hr ough a model of f r i ends- t o- f r i ends
out r each and user - f r i endl y ser vi ces f or HIV/ STI di agnosi s as suppor t ed by t he
TUC and USAID; t he pr oj ect t o cont i nue i nt ensi ve act i vi t i es i n hi gh-
pr eval ence pr ovi nces ( Bangkok, Phuket , Chi ang Mai , Udor n, Khon Kaen, and
Chol bur i ) .
90
B. 3 Act i vi t i es by ci vi l soci et y (NGOs)
Dur i ng 2008- 9 t he HIV pr event i on pr oj ect f or MSM and ot her s wi t h di ver se
sex l i f est yl es was i mpl ement ed wi t h suppor t f r om t he Nat i onal Heal t h
Secur i t y Of f i ce ( NHSO) t hr ough t he Inst i t ut e f or Heal t h Ser vi ces Resear ch,
and appr oved by t he subcommi t t ee f or accel er at ed AIDS pr event i on under
t he NAPAC. Thi s pr oj ect was t he f i r st and l ar gest t o i mpl ement t hr ough t he
net wor k of 20 MSM or gani zat i ons i n t en pr ovi nces. It r ecr ui t ed and t r ai ned
1, 100 peer l eader s and r eached 16, 800 MSM. Thi s pr oj ect was t he f i r st
successf ul col l abor at i on among such a l ar ge and di ver se net wor k. The
pr oj ect i ncl uded a f or mal eval uat i on component t o document exper i ence
and par t i ci pat i on of t he net wor k member s as a basi s f or r ecei vi ng f unds
f r om t he GFATM. In 2010, t he pr oj ect wi l l be expanded t o f our mor e
pr ovi nces.
B. 4 Int egrat ed HIV prevent i on f or most -at -ri sk popul at i ons by conduct i ng
out reach and creat i ng a l i nked servi ce net work
MSM ar e a pr i or i t y t ar get popul at i on f or t hi s pr oj ect whi ch del i ver s
i nt egr at ed HIV pr event i on f or most - at - r i sk popul at i ons, and i s f unded by t he
GFATM Round 8 over f i ve year s f r om Jul y 2009 t o June 2014.
The pr i nci pal st r at egy f or t hi s pr oj ect i s t o expand cover age and access t o
pr event i on f or hi gh- r i sk popul at i ons by i ncr easi ng par t i ci pat i on of NGOs and
t he t ar get benef i ci ar i es. The pr oj ect suppor t s act i vi t i es t o i mpr ove ser vi ces
i n t he publ i c sect or so t hat t hey ar e mor e user - f r i endl y f or t he t ar get
gr oups, and ar e l i nked wi t h t he out r each pr ogr am component i mpl ement ed
by NGOs. The pr oj ect st r engt hens gover nment and NGO ser vi ce pr ovi der s
by bui l di ng knowl edge and under st andi ng about sex, sex l i f est yl es, and
r i ght s pr ot ect i ons, whi l e i mpl ement i ng i n accor dance wi t hi n t he pr evai l i ng
pol i cy f r amewor k.
The Rai nbow Sky Associ at i on i s a pr i nci pal gr oup whi ch i mpl ement s act i vi t i es
i n t he ci vi l soci et y sect or . They conduct communi t y out r each and manage
dr op- i n cent er s, pr ovi de condoms and l ubr i cant t o i mpr ove cover age of t he
t ar get popul at i on.
The DDC, t hr ough t he STI gr oup of BATS i mpl ement s user - f r i endl y ser vi ces
f or HIV VCT and t r eat ment of STIs i n 14 pr ovi nces, i ncl udi ng Bangkok i n
2009, and 31 pr ovi nces i n 2010.
C. Knowl edge and behavi or
Due t o l i mi t at i ons of t he cover age of behavi or al sur vei l l ance, t he dat a i n
t hi s sect i on r el y on a var i et y of ad hoc st udi es t o pr esent a mor e compl et e
pi ct ur e of t he knowl edge and behavi or of MSM under di f f er ent condi t i ons.
Surveys by t he Bureau of Epi demi ol ogy
In Bangkok, Phuket and Chi ang Mai i n 2007 i t was f ound t hat pr opor t i on of
MSM who r epor t ed havi ng al ways used condoms i n t he t hr ee mont hs pr i or
t o t he sur vey was 66%, 44%, and 36%r espect i vel y. In 2008, t he sur vey i n t he
r at her smal l pr ovi nces of Udor n and Pat al ung f ound t hat al ways used
91
condoms by MSM i n t he pr i or t hr ee mont hs wer e al so r at her l ow at 56. 3%
and 57. 0%r espect i vel y.
In 2009, a sur vey of condom use f ound t hat MSM condom use dur i ng l ast
epi sode of anal sex was onl y 21. 7%, whi ch r epr esent ed a shar p decr ease
f r om t he l evel f ound i n t he pr evi ous year s sur vey. It must be not ed t hat
t he l at est r ound of t hi s sur vey modi f i ed t he quest i onnai r e sl i ght l y f r om
pr evi ous r ounds by aski ng about condom use wi t h l ast mal e par t ner and di d
not di st i ngui sh among t ypes of par t ner . Thus, t he decl i ne may be an ar t i f act
of t he change i n met hodol ogy r at her t han a behavi or al t r end t owar d unsaf e
sex. In any event , MSM and t r ansgender sex wor ker s r epor t ed condom use
wi t h cust omer s over t he pr i or t hr ee mont hs at a r at her hi gh l evel of 87. 6%
and 79. 5%r espect i vel y.
Regar di ng bl ood t est s f or HIV and knowl edge of one s ser ost at us, t he sur vey
i n Phuket , Chi ang Mai and Bangkok f ound t hat onl y 21. 7%of MSM and 20. 8%
of t r ansgender s sai d t hey had been t est ed f or HIV and r ecei ved t he r esul t s i n
t he past 12 mont hs. The dat a f r om t hi s sur vey t hat knowl edge of one s
ser ost at us i n t hi s gr oup i s l ow even t hough t he knowl edge scor e ( based on
f i ve t est i t ems) i ncr eased f r om 21. 4%i n 2008 t o 25. 5%i n 2009.
Dat a f rom t he out reach proj ect f or MSM i n t hree provi nces: Phuket ,
Udorn, Khon Kaen
In 2009 i t was f ound t hat t he pr opor t i on usi ng condoms wi t h casual par t ner s
when compar ed t o dat a f r om 2008 i ncr eased i n some pr ovi nces: f r om 56%t o
64% i n Khon Kaen; and f r om 71% t o 82% i n Phuket . However , i n Udor n t he
pr opor t i on decl i ned f r om 68%t o 64%. The pr opor t i on usi ng a condom at l ast
sex r egar dl ess of par t ner t ype dur i ng Oct ober 2008 t o Sept ember 2009 was
68. 3%among t hose under age 25 year s ( N=1, 899) and 71. 7%f or t hose age 25
year s or ol d ( N=717) .
Dat a on MSM cl i ni c servi ces
The popul at i on of MSM at t endi ng cl i ni cs at Bang Rak Hospi t al i n Bangkok,
t he Sabai Dee Cl i ni c i n Phuket , t he Pl ai Fah Cl i ni c i n Khon Kaen, and t he
Napa Cl i ni c i n Udor n, i ncr eased f r om 345 cl i ent s i n 2008 t o 825 cl i ent s i n
2009. Ref er r al f r om out r each pr oj ect st af f i ncr eased f r om 38 cases i n 2008
t o 265 cases i n 2009. The number of HIV VCT cl i ent s who r ecei ved t est
r esul t s i ncr eased f r om 242 cl i ent s i n 2008 t o 513 cl i ent s. Among t he f our
cl i ni cs, 19%of cl i ent s who wer e t est ed di d not r et ur n f or t hei r r esul t s.
Dat a f rom t he Mal e Heal t h Cl i ni c, Cl i ni cal Research Group, Bang Rak
Hospi t al
It was f ound t hat MSM who ar e not sex wor ker s had i ncr eased i nci dence of
syphi l i s f r om 2. 4% i n 2004 t o 3. 4%, 4. 2%, and 5. 6% i n 2006, 2008, and 2009
r espect i vel y. The compar abl e r at es f or mal e sex wor ker s wer e 1. 8%, 0. 8%,
92
2. 5%, and 1. 4% over t he same per i od. Regar di ng HIV pr eval ence, MSM i n
bot h gr oups had si mi l ar l evel s of i nf ect i ons, 18. 0% among non- sex wor ker
MSM, and 18. 1%among mal e sex wor ker s.
Over al l , 60. 1%of ser vi ce r eci pi ent s r epor t ed a hi st or y of ever havi ng an HIV
bl ood t est , and 55. 3%know t hei r ser ost at us. Regar di ng condom use i n t he
pr i or t hr ee mont hs, 41. 7% al ways used a condom wi t h al l sex par t ner s
( excl udi ng commer ci al sex cl i ent s) ; 20. 8% somet i mes used a condom, and
37. 5% never used a condom. Ful l y 60. 8%r epor t ed usi ng a condom at l ast
sex; 2. 4%sai d t hat t he condom br oke.
D. Probl ems and chal l enges
Ther e ar e a number of i mpor t ant chal l enges f or pr oj ect s r ecei vi ng t he
GFATM Round 8 f undi ng t o achi eve t hei r t ar get s:
1) Ther e i s a need f or capaci t y devel opment of gover nment and NGO
ser vi ce pr ovi der s and vol unt eer s i n t he t ar get communi t i es t o i ncr ease
knowl edge and ski l l s i n r eachi ng t he t ar get popul at i on, pr ovi di ng ef f i ci ent
ser vi ces, and achi evi ng r eal pr event i on r esul t s. The expansi on of act i vi t i es
t o 14 pr ovi nces i n t he f i r st year and 31 pr ovi nces i n t he second year r equi r es
t hat at t ent i on be pai d t o qual i t y assur ance al ong wi t h t he bui l di ng of
i mpl ement er capaci t y.
2) The r ef er r al net wor k f r om t he out r each by NGOs t o t he ser vi ces
pr ovi di ng di agnosi s and t r eat ment f or STIs and HIV VCT i s not f unct i oni ng
opt i mal l y.
3) Reachi ng t he l ar ge and di sper sed number MSM, bi - sexual men,
t r ansgender s, and kat oeys i s a chal l enge, par t i cul ar l y gi ven t he f act t hat
most ar e not publ i cl y open about t hei r sexual or i ent at i on. Thus, new
met hods of out r each ar e needed. In addi t i on t o per son- t o- per son out r each,
t her e i s a need t o i ncr ease t he number of vol unt eer s and f i el d st af f f or
adequat e cover age of t he t ar get .
4) Ther e i s a need t o i mpr ove under st andi ng and bui l d capaci t y at t he
pr ovi nci al and l ocal admi ni st r at i ve or gani zat i on l evel so t hat t hese st af f can
devel op pr oj ect s and suppor t pol i cy, measur es and budget f or t he t ar get
popul at i on of MSM. Thi s wi l l hel p pr omot e sust ai nabi l i t y of HIV pr event i on
f or MSM by i nt egr at i ng t hi s component i nt o t he r out i ne pol i cy, st r at egy, pl an
and budget f or t he pr ovi nce and t he l ocal ar eas.
E. Pl an f or addressi ng t he probl ems and chal l enges
The budget f r om t he GFATM Round 8 awar d wi l l be used t o addr ess t hese
chal l enges ef f i ci ent l y and ef f ect i vel y f or bet t er pr event i on r esul t s among
MSM as f ol l ows:
1) Capaci t y bui l di ng f or cl i ni c st af f i ncl udi ng t r ai ni ng i n sexual
di ver si t y, sexual heal t h, and MSM counsel i ng.
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2) Devel opment of t he Pr ovi nci al Coor di nat i ng Mechani sm whi ch has
t he pr ovi nci al chi ef medi cal of f i ce as t he pr i nci pal or gani zat i on r esponsi bl e
f or coor di nat i on among t he var i ous sect or s i ncl udi ng t he l ocal admi ni st r at i ve
or gani zat i ons. The f ocus wi l l be on i ncr eased cont act , moni t or i ng,
coor di nat i on, and pl anni ng among r el evant pl ayer s i n pr event i on, wi t h
par t i ci pat i on of t he t ar get popul at i ons i n a col l abor at i ve f ashi on.
Especi al l y, ef f or t s wi l l be made t o suppor t t he syst em of r ef er r al bet ween
t he out r each wi t h t he cl i ni cal ser vi ce out l et s, i ncl udi ng t r ai ni ng f or st af f of
t he l ocal admi ni st r at i ve or gani zat i ons t o i mpr ove under st andi ng about t he
i ssues and pr obl ems i n wor ki ng on AIDS wi t h hi gh- r i sk popul at i ons.
3) Devel opment of NGO st af f t hr ough t r ai ni ng on var i ous t opi cs t hat ar e
necessar y f or ef f ect i ve i mpl ement at i on i n accor dance wi t h t he st r at egy f or
behavi or change communi cat i on. These i ncl ude ski l l s i n f i el d wor k, HIV
knowl edge- shar i ng, st andar ds f or ser vi ces i n f r i end cent er s, col l ect i on of
dat a f or moni t or i ng and i mpr ovi ng t he qual i t y of ser vi ces, bui l di ng r ef er r al
net wor ks, and devel opment of educat i onal medi a f or speci f i c t ar get gr oups.
4) St r engt heni ng of t he nat i onal MSM net wor k t o suppor t MSM gr oups at
t he pr ovi nci al and di st r i ct l evel s so t hat t hey can uni t e and i mpr ove t hei r
capaci t y t o i mpl ement t he pr event i on act i vi t i es f or MSM i n per i pher al ar eas.
F. Best pract i ces
St rengt heni ng MSM net works t o i mpl ement HIV prevent i on among MSM
Twent y MSM or gani zat i ons i n t en pr ovi nces j oi ned f or ces t o cr eat e a
nat i onal MSM net wor k wi t h t he Rai nbow Sky Associ at i on as t he coor di nat i on
f ocal poi nt . They ar e i mpl ement i ng act i vi t i es under t he nat i onal st r at egy
and t o st r engt hen t he net wor k. The MSM net wor k i mpl ement ed t wo l ar ge
pr ogr ams t o i ncr ease cover age of pr event i on ser vi ces f or MSM. These
i ncl uded t he pr oj ect suppor t ed by t he Heal t h Ser vi ces Resear ch Inst i t ut e
and t he GFATM. They wer e abl e t o i mpr ove t he met hods and ef f ect i veness
of access and cover age of MSM t hr ough a syst em of f i el d st af f and peer
vol unt eer s. In t he past , t hese ef f or t s wer e onl y sub- pr oj ect s wi t h
i ndependent , uncoor di nat ed i mpl ement at i on wi t hout syst emat i c r epor t i ng
or eval uat i on.
MSM-f ri endl y servi ces and l i nkages wi t h out reach and care and t reat ment
f or HIV i l l ness
The syst em of ser vi ces f or STI di agnosi s and t r eat ment and HIV VCT i n t he
Udor n Pr ovi nci al Hospi t al i s a model by vi r t ue of i t s car ef ul pl anni ng of
appr opr i at e and MSM- f r i endl y ser vi ces. They ar e mi ndf ul of t he need t o
manage ser vi ces so t hat t her e i s an adequat e number of st af f , t her e i s
cl ear l y adver t i sed days and t i mes of ser vi ce f or t he speci f i c t ar get
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popul at i ons, i ncl udi ng an af t er - hour s cl i ni c whi ch i s l ocat ed i n a conveni ent
par t of t he communi t y. The ser vi ce pr ovi der s have been t r ai ned i n
pr ovi di ng cl i ent - f r i endl y ser vi ces. They pl an and coor di nat e cl osel y wi t h
pr oj ect out r each st af f whi ch cr eat es a st r ong l i nk bet ween t he f i el d
act i vi t i es and t he cl i ni cal ser vi ces. In addi t i on, t he STI cl i ni c i s l ocat ed at
t he same si t e as t he ARV cl i ni c. Thi s f aci l i t at es l i nks f or t he t ar get
popul at i on t o r ecei ve HIV t est s pr ompt l y and r api dl y access t r eat ment as
needed.
Thr ee ot her model pr ogr am si t es i ncl ude t he Mal e Heal t h Cl i ni c of Bang Rak
Hospi t al of t he DDC, t he Si l om Communi t y Cl i ni c, and t he Mal e Heal t h Cl i ni c
of t he AIDS Cent er of t he Thai Red Cr oss.
3. 3. 7 HIV Prevent i on among Inj ect i ng Drug Users (IDU)
A. St at us of HIV i nf ect i on among IDU
The HIV sur vei l l ance syst em of t he Bur eau of Epi demi ol ogy ( BoE) moni t or s
t he l evel of HIV i nf ect i on among IDU i n gover nment dr ug r ehabi l i t at i on
cent er s. The pr eval ence of HIV among t hi s popul at i on of IDU i s st i l l hi gh,
bet ween 30% and 40%, wi t h an i ncr easi ng t r end i n t he l at est year . Usi ng
medi an val ue, HIV pr eval ence i ncr eased f r om a r ange of 26%t o 33%i n 2006-
2007 t o a r ange of 48%t o 52%dur i ng 2008- 2009
24
.
The pr oj ect ed number of new i nf ect i ons ( al l causes) der i ved f r om t he Asi an
Epi demi c Model comput er pr ogr am i s 10, 853 f or 2010. Of t hi s t ot al , 8. 7%i s
est i mat ed t o be among IDU. The pr eval ence of needl e/ syr i nge- shar i ng
among IDU was 36% i n 2008 and, when appl i ed t o 2010 IDU, yi el ds an
est i mat ed number of new HIV i nf ect i ons f r om shar i ng equi pment of 941
IDU.
25
Because i nj ect i on of i l l i ci t dr ugs i s a secr et i ve behavi or , i t i s di f f i cul t t o
est i mat e t he number of dr ug addi ct s, whet her by f i el d sur veys or count i ng
t hose admi t t ed t o r ehabi l i t at i on cent er s. Never t hel ess, a conser vat i ve
est i mat e of t he number of IDU i n Thai l and at t he t i me of t hi s r epor t i s
30, 000.
The l at est ad hoc sur vey of IDU i n 2009 ( 746 i n Bangkok and 309 i n Chi ang
Mai ) f ound HIV pr eval ence l evel s of 24% and 11%r espect i vel y. Ther e i s wi de
var i at i on of i nj ect i on pr act i ces. In Bangkok, t he f ol l owi ng di f f er ent dr ugs
wer e i nj ect ed: her oi n ( 34%) , met hamphet ami nes ( 63%) ,
24
Bur eau of Epi demi ol ogy, HIV Sent i nel Ser o sur vei l l ance
25
Thai Wor ki ng Gr oup and A
2
Thai l and, The Asi an Epi demi c Model ( AEM) Pr oj ect i ons f or
HIV/ AIDS i n Thai l and: 2005- 2025
95
Dor mi cum/ Mi dazol am ( 42%) , and met hadone ( 13%) . In Chi ang Mai t he dr ugs
t hat IDU i nj ect ed i ncl uded her oi n ( 34%) , met hamphet ami ne ( 32%) ,
Dor mi cum ( 4%) , met hadone ( 6%) , and opi um ( 14%) .
26
B. HIV prevent i on among IDU
B. 1 Pol i cy and pl an/ program addressi ng t he probl em of AIDS i n IDU
1) The Nat i onal AIDS Pl an f or 2007-2011
IDU ar e one of t he popul at i ons wi t h a t ar get r educt i on of HIV i nci dence by
hal f dur i ng t he pl an per i od. Thi s t ar get i ncl udes bot h gener al IDU and t hose
i n j ai l s, pr i sons, r ehabi l i t at i on cent er s and j uveni l e det ent i on cent er s. The
pr event i on st r at egy i s t hr ough r educed st i gma and di scr i mi nat i on of IDU and
use of appr opr i at e pol i ci es and measur es, st udi es t o devel op dat a and
i nf or mat i on and l essons l ear ned, i ncl udi ng met hods of r eachi ng IDU i n t he
communi t y, and det ent i on f aci l i t i es.
2) Int egrat ed program t o prevent HIV among most -at -ri sk popul at i ons
t hrough pro-act i ve measures and creat i ng a net work of i nt egrat ed
servi ces
IDU ar e a pr i or i t y popul at i on i n t he Nat i onal AIDS Pl an, and pr o- act i ve
measur es ar e bei ng appl i ed, al ong wi t h t he cr eat i on of a net wor k of
i nt egr at ed ser vi ces wi t h f undi ng f r om t he GFATM Round 8 over a per i od of
f i ve year s f r om Jul y 2009 t o June 2014.
A key st r at egy i n t hi s ef f or t i ncl udes expandi ng t he l i mi t s t o accessi ng t he
IDUs and maxi mi zi ng t he cover age of HIV pr event i on ser vi ces by i ncr easi ng
par t i ci pat i on of ci vi l soci et y ( NGOs) and t he IDUs t hemsel ves. In addi t i on,
ef f or t s ar e bei ng made t o make gover nment ser vi ces mor e user - f r i endl y wi t h
l i nks t o out r each ser vi ces pr ovi ded by NGOs. A compani on st r at egy i s t he
ef f or t t o i ncr ease ser vi ce pr ovi der s knowl edge and under st andi ng of
di f f er ent cont ext s of sex, and sex l i f est yl es, and t he pr ot ect i on of i ndi vi dual
r i ght s, al l wi t hi n t he f r amewor k of t he over ar chi ng pol i cy.
The PSI Foundat i on of Thai l and i s a pr i nci pal r eci pi ent ( PR) among NGOs t o
wor k wi t h IDU. They ar e del i ver i ng out r each and condom suppl i es, cl ean
needl es and syr i nges t o IDUs i n t he communi t y. They ar e wor ki ng wi t h t he
Phar maci st s Associ at i on t o make cl ean needl es and syr i nges avai l abl e
t hr ough communi t y- based dr ug st or es.
The Depar t ment of Di sease Cont r ol ( DDC) i s t he PR on t he gover nment si de.
The i mpl ement i ng par t ner s i ncl ude t he Thanyar ak Inst i t ut e, Of f i ce of t he
Of f i ce of Nar cot i cs Cont r ol Boar d, and t he Bangkok Met r opol i t an
26
Respondent -dr i ven sampl i ng sur vey of HIV- r el at ed r i sk behavi or and HIV pr eval ence i n
i nj ect i on dr ug user s i n Bangkok and Chi ang Mai , Thai l and, 2009 ( unpubl i shed dat a)
96
Admi ni st r at i on ( BMA) . These agenci es ar e al so r esponsi bl e f or pol i cy
devel opment , cr eat i ng awar eness and under st andi ng among ser vi ce
pr ovi der s, and appl yi ng t he l aw t o f aci l i t at e i mpl ement at i on.
The ar ea of i mpl ement at i on dur i ng t he f i r st t wo year s i ncl udes 15 pr ovi nces
and Bangkok.
C. Progress of i mpl ement at i on duri ng 2008-2009
1) Expansi on of benef i t packages under t he UC program t o i ncl ude
met hadone mai nt enance t herapy (MMT)
NGOs have l ong advocat ed f or MMT t o be cover ed by t he UC pr ogr am. On
Oct ober 26, 2006, Ms. Supat r a Nar kpi ew, Chai r per son of t he Thai NGO
Coal i t i on on AIDS ( TNDA) , whi ch i s a subcommi t t ee member of t he NHSO
commi t t ee on benef i t packages, pr oposed t o t he commi t t ee t hat t hey
shoul d consi der addi ng MMT t o t he benef i t s f or el i gi bl e per sons. A wor ki ng
gr oup was assi gned t o exami ne t he necessi t y and f easi bi l i t y of t hi s pr oposal .
The wor ki ng gr oup met wi t h r el evant or gani zat i ons i n t he publ i c, NGO, and
IDU net wor k t o f or mal i ze a set of r ecommendat i ons f or t he sub- commi t t ee.
However , despi t e f our r ounds of pr oposal , no act i on was t aken bef or e t he
t er m of t he subcommi t t ee expi r ed.
On November 7, 2007, r epr esent at i ves of t he NGOs, i ncl ude member s of t he
Thai Net wor k of Peopl e Li vi ng wi t h HIV/ AIDS ( TNP+) , t he Thai Dr ug User
Net wor k ( TDN) , Thai Tr eat ment Act i on Gr oup ( TTAG) , ACCESS, Foundat i on
f or AIDS Ri ght s ( FAR) , Thai Tr eat ment Act i on Cent er ( TTAG) , MSF ( Bel gi um)
and t he TNCA j oi nt l y submi t t ed a l et t er t o Dr . Suwi t Wi bul pr aser t ,
Chai r per son of t he subcommi t t ee f or devel opment of benef i t packages, t o
consi der addi ng MMT t o t he NHSP. The Of f i ce of Pol i cy and Pl anni ng
coor di nat ed wi t h t he Pr ogr am f or Dr ug Knowl edge Management and r el at ed
gover nment and non gover nment or gani zat i ons vi a a number of meet i ngs
unt i l t he NHSO commi t t ee passed a r esol ut i on t o add MMT t o t he benef i t s
package on Oct ober 1, 2008.
2) Devel opment of harm reduct i on of i nj ect i on drug pol i cy
Dur i ng 2008- 2009 t he ONCB and t he Mi ni st r y of Publ i c Heal t h ( MOPH)
r epr esent ed by t he DDC and Thanyar ak Inst i t ut e coor di nat ed wi t h ot her
gover nment agenci es, NGOs, exper t s, and i nt er nat i onal or gani zat i ons t o
advance har m r educt i on pol i cy by i ncor por at i ng i nput f r om speci al i st s and
par t i ci pat i on by al l sect or s.
The ONCB convened many semi nar s, bot h f or st af f of t he ONCB at t he
cent r al and f i el d l evel s. In December 2008, ONCB and t he MOPH convened a
wor ki ng meet i ng t o pr oduce r ecommendat i ons f or pol i cy and
i mpl ement at i on gui del i nes f or har m r educt i on f or IDUs wi t h par t i ci pant s
f r om t he publ i c sect or , NGOs, and i nt er nat i onal or gani zat i ons. The meet i ng
pr oduced Or der 8/ 2009, si gned on Januar y 8, 2009 t o cr eat e a wor ki ng
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gr oup t o pr epar e pol i cy r ecommendat i ons and gui del i nes f or i mpl ement at i on
of r educt i on of har m and i mpact f r om t he use of addi ct i ve dr ugs.
The Har m Reduct i on 2009 meet i ng dur i ng Apr i l 20- 23, 2009, managed by t he
Int er nat i onal Har m Reduct i on Associ at i on i n Bangkok was anot her mi l est one
whi ch hel ped t o advance t he cause of har m r educt i on f or IDUs i n Thai l and,
and pr omot e st r at egi es f or t he comi ng per i od.
On June 25, 2009, t he Mi ni st er of Heal t h pr esi ded over t he si gni ng cer emony
f or t he memor andum of under st andi ng ( MOU) f or cooper at i on on har m
r educt i on f or IDU among t he Of f i ce of t he Per manent Secr et ar y f or Heal t h,
t he Depar t ment of Medi cal Ser vi ces, t he DDC, t he NHSO, and t he ONCB,
wi t h r epr esent at i ves of t he Nat i onal AIDS Pl an, t he UNODC of f i ce f or East
Asi a and t he Paci f i c, and WHO ser ved as wi t nesses.
The MOU was an expr essi on of i nt ent t o wor k t oget her t o advance pol i cy f or
equal t r eat ment of IDUs as f or ot her pat i ent s, and t o enabl e uni ver sal
access and cover age. Al l t he par t i ci pat i ng agenci es agr eed t o wor k t oget her
t o i mpl ement har m r educt i on f or IDUs t o r educe t he spr ead of HIV and ot her
di seases. The par t i es al so agr eed t o pur sue mor e ef f ect i ve t r eat ment and
r ehabi l i t at i on f or dr ug addi ct s t o r educe dr ug- r el at ed har m by pr ovi di ng
met hadone mai nt enance.
In Apr i l 2009, t he Senat e Heal t h Commi t t ee i nvi t ed r epr esent at i ves f r om t he
gover nment , NGOs, and i nt er nat i onal or gani zat i ons t o t est i f y t o t he
commi t t ee. In 2008- 2009, i t can be sai d t hat devel opment of pol i cy on
har m r educt i on f or IDU showed consi der abl e pr ogr ess. Suppor t f or st udy
t our s t o count r i es wi t h successf ul pr ogr ams was i mpl ement ed t hr ough t he
AHRN f or pol i t i ci ans, hi gh- l evel manager s of r el evant or gani zat i ons, and
NGOs. They t r avel ed t o Tai wan and, wi t h suppor t f r om WHO, t he ot her
gr oup t r avel ed t o Mal aysi a. These t our s hel ped t o cr eat e a net wor k among
gover nment agenci es f r om mul t i pl e sect or s and t he NGOs. In coor di nat i on
wi t h t he ONCB, t hi s net wor k dr af t ed har m r educt i on pol i cy gui del i nes f or
IDU, and pr epar ed r ecommendat i ons f or t he NAPAC and t he Nar cot i c Cont r ol
Boar d
3) Impl ement at i on gui del i nes f or harm reduct i on f or IDU
Dur i ng 2009, t he Bur eau f or AIDS, TB and STIs ( BATS) wi t h suppor t f r om
WHO, devel oped i mpl ement at i on gui del i nes f or heal t h wor ker s i n del i ver i ng
har m r educt i on f or IDU, i n coor di nat i on wi t h NGOs, ot her gover nment
agenci es, exper t s, and i nt er nat i onal or gani zat i ons.
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The r esul t i ng mat er i al s i ncl uded gui del i nes f or an out r each pr ogr am,
mot i vat i onal i nt er vi ew, basi c heal t h awar eness f or IDU, HIV VCT, and
counsel i ng f or scr eeni ng and t r eat ment , MMT, det oxi f i cat i on, and gui del i nes
f or needl e/ syr i nge exchange pr oj ect s f or consi der at i on.
D. Harm reduct i on servi ces f or IDU
D. 1 Government programs
1) The Bangkok Met r opol i t an Admi ni st r at i on ( BMA) has 20 met hadone cl i ni cs
under i t s Medi cal Depar t ment , t wo hospi t al s and 18 heal t h cent er s. Each
cl i ni c has a r esi dent physi ci an who pr ovi des physi cal exami nat i on and
pr escr i bes r ehabi l i t at i on act i on. Regi st er ed nur ses admi ni st er t he
met hadone. The t ypes of ser vi ces i ncl ude t he f ol l owi ng:
- The met hadone cl i ni cs pr ovi de out - pat i ent ser vi ce.
- Det oxi f i cat i on i nvol ves subst i t ut i ng met hadone t o ease wi t hdr awal . New
cl i ent s under go 45 days of det oxi f i cat i on. However , si nce her oi n addi ct s
have decl i ned ( due t o i ncr eased cost of dr ug) most of t he cl i ent s at t he
det ox cl i ni cs ar e not new addi ct s but r et ur ni ng IDU. The BMA s Depar t ment
of Heal t h t hus ext ended t he det oxi f i cat i on per i od t o 90 days and t o MMT.
- HIV VCT i s of f er ed i n 68 BMA heal t h cent er s and dr op- i n cent er s of NGOs.
- Communi t y- based out r each i s conduct ed t hr ough a syst em of peer wor ker s
assi gned t o f i ve ar eas. They t r y t o access IDU i n t he communi t y t o pr ovi de
HIV r i sk r educt i on i nf or mat i on and r ef er r al t o heal t h cent er s as needed.
The GFATM pr ovi des budget suppor t al ong wi t h t he Thai - US Col l abor at i on
( TUC) .
- In a pi l ot ef f or t , a har m r educt i on cl i ni c was opened on Sat ur days dur i ng
Oct ober t o December 2009. These i ncl uded gr oup educat i on on AIDS and
har m r educt i on, and i ncl uded occupat i onal t r ai ni ng wi t h suppor t f r om t he
Inst i t ut e f or Heal t h Ser vi ces Resear ch.
2) Agenci es under t he MOPH These i ncl ude Thanyar ak Inst i t ut e and seven
dr ug r ehabi l i t at i on cent er s. These si t es pr ovi de heal t h ser vi ces f or al l t ypes
of dr ug addi ct s i ncl udi ng har m r educt i on, HIV VCT, condoms, MMT,
communi t y out r each, scr eeni ng f or STIs, hepat i t i s, and TB.
D. 2 NGO i mpl ement at i on
Ci vi l soci et y i mpl ement ed act i vi t i es t hr ough t he IDU net wor k and NGOs
i ncl udi ng t he PSI Foundat i on/ Ozone House, Raks Thai Foundat i on, AIDS
Campai gn Foundat i on, by pr ovi di ng peer out r each i n coor di nat i on wi t h f i el d
st af f and dr op- i n cent er s ( Di Cs) .
The Di C ser vi ces ar e conveni ent f or t he IDU t o access. They have
r ecr eat i onal act i vi t i es, exper i ence- exchange gr oups, and smal l - gr oup
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di scussi ons on har m r educt i on, qui t t i ng i nj ect i on dr ugs, avoi di ng needl e-
shar i ng, cur r ent dr ug use, knowl edge about STIs, needl e di st r i but i on and
exchange, condoms and al so r ef er r al f or MMT, HVI VCT, STI t r eat ment and
ot her heal t h pr obl ems.
D. 3 Occupat i onal devel opment f or IDU
Occupat i onal devel opment i ncl udes pr epar i ng IDU t o r et ur n t o mai nst r eam
soci et y, and i nvol ves pr omot i ng sel f - est eem, t r ai ni ng i n sel f - r est r ai nt ,
concent r at i on, sel f - conf i dence, and const r uct i ve use of f r ee t i me. Bot h
gover nment and NGOs have been i nvol ved i n t hi s ef f or t .
By gover nment : The BMA and Thanyar ak Inst i t ut e i mpl ement ed t hr ee
act i vi t i es i ncl udi ng occupat i onal t her apy, t r ai ni ng on appl yi ng f or j obs, and
j ob seeki ng.
By NGOs: Ozone House of t he PSI Foundat i on suppor t s occupat i onal
devel opment by or gani zi ng i nt er est gr oups based on t he pr ef er ences of t he
IDU i ncl udi ng a gr oup f or f emal e IDU whi ch makes decor at i ve i t ems and si l k
scr eeni ng t - shi r t s. For mal e IDUs t he gr oups i ncl ude t eam act i vi t i es f or
i ncome- gener at i on, r evol vi ng l oan f unds, et c. Over t he l ong t er m, t hese
ef f or t s may conf r ont obst acl es of l ack of mar ket f or t hei r pr oduct s or l ack of
r epl eni shi ng t he r evol vi ng l oan f und.
E. Ci vi l soci et y and advanci ng harm reduct i on f or IDUs
E. 1 Thai Drug Users Net work (TDN)
The negat i ve consequences of di scr i mi nat i on pr event bet t er access t o
t r eat ment f or HIV- posi t i ve IDU. For exampl e, i n t r yi ng t o get ART, t her e i s
t he condi t i on t hat t he IDU must qui t dr ugs bef or e st ar t i ng ART. Mr . Pai sal
Suwannawongse, who hel ped set up t he TDN, began t he pr ecur sor f or t he
net wor k i n 2000 wi t h t he goal of equal access of dr ug user s t o heal t h car e
and t r eat ment .
Process of est abl i shi ng t he drug user net work of Thai l and
On December 10, 2003, 2 t o 3 dr ug user s f r om t he nor t h, sout h and cent r al
r egi ons met t o f or m t he TDN. Wi t h suppor t f r om t he UN and BATS, t he TDN
cr eat ed a f or um f or exchangi ng exper i ence among peer s, and l ocat i ng
budget f or const r uct i ve act i vi t i es.
In 2004, t he TDN, wi t h suppor t f r om t he TUC convened a wor ki ng meet i ng
on Ref l ect i ons f r om dr ug user s and t he AIDS chal l enge i n col l abor at i on
wi t h par t ner s f r om each r egi on. The pur pose of t he meet i ng was t o
br ai nst or m on sol ut i ons t o t he pr obl ems i n each l ocat i on and st r engt hen and
expand t he net wor k, so t hat member s can shar e i nf or mat i on on t he
si t uat i on of dr ug user s at r egi onal , nat i onal and i nt er nat i onal f or ums.
100
In 2006, t he TDN was f or mal l y est abl i shed as a net wor k wi t h col l abor at i on
f r om t he Pr oj ect t o pr event HIV among IDU i n Bangkok.
Impl ement at i on by t he TDN
The TDN devel op model s of i mpl ement at i on and out r each t hr ough a f r i ends-
hel p- f r i ends appr oach usi ng act i ve and ex- dr ug user s who wer e t r ai ned.
These peer out r each wor ker s t hen shar ed knowl edge and i nf or mat i on
concer ni ng t he sever i t y of t he pr obl em of dr ug use and AIDS. The peer s
l ocat ed and i nt egr at ed wi t h dr ug user s i n t he communi t y t o r educe r i sk
behavi or and t he negat i ve i mpact of HIV, di st r i but e condoms, and cl ean
suppl i es f or t he dr ug user s who st i l l wer en t abl e t o qui t t he dr ugs. At t he
same t i me, t her e was a syst em of r ef er r al t o i mpr ove access t o t r eat ment
and car e, such as HIV VCT, STI di agnosi s and t r eat ment , and MMT, i ncl udi ng
compr ehensi ve car e t hr ough Di Cs i n t he net wor k.
Chal l enges f rom t he TDN
Accessi ng dr ug user s i s di f f i cul t . They ar e secr et i ve and f ear f ul of bei ng
ar r est ed. Fr om t al ki ng wi t h t hei r f el l ow dr ugs user s, t he peer s r epor t ed
t hat , i n t he past , t he i nf or mat i on t hey got on HIV/ AIDS was onl y f r om
bookl et s and pamphl et s di st r i but ed by t he MMT cl i ni c, or f r om t he
i nf or mat i on boar d at t hese cl i ni cs. They never had a chance t o get i n- dept h
i nf or mat i on f r om t he gover nment or NGOs whi ch l ed t o i gnor ance about
HIV/ AIDS. They mi sunder st ood t hat HIV i nf ect i on was asympt omat i c at f i r st .
Al so, t he gover nment s War on Dr ugs act ual l y i ncr eased IDU r i sk of i nf ect i on
because t he IDU wer e not abl e car r y per sonal needl es, t her ef or e i ncr easi ng
t he f r equency of needl e- shar i ng.
E. 2 Net work of peopl e worki ng on drugs (12D)
12D i s a wor ki ng gr oup compr i sed of r epr esent at i ves f r om 12 agenci es
wor ki ng on dr ugs i ncl udi ng ( 1) Cent er f or AIDS Ri ght s; ( 2) TDN; ( 3) Asi an
Har m Reduct i on Net wor k; ( 4) Raks Thai Foundat i on; ( 5) Thai PLHA Net wor k;
( 6) Foundat i on f or Access t o AIDS Tr eat ment ; ( 7) ACCESS Foundat i on; ( 8) PSI
Foundat i on/ Ozone House; ( 9) NGO Coal i t i on on AIDS; ( 10) Al den House; ( 11)
Fr i ends Har m Reduct i on House of Bangkok; and ( 12) Independent wor ker s
wi t h dr ug user s.
The 12D began t o be f or med at t he end of 2008 t o i mpr ove under st andi ng
among peopl e who wor ked wi t h dr ug user s, and exami ni ng t he f easi bi l i t y of
MMT bei ng i ncl uded i n t he NHSP benef i t package st ar t i ng i n Fi scal Year 2009.
The 12D net wor k was not l i mi t ed t o onl y t hese 12 gr oups and had t he
obj ect i ve t o r ef l ect t he chal l enges of dr ug addi ct s f r om a br oader
per spect i ve. 12D est abl i shed f or ums f or exchange of i deas, exper i ence and
101
advi ce as a way t o modi f y t he way of t hi nki ng and i mpl ement at i on so t hat i t
i s mor e coor di nat ed, f ocused, and uni t ed. Ini t i al l y, Mr . Wer aphan Ngammi
who, at t he t i me, was a f r ee- l ance wor ker , was chosen t o coor di nat e among
t he member s on behal f of 12D by communi cat i ng vi a t he Int er net r egul ar l y,
and st i l l does so up t o t he pr esent .
F. Probl ems and chal l enges
1) Even t hough MMT i s now i ncl uded i n t he NHSP, t her e ar e f ew user s, and
use i s i r r egul ar .
2) Har m r educt i on f or dr ug user s, despi t e t he pol i cy at t ent i on and mat er i al
suppor t i t has r ecei ved f r om t he GFATM f or t he publ i c and pr i vat e sect or , i s
st i l l havi ng pr obl ems obt ai ni ng t he under st andi ng and goodwi l l of l ocal
heal t h pr ovi der s and pol i ce of f i ci al s i n t he ar eas of i mpl ement at i on, and t he
need f or bet t er coor di nat i on wi t hi n t he pr ovi nce.
3) At t he pol i cy l evel , even t hough i t i s cl ear t hat har m r educt i on has t o be
i nt egr at ed and compr ehensi ve, t her e i s di f f er ence of opi ni on concer ni ng
pr ovi si on of cl ean needl es and syr i nges f or IDU.
G. Pl an f or addressi ng t he probl ems and chal l enges
1) Ther e i s an ur gent need t o devel op t he qual i t y of MMT and est abl i shment
of nat i onal st andar ds f or har m r educt i on f or IDUs. Ther e i s an ur gent need
t o r evi ew, devel op and i mpr ove har m r educt i on ser vi ces, and pr epar e a
handbook f or ser vi ce pr ovi der s i n t he gover nment and NGO sect or s at
di f f er ent l evel s, i ncl udi ng speci f i cat i ons f or l i nkages among t he var i ous
ser vi ces i n a compr ehensi ve way.
2) Est abl i sh st r at egi es and communi cat e pol i cy and bui l d under st andi ng and
const r uct i ve at t i t udes of i mpl ement er s bot h i n t he cent r al ar ea and t he
t ar get i mpl ement at i on ar eas.
3) Eval uat e t he l essons l ear ned f r om ot her count r i es, and f r om wi t hi n
Thai l and, t o cl ar i f y needs and met hods of i mpl ement i ng ser vi ces f or IDUs,
and cl ean i nj ect i ng equi pment . Thi s i ncl udes suppor t f or r esear ch on t he
r esul t s of har m r educt i on ef f or t s i n t he ar ea of pr event i on of addi ct i on,
r ehabi l i t at i on, pr event i on of HIV, pr event i on of cr i me, and pr omot i on of
qual i t y of l i f e of IDU i n var i ous di mensi ons i ncl udi ng f i ndi ng r out i ne wor k.
H. Best pract i ces
Ozone House of Bangkok
The Ozone House i s a cent er of i nf or mat i on on AIDS and dr ug use
i mpl ement ed by t he PSI Foundat i on ( Thai l and) wi t h i ni t i al f undi ng f r om
USAID. It i s i mpl ement ed i n t hr ee pr ovi nces i ncl udi ng Chi ang Mai , Chi ang
Rai and Bangkok.
The ser vi ces of Ozone House i n Bangkok wer e l aunched i n 2005 wi t h a t ar get
t o l ower t he new i nf ect i ons among IDU. Ozone House suppor t s par t i ci pat i on
of t he IDU i n addr essi ng pr obl ems r el at ed t o AIDS and dr ug use, and suppor t s
102
IDU access t o heal t h ser vi ces. The act i vi t i es of Ozone House emphasi ze
cr eat i ng a home at mospher e wi t h user - f r i endl y ser vi ces whi ch ar e sui t ed
t o t he pr obl ems and needs of t he IDU. The act i vi t i es emphasi ze
par t i ci pat i on of t he IDU i n i mpl ement at i on. The ser vi ces consi st of House-
based ser vi ces as a Di C and out r each i n t he communi t y.
Sel ect i on of si t es t o be Di Cs
Ozone House sel ect s si t es t hat ar e conveni ent and saf e f or accessi ng
ser vi ces by t he IDU. It shoul d be a cent r al l ocat i on r el at i ve t o t he f i ve
heal t h cent er s of t he DOH of t he BMA whi ch of f er MMT. Bef or e openi ng f or
ser vi ces, t her e has t o be a per i od of coor di nat i on t o expl ai n t he t ar get ,
obj ect i ves and i mpl ement at i on pl an of t he house. The or gani zer s need t o
seek advi ce and r equest cooper at i on f r om r epr esent at i ves of t he r el evant
agenci es such as t he pol i ce, heal t h wor ker s, l ocal l eader s, NGO
devel opment wor ker s, and IDU peer educat or s. For mal meet i ngs ar e hel d t o
expl ai n t he t ar get s, obj ect i ves and met hods of i mpl ement at i on of Ozone
House wi t h t he r epr esent at i ves of t hese agenci es and i nt er est gr oups i n t he
gover nment , ci vi l soci et y, t he l ocal communi t y and peer gr oups.
IDU part i ci pat i on i n servi ce provi si on
Act i vi t i es and dur at i on of oper at i ons of Ozone House ar e det er mi ned i n
consul t at i on wi t h a t eam compr i sed of Ozone House st af f and IDU. Thi s i s
done t o ensur e t hat i mpl ement at i on of t he act i vi t i es ar e consi st ent wi t h t he
nat ur e of t he pr obl ems and needs of t he IDU so t hat ut i l i zat i on of Ozone
House wi l l be maxi mi zed. The t eam devel ops house r ul es. The nat ur e of
t he ser vi ces emphasi zes devel opment of t he IDU mor e t han pr ovi di ng hand-
out s or wel f ar e. The f ol l owi ng i s a sampl e of t he house r ul es f or an Ozone
House:
1. No dr ug use of any ki nd i n t he house
2. No pur chase or sel l i ng of any ki nd of dr ug i n t he house
3. No f i ght i ng or ar gui ng i n t he house
4. No t hef t i n t he house
The IDUs don t have t o pay any f ee f or usi ng t he ser vi ces of Ozone House.
The house does not suppor t t r anspor t at i on cost s f or IDUs t o t r avel t o t he
house. Inst ead i t r el i es on pr ovi di ng i ncent i ves t o peopl e who do vi si t t he
house as i n- ki nd compensat i on such as:
1. Par t i ci pat e i n 15 house act i vi t i es = 1 T- shi r t
2. Par t i ci pat e i n 25 house act i vi t i es = 1 hat
3. Par t i ci pat e i n 35 house act i vi t i es = 1 t ot e bag
4. Par t i ci pat e i n 40 house act i vi t i es = t he r i ght t o par t i ci pat e i n t he
annual Ozone camp
Coordi nat i on wi t h ot her organi zat i ons
Coor di nat i on wi t h ot her or gani zat i ons i ncl udes such act i vi t i es as MSF sendi ng
st af f t o hel p wi t h counsel i ng and nur si ng, and medi cal speci al i st s t o pr ovi de
heal t h car e on- si t e at Ozone House. Thi s i s done ever y Monday. The #3
BMA Heal t h Cent er at Bang Si r cont i nued t hese on- si t e cl i ni cal vi si t s af t er
103
t he MSF di scont i nued t hei r suppor t . It was f ound t hat many IDU di d not have
t hei r NHSP car d or even t hei r nat i onal ID car d. Thus, at Ozone House t hey
at l east ar e abl e t o get pr i mar y car e and l at er coul d be r ef er r ed i nt o t he
r egul ar syst em af t er hel pi ng t hem get t he necessar y document at i on. Ther e
ar e house st af f s or vol unt eer s r eady t o hel p IDU wi t h t hi s pr ocess on a
cont i nuous basi s.
Out reach Servi ces
IDU who ar e i nt er est ed i n j oi ni ng t he act i vi t y f or i nf or mat i on shar i ng or
ext endi ng hel p t o t hose i n t he communi t y who cannot come t o Ozone House
ar e t r ai ned i n peer out r each. They pr ovi de i nf or mat i on on AIDS and dr ug
use t o IDUs i n t he communi t y. They al so hel p l i nk IDU who have heal t h
pr obl ems wi t h t he appr opr i at e ser vi ce pr ovi der s. The out r each i s a way t o
bui l d capaci t y of t he IDU and i ncr ease IDU access t o ser vi ces. Ozone House
st af f wor k cl osel y wi t h t he peer out r each vol unt eer s t o pr ovi de over si ght
and suppor t as needed.
Import ant f act ors behi nd t he success of Ozone House
x Par t i ci pat i on f r om r el evant agenci es t o hel p cr eat e a net wor k of
par t ner s i n t he var i ous ar eas t hat af f ect t he dai l y l i f e of IDUs. Thi s
i ncl udes a r ef er r al net wor k of car e f or IDU or ot her net wor ks f or
coor di nat i on of i mpl ement at i on.
x Par t i ci pat i on of t he IDU t hemsel ves i n desi gni ng ser vi ces t hr ough a
l ear ner - cent er ed appr oach. Pr oj ect st af f di d not at t empt t o t hi nk f or
t he IDU or be j udgment al . That way t he IDU devel op a sense of
owner shi p of t he act i vi t i es so t hey want t hem t o succeed. Ot her wi se,
r esul t s coul d go i n a negat i ve di r ect i on.
x Uni nt er r upt ed schedul e of act i vi t i es and ser vi ces t o bui l d t r ust and
conf i dence among IDU.
x Suppor t f or IDU t o hel p sol ve pr obl ems i n t hei r communi t y i n a
sust ai nabl e way usi ng a devel opment appr oach t hat enabl es t he IDU t o
be a const r uct i ve member of soci et y i nst ead of a wel f ar e r eci pi ent , who
j ust sur vi ves day- t o- day.
3. 3. 8 HIV Prevent i on among Mi grant s and Mobi l e Popul at i on
A. Def i ni t i on of mi grant s
The t ask f or ce f or moni t or i ng and eval uat i on of HIV pr event i on among
mi gr ant s has of f er ed oper at i onal def i ni t i ons of mi gr ant s and mobi l e
popul at i ons f or t he pur pose of r epor t i ng cover age of t hese popul at i ons as
f ol l ows:
104
1. Document ed and non- document ed mi gr ant wor ker s most l y r ef er s t o
Bur mese, Cambodi an and Lao l abor er s
2. Ref ugees or asyl um seeker s
3. Et hni c mi nor i t i es
4. Thai l abor er s wor ki ng abr oad
Thi s r epor t does not cover f or ei gn t our i st s, f or ei gner s r esi di ng per manent l y
i n Thai l and, and f or ei gner s comi ng t o Thai l and t o pur sue t hei r st udi es. Al so
not i ncl uded ar e cer t ai n gr oups of di spl aced per sons such as t he Rohi ngya,
Nor t h Kor eans, and ot her s.
A. 1 Number of mi grant s and mobi l e popul at i ons
At pr esent , t he number of cr oss- bor der mi gr ant s i n Thai l and i s uncer t ai n,
but t he Of f i ce of Nat i onal Secur i t y Counci l est i mat es t hat t her e ar e about
2. 5 mi l l i on document ed and undocument ed mi gr ant wor ker s i n Thai l and
( 2009 publ i cat i on f r om t he NSC) .
The di f f er ent gr oups of mi gr ant s ar e enumer at ed as f ol l ows
x 1, 475, 317 mi gr ant s f r om Myanmar , Lao PDR, and Cambodi a, r egi st er ed t o
wor k i n Thai l and ( Of f i cer of For ei gn Labor , 2010) wi t h sub- di vi ded t ot al s
as f ol l ows:
1. 1, 314, 382 mi gr ant wor ker s who ar e economi c r ef ugees who have
been gr ant ed t empor ar y per mi ssi on t o r emai n unt i l r epat r i at i on, and
who can be subdi vi ded as f ol l ows:
- 382, 541 mi gr ant wor ker s wor ki ng i n Thai l and cont i nuousl y si nce
2004 ( 370, 711 Bur mese, 5, 700 Lao, and 6, 130 Cambodi ans) .
- 931, 841 mi gr ant wor ker s r egi st er ed t o wor k i n 2009 ( 708, 056
Bur mese, 105, 154 Lao, and 118, 631 Cambodi ans) .
2. 133, 488 mi gr ant wor ker s whose nat i onal i t y document at i on i s pendi ng
ver i f i cat i on but ar e r egi st er ed t o wor k l egal l y i ncl udi ng 15, 784
Bur mese, 58430 Lao, and 59238 Cambodi ans.
3. 27, 447 mi gr ant wor ker s l egal l y ent er i ng Thai l and f or wor k under t he
t r i - par t i t e MOU i ncl udi ng 10, 212 Lao and 17, 235 Cambodi ans.
x The UNHCR est i mat ed t hat t her e ar e 103, 566 di spl aced per sons i n ni ne
camps i n Thai l and i n i t s r epor t dat ed December 31, 2009. Ther e ar e
equal number s of mal es and f emal es, and t wo- t hi r ds ar e age 12 year s or
ol der . The number of di spl aced per sons at t he end of 2009 was l ess t han
at t he end of 2008.
x Ther e ar e about 1. 9 mi l l i on et hni c mi nor i t i es i n 2009 of whom 19, 775
wer e r egi st er ed f or ei gn mi gr ant l abor er s.
x Appr oxi mat el y 6, 500 Thai s ar e r egi st er ed as mi gr ant l abor er s i n ot her
count r i es i n 2009.
105
B. Si t uat i on of HIV
B.1 Si t uat i on of HIV among mi grant s
The Bur eau of Epi demi ol ogy ( BOE) , i n col l abor at i on wi t h t he pr ovi nci al chi ef
medi cal of f i ces of seven pr ovi nces conduct ed HIV ser osur vei l l ance among
f i shi ng boat cr ew i ncl udi ng Thai s and mi gr ant s si nce 1997. The t r ends of
HIV pr eval ence show cont i nuous decl i nes among t hi s popul at i on, but t he
t ask f or ce caut i ons t hat t he dat a need t o be i nt er pr et ed car ef ul l y si nce
t her e ar e quest i ons of t he qual i t y of t he dat a i n some si t es due t o t he smal l
si ze of t he sampl e, especi al l y f or r ounds pr i or t o 2007. Some pr ovi nces wi t h
adequat e sampl e si zes show an i ncr easi ng t r end, f or exampl e, i n Samut
Sakor n, Pr achuap, Pat t ani , and Kanchanbur i .
HIV preval ence i s hi gher among mi gr ant s t han Thai s i n many l ocat i ons
HIV pr eval ence among f or ei gn mi gr ant l abor er s i s hi gher t han t hat f or t he
gener al Thai popul at i on ( under 1% i n 2009) i n many l ocat i ons. The
Int er nat i onal Or gani zat i on on Mi gr at i on ( IOM) r epor t ed t hat , i n 2006, f or
most pr ovi nces wi t h dat a, t he HIV pr eval ence f or mi gr ant s was hi gher t han
t hat f or Thai mi l i t ar y r ecr ui t s and pr egnant women. Pr egnant mi gr ant
women had hi gher HIV pr eval ence t han Thai pr egnant women i n Tr ad,
Ranong and Tak Pr ovi nces
27
( Fi gur e 29) .
HIV preval ence among mi grant f emal e sex workers (FSW) i s hi gher t han
f or Thai FSW
In t he same way, dat a f r om Ranong and Tak show t hat mi gr ant FSW have
consi der abl y hi gher l evel s of HIV t han Thai FSW, despi t e decl i ni ng t r ends
f r om 2003 t o 2006 i n bot h pr ovi nces
28
( Fi gur e 30) .
Knowl edge of AIDS and sexual behavi or of mi grant s
The dat a i n t hi s sect i on come f r om t he PHAMIT Pr oj ect i mpl ement ed by t he
Raks Thai Foundat i on. The Pr oj ect f ound t hat mi gr ant s i n t he
i mpl ement at i on ar ea had i ncr easi ng AIDS knowl edge l evel s ( f r om under 20%
cor r ect of 5 knowl edge i ndi cat or s i n 2004 t o over 27% i n 2008) wi t h t he
except i on of f emal e mi gr ant s i n pr ovi nces bor der i ng on Cambodi a.
29
Mal e mi gr ant s r epor t ed hi gh and i ncr easi ng l evel s of buyi ng sex and sex wi t h
mul t i pl e non- r egul ar par t ner s. The eval uat i on of t he PHAMIT Pr oj ect i n 17
27
Mi gr at i on and HIV/ AIDS i n Thai l and: Tr i angul at i on of bi ol ogi cal , behavi or al and
pr ogr ammat i c r esponse dat a i n sel ect ed pr ovi nces, IOM, 2010
28
Ibi d 1
29
Pr event i on of HIV/ AIDS Among Mi gr ant Wor ker s i n Thai l and: The i mpact sur vey 2008, IPSR
page 40
106
pr ovi nces i n 2008 f ound t hat an i ncr easi ng pr opor t i on of mi gr ant s wer e
buyi ng sex, especi al l y i n Thai - Cambodi a bor der pr ovi nces ( f r om 34%t o 47%) .
However , condom use dur i ng l ast commer ci al sex epi sode was 97%.
30
Fi gur e 29: Pr eval ence of HIV among Thai f i shi ng boat cr ew, ar my r ecr ui t s, mi gr ant
wor ker s, Thai and mi gr ant pr egnant women i n 4 pr ovi nces i n 2006
Sour ce: Mi gr at i on and HIV/ AIDS i n Thai l and: Tr i angul at i on of bi ol ogi cal , behavi or al and
pr ogr ammat i c r esponse dat a i n sel ect ed pr ovi nces, IOM, 2010 usi ng r esul t s of HIV Sent i nel
Sur vei l l ance by t he Pr ovi nci al Heal t h Of f i ces
Fi gur e 30: HIV pr eval ence among Thai and Mi gr ant FSWs i n sel ect ed pr ovi nce i n
2005
31.4
0
7.9
28.8
2.1
7.2
3.7
21.3
1.5
5.1
4.2
6.7
0.8
3.6
4
7.3
0
5
10
15
20
25
30
35
Thai FSWs - Ranong Migrant FSWs - Ranong Thai FSWs - Tak Migrant FSWs - Tak
Percent
2003 2004 2005 2006
Sour ce: Mi gr at i on and HIV/ AIDS i n Thai l and: Tr i angul at i on of bi ol ogi cal , behavi or al and
pr ogr ammat i c r esponse dat a i n sel ect ed pr ovi nces, IOM, 2010 usi ng r esul t s of HIV Sent i nel
Sur vei l l ance by t he Pr ovi nci al Heal t h Of f i ces.
30
Ibi d 3
HIV prevalence among Thai Fishermen or Military
Conscripts and Migrant workers in 2006
0.7
0
1
1.5
3.5
1.9
1
0
0.5
8.1
0
1
2
3
4
5
6
7
8
9
10
Trat Samut
Sakhon
Ranong Tak Sa Kaeo
Percent
Thai military conscripts
Migrant workers
Thai fishermen
Migrant fishermen
HIV prevalence among Thai and Migrant
Pregnant women in 2006
0.8
1.4
0.8 0.8
0.4
2.4 2.3
1.5
1.5
4.2
0
1
2
3
4
5
6
7
8
9
10
Trat Samut
Sakhon
Ranong Tak Sa Kaeo
Percent
Thais
Migrants
107
The number of non- r egul ar sex par t ner s i n t he year pr i or t o t he i nt er vi ew
was al so hi gher , at an aver age of f our , and exceeded f i ve i n some ar eas.
The 2008 sur vey f ound t hat t her e wer e sl i ght decr eases i n t he number of
non- r egul ar par t ner s f r om 2004,
31
but t hat t he number of non- r egul ar sex
par t ner s of mi gr ant s was hi gher t han t hat f or t hei r Thai count er par t s
( aver age of t wo) .
32
The 2010 IOM r epor t whi ch assembl ed r i sk behavi or dat a f r om t he pr ovi nci al
heal t h of f i ces of Samut Sakon, Pr achuap Ki r i khan, Mukdahan, and Chi ang Rai ,
r epor t ed consi st ent t r ends f or t he per i od of 2004- 2006: t he l evel of condom
use i n l ast commer ci al sex epi sode was over 90%, wi t h t he except i on of
Chi ang Rai i n whi ch condom use i ncr eased f r om 77% i n 2004 t o 83% i n
2006.
33
B.2 HIV si t uat i on among di spl aced persons
The pr eval ence of HIV among di spl aced per sons i s r at her l ow. In 2009 a
ser o- sur vey of 150 per sons who wer e pr egnant women f ound a l evel of HIV
of 0. 16%. The per cent wi t h syphi l i s was 0. 3%. Ther e ar e no r i sk behavi or
sur veys f or t hi s popul at i on. But i t has been obser ved t hat t her e mi ght be
some r i sk among t he adol escent mal es who go out si de t he det ent i on camps
f or var i ous dur at i ons and may have sex wi t h sex wor ker s. Ther e ar e no
r epor t s of i nj ect i on dr ug use i n t he camps. STI pr eval ence was at t r ace
l evel s i n men and women at 0. 05 per 1, 000 and 0. 0051 per 1, 000
r espect i vel y.
C. Impl ement at i on of prevent i on of HIV i n mi grant s and mobi l e
popul at i ons
C.1 Pol i cy and pl an/ proj ect s address t he probl em of HIV among mi grant s
and ot her mobi l e popul at i ons
1) The Nat i onal AIDS Pl an f or 2007-2011
The f our gr oups, as def i ned at t he begi nni ng, i ncl ude mi gr ant wor ker s,
di spl aced per sons, et hni c mi nor i t i es and Thai l abor er s abr oad. These gr oups
ar e i dent i f i ed i n t he Nat i onal AIDS Pl an f or pr i or i t y pr event i on i nt er vent i ons,
t r eat ment and mi t i gat i on of AIDS i mpact . Ther e ar e a number of measur es
t o be t aken t o i mpr ove AIDS knowl edge and under st andi ng, cr eat i ng a
suppor t i ve envi r onment , suppor t i ng a saf e l i f est yl e, suppor t i ng par t i ci pat i on
i n pr event i on act i vi t i es t hr ough t he i mpl ement i ng par t ner s, and suppor t i ng
31
Ibi d 3
32
Nat i onal sexual behavi or al sur vey of Thai l and, IPSR, 2006
33
Ibi d 1
108
access t o heal t h ser vi ces. The f ol l owi ng ar e addi t i onal measur e speci f i c t o
cer t ai n gr oups:
- Int egr at i on of AIDS i nt o t he pol i cy f or l abor mi gr at i on
- Int egr at i on of gui del i nes and measur es f or pr event i on, car e and
suppor t i nt o t he pl an f or t he pr ot ect i on of Thai l abor er s abr oad.
- Suppor t i ng access t o heal t h ser vi ces f or di spl aced per sons under t he
agr eement bet ween Thai l and and UNHCR. Even t hough t hi s measur e
i s speci f i ed i n t he f i ve- year pl an, t her e i s no budget f or t he act i vi t y.
2) Int egrat ed HIV prevent i on f or most -at -ri sk popul at i ons by support i ng
out reach and i nt egrat ed servi ce net works
Thi s pr oj ect onl y cover s mi gr ant s, and r ecei ves suppor t f r om t he GFATM
Round 8 f or f i ve year s of i mpl ement at i on f r om June 2009 t o May 2014.
The key st r at egy i s t o expand t he scope of access t o and cover age of HIV
pr event i on ser vi ces f or t he t ar get popul at i on by i ncr easi ng par t i ci pat i on of
t he NGOs and t he t ar get benef i ci ar i es t hemsel ves. In addi t i on, t he pr oj ect
ai ms t o i ncr ease t he user - f r i endl i ness of gover nment ser vi ces and l i nk t hese
wi t h t he NGO out r each act i vi t i es. Anot her st r at egy i s t o st r engt hen t he
t ar get popul at i on, and i ncr ease knowl edge about sex and sex l i f est yl es,
pr ot ect i on of r i ght s and ser vi ce pr ovi der s i n t he publ i c and pr i vat e sect or ,
and advocat e f or enabl i ng pol i ci es.
The Raks Thai Foundat i on ( RTF) i s t he pr i nci pal r eci pi ent i n t hi s ef f or t . RTF
manages out r each t o t he communi t y and dr op- i n cent er s, i ncl udi ng condom
r e- suppl y. The Depar t ment of Di sease Cont r ol ( DDC) vi a t he STI gr oup and
t he AIDS Bur eau have devel oped user - f r i endl y ser vi ces i n t he ar ea of HIV
VCT and STI di agnosi s and t r eat ment . The pr oj ect i s i mpl ement ed i n 36
pr ovi nces i ncl udi ng Bangkok.
3) Impl ement at i on of HIV prevent i on f or di spl aced persons
Thi s act i vi t y i s i mpl ement ed by f our i nt er nat i onal NGOS i ncl udi ng Ai ds
Medi cal Int er nat i onal ( AMI) , Int er nat i onal Rescue Commi t t ee ( IRC) , Mal t ese
Int er nat i onal and t he Amer i can Ref ugee Commi t t ee ( ARC) under
coor di nat i on wi t h t he UNHCR. The ser vi ces i ncl ude:
x Suppor t f or access t o condoms ( f emal e and mal e) i n cl i ni cal set t i ngs
x Pr ovi si on of post - pr ophyl axi s f or sur vi vor s of sexual vi ol ence
x Campai gns t o cr eat e awar eness and concer n about AIDS among t he
gener al popul at i on i ncl udi ng shor t dr ama pr esent at i ons and ot her
medi a as del i ver ed by vol unt eer s
x Pr ovi si on of educat i on on sex and AIDS as i nt egr at ed i nt o t he
r epr oduct i ve heal t h cur r i cul um f or adol escent s
109
x Tar get ed i nt er vent i ons f or hi gh r i sk gr oups such as mal es goi ng out of
t he camps on a r egul ar basi s
x Suppor t f or uni ver sal access t o VCT usi ng t he r api d t est , and STI
di agnosi s as i nt egr at ed t hr ough t he ANC and medi cal cl i ni cs, among
ot her s.
4) Impl ement at i on of HIV Prevent i on f or et hni c mi nori t i es
For t he past per i od of t i me t hat AIDS has been spr eadi ng i nt o t hi s
popul at i on, Thai l and has not i mpl ement ed a cl ear and cont i nuous pr ogr am
of pr event i on. The r esour ces f or t hi s usual l y come f r om f or ei gn donor s
whi ch has hel ped encour age or gani zat i ons wor ki ng wi t h et hni c mi nor i t i es t o
f ocus on AIDS and r el at ed heal t h i ssues such as t he AIDS Pr oj ect of t he Li su
Or gani zat i on, t he Pr oj ect f or AIDS Educat i on i n Hmong Communi t i es, t he
Lahu Heal t h Pr oj ect , whi ch can be consi der ed a f i r st st ep by et hni c
mi nor i t i es t o become i nvol ved i n t he Nat i onal AIDS Pl an. Ther e have been
at t empt s t o cr eat e net wor ks f or et hni c mi nor i t y heal t h t hr ough a 4- pr onged
st r at egy of heal t h devel opment , capaci t y bui l di ng, st r engt heni ng net wor ks,
and publ i c pol i cy and communi cat i on wi t h t he communi t y, soci et y and t he
publ i c at l ar ge.
In t he t wo year s cover ed by t hi s pr ogr ess r epor t , t he f ol l owi ng pr event i on
act i vi t i es f or et hni c mi nor i t i es have t aken pl ace:
1. The hi ghl ands et hni c mi nor i t y heal t h net wor k has bui l t t he capaci t y
of a wor k t eam of et hni c mi nor i t i es, col l ect ed dat a, cr eat ed a dat abase,
anal yzed dat a, pr oduced medi a on et hni c mi nor i t i es i n t he l ocal i t i es, and
l i nked and coor di nat ed wi t h t he hospi t al and gover nment of f i ces, and t he
di st r i ct heal t h of f i ce t o devel op t he model of user - f r i endl y ser vi ces f or
et hni c mi nor i t i es.
2. For ums have been conduct ed f or exchange of exper i ence and
knowl edge bet ween agenci es wor ki ng wi t h et hni c mi nor i t i es, and j oi ned
f or ces t o cr eat e a net wor k of or gani zat i ons wor ki ng i n t he f i el d, speci f i ed
di r ect i ons and gui del i nes f or col l abor at i ve wor k t hr ough t he et hni c mi nor i t y
net wor k t o r educe dupl i cat i on of t he wor k wi t h t he var i ous gr oups of
benef i ci ar i es and l ocal i t i es.
3. The AIDS Act i vi t y Or gani zat i on of t he Thai Chr i st i an Counci l , whi ch
has al so been wor ki ng wi t h et hni c mi nor i t i es f or a l ong t i me, suppor t s t he
comi ng t oget her of PLHA who ar e et hni c mi nor i t i es i n Chi ang Dao Di st r i ct of
Chi ang Mai .
4. In Chi ang Mai , a wor ki ng gr oup on AIDS was est abl i shed wi t h a f ocus
on et hni c mi nor i t i es, and pr oduced a col l abor at i ve pl an f or pr event i on of
AIDS among et hni c mi nor i t i es i n Chi ang Mai .

5) HIV prevention for Thai laborers abroad
The Depart ment f or Thai Labor Abroad support s a program f or awareness of HIV
prevent i on by t rai ni ng workers expressi ng t he i nt ent i on t o seek work abroad, t o
prot ect t hem and t hei r part ners f rom HIV, and reduce myt hs about AIDS. In 2009,
29 t rai ni ng sessi ons were hel d among 6, 463 persons i ncl udi ng 5, 743 mal es and 720
f emal es.
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Thai s goi ng abr oad f or wor k need t o have a heal t h exam f r om one of 96
cer t i f i ed cl i ni cs i ncl udi ng 37 gover nment and 59 pr i vat e cl i ni cs. Empl oyer s
who conduct a r epeat heal t h exam and di agnose a f or bi dden i l l ness
( i ncl udi ng AIDS) can send t he Thai l abor er back t o Thai l and who may r ecei ve
compensat i on dependi ng on dur at i on of member shi p i n t he wel f ar e f und f or
Thai wor ker s abr oad.
C.2 Resul t s of t he i mpl ement at i on
C.2. 1 Coverage and access t o act i vi t i es f or prevent i on and cont rol of HIV
among mi grant l aborers
Dur i ng 2008 t her e wer e HIV pr event i on pr oj ect s f or mi gr ant l abor er s i n 23
pr ovi nces under t he PHAMIT Pr oj ect , t he Pl anned Par ent hood Associ at i on of
Thai l and ( PPAT) , and t he Wor l d Vi si on Foundat i on. These act i vi t i es wer e
expanded t o 36 pr ovi nces i n 2009, most l y wi t h t he suppor t of t he GFATM
Round 8.
The RTF, PPAT and Wor l d Vi si on r eached appr oxi mat el y 100, 000 mi gr ant
l abor er s wi t h HIV pr event i on ser vi ces i n 2008. The RTF r epor t ed t hat t hei r
pr oj ect benef i ci ar i es had i mpr oved access t o knowl edge on HIV, AIDS and
STIs f r om 27% i n 2004 t o 63% i n 2008, wi t h women havi ng gr eat er
par t i ci pat i on t han men. The per cent of mi gr ant s r ecei vi ng STI exams
i ncr eased f r om 20%i n 2004 t o 35%i n 2008, and f emal e mi gr ant s had about
doubl e t he exami nat i on r at e as mal es i n 2008. Ful l y 24% had HIV VCT
( Fi gur e 31) .
Fi gur e 31: Per cent age of mi gr ant wor ker s r eached t o key pr event i on
i nt er vent i ons i n 2004 and 2008
20
35
24 27
63
0
10
20
30
40
50
60
70
80
90
100
Exposed to STI and HIV education Received STI check up Received HIV counseling and
testing and received HIV test result
Percent
2004 2008
Sour ce: Pr event i on of HIV/ AIDS among Mi gr ant Wor ker s i n Thai l and Pr oj ect ( PHAMIT) : The
i mpact sur vey 2008, IPSR, 2008
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D. Probl em, obst acl e and chal l enges
Gaps and chal l enges t hat st i l l need t o be addr essed ar e numer ous and t ouch on
br oader pol i cy i ssues such as mi gr ant s l egal st at us, heal t h i nsur ance syst ems, and
heal t h syst ems budget i ng. These i n t ur n af f ect pr act i cal i ssues such as hi r i ng of
Mi gr ant Heal t h Wor ker s and maki ng ART avai l abl e t o mi gr ant s on a sust ai nabl e and
on- goi ng basi s. Det ai l s ar e f ol l owi ng;
Pol i cy f or mi gr ant wor ker i s i mpl ement i ng as shor t t er m basi c and ad hoc
appr oach. A l ong- t er m, r easonabl e pol i cy i s needed.
Memor andum Of Under st andi ng ( MOU) wi t h Laos, Cambodi a and Myanmar on
The Empl oyment of Wor ker s f r om t hose count r i es has not been successf ul
i n at t r act i ng hi gh number s of wor ker s t o mi gr at e t hr ough f or mal channel s.
Heal t h i nsur ance cover s document ed mi gr ant s but est i mat ed 1 mi l l i on
mi gr ant s ar e undocument ed wi t hout i nsur ance. Need t o i ncr ease access t o
car e and ART f or mi gr ant wor ker s and make sust ai nabl e by i ncl udi ng ART i n
t he heal t h i nsur ance package.
Under heal t h i nsur ance, 206 baht out of 1300 baht per capi t a i s f or
pr event i on and heal t h pr omot i on, 50 baht al l ocat ed t o subsi di ze hi gh cost
car e and t r eat ment . Si nce i t i s l ow pr opor t i on of cl i ent under t he scheme,
t ot al budget f or heal t h pr omot i on i s not enough t o i mpl ement i nt er vent i ons.
Need t o i nst i t ut i onal i ze mi gr ant heal t h wor ker s as par t of ser vi ce pr ovi si on
Qual i t y Cont r ol and Qual i t y Assur ance shoul d be i mpl ement ed i n expansi on
of i nt er vent i ons dur i ng 2010- 2013
Enhanci ng and expandi ng i mpact at nat i onal l evel shoul d be a goal f or
pr event i on t ar get i ng mi gr ant wor ker s
IBBS i mpl ement at i on wi l l be conduct ed but st i l l a need f or ot her t ypes of
r esear ch t o bet t er under st and t r ansmi ssi on dynami cs and sexual net wor ks
among mi gr ant wor ker s
E. Pl an f or addressi ng t he probl ems and chal l enges
x Synt hesi ze l essons l ear ned f r om PHAMIT and ot her i nt er vent i ons f or nat i onal
scal i ng up.
x Wi t h suppor t f r om t he GFATM r ound 8, pr event i on, t est i ng and t r eat ment
ser vi ces ar e bei ng scal ed- up i n t he second phase of PHAMIT. The pr oj ect has
st ar t ed si nce June 2009 and wi l l be i mpl ement ed t i l l 2013. In or der t o
i nt ensi f y pr event i on i nt er vent i ons, an i nt egr at ed package of ser vi ces have
been i mpl ement ed, St andar d Oper at i on Pr ocedur e ( SOP) wi l l be devel oped
or modi f i ed and wi l l be t ai l or ed t o make i t appr opr i at e f or t ar get i ng sub-
gr oups of mi gr ant wor ker s.
x WHO i s suppor t i ng pol i cy advocacy t o ensur e ART wi l l be avai l abl e and
accessi bl e f or non- Thai HIV/ AIDS pat i ent s among key st akehol der s.
x Advocat e f or devel opi ng l ong t er m pol i cy, i mpr ovi ng medi cal heal t h
i nsur ance package and r egi st r at i on syst em st i l l cont i nuous and cl osel y
moni t or i t s pr ogr ess wi l l be i mpl ement ed.
x In 2010, i nt egr at ed bi ol ogi cal and behavi or al sur vei l l ance ( IBBS) among
mi gr ant wor ker s wi l l be conduct ed as t he f i r st t i me i n Thai l and. It woul d be
112
key dat a sour ce f or moni t or pr ogr ess of HIV epi demi c and nat i onal
r esponses. To compl ement wi t h out come and i mpact moni t or i ng,
pr ogr am eval uat i on f or mi gr ant wor ker s wi l l be under t aki ng by 2011.
F. Best pract i ces
1) Enabl i ng Envi ronment f or Mi grant Workers t o Access HIV Servi ces: The
PHAMIT (Prevent i on of HIV/ AIDS among Mi grant Workers i n Thai l and)
Proj ect ( See det ai l s i n Best Pr act i ce Sect i on)
Lessons Learned
x The i mpor t ance of par t i ci pat i on by benef i ci ar i es The par t i ci pat i on of
mi gr ant s i n i nt er vent i ons i s a key el ement of PHAMIT s success. By
bui l di ng t he capaci t y of mi gr ant s t o assi st i n di r ect l y i mpl ement i ng
act i vi t i es and pr ovi di ng ser vi ces, i ssues of accessi ng har d t o r each
popul at i ons and l anguage bar r i er s ar e over come.
x HIV pr event i on l eads t o t he need f or t r eat ment Wi t h r egul ar exposur e
and sensi t i zat i on t o HIV pr event i on act i vi t i es over t he dur at i on of t he
pr oj ect , mor e mi gr ant s wi t h HIV st ar t ed comi ng f or war d needi ng
assi st ance. For t unat el y, PHAMIT s st r at egi es wer e easi l y adj ust ed t o
accommodat e mi gr ant PLHIV s needs.
x HIV pr ogr ammi ng f or vul ner abl e and mar gi nal i zed gr oups needs t o
suppor t r i ght s and communi t i es Mi gr ant wor ker s secur i t y i s di r ect l y
i mpact ed by br oader i ssues of r i ght s and pol i ci es, and t hei r wel l - bei ng i s
r ef l ect ed by t he condi t i ons of t hei r communi t y. Ignor i ng t hese i ssues and
si ngul ar l y pur sui ng HIV pr ogr ammi ng- r el at ed act i vi t i es l eaves mi gr ant
wor ker s and t hei r f ami l i es vul ner abl e t o r i ght s vi ol at i ons and ot her
condi t i ons t hat wi l l under mi ne HIV- r el at ed gai ns. A hol i st i c appr oach i s
r equi r ed wi t h mi gr ant wor ker popul at i ons t hat addr esses r i ght s and
communi t y si mul t aneousl y wi t h HIV r el at ed i nt er vent i ons.
2) St rengt heni ng Access t o VCT t hrough Communi t y Mobi l i zat i on i n
Ref ugee Camps i n Thai l and
Act i ons f or Change
In Mae La camp i n 2001 t her e wer e 78 peopl e who r ecei ved pr et est
counsel i ng and onl y 35 agr eed t o t he t est . Si nce t hen, ef f or t s have been
made t o i mpr ove t he avai l abi l i t y and accessi bi l i t y of HIV t est i ng wi t h
i mpr essi ve r esul t s. In t he f i r st ni ne mont hs of 2009 t her e wer e 3, 825
per sons counsel ed and t est ed i n Mae La Camp ( r egi st er ed popul at i on 30, 033) .
The camp popul at i on has i ncr eased bet ween 2001 t o 2009, but t he VCT
upt ake has i ncr eased mar kedl y over what woul d be expect ed based on t he
popul at i on i ncr ease. Addi t i onal l y, AMI expanded VCT t o Umpi em and Nupo
camps i n 2005 wher e t her e has been si mi l ar success wi t h 1, 310 per sons
counsel ed and t est ed i n Nupo Camp and 1100 i n Umpi em Mai dur i ng t he f i r st
ni ne mont hs of 2009.
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Int ervent i ons and Posi t i ve Out comes
The i ncr eased VCT upt ake i s due t o a number of f act or s i ncl udi ng t he
f ol l owi ng: communi t y i nvol vement t hr ough t he Kar en HIV Educat i on
Wor ki ng Gr oup ( many VCT counsel or s wer e chosen f r om t hi s wor ki ng
gr oup) ; t he pr ovi si on of mobi l e VCT whi ch i s pr eceded by educat i onal
sessi ons on HIV and t he of f er of VCT i n communi t y cent er s and si t es;
r api d t est i ng and same day r esul t s; r ef er r al of STI and TB pat i ent s f or
r out i ne of f er of t est i ng, and f i nal l y, mass awar eness such as Wor l d AIDS
Day and door - t o- door campai gns conduct ed by AMI s VCT counsel or s.
Ref ugees cur r ent l y have access t o ant i r et r ovi r al t her apy wi t h dr ugs
suppor t ed by t he gover nment or AMI and wi t h AMI pr ovi di ng most cl i ni cal
ser vi ces r el at ed t o t r eat ment i n t he camps. The avai l abi l i t y of
ant i r et r ovi r al t her apy f or r ef ugees encour ages peopl e t o know t hei r st at us
as t he opt i on of t r eat ment i s avai l abl e i f t hey ar e HIV posi t i ve.
AMI s VCT counsel or s r ecei ve t hor ough t r ai ni ng and have ef f ect i ve
counsel i ng ai ds i n Bur mese and Kar en l anguage sui t abl e f or a l ow l i t er at e
audi ence ( f l i pchar t s, pamphl et s and ot her IEC mat er i al s) . The VCT
t r ai ni ng cur r i cul um has been devel oped by t he Kar en HIV/ AIDS Educat i on
Wor ki ng Gr oup wi t h some suppor t f r om ext er nal agenci es.
The t r ai ni ng of counsel or s f or VCT i s one mont h l ong and consi st s of t wo
week s basi c counsel i ng t r ai ni ng, one week s pr act i cal and one week on
bl ood speci men col l ect i on. Inf or mat i on on CD4 count s and ARV t r eat ment
i s i ncl uded i n t he t r ai ni ng. Dur i ng t he t r ai ni ng much at t ent i on i s gi ven t o
t he mai nt enance of conf i dent i al i t y and pr i vacy. Thi s i s cr i t i cal i n a cl osed
camp set t i ng i n or der t o r espect t he r i ght s of t hose accessi ng ser vi ces and
ensur es communi t y conf i dence i n t he ser vi ces.
The VCT super vi sor conduct s moni t or i ng wi t h checkl i st s t o assess qual i t y
of ser vi ces i ncl udi ng a counsel i ng checkl i st ; an eval uat i on of each
counsel or i s done ever y t hr ee mont hs t hr ough obser vat i on of a counsel i ng
sessi on and pr ovi si on of f eedback.
Per sons t est i ng posi t i ve ar e r ef er r ed f or f ur t her assessment t o a cl i ni cal
pr ovi der . Thi s wi l l i ncl ude CD4 count t o assess t he need f or ART; TB
scr eeni ng; r ef er r al f or nut r i t i onal suppor t and i nf or mat i on about posi t i ve
suppor t gr oups avai l abl e.
The UNHCR Heal t h Inf or mat i on Syst em dat a pr ovi des f eedback by
moni t or i ng key i ndi cat or s such as VCT upt ake and per cent of per sons who
r et ur n f or post - t est counsel i ng and per cent of HIV posi t i ve per sons on ART.
These dat a ar e used by t he NGOs t o moni t or t he access and qual i t y of
t est i ng.
AMI have enr ol l ed i n Thai l and s nat i onal l abor at or y qual i t y assur ance
pr ogr am f or HIV t est i ng t o ensur e accur acy and r el i abi l i t y of t est r esul t s.
Thi s consi st s of par t i ci pat i on i n t he nat i onal qual i t y cont r ol scheme wher e
qual i t y cont r ol sampl es f or speci f i ed HIV t est s ar e di st r i but ed and t he
nat i onal qual i t y assessment exer ci se whi ch i s conduct ed t hr ee t i mes year l y.
The VCT i s i nt egr at ed wi t h ot her HIV r el at ed act i vi t i es i ncl udi ng condom
pr omot i on. Ther e has been a concer t ed ef f or t t o pr omot e condoms si nce
2005 wi t h much success. Ini t i al l y t her e was st r ong r esi st ance on r el i gi ous
and cul t ur al gr ounds but now t her e ar e publ i c pr omot i on campai gns and
demonst r at i ons and wi der avai l abi l i t y of condoms.
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Concl usi on
Even i n a l ow- pr eval ence set t i ng, r ef ugees wi l l access HIV counsel i ng and
t est i ng i f t he ser vi ces ar e appr opr i at el y pr omot ed and ar e pr ovi ded t o a
sat i sf act or y qual i t y. Concer ns about st i gma shoul d not be used as a r eason
t o deny on- si t e access t o VCT i n camp set t i ngs i f t he cont ext war r ant s t hi s.
Inst ead measur es shoul d be made t o pr ovi de a qual i t y ser vi ce i n l anguages
t hat r ef ugees under st and wi t h due at t ent i on t o pr i vacy and conf i dent i al i t y.
Counsel i ng and t est i ng ser vi ces shoul d be suppor t ed by l i nkages t o ot her
i ni t i at i ves i ncl udi ng posi t i ve suppor t gr oups, communi t y suppor t , TB
scr eeni ng and t r eat ment , and ART pr ovi si on.
3. 3. 9 HIV Prevent i on among Pri soners
A. Background
Thai l and has 142 pr i sons and ot her det ent i on f aci l i t i es wi t h 209, 427 i nmat es
( as of December 2009) . Of t hese, 85. 9% ar e mal e and 14. 1% ar e f emal e.
Dr ug- r el at ed of f enses account f or 57. 1% wi t h met hamphet ami nes ( met h)
bei ng t he most common i l l egal dr ug i nvol ved ( 87%) , f ol l owed by her oi n ( 8%) ,
opi um ( 4%) , and t hi nner ( 1%) . Ful l y 18% wer e dr ug user s whi l e 82% wer e
deal er s/ possessor s of t he dr ugs.
Heal t h ser vi ces f or pr i soner s i ncl ude an i nf i r mar y i n t he pr i sons and
det ent i on cent er s st af f ed by 1 t o 2 i ndi vi dual s. Ther e i s a 500- bed hospi t al
under t he Depar t ment of Cor r ect i ons ( DoC) l ocat ed i n Bangkok. In t he
pr ovi nces, t he r egul ar hospi t al s pr ovi de car e, wi t h ser vi ce subsi di es f r om
t he NHSP f or Thai nat i onal s. Appr oxi mat el y 20%t o 30%of pr i soner s ar e not
el i gi bl e f or NHSP benef i t s.
B. Si t uat i on of HIV/ AIDS among pri soners
Cur r ent l y, t her e i s no f or mal sur vei l l ance of HIV among t he pr i soner
popul at i on. The DoC has t he pol i cy t o not conduct compul sor y HIV t est i ng.
Vol unt ar y t est i ng i s al l owed as a gui de t o t r eat ment . In June 2009, a t ot al
of 1, 768 pr i soner s wer e known t o have HIV( 76. 5% mal e) . Ful l y 63. 2%
r epor t ed sexual behavi or as t he r out e of t r ansmi ssi on, and 36. 8% by
i nj ect i on dr ug use. A t ot al of 1, 172 wer e r ecei vi ng ART and 723 had been
t r eat ed f or OIs.
A st udy conduct ed by t he Medi cal Ser vi ces Di vi si on ( MSD) of t he DoC i n
col l abor at i on wi t h ot her agenci es r epor t ed t he f ol l owi ng:
1) In 2005, t he MSD conduct ed a st udy of pr event i on of HIV among 587
i nmat es i n pr i sons and DoC det ent i on cent er s i n Bangkok wi t h a hi st or y of
addi ct i ve dr ug use. Of t hese, 89. 3% had used met h, 3. 4% had used her oi n,
115
16. 5% had i nj ect ed dr ugs, and 10. 7% had shar ed needl es/ syr i nges wi t h
ot her s. A t ot al of 9. 5%r epor t ed ever havi ng sex wi t h someone of t he same
sex.
2) In 2007, t he MSD col l abor at ed wi t h t he PSI Foundat i on t o conduct a
st udy of 200 pr i soner s wi t h a hi st or y of dr ug addi ct i on. The st udy f ound
t hat 6% had ever i nj ect ed dr ugs, whi l e 68% had t aken dr ugs or al l y. Ful l y 2%
r epor t ed i nj ect i ng dr ugs whi l e i n pr i son, and 75% r epor t ed havi ng sex wi t h
someone of t he same sex. A t ot al of 88%r epor t ed havi ng a t at t oo done wi t h
shar ed equi pment , whi l e 67% r epor t ed modi f yi ng t he f or eski n of t he peni s
usi ng a shar ed shar p, and 32%sai d t hey used condoms.
3) In 2008 t he MSD col l abor at ed wi t h t he TUC t o st udy 584 young mal e
i nmat es. Pr i or t o i ncar cer at i on, 49% had a hi st or y of addi ct i ve dr ug use
i ncl udi ng 4% i nj ect i on. Ri sk behavi or whi l e i n pr i son i ncl uded usi ng shar ed
t at t ooi ng equi pment ( 79%) , peni s f or eski n modi f i cat i ons usi ng a shar ed shar p
( 28%) , havi ng sex wi t h anot her man ( 15%) , and secr et l y i nj ect i ng dr ugs ( 1%) .
Among t hose r epor t i ng sex behavi or , 15%sai d t hey used condoms.
C. Prevent i on of HIV among pri soners
1) The Nat i onal AIDS Pl an f or 2007-2011
The NAP pl an speci f i es pr i soner s as a t ar get popul at i on bot h as a sub- gr oup
of IDU and MSM pr i or i t y gr oups. It i s hoped t hat pr event i on ser vi ces coul d
be ext ended t o t hi s popul at i on.
2) Gui del i nes f or prevent i on of HIV among i n-mat es of pri sons and
det ent i on cent ers
The DoC has i ssued t he f ol l owi ng gui del i nes f or pr event i on and cont r ol of
HIV/ AIDS:
Prevent i on
1. Bui l d cor r ect knowl edge and under st andi ng about HIV/ AIDS i ncl udi ng:
- Educat i onal t r ai ni ng f or pr i soner s; t r ai ni ng of peer educat or s t o
i mpr ove cor r ect knowl edge and under st andi ng, r educe st i gma of PLHA, and
l ear n about ser vi ces i n t he pr i son.
- Educat i onal t r ai ni ng f or st af f , t r ai ni ng r esour ce per sons and peer
l eader s i n or der t o bui l d cor r ect knowl edge and under st andi ng and posi t i ve
at t i t udes r egar di ng PLHA, gai n cooper at i on i n i mpl ement i ng pr event i on
act i vi t i es such as di ssemi nat i ng knowl edge and di st r i but i ng condoms.
- Pr oduct i on of educat i onal medi a i n a var i et y of f or mat s t o
di ssemi nat e among t he pr i soner s and st af f , i ncl udi ng r equest s f or suppor t
f r om ot her agenci es, t o i ncr ease t he knowl edge of t he pr i soner s.
- Conduct Wor l d AIDS Day campai gns.
2. Pr ovi de condom ser vi ces wi t h condom suppl y suppor t f r om t he
Depar t ment of Di sease Cont r ol . Di st r i but e condoms t o t he pr i soner s
by cl i ni cal st af f and DoC of f i ci al s, peer vol unt eer s, and by vendi ng
machi nes ( onl y i n Bang Khwang Pr i son) .
116
3. Pr ovi de HIV VCT f or pr i soner s wi t h r i sk behavi or so t hat t hey can
l ear n t hei r ser ost at us on a vol unt ar y basi s t o hel p i n car e and
t r eat ment and pr event i on of OIs.
Care and t reat ment
1. PLHA pr i soner s who ar e heal t hy and have no cl i ni cal sympt oms ar e
al l owed t o par t i ci pat e wi t h t he ot her pr i soner s as a r egul ar i nmat e
t her e i s no segr egat i on. If t hey weaken and devel op sympt oms, t hey
ar e conf i ned t o t he i nf i r mar y or sent t o t he hospi t al t o pr event
spr ead of OIs and r ecei ve t r eat ment as i s t hei r r i ght .
2. PLHA pr i soner s who need ART can r ecei ve t hi s t hr ough t he NHSP, j ust
t he same as non- i nmat es.
3. Capaci t y bui l di ng f or medi cal and publ i c heal t h st af f f or on- goi ng
car e f or PLHA.
4. Coor di nat i on wi t h r el evant agenci es so t hat pr i soner s can have
opt i mal access t o ser vi ces.
5. Int egr at e TB cont r ol wi t h HIV pr event i on t hr ough sput um exams t o
di agnose TB among al l HIV+ i nmat es, and t est f or HIV among TB
pat i ent s on a vol unt ar y basi s.
3) Proj ect of i nt egrat ed prevent i on of HIV f or most -at -ri sk popul at i ons
t hrough out reach and i nt egrat ed servi ce net worki ng
The mal e and f emal e pr i soner s ar e a t ar get popul at i on under t he NAP who
ar e most - at - r i sk f or HIV. Thus, t he GFATM i s suppor t i ng act i ve out r each t o
t hi s popul at i on and t he cr eat i on of i nt egr at ed ser vi ce net wor ks usi ng Round
8 f undi ng f or a per i od of f i ve year s f r om Jul y 2009 t o June 2014. The DoC i s
t he Pr i nci pal Reci pi ent f or t hi s f undi ng. The ar ea of i mpl ement at i on
i ncl udes 32 pr i sons and det ent i on f aci l i t i es i n 19 pr ovi nces i ncl udi ng
Bangkok.
D. Probl ems and chal l enges
1) Lack of medi cal and nur si ng st af f gi ven t he l ar ge number of pr i soner s.
Thi s r educes t he abi l i t y t o access ser vi ces whet her t hi s i s HIV VCT or ART, or
whet her t hey ar e el i gi bl e f or benef i t s f or t hese ser vi ces under t he NHSP.
2) Some st af f st i l l has negat i ve at t i t udes t owar d same- sex sex, and f eel s
t hat condom di st r i but i on i s a f or m of encour agement f or mor e sex behavi or .
Thi s l i mi t s t he abi l i t y of t he pr ogr am t o di st r i but e condoms t o al l i n need.
3) Ther e i s st i l l no syst em of met hadone mai nt enance t her apy f or pr i soner s.
E. Pl an f or addressi ng t he probl ems and chal l enges
Impl ement at i on of pr ogr ams f or pr i soner s accor di ng t o t he GFATM Round 8
pr ogr am i n col l abor at i on wi t h t he Pr ovi nci al Coor di nat i ng Mechani sm, and i t
i s expect ed t hat t hi s suppor t and col l abor at i on wi l l ensur e t hat al l r el evant
par t i es di scuss and coor di nat e act i vi t i es f or maxi mum benef i t .
117
3. 4 Treat ment , Care and Support f or PLHA and Af f ect ed
Fami l i es
Thai l and car e and t r eat ment pr ogr am, i ncl udi ng pr event i on and t r eat ment
f or oppor t uni st i c i nf ect i ons and ant i r et r ovi r al t r eat ment ( ART) , has been
ef f ect i vel y st r engt hened. Cur r ent l y, i t was i ncl uded i n al l gover nment al
heal t hcar e schemes. An at t empt t o i ncr ease ear l y access t o t r eat ment
ser vi ces has l ed t o i ncr ease cover age of t r eat ment and car e f or PLHA. By
2009, t her e wer e 200, 000 ( cover age 75%) wer e cur r ent l y r ecei vi ng ART.
Chal l engi ng f or pr ogr am ef f ect i veness i ncl uded a compr ehensi ve appr oach
t o i mpr ove qual i t y of l i f e of PLHA af t er ART and i nt egr at ed TB and HIV
t r eat ment and car e.
3. 4. 1 HIV Vol unt ary Counsel i ng and Test i ng
The HIV VCT ser vi ce i s an i mpor t ant st ep f or t he i nf ect ed t o know t hei r
ser ost at us and access t he t r eat ment syst em at t he opt i mal t i me. Knowi ng
one s ser ost at us i s an i mpor t ant way t o ensur e ef f i ci ent and cost - ef f ect i ve
car e, and t o l ear n how t o assess one s r i sk, gai n knowl edge about HIV and
AIDS and t o l ear n how t o best pr event HIV t r ansmi ssi on.
The pr ovi si on of coupl e counsel i ng, especi al l y f or pr egnant women and t hei r
par t ner s, can hel p r educe t he bur den of ANC f or HIV+ women. It i s of t en a
di f f i cul t chal l enge f or t he pr egnant woman who has j ust l ear ned of her HIV
i nf ect i on t o t hen have t o i nf or m her par t ner her sel f , and encour age t he
par t ner t o be t est ed hi msel f so t hat he can access t r eat ment and ser vi ces as
appr opr i at e.
Post - t est counsel i ng can hel p t he PLHA t o l ook af t er t hemsel ves up unt i l and
t hr ough t he t i me t hey st ar t ART. Thi s ser vi ce al so hel ps t hem t o di scl ose
t hei r ser ost at us t o t he f ami l y or communi t y, i f t hat i s one of t hei r concer ns
and pr obl ems. Counsel i ng i s especi al l y i mpor t ant , whet her usi ng i ndi vi dual ,
peer , or gr oup f or mat s, t o hel p t he i nf ect ed per son under st and and be abl e
t o deci de about havi ng saf e sex.
In t he case of ver t i cal t r ansmi ssi on f r om t he mot her , i nf or mi ng t he chi l d
needs t o be t ai l or ed t o t he i ndi vi dual s, as t hi s wi l l f aci l i t at e ART deci si ons
and hel p pr epar e t he chi l d as he/ she mat ur es and adopt s a sexual l i f est yl e
t hat i s appr opr i at e t o hi s/ her si t uat i on.
Access t o HIV VCT
The UC pr ogr am has i ncl uded semi - annual HIV check- ups as a benef i t f or
per sons at r i sk of acqui r i ng HIV i nf ect i on. However , i n 2008, onl y 170, 000
per sons t ook advant age of t hi s benef i t of t he est i mat ed 500, 000 el i gi bl e.
Most of t hose r ecei vi ng ser vi ce al r eady had l ow CD4 cel l count s and shoul d
118
have st ar t ed on ART sooner . In a st udy of 798 PLHA, i t was f ound t hat 53%
l ear ned/ suspect ed t hey wer e i nf ect ed because of epi sodes of OIs, wher eas
onl y 6% l ear ned t her e ser ost at us because t hey had assessed t hemsel ves t o
be at r i sk and went f or t est i ng.
34
The nat i onal sur vey of sex behavi or i n
2006 conduct ed by t he Inst i t ut e f or Popul at i on and Soci al Resear ch of
Mahi dol Uni ver si t y f ound t hat 19. 1% of t he popul at i on age 18- 49 year s had
had an HIV t est i n t he pr evi ous year .
The pr opor t i on bei ng t est ed and r ecei vi ng t est r esul t s i n t he past 12 mont hs
decl i ned among t hose wi t h hi gh r i sk. The r at e of HIV t est i ng wi t h known
r esul t s among FSW and MSW decl i ned f r om 43. 1%and 54. 2%i n 2007 t o 36. 3%
and 35. 2%i n 2009 r espect i vel y. The st udy of BoE and among MSM i n 3 t our i st
pr ovi nces i ndi cat ed t hat t he r at e of HIV t est i ng and knowi ng r esul t s
decr ease f r om 34. 9%i n 2007 t o 21. 3%i n 2009, whi l e t he pr opor t i on f or IDU
was hi gher at 62. 5%
The accel er at ed MOPH st r at egy f or TB cont r ol dur i ng 2008- 9 l ed t o mor e TB
case- f i ndi ng act i vi t y i n cl i ni cal set t i ngs, i ncl udi ng scr eeni ng f or HIV among
newl y- di agnosed TB pat i ent s usi ng t he pr i nci pl es of pr ovi der - i ni t i at ed
counsel i ng and t est i ng. Thi s st r at egy i ncr eased HIV scr eeni ng of new TB
cases f r om 68. 2%i n 2007 t o 87. 6%i n 2009
35
and l ed t o t he di agnosi s of 8, 414
and 5, 815 HIV cases, or 21. 3%and 17. 2% of al l TB cases scr eened f or HIV i n
2007 and 2009 r espect i vel y.
The subgr oup of t he popul at i on r ecei vi ng hi ghest cover age of HIV VCT ar e
t he ANC cl i ent s i n publ i c heal t h ser vi ce out l et s because of t he nat i onal
pol i cy of PMTCT whi ch has mandat ed t hat al l pr egnant women r ecei ve t hi s
ser vi ce. Fr om MOPH r epor t s i n 2009, 99% of ANC cl i ent s wer e scr eened f or
HIV. Even t hough t he l evel of cover age i s hi gh, t he qual i t y of ser vi ce needs
i mpr ovement . Dat a f r om a PMTCT eval uat i on st udy of women who del i ver ed
bet ween Oct ober 2006 t o December 2007 i n 27 hospi t al s of 12 pr ovi nces i n
each r egi on of t he count y show t hat 66% of t he sampl e di d not know t hei r
ser ost at us bef or e t he l at est pr egnancy, and 81% of t hese women r ecei ved
pr e- t est counsel i ng and 93%r ecei ved post - t est counsel i ng.
36
A pi l ot pr oj ect
t o moni t or qual i t y of VCT i n ni ne Bangkok hospi t al s sampl ed 1, 344 per sons
who wer e t est ed f or HIV and f ound t hat 86% r ecei ved pr e- t est counsel i ng
and 81%r ecei ved post - t est counsel i ng ( HIVQUAL VCT, 2008) .
34
Dr . Sakchai Chayamahaeuk, Posi t i ve pr event i on f or HIV/ AIDS: Pol i cy and pr act i ces, of f i ce
of pr event i on and cont r ol 9, Phi sanul ok, 2009
35
Dat a f or 2009 i ncl ude onl y t he f i r st ni ne mont hs of t he year
36
Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h, Bur eau of Epi demi ol ogy, and t he TUC
119
Indicator 2007 2009
1. % of risk population who received an HIV test and
results in the past 12 months by group:
Female sex workers (N: 07 = 4,168, 09 = 2,140)
Male sex workers (N: 07 = 906, 09 = 1,500)
MSM (N: 07= 906 , 09 = 1,500)
IDU (N 09 = 741)


43.1
54.2
34.9
NA


36.o
35.2
21.3
59.7
2. HIV screening of hospital clients
2.1 TB patients
% of new TB cases screened for HIV
(N: 07=58,044, 09=38,556)
% of new TB cases with HIV infection
2.2 ANC clients
(N: 07= 797,356, 09=791,775)
% of new pregnant women with HIV infection


68.2

21.3
99.8

NA


87.6*

17.2*
99.3

0.7
3. % of general population receiving HIV testing and
results within the previous 12 months**
age 18-49 year total (N=5,208)
age 18-49 year male (N=2,542)
age 18-49 year female (N=2,666)
age 18-19 year (N=347)
age 20-24 year N=873)
age 25-49 year (N=3,988)


19.1
16.3
21.8
16.4
22.0
18.7



Remarks
* Data for first nine months of the year
** National survey of sex behavior: 2006

Pl an f or t he devel opment and promot i on of access t o HIV VCT
37
The wor ki ng gr oup compr i sed of r epr esent at i ves f r om t he Depar t ment of
Di sease Cont r ol , DoH, Ment al Heal t h Depar t ment , ACCESS, AIDSNet
37
Pl an f or devel opi ng t he syst em and qual i t y of counsel i ng ser vi ces i n t he car e and
t r eat ment of PLHA: Pr oposed t o t he meet i ng of t he subcommi t t ee on devel opment of
ser vi ces f or PLHA on Mar ch 2, 2009.

120
Foundat i on, NHS, and t he TUC have devel oped a syst em f or qual i t y
i mpr ovement f or HIV VCT t hat addr esses counsel i ng and t est i ng pr ocedur es
among t hose not yet needi ng ART t o t hose r eady f or / or on t r eat ment t o
ensur e under st andi ng and compl i ance wi t h t he r egi men and t o l ead a qual i t y
l i f e, a heal t hy sex l i f e, and hol i st i c heal t h car e i n accor dance wi t h t he
f ol l owi ng pr i nci pl es:
1. Devel opment and pr omot i on of access t o HIV VCT i n t he gener al
popul at i on by campai gns and publ i c i nf or mat i on di ssemi nat i on t o enabl e t he
popul at i on t o assess t hei r r i sk f or HIV and under st and t he benef i t of knowi ng
one s ser ost at us f r om t he ear l i est st age of i nf ect i on. They wi l l al so l ear n of
t hei r el i gi bi l i t y f or benef i t s package, and var i ous channel s t o access VCT.
Thei r conf i dence wi l l be bui l t i n t er ms of t he conf i dent i al i t y of t he VCT
i nf or mat i on and t he qual i t y of t he ser vi ce. Ther e wi l l be a phone hot l i ne
ser vi ce f or t hose i nf or med t hr ough publ i c medi a channel s t o access
pr el i mi nar y dat a i n or der t o deci de whet her t o use t he ser vi ce. Thi s i s
especi al l y i mpor t ant f or t hose who do not yet have t he cour age t o see
someone f ace- t o- f ace t o di scuss r i sk and HIV t est i ng.
2. Devel op and suppor t access t o HV VCT f or t hose at hi gh r i sk
t hr ough publ i c- pr i vat e col l abor at i on net wor ks. Del i ver out r each ser vi ces t o
access t he hi gh- r i sk popul at i ons, and use dr op- i n cent er s managed by NGOs;
of f er HIV VCT ser vi ces, STI exams, and subst i t ut i on t her apy f or her oi n
addi ct s. These ser vi ces ar e t o be user - f r i endl y i n bot h sect or s t o f aci l i t at e
seaml ess r ef er r al bet ween t he NGO out r each and gover nment ser vi ce
out l et s i n cases r equi r i ng mor e sophi st i cat ed car e and t r eat ment .
3. Devel op t he counsel i ng syst em and devel op capaci t y of st af f t o
del i ver qual i t y counsel i ng, and devel op t he moni t or i ng and eval uat i on
syst em.
4. Suppor t t he r ol e of gr oups/ net wor ks of PLHA f or l i f e af t er
i ni t i at i ng ART by bui l di ng t he capaci t y of PLHA t o pr ovi de peer counsel i ng
f or ot her PLHA t o hel p t hem adher e t o t he t r eat ment r egi men, conduct
appr opr i at e heal t h behavi or , and have saf e sex i f sexual l y act i ve.
3. 4. 2 Ant i ret rovi ral Therapy and OI Management
Al t hough Thai l and has been successf ul i n nat i onwi de scal i ng up and
i ncr easi ng ART cover age, r esul t s f r om t he pr oj ect i on and est i mat i on
r eveal ed t hat t her e wer e 25%of PLHA coul d not access t o ART.
38

The number of cumul at i ve HIV i nf ect i on and number of al i ve PLHA i n
Thai l and by 2009 f r om t he Asi an Epi demi ol ogi cal Model ( AEM) pr oj ect i on
1
38
The Thai Wor ki ng Gr oup on HIV/ AIDS Pr oj ect i on ( 2005) . The Asi an Epi demi c Model ,
Pr oj ect i ons of HIV/ AIDS i n Thai l and 2005 2025. 2008. FHI.
121
was 1, 127, 168 and 516, 632, r espect i vel y. Of t hose, est i mat ed number of
PLHA who met t he i ndi cat i on cr i t er i a f or ART i n 2008 and 2009 wer e 266, 369
and 275, 621 For chi l dr en, t he number of HIV i nf ect ed chi l dr en ( age < 15
year ol d) as 14, 000 i n 2008 was est i mat ed f r om HIV pr eval ence among
pr egnant women and HIV per i nat al t r ansmi ssi on r at e. Usi ng SPECTRUM
Model , number of HIV i nf ect ed chi l dr en needed ART i n 2008 and 2009,
est i mat ed by wer e 9, 284 and 9, 450.

A. Nat i onal Pol i cy on Ant i ret rovi ral Treat ment
The Nat i onal Pol i cy f or HIV/ AIDS Pr event i on and Al l evi at i on, 2007-
2011 pr oposed t he i mpl ement at i on of ART ser vi ces as one pr i or i t y l i st s. The
nat i onal pr ogr am goal st at ed t he cont i nuum access t o ART and
compr ehensi ve car e, i ncl udi ng cl i ni cal t r eat ment , psychol ogi cal and
soci oeconomi c suppor t . The mai n st r at egi es ar e i mpl ement at i on and scal i ng
up of car e and t r eat ment ser vi ces nat i onwi de t o i ncr ease cover age and
equal l y access by al l , st r engt heni ng qual i t y of ser vi ces and st andar d of car e
by pr epar at i on of ser vi ce i nf r ast r uct ur e, human r esour ce devel opment at al l
l evel s and i ncr ease i nvol vement of ci vi l soci et y and communi t y ser vi ces, and
i nt egr at ed HIV/ TB car e and t r eat ment ser vi ces.
B. Nat i onal Gui del i ne f or Ant i ret rovi ral Treat ment
For t hi s r epor t i ng per i od, t he nat i onal pr ogr am has f ol l owed t he st andar d
nat i onal gui del i ne, 2006- 2007 whi ch i ndi cat ed t he cr i t er i a f or ART i ni t i at i on
by cl i ni cal def i ni t i on ( AIDS sympt oms and si gns) and i mmunol ogi cal cr i t er i a
by CD4 l evel l ess t han 200 cel l / mm
3
. The r evi sed gui del i ne ( 2010- 2011) was
wr i t t en by usi ng WHO r ef er ence. It i s bei ng r evi ewed by t echni cal exper t s
bef or e publ i cat i on i n Oct ober 2010.
C. Government al Rol es
Bur eau of AIDS, Depar t ment of Di sease Cont r ol has maj or r ol es on pr ovi di ng
t echni cal suppor t f or i nnovat i ve model , r esear ch and human r esour ce
devel opment . The new model s have been i mpl ement i ng dur i ng t he
r epor t i ng per i od i ncl uded moni t or i ng and sur vei l l ance of HIV dr ug r esi st ance,
qual i t y i mpr ovement f or car e and t r eat ment i n chi l dr en usi ng HIVQAUL- T
and pr event i on wi t h posi t i ve i n cl i ni c set t i ng. In addi t i on, number of
gui del i nes have been devel oped such as st r engt heni ng of vol unt ar y
counsel i ng and t est i ng and car e and suppor t of chi l dr en af f ect ed by
HIV/ AIDS. Devel opment of ARV dr ug adher ence moni t or i ng, expanded
pedi at r i c car e and t r eat ment by i nvol vement of ci vi l soci et y have cont i nued.
Col l abor at i ve net wor k i ncl udes t he GFATM, TUC, ci vi l soci et i es and l ocal
or gani zat i ons.
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The NHSO, Soci al Secur i t y Of f i ce ( SSO) and t he Ci vi l Ser vant s Wel f ar e has
suppor t ed f or t he expenses on ART, l abor at or y t est s and pr event i on and
t r eat ment f or oppor t uni st i c i nf ect i ons f or Thai nat i onal s who have t he
nat i onal i dent i f i cat i on number s. NHSO has r evi sed t hei r r egul at i on t o cover
t he expense of second l i ne r egi mens i f cl i ni cal i ndi cat ed. In addi t i on, NHSO
has suppor t ed t he devel opment and i mpl ement at i on of nat i onal moni t or i ng
and eval uat i on syst em f or ART pr ogr am and t he st r engt heni ng of PLHA
net wor ki ng. The HIV/ AIDS t r eat ment f or mi gr ant s and t hose who ar e not
el i gi bl e f or uni ver sal cover age scheme, have been suppor t ed by t he GFATM.
D. Ci vi l Soci et y Rol es
Dur i ng t he past 5 year s, t he Thai Net wor k of PLHA ( TNP+) t oget her wi t h
AIDS Access Foundat i on and Mdeci ns Sans Fr ont i r es ( Bel gi um) have
suppor t ed t he i ncr easi ng of PHLA par t i ci pat i on i n car e and t r eat ment
pr ogr am devel opment and ser vi ces t hr ough Compr ehensi ve Cont i nuum of
Car e Cent er s . The j oi nt col l abor at i on bet ween PLHA and hospi t al st af f as
co- ser vi ce pr ovi der i s obvi ousl y seen i n many hospi t al s. Peer l eader s and
vol unt eer s have maj or r ol es i n pr ovi di ng f ul l i nf or mat i on and under st andi ng
of t he ART, counsel i ng, gr oup act i vi t i es, and home vi si t s t o ensur e t he
ef f i cacy i n ART and abi l i t y of sel f - car e f or t r eat ed per sons. The peer
l eader shi ps and vol unt eer s need t r ai ni ng and human r esour ce devel opment s.
Pr esent l y, t her e ar e 367 compr ehensi ve cont i nuums of car e cent er s wor ki ng
wi t h t he hospi t al s wi t h 42, 763 cl i ent s ( Updat ed by Januar y 2010) .
The maj or evol ut i on dur i ng t he past 2 year s i ncl uded:
1. Ther e ar e cl ear benef i t s on st andar d of car e and t r eat ment under t he
nat i onal heal t h car e cover age. It l ed t o i ncr ease access of PLHAs t o
ART and OI t r eat ment , subsequent l y wi t h r educt i on of mor bi di t y and
mor t al i t y.
2. The nat i onal pol i cy has suppor t ed i n pr oduct i on and i mpor t i ng
cheaper ant i r et r ovi r al dr ugs such as i mpor t i ng Ef avi r enz,
Lopi navi r / Ret r onavi r , et c. t hr ough compul sor y l i censi ng, pr oduct i on
of GPO- vi r - s and GPO- vi r - z by t he Gover nment Phar maceut i cal
Or gani zat i on, Thai l and. It has l ed t o t he r educt i on of t r eat ment cost
f r om 20, 000 THB ( USD 600) t o 870- 1000 THB ( USD 26- 30) per mont h
3. Incr easi ng of PLHA human r esour ces and per sonal capaci t y on car e
and t r eat ment ser vi ces. The pr ogr am has devel oped wi t h cl ear
pr ogr am goal s, st r at egi es and act i on pl ans t o i ncr ease access t o
qual i t y of car e and t r eat ment . The par t i ci pat i on of PLHA i n pr ogr am
devel opment and ser vi ces ar e subst ant i al bot h at pol i cy and ser vi ce
l evel s. Pr esent l y, t her e ar e 1, 726 l eader s ar e wor ki ng f or t he
net wor ks ( updat ed by Januar y 2010) .
123
4. The NHSO has a cl ear pol i cy on pr ovi di ng budget ar y suppor t f or PLHA
net wor ks. Cur r ent l y, t her e ar e 182 cent er s r ecei vi ng NHSO suppor t
( Januar y 2010) . In 2011, t he NHSO wi l l pr ovi de budget ar y suppor t f or
400 cent er s and 7 r egi onal of f i ces.
E. Coverage and Access t o Care and Treat ment
In Thai l and, t her e ar e 1, 014 ART f aci l i t i es nat i onwi de. As of Sept ember 2008
and 2009, t her e wer e 185, 086 and 216, 118 PLHA r ecei vi ng ART and t he
over al l cover age wer e 67. 14% and 75. 76%, r espect i vel y. Gener al l y, t her e
wer e about 58% ar e suppor t ed by t he Nat i onal Heat h Secur i t y Of f i ce under
t he Uni ver sal Cover age pol i cy.
Al t hough t her e ar e mor e t han 200, 000 per sons r ecei vi ng ART, most of t hem
accessed t o t he t r eat ment at l at e st age wi t h AIDS sympt oms or l ow CD4
l evel . Resul t s f r om t he NHSO moni t or i ng syst em, 52. 6% and 51. 9% of PLHA
who st ar t ed ART i n FY 2008 and 2009 had AIDS sympt oms and/ or CD4 l evel s
was l ess t han 100 cel l s/ mm.
39
Thi s r esul t i ndi cat ed t he possi bi l i t y of l ess
access t o ear l y HIV di agnosi s and r esul t not i f i cat i on among PLHA. Ot her
possi bl e f act or s i ncl uded havi ng no knowl edge on access t o t r eat ment
ser vi ces, not bei ng r ef er r ed by heal t h car e pr ovi der s, no suppor t ed heal t h
car e i nsur ance, mi gr at i on or soci oeconomi c pr obl ems. By now, t her e i s no
i nt ensi ve expl or i ng on t hi s pr obl em and i t s r el at ed f act or s.
F. Treat ment Out comes
The st at i st i cal anal ysi s f r om t he NHSO moni t or i ng syst em r eveal ed 1 and 2
year sur vi val r at e among PLHA t r eat ed wi t h ART wer e 90. 6% and 86. 7%,
r espect i vel y. It was consi st ent wi t h t he r epor t among adul t and chi l dr en
who st ar t ed ART dur i ng Oct ober 1, 2007 Sept ember 30, 2008 t hat 90. 0%
and 84. 9% of t hem ar e al i ve and r ecei vi ng ART at 12 mont h af t er ART
i ni t i at i on. Deat h r at e and l ost t o f ol l ow up r at e wer e obser ved hi gher among
adul t s t han chi l dr en whi ch wer e 7. 8 and 4. 6 among adul t s and 7. 2 and 5. 4
among chi l dr en r espect i vel y.
40
HIV dr ug r esi st ance ( HIVDR) i s a maj or pr obl em whi ch has cr i t i cal i mpact t o
t he ef f ect i veness of ART. In Thai l and, cur r ent sur vei l l ance syst em r eveal ed
t hat t he i nci dence of HIVDR at 1 and 2 year s af t er ART i ni t i at i on wer e 2. 6%
and 4. 4% r espect i vel y.
41
The maj or r esi st ance was obser ved i n Non-
39
Nat i onal AIDS Pr ogr am Moni t or i ng ( Dat a of 38, 880 per sons who st ar t ed ART dur i ng Oct 1,
2007-June 30, 2009) , Nat i onal Heal t h Secur i t y Of f i ce.
40
Ibi d 2
41
HIV Dr ug Resi st ance Sur vei l l ance among ART Pat i ent s, Bur eau of AIDS and Thai l and MOPH-
U. S. CDC Col l abor at i on
124
nucl eosi de r ever se t r anscr i pt ase i nhi bi t or s ( NNRTIs) i ncl udi ng nevi r api ne and
ef avi r enz. HIVDR l eads t o swi t chi ng of t he ART r egi men f r om t he f i r st l i ne t o
second l i ne t o ensur e t he ef f ect i veness of st oppi ng vi r al r epl i cat i on. Resul t s
f r om t he moni t or i ng syst em on Ear l y War ni ng Indi cat or s f or HIVDR among
per sons r ecei vi ng ART under UC f ound t hat 1. 8%had t o swi t ch t he f i r st l i ne
r egi men t o t he second l i ne r egi men at 1 year af t er ART.
42
G. Opport uni st i c i nf ect i on management
As wi t h t he ART, pr event i on and t r eat ment of OI i s al so par t of t he benef i t
package under t he uni ver sal heal t h i nsur ance, soci al secur i t y and ci vi l
ser vant medi cal benef i t schemes. Tuber cul osi s, Pnumocyst i c car i nei
pneumoni a and Cr ypt ocoocosi s ar e t he common oppor t uni st i c i nf ect i ons i n
Thai l and.
The eval uat i on of qual i t y t r eat ment i n al l 106 af f i l i at ed hospi t al s, t he
number of PLHA cl i ent s as r andoml y est i mat ed was 11, 699 per sons. Of t hese
87% of adul t PLHA i n t he t r eat ment r egi st r at i on syst em r ecei ved
cot r i moxazol e ( CTX) f or pr event i ng PCP, whi l e 82% of i nf ect ed chi l dr en
r ecei ved CTX f or PCP pr ophyl axi s. Cover age of t he pr event i on of
Cr ypt ocoocosi s was 80% Cover age of TB scr eeni ng has i ncr eased f r om 78% i n
2006 t o 96% i n 2009 and 95% of per sons wi t h HIV/ TB i nf ect i ons r ecei ved TB
t r eat ment .
H. Best Pract i ce
1. ART moni t ori ng by usi ng dat a f rom Nat i onal AIDS Program
Thai l and Mi ni st r y of Publ i c Heat h has st ar t ed t he ART pr ogr am si nce 1994 as
a r esear ch pr oj ect s. In 2005, i t became a nat i onal pr ogr am ent i t l ed as
Nat i onal Access t o ARV f or Peopl e wi t h HIV/AIDS (NAPHA) . The ART
moni t or i ng syst em was devel oped f or moni t or i ng of pr ogr am out put s and
out comes. In 2008, wi t h t he Uni ver sal Cover age Pol i cy, ART was i ncl uded as
one of t he heal t h car e benef i t s under t he r esponsi bi l i t i es of t he NHSO.
In or der t o obt ai n key i nf or mat i on f or pol i cy maker s and ser vi ce pr ovi der s,
t he NHSO devel oped a moni t or i ng syst em by der i vi ng and usi ng l essons
l ear ned f r om NAPHA pr ogr am t o moni t or ser vi ce del i ver i es and pr ogr am
out comes. The sof t war e pr ogr am was gener al l y known as Nat i onal AID
Pr ogr am or NAP.
42
HIVDR Ear l y War ni ng Indi cat or s, Bur eau of AIDS, Nat i onal Heal t h Secur i t y Of f i ce and
Thai l and MOPH- U. S. CDC Col l abor at i on
125
NAP has been used as moni t or i ng syst em and i nf or mat i on cent er s acr oss 953
ART f aci l i t i es, r egi onal and cent r al l evel s. Ther e wer e 161, 582 and 186, 124
HIV i nf ect ed per sons r egi st er ed t o NAP at t he end of FY 2008 and 2009
r espect i vel y. NAP coul d be desi gnat ed as havi ng hi ghest number of
i nf or mat i on net wor ks and r egi st er ed cl i ent s, compar i ng wi t h t he moni t or i ng
syst em of ot her di seases.
St r engt hs of NAP i ncl ude 1) Onl i ne syst em wi t h syst emat i c l i nkages bet ween
var i ous modul es, havi ng secur i t y pr ot ect i on f or per sonal i dent i f i er s ( t he
nat i onal i dent i f i cat i on number s whi ch ar e encr ypt ed and ot her per sonal
i nf or mat i on wi l l not be accessed by publ i c and absent i n t he dat abase) ,
accessi bl e t o mor e t han 1, 000 user s at t he same t i me, syst emat i c l i nkage
wi t h Vender Management Invent or y (VMI) f or dr ug st ock management , abi l i t y
t o gener at e r epor t s f or ser vi ce del i ver y moni t or i ng and avai l abl e of
communi cat i ng modul e f or i nf or mat i on shar i ng among user s and pr ogr am
mai nt enance; 2) var i ous modul es f or moni t or i ng of car e and t r eat ment
pr ogr am, i ncl udi ng VCT, HIV t est i ng and ot her l abor at or y ser vi ces,
r egi st r at i on of HIV i nf ect ed cl i ent s, f ol l ow up of t r eat ment ser vi ces, ARV
management and appr oval of t he second l i ne ARV r egi mens, pr event i on of
mot her t o chi l d HIV t r ansmi ssi on and post exposur e pr ophyl axi s modul es.
Benef i t s f rom NAP Dat a
Faci l i t y l evel
1) Use as moni t or i ng r ecor ds f or budget r ei mbur sement f r om t he
NHSO accor di ng t o t he pr ovi ded ser vi ces.
2) Use as i nf or mat i on shar i ng and t r ansf er r i ng, i . e. , qui ckl y
obt ai ni ng l abor at or y r esul t s f or t r eat ment pl an
3) Use f or moni t or i ng of ser vi ce del i ver i es and t r eat ment
out comes
Pr ovi nci al and r egi onal Level
Use f or moni t or i ng of ser vi ce del i ver i es and t r eat ment out comes of
t he pr ovi nce or r egi on, i ncl udi ng moni t or i ng ser vi ce per f or mance of
t he f aci l i t i es wi t hi n t he pr ovi nce or r egi on.
Nat i onal l evel
1) Use f or moni t or i ng of ser vi ce del i ver y at t he f aci l i t y l evel t o
ensur e t he benef i t package was pr ovi ded t o PLHA
2) Use f or moni t or i ng of t he di st r i but i on of compul sor y l i censi ng
ARV
3) Use f or eval uat i on of pr ogr am ef f i ci ency and ef f ect i veness at
nat i onal l evel
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4) Use f or annual budget ar y pl an and pr epar at i on of ARV and
medi cal suppl i es
5) Use f or publ i c heal t h and medi cal r esear ch
Chal l enges and remedi al act i ons
Si nce NAP i s onl i ne wi t h hi gh number of user s, somet i mes t he syst em i s
t r af f i c wi t h sl ow pr ocessi ng. Cur r ent l y, t he NHSO has r evi sed t he syst em t o
i mpr ove t he onl i ne ser vi ces. Anot her chal l enge i s dat a qual i t y whi ch was
unr el i abl e, especi al l y dur i ng t he f i r st year of pr ogr am i mpl ement at i on. The
pr obl em on t r ansf er r i ng of NAPHA dat a, l ess ski l l s and uncl ear under st andi ng
of par amet er s, as wel l as bur den of dat a ent er i ng have l ed t o t he unr el i abl e
of t he dat a. Dur i ng t he past year s, t o st r engt hen t he i mpr ovement of dat a
qual i t y and encour age usi ng of dat a f or ser vi ce moni t or i ng pr ogr am pl anni ng,
t he NHSO has r evi sed t he pr ogr am and pr ovi di ng t r ai ni ng, as wel l as set up
t he i nf or mat i on cent er s f or pr obl em sol vi ng f or t he st af f at ser vi ce
del i ver i es.
Act i on pl an f or 2010-2011
The dat a qual i t y has been r el at ed t o t he knowl edge and at t i t ude of
r esponsi bl e per sons at t he f aci l i t i es i n usi ng of dat a f or moni t or i ng and
pr ogr am pl anni ng. Incr easi ng i n dat a usi ng by t he l ocal f aci l i t i es, mor e
r el i abl e dat a wi t h dat a compl et eness and cor r ect ness wi l l be obser ved. The
NHSO wi l l col l abor at e wi t h r esponsi bl e net wor k at al l l evel s and t echni cal
or gani zat i ons, i ncl udi ng Bur eau of AIDS and TUC t o devel op a sof t war e
pr ogr am cal l ed NAP Dat a Anal ysi s and Repor t i ng t o gener at e a st andar d
r epor t s of key i ndi cat or s, needed f or moni t or i ng of ser vi ce del i ver i es and
pr ogr am out comes, and st r engt hen human r esour ce capaci t y f or usi ng of
t hese i nf or mat i on f or ef f ect i ve pr ogr am pl anni ng and i mpr ovement .
2. Model devel opment on HIV di scl osure f or chi l dren i nf ect ed wi t h HIV
Appr opr i at e appr oaches f or di scl osur e of HIV st at us t o chi l dr en i nf ect ed wi t h
HIV i s t he ver y i mpor t ant st ep t o i ncr ease t he posi t i ve at t i t ude i n HIV st at us,
as wel l as havi ng knowl edge and accept at i on t o cooper at e i n car e and
pr event i ve i nt er vent i ons, especi al l y when chi l dr en ar e i ndi cat ed f or ART,
st ar t i ng puber t y and r epr oduct i ve age gr oup or suspi ci ous of t hei r i l l nesses.
Dur i ng 2006- 2007, Facul t y of Medi ci ne Si r i r aj Hospi t al , Queen Si r i ki t
Nat i onal Inst i t ut e of Heal t h and TUC has pi l ot ed a model f or HIV di scl osur e
among chi l dr en. Eval uat i on had been conduct ed by assessi ng t he at t i t ude
and accept at i on, as wel l as negat i ve i mpact of HIV di scl osur e at 2 and 6
mont hs af t er di scl osur e. Resul t s has been anal yzed f r om 163 chi l dr en
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par t i ci pat ed i n t he pi l ot has f ound no any negat i ve consequence af t er t he
di scl osur e. The model has been scal ed up t o ot her hospi t al s nat i onwi de.
Desi gn of HIV di scl osure f or chi l dren i nf ect ed wi t h HIV
HIV di scl osur e f or chi l dr en i nf ect ed wi t h HIV i s sensi t i ve. Cl ose and r egul ar
communi cat i on i s needed among t he r esponsi bl e heal t h car e pr ovi der t eam
t o consi der t he appr opr i at e st eps and t i me f or di scl osur e whi ch ar e var i ed
by case basi s. Cl i ent and Fami l y Cent er ed i s cr i t i cal l y needed, so
pr epar at i on of chi l dr en and t hei r f ami l y i s consi der ed as t he f i r st st ep. HIV
di scl osur e i s not onl y f or r esul t not i f i cat i on, but al so t he communi cat i on and
counsel i ng t o ensur e t hat chi l dr en cor r ect l y know t hei r st at us, havi ng
posi t i ve at t i t ude wi t h HIV i nf ect i on and accept t o cooper at e f or t he
i nt er vent i on pl an. St eps of t he di scl osur e i ncl uded:
St ep 1: Assessment f or readi ness
To assess t he r eadi ness of chi l dr en and car e t aker s on HIV di scl osur e,
i nt er vi ewi ng and assessi ng of chi l dr en at t i t ude and car e t aker s t o ver i f y
cur r ent per sonal and envi r onment al st at us of chi l dr en and car e t aker s.
Cr i t er i a used f or def i ne chi l dr en wi t h capabi l i t y on HIV st at us per cept i ons
i ncl ude:
1) Age 7 year ol d or mor e who had HIV posi t i ve di agnosi s
2) Car e t aker s ar e abl e t o get r egul ar counsel i ng ser vi ces
3) Car e t aker s have no ser i ous i l l nesses or ar e admi t t ed i n
hospi t al
4) Chi l dr en ar e not i n t he depr essi ve st at us, commi t t ed sui ci de,
havi ng psychol ogi cal i l l nesses of ment al r et ar d
St ep 2: Preparat i on of readi ness
Counsel i ng basi c i s used f or pr epar at i on of t he r eadi ness of chi l dr en and
car e t aker s on HIV di scl osur e. Fear , concer n and t he expect at i on of car e
t aker s and chi l dr en wi l l be assessed and r educed by counsel i ng pr ocess. By
t he meant i me, encour agement of conf i dence and i ncr easi ng ski l l s on
communi cat i on wi l l be gui ded.
2. 1 Pr epar at i on of r eadi ness of car e t aker s
The obj ect i ve i s t o obt ai n i nf or mat i on on t he cur r ent r el at i onshi p among
car e t aker s and chi l dr en, i ncl udi ng t he suppor t s f r om ot her f ami l y member s,
and pr epar e t he r eadi ness of car e t aker s by r evi ewi ng pot ent i al pr obl ems,
bar r i er s and sol ut i ons. If t he chi l d t aker s ar e not r eady f or t he di scl osur e,
cont i nuum assessment i s needed.
2. 2 Pr epar at i on of r eadi ness of chi l dr en
The obj ect i ve of t hi s st ep i s t o bui l d r el at i onshi p bet ween chi l dr en and
counsel or s i n or der t o i ncr ease adapt at i on and pr obl em sol vi ng ski l l s under
t he st r essf ul pr essur e. In addi t i on, counsel or s wi l l get chi l d backgr ound and
envi r onment al i nf or mat i on, such as per sonal behavi or s, t emper , qual i t y of
l i f e, adapt at i on ski l l s, et c.
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St ep 3: HIV posi t i ve resul t not i f i cat i on by usi ng counsel i ng pri nci pl e
The obj ect i ve of t hi s st ep i s t o assess t he chi l d s per cept i on, accept at i on
and at t i t ude on HIV i nf ect i on, as wel l as f ear and concer n i n i l l nesses,
bef or e r esul t not i f i cat i on. If t he chi l dr en ar e r eady, r esul t s can be di scl osed,
f ol l owi ng wi t h counsel i ng on i nf or mat i on of HIV di sease, heal t h r el at ed
st at us, car e and t r eat ment . The psychol ogi cal assessment wi l l be pr ovi ded
al ong wi t h t he di scl osur e and counsel i ng.
St ep 4: Moni t ori ng and eval uat i on
The obj ect i ve of t hi s st ep i s t o assess t he consequence af t er di scl osur e, as
wel l as r evi ewi ng t he chi l dr en under st andi ng and accept at i on on t hei r
heal t h st at us, abi l i t y f or sel f car e, and pr obl ems and sol ut i ons.
Model scal i ng up
In 2007, a t r ai ni ng cur r i cul um on Chi l d HIV Di scl osur e was devel oped.
A year l at er i t was used f or t r ai ni ng t o 578 heal t h car e pr ovi der s f r om 67
pr ovi nci al and communi t y hospi t al s i n 10 pr ovi nces nat i onwi de. Ei ght y
per cent s of t he t r ai nees ar e nur ses who ar e wor ki ng at pedi at r i c HIV cl i ni cs.
Af t er t r ai ni ng, t hey ar e abl e t o use t he knowl edge and ski l l s t o pr ovi de HIV
di scl osur e t o HIV i nf ect ed chi l dr en. In 2009, t he model has expanded t o 48
hospi t al s. Eval uat i on r esul t s f ound t hat 95%of t r ai nees of 13 hospi t al s have
used t he knowl edge and ski l l s t o pr ovi de HIV di scl osur e. At pr esent , t her e
ar e 482 HIV i nf ect ed chi l dr en al r eady known t hei r HIV st at us.
Lessons Learned
1. Desi gn of HIV di scl osur e i s f l exi bl e due t o under l yi ng psychol ogi cal
st at us and envi r onment f act or s of chi l dr en and car e t aker s and t hei r
f ami l i es.
2. Desi gn and gui del i ne of HIV di scl osur e f or HIV i nf ect ed chi l dr en can
be used by hospi t al heal t hcar e pr ovi der s
3. Cur r i cul um on Chi l d HIV Di scl osur e can be used f or i ncr ease human
r esour ce capaci t y and scal i ng up of t he HIV di scl osur e model
3. 4. 3 TB/ HIV Co-i nf ect i on Treat ment
Tuber cul osi s i s t he most common oppor t uni st i c i nf ect i on f ound among Thai
PLHAs. The wr i t t en pol i cy on HIV/ TB was document ed i n 2004
43
wi t h t he
f ol l owi ng key st r at egi es:
1. Est abl i sh coor di nat i ng mechani sm bet ween TB and HIV pr ogr ams as
wel l as t he sur vei l l ance of HIV i nf ect i on among TB pat i ent s and
pr ovi di ng capaci t y bui l di ng t o t hose who pr ovi de TB and HIV car e t o
43
TB Cluster, Guideline for TB/HIV management, Bangkok, Ak-sorn Graphic, 2009
129
under st and how t o pr ovi de bot h TB and HIV ser vi ces. Mor eover ,
moni t or i ng and eval uat i on syst em wi l l be desi gned f or t hi s co-
i nf ect i on.
2. Pr ovi de HIV VCT, OI pr ophyl axi s and t r eat ment i f CD4 < 200
cel l / cu. mm, and ART i f CD4 < 250 cel l / cu. mm. f or and HIV
i nf or mat i on f or pr event i on t o TB pat i ent s.
3. Pr ovi de TB scr eeni ng t o HIV+ cases by hi st or y t aki ng f or i dent i f i cat i on
of suspect ed cases and havi ng f ur t her di agnosi s by l abor at or y t est i ng
and chest x- r ay. The scr eeni ng shoul d be done r egul ar l y at ever y vi si t
f or HIV ser vi ces. In addi t i on, pr event i on of TB spr eadi ng i n heal t h
car e f aci l i t i es i s i ncl uded. .
Cur r ent l y, t he Isoni azi d Pr event i ve Ther apy ( IPT) has not been a
consensus t o be t he nat i onal pol i cy. However , i t was pr oposed t o i mpl ement
i n t he heal t hcar e f aci l i t i es wher e t he r esour ces ar e avai l abl e and i s l ocat ed
i n ar eas wi t h hi gh HIV epi demi c.
The 2008- 2009 TB/ HIV pr ogr am goal s i ncl uded t he f ol l owi ng i ndi cat or s:
1. Mor e t han 85% of r egi st er ed TB per sons f or al l heal t h car e schemes
wi l l r ecei ve vol unt ar y counsel i ng and t est i ng f or HIV
2. Mor e t han 90% of newl y di agnosed of HIV i nf ect i on wi l l r ecei ve TB
scr eeni ng
3. Mor e t han 60% of TB/ HIV i nf ect i ons wi l l r ecei ved t r eat ment f or HIV
and TB
TB/ HIV Coverage
In t hi s r epor t s, t he est i mat ed cover age of TB/ HIV t r eat ment among TB/ HIV
i nf ect ed per sons was est i mat ed f r om t he est i mat ed TB i nf ect i on r at e among
Thai popul at i on by WHO as 142 per 100, 000 popul at i on and t he HIV i nf ect ed
r at e among TB pat i ent s whi ch was r evi sed f r om 7. 6%whi ch wer e r epor t ed i n
2007 t o 17% i n 2009. So t he number of TB/ HIV was est i mat ed as 16, 077 i n
2009. Resul t s f r om t he cur r ent moni t or i ng syst em on t he t r eat ment ser vi ces,
r eveal ed t hat 4, 151 cases ar e r ecei vi ng TB/ HIV and t he cover age was 25.82.
The success r at es of TB t r eat ment r eveal ed by t he cur r ent moni t or i ng
syst em wer e 67. 7% and 67. 9% i n 2004- 2005 and t he deat h r at es ( by al l
r easons) The over al l deat h r at e among newl y di agnosed TB wi t h posi t i ve
sput um scr eeni ng f ound 8. 6%and 7. 6%r espect i vel y.
TB/ HIV program achi evement s
Accor di ng t o t he nat i onal pol i cy, t he TB/ HIV pr ogr am has been i mpl ement ed.
The 2008- 2009 pr ogr am goal s wer e achi eved as i ndi cat ed by 93% of HIV
130
i nf ect ed pat i ent s r ecei ved TB scr eeni ng and 87. 6% of TB pat i ent s r ecei ved
HIV counsel i ng and t est i ng.
3. 4. 4 Care and support f or HIV/ AIDS-af f ect ed Chi l dren
A. Si t uat i on of AIDS orphans and ot her AIDS-af f ect ed chi l dren
Even t hough t he pr eval ence of HIV among pr egnant women showed a
downwar d t endency f r om 1. 53%i n 2006 t o 0. 64 i n 2009
44
wi t h cor r espondi ng
r educt i ons i n MTCT of HIV, t he cumul at i ve number of chi l dr en af f ect ed by
HIV/ AIDS cont i nues t o r i se.
The Thai pr ogr ess r epor t t o UNGASS f or t he per i od f r om 2006- 7 t o t he
pr esent i ndi cat ed t hat t her e ar e st i l l no new devel opment s i n cr eat i ng a
uni f i ed dat abase of AIDS or phans and chi l dr en af f ect ed by AIDS. Dat a f r om
var i ous sour ces ar e pr esent ed bel ow.
The pr oj ect i ons f r om UNAIDS, USAID, and UNICEF est i mat ed t hat i n 2010
Thai l and woul d have 1, 054, 000 or phans age 0- 14 ( f at her and/ or mot her
dead, al l causes) or 6. 3% of t he t ot al popul at i on under 15. Of t hese,
374, 000 wer e est i mat ed t o be AIDS or phans ( or 35. 5%) or about one- t hi r d of
al l Thai or phans.
45
Usi ng t he mul t i pl e i ndi cat or s cl ust er sur vey t o assess t he
si t uat i on of Thai chi l dr en i n 2006, i t was f ound t hat t her e wer e 854, 215
or phans age 0 t o 17 year s, or about 4. 7% of t he t ot al popul at i on of
18, 174, 805 i n t hat age gr oup.
46

At t he soci et al l evel t her e i s st i l l negat i ve st i gma on AIDS and HIV even
among HIV- negat i ve chi l dr en of a PLHA. The MICS
47
sur vey f ound t hat 65%
of women age 15 t o 49 st i l l r ef use t o buy f ood f r om someone t hey know i s
HIV+, and 37%woul d want t o keep i t a secr et i f someone i n t hei r f ami l y was
HIV+. Chi l dr en of PLHA wi l l al so suf f er t he ef f ect s of t he pr ej udi ce
expr essed by t hese women.
Regar di ng act i vi t i es t o suppor t and car e f or t he wel f ar e and educat i on of
AIDS or phans and af f ect ed chi l dr en, t he MICS
48
sur vey f ound t hat onl y about
one i n f i ve or phans r ecei ved soci al / l egal suppor t , mat er i al s/ suppl i es,
44
BOE, DDC, MOPH, 2009
45
UNAIDS, USAID, UNICEF, Chi l dr en on t he Br i nk 2002: a Joi nt Repor t on Or phan Est i mat e
and Pr ogr am St r at egi es, Jul y 2002, quot ed i n Count r y r epor t : Thai l and. East Asi a and
Paci f i c Regi onal Consul t at i on on Chi l dr en and HIV/ AIDS, Hanoi , Vi et Nam 22- 24 Mar ch 2006
46
UNICEF Thai l and and t he Nat i onal St at i st i cal Of f i ce, Summar y Repor t of MICS, December
2005- November 2006.
47
Ibi d 4
48
Ibi d 4
131
medi ci nes, and/ or educat i onal st i pend. In addi t i on, t he sur vey f ound mor e
chr oni c mal nut r i t i on and gener al l y gr eat er vul ner abi l i t y t han non- or phans:
15- 16% of or phans wer e mal nour i shed compar ed wi t h 12% of non- or phans.
The pr opor t i on i n school i s sl i ght l y di f f er ent bet ween or phans and non-
or phans: 95. 5%ver sus 96. 4%r espect i vel y.
Fr om a r evi ew of many st udi es i n Thai l and over many year s, t her e i s a r ange
of adver se i mpact on chi l dr en af f ect ed by AIDS such as t he f ol l owi ng:
1) Heal t h pr obl ems: Chi l dr en wi t h HIV who di d not r ecei ve t r eat ment at t he
appr opr i at e t i me wi l l exper i ence OIs and deat h. Eval uat i on of t he PMTCT
pr ogr am among 911 chi l dr en bor n dur i ng Oct ober 2006 t o December 2007 i n
27 hospi t al s of 12 pr ovi nces i n each r egi on f ound t hat 56%r ecei ved di agnosi s
of t hei r ser ost at us.
49
In addi t i on, some chi l dr en who wer e di agnosed wi t h
HIV and had begun ART had di f f i cul t y t aki ng t he pi l l s and r ecei vi ng
cont i nuous r e- suppl y of ARVs. Bot h HIV- i nf ect ed and uni nf ect ed suf f er f r om
i nadequat e nut r i t i on and under - devel opment f or t hei r age.
2) Psycho- emot i onal di f f i cul t y: The af f ect ed chi l dr en exper i ence depr essi on
f r om t he l oss of one or bot h par ent s and t he l ack of par ent al car e. Some
ar e f r i ght ened, angr y, sad, or anxi ous af t er l ear ni ng t hat t hei r par ent s or
t hey t hemsel ves ar e HIV+. Some chi l dr en ar e r ai sed i n f ost er homes or
homes of r el at i ves, or ar e sent t o or phanages. Thi s causes st r ess among t he
chi l dr en. Or phans who ar e i nf ect ed ar e af r ai d of i l l ness and wor r y about
t he st r i ct ness of t he ART r egi men. These st r esses and anxi et i es may cauyse
behavi or t hat f ur t her er odes t he si t uat i on of t he chi l d and cr eat es mor e
chal l enges f or t hei r dai l y l i f e and happi ness.
3) Soci al pr obl ems: Myt hs about AIDS gi ve r i se t o st i gma and di scr i mi nat i on
agai nst PLHA and t hei r f ami l i es, i ncl udi ng chi l dr en. Some chi l dr en ar e
t r eat ed badl y and excl uded f r om t he soci al ci r cl e. They ar e depr i ved of
assi st ance, car e and educat i onal suppor t t hat ot her unaf f ect ed chi l dr en
r ecei ve. They have f ewer or no f r i ends and t hi s has a det r i ment al ef f ect on
t hei r ment al heal t h. AIDS or phans ar e mor e l i kel y t o be t he vi ct i m of
bul l yi ng t han ot her chi l dr en.
49
DOH and BOE, DDC, MOPH 2009
132
B. Impl ement at i on of care and assi st ance f or AIDS orphans and af f ect ed
chi l dren
B1. Pol i cy and pl an addressi ng care and assi st ance f or AIDS orphans and
chi l dren af f ect ed by AIDS
Thai l and has no AIDS l aw i n par t i cul ar , but t her e ar e measur es and
r egul at i ons t hat ar e r el evant , such as t he l aw on pr ot ect i ng t he r i ght s of t he
chi l d ( 2003) , t he nat i onal pr ocl amat i on t o pr omot e t he devel opment of
chi l dr en and yout h, and t he dr af t l aw on r epr oduct i ve heal t h r i ght s.
Regar di ng t he pol i cy and st r at egy of Thai l and, as a si gnat or y on t he
convent i on of t he r i ght s of t he chi l d whi ch pr omot es t he sur vi val ,
pr ot ect i on and i nvol vement of chi l dr en t he por t i ons t hat ar e r el evant f or
AIDS- af f ect ed chi l dr en i ncl ude t he f ol l owi ng:
1) The Nat i onal AIDS pl an has set a t ar get of 80%of chi l dr en and f ami l i es
af f ect ed by AIDS can access heal t h, educat i on and soci al ser vi ces equal t o
ot her s by 2011. The pl an al so speci f i es t he r esponsi bl e agenci es t o achi eve
t hi s goal , especi al l y wi t h r espect t o AIDS- af f ect ed chi l dr en. These agenci es
i ncl ude:
- The Mi ni st r y of Soci al Devel opment and Human Secur i t y, t o l ook af t er
pol i cy and t ake r esponsi bi l i t y f or soci al wel f ar e ser vi ces f or PLHA, per sons
af f ect ed by AIDS, AIDS or phans and AIDS- af f ect ed chi l dr en bot h i n
or phanages and i n t he communi t y.
- The MOPH, whi ch i s t o assi st wi t h heal t h pr omot i on, HIV pr event i on
and t r eat ment .
- Mi ni st r y of Educat i on, whi ch i s t o assi st wi t h school i ng, sex educat i on,
HIV/ AIDS awar eness, and r educt i on of st i gma and di scr i mi nat i on i n t he
school s.
- Mi ni st r y of Int er i or , whi ch i s r esponsi bl e f or pol i cy at t he r egi onal ,
pr ovi nci al and l ocal l evel .
- Mi ni st r y of Just i ce, whi ch i s r esponsi bl e f or over seei ng t he pr ocess of
j ust i ce, i ncl udi ng l aws r el at i ng t o abuse.
- Bangkok Met r opol i t an Admi ni st r at i on, by vi r t ue of i t s Di vi si on f or t he
Cont r ol of AIDS, TB and STIs of i t s Heal t h and Medi cal Depar t ment s.
2) Pol i cy and nat i onal st r at egi c pl an f or chi l d devel opment accor di ng t o
A Wor l d Fi t f or Chi l dr en 2007- 2009
The Uni t ed Nat i ons Gener al Assembl y Speci al Sessi on on Chi l dr en, convened
i n May 2002, endor sed t he document A Wor l d Fi t f or Chi l dr en. Thi s
pr ovi des gui del i nes f or i mpl ement i ng pr ogr ams f or chi l dr en dur i ng 2007-
133
2016. Thai l and has adopt ed t hese gui del i nes as appr oved by t he Cabi net ,
and wi l l i mpl ement a pr ogr am under t he l eader shi p of t he Bur eau f or
Suppor t and Pr ot ect i on of Chi l dr en, Yout h, t he Di sadvant aged, and El der l y.
Thi s Bur eau wi l l def i ne measur es and i mpl ement at i on st r at egi es i n
col l abor at i on wi t h r el evant agenci es i n t he publ i c and pr i vat e sect or acr oss
el even component s as f ol l ows:
1) Fami l y and t he chi l d
2) Physi cal and ment al heal t h of t he chi l d
3) Pr event i on and pr ot ect i on of chi l dr en f r om i nj ur y
4) AIDS and chi l dr en
5) Educat i on and t he chi l d
6) Chi l dr en and r ecr eat i on
7) Chi l dr en and cul t ur e and r el i gi on
8) Mass medi a and chi l dr en
9) Par t i ci pat i on of chi l dr en
10) Pr ot ect i on of chi l dr en i n speci al ci r cumst ances
11) Laws, r egul at i ons and measur es r el at ed t o chi l dr en and t hei r
enf or cement
B2. Progress duri ng 2008-9
Fr om dat a on AIDS- af f ect ed chi l dr en, t he f ol l owi ng act i vi t i es can be
r epor t ed.
Government
Mi ni st ry of Soci al Devel opment and Human Securi t y: Del i ver s
wel f ar e and assi st ance t o AIDS or phans and af f ect ed chi l dr en and f ami l i es
i ncl udi ng counsel i ng f or par ent s/ guar di ans, educat i onal schol ar shi ps, and
occupat i onal schol ar shi ps, among ot her s. In addi t i on, t he mi ni st r y suppor t s
HIV- i nf ect ed and af f ect ed chi l dr en at wel f ar e cent er s of whi ch t her e ar e
f our : i n Chi ang Mai , Nont habur i , Udor n Thani , and Songkl a. The mi ni st r y
i dent i f i es f ost er homes f or or phans and gi ves f i nanci al suppor t f or f ost er
f ami l i es, pr ovi des mi l k, f ood suppl ement s, heal t h ser vi ces, and ar r anges
act i vi t i es t o pr omot e under st andi ng and accept ance t hr ough camps f or
f ost er f ami l i es.
Mi ni st ry of Publ i c Heal t h: The Bur eau of AIDS, TB and STIs wi t h t he
Mi ni st r y of Soci al Devel opment and NGOs have devel oped a handbook wi t h
gui del i nes on l i vi ng wi t h chi l dr en af f ect ed by AIDS i n wel f ar e cent er s and
pr i vat e i nst i t ut i ons ( 2008) .
Mi ni st ry of Educat i on: Suppor t s f r ee educat i on or pr ovi des
educat i onal schol ar shi ps f or or phans and chi l dr en af f ect ed by AIDS,
134
i ncl udi ng a l esson pl an on AIDS, sex educat i on and l i f e school s t o hel p
r educe pr ej udi ce and abuse i n school .
Mi ni st ry of Int eri or: The Pr ovi nci al Admi ni st r at i on Or gani zat i on
suppor t s and/ or par t i ci pat es wi t h agenci es and NGOs i n t he f i el d t o pr ovi de
car e and t r eat ment and assi st ance f or PLHA and t hei r f ami l i es, i ncl udi ng
chi l dr en. They suppor t t he i nt egr at i on of chi l dr en af f ect ed by AIDS i n t he
communi t y t o r educe st i gma, and pr ovi de f i nanci al and mat er i al suppor t ,
and occupat i onal suppor t . The st r engt h and ef f ect i veness of act i vi t i es
depends on t he l ocal si t uat i on, capabi l i t i es and ext ent of t he AIDS epi demi c.
Ci vi l soci et y
The we underst and group Thi s gr oup wor ks wi t h hospi t al s,
school s, NGOs, net wor ks of PLHA, mass medi a, and vol unt eer s wi t h suppor t
f r om UNICEF t o devel op model s t o suppor t ment al heal t h, val ues, and sense
of sel f - wor t h, and bui l d t he capaci t y of chi l dr en wi t h HIV t hr ough t he
cr eat i ve ar t s. Psycho- soci al i nput s ar e i nt egr at ed wi t h heal t h car e t o
pr ovi de a compr ehensi ve devel opment pr ogr am f or chi l dr en wi t h HIV. They
have devel oped a handbook f or devel opi ng vi deo medi a, post er s, and
pamphl et s f or campai gns t o i mpr ove under st andi ng and car e f or chi l dr en
l i vi ng wi t h HIV.
Thai l and AIDS Foundat i on: Wi t h suppor t f r om t he MOPH and t he
GFATM, t he TAF i mpl ement s a pr ogr am of car e f or post - par t um women and
f ami l i es l i vi ng wi t h HIV i n t he communi t y. The act i vi t i es ar e conduct ed i n
col l abor at i on wi t h t he DOH and suppor t qual i t y of l i f e devel opment by
pr ovi di ng compr ehensi ve heal t h car e addr essi ng t he physi cal , emot i onal and
soci al needs of i nf ect ed women, t hei r chi l dr en and f ami l i es i n 41 pr ovi nces.
Thai l and Net work of PLHA: Thi s gr oup suppor t s gr oups of PLHA so
t hat can l ook af t er chi l dr en af f ect ed by AIDS, pr ovi de counsel i ng f or
chi l dr en and f ami l i es, l i nk t hem wi t h ser vi ces, and f ol l ow up i nf ect ed
chi l dr en who ar e t aki ng ART. In addi t i on, t hi s gr oup col l abor at es wi t h
ot her s f or pol i cy advocacy r el at ed t o appr opr i at e ART r egi mens f or chi l dr en,
and t r eat ment cent er s t hat ar e cl oser t o home.
In addi t i on t o t he above gr oups, many NGOs ar e hel pi ng AIDS- af f ect ed
chi l dr en and t hei r f ami l i es by pr ovi di ng soci al suppor t or educat i onal
schol ar shi ps, counsel i ng, act i vi t i es t o enhance qual i t y of l i f e. Some of t hese
NGOs i ncl ude t he Foundat i on f or Human Devel opment Suppor t , t he
Rachapr achasmasai Foundat i on, Wor l d Vi si on Foundat i on, and t he Si am- Car e
Foundat i on.
135
C. Probl ems and chal l enges
Pol i cy management
1. Pol i ci es r el at ed t o chi l dr en ar e i ncl uded i n many of t he pl ans of
mi ni st r i es, yet t hey of t en l ack concr et e i mpl ement at i on pl ans t hat
r esul t i n r eal act i on.
2. Ther e i s a l ack of st r at egi c dat a; t he cur r ent dat a i s i nadequat e f or
pol i cy f or mul at i on and pl anni ng t o r esol ve pr obl ems or i mpr ove
ser vi ces so t hat t hey ar e mor e appr opr i at e f or t he needs of AIDS
or phans and ot her af f ect ed chi l dr en.
3. Ref or m i n t he gover nment sect or has not l ed t o cl ear pl ans f or t he
car e and assi st ance f or AIDS af f ect ed chi l dr en. Ther e i s no cent r al
coor di nat i ng body at t he f i el d l evel .
4. Despi t e t he exi st ence of measur es f or t he pr ot ect i on of chi l dr en i n
or phanages and day car e cent er s, t her e i s i nadequat e i mpl ement at i on
of t hese, and t her e st i l l exi st cases of r i ght s vi ol at i on and
expl oi t at i on of chi l dr en.
Provi di ng servi ces f or t he care, t reat ment and support
1. Devel opment of t he capaci t y of ser vi ce pr ovi der s f or AIDS- af f ect ed
chi l dr en, i n t he gover nment and pr i vat e sect or , so t hat ser vi ces ar e
mor e compr ehensi ve, i ncl usi ve of physi cal , ment al , and soci al
di mensi ons i s st i l l not syst emat i c, and cover age i s not opt i mal .
2. Budget f or suppor t of chi l dr en and f ami l i es af f ect ed by AIDS i s onl y
500 baht per mont h. Thi s i s i nadequat e f or f ami l i es f aci ng economi c
di f f i cul t y. Al so, t o r ecei ve t hat assi st ance one needs t o di scl ose
one s ser ost at us t o t he l ocal admi ni st r at i ve or gani zat i on, and t hi s i s a
bar r i er f or some PLHA.

ART on a cont i nuous basi s, and sex educat i on f or adol escent s growi ng
wi t h HIV
Adol escent s f ace numer ous changes dur i ng t he t r ansi t i on f r om chi l dhood t o
adul t hood. Thi s i s especi al l y t r ue f or adol escent s wi t h HIV. Some have
mor e di f f i cul t y i n adapt i ng t o adol escence t han ot her s, and t hi s has
i mpl i cat i ons f or r ecei vi ng uni nt er r upt ed t r eat ment , and devel opi ng
appr opr i at e sexual behavi or . Soci et y may vi ew adol escent PLHA as
spr eader s of di sease, r esul t i ng i n pr essur e not t o have r omant i c
r el at i onshi ps, or onl y t o be i nvol ved wi t h ot her PLHA.
St i gma and di scri mi nat i on:
St i gma and di scr i mi nat i on of chi l dr en i n t he communi t y i s st i l l a pr obl em i n
some communi t i es. Thi s has mul t i pl e adver se i mpact s on t he chi l d af f ect ed
136
by AIDS. It i s a cont i nui ng chal l enge t o conduct knowl edge and
under st andi ng campai gns i n t hese communi t i es t o al l ow af f ect ed chi l dr en t o
l i ve i n har mony wi t h ot her s.
D. Pl an t o address t he probl em and chal l enges
1. Est abl i sh st r at egi es f or pol i cy management t hr ough t he Mi ni st r y of
Soci al Wel f ar e as t he coor di nat i on f ocal poi nt f or gover nment , pr i vat e, and
i nt er nat i onal or gani zat i ons and exper t s. Ther e needs t o be pol i cy
devel opment at t he cent r al l evel and concr et e i mpl ement at i on of t he pol i cy
at t he cent r al and f i el d l evel s.
2. Est abl i sh a syst em t o i mpl ement capaci t y bui l di ng and at t i t ude
devel opment f or st af f of gover nment and NGOs wor ki ng wi t h chi l dr en
af f ect ed by AIDS i ncl udi ng physi cal and psycho- soci al di mensi ons, and
pr event i on of new i nf ect i ons and pr ot ect i on of t he r i ght s of t he chi l d.
3. Suppor t and est abl i sh a syst em of car e and suppor t f or chi l dr en i n
or phanages and day- car e cent er s of t he pr i vat e and publ i c sect or so t hey
conf or m t o st andar d.
4. Suppor t st r at egi es i n t he communi t y so t hat t hey ar e abl e t o suppor t
and car e f or or phans and AIDS- af f ect ed chi l dr en i n a way t hat i s appr opr i at e
and maxi mi zes cover age.
5. Suppor t t he devel opment of model s t o l ower st i gma i n t he
communi t y, and model s of user - f r i endl y ser vi ces f or HIV- i nf ect ed
adol escent s.
6. Devel op t he moni t or i ng and eval uat i on syst em at al l l evel s i ncl udi ng
devel opment of t he dat abase l i nkages concer ni ng or phans and chi l dr en
af f ect ed by AIDS i n Thai l and.
E. Best pract i ces
1) Int egr at ed psycho- soci al ser vi ces wi t h cl i ni cal car e and t r eat ment by t he
We Under st and gr oup. ( see det ai l s on page 136)

2) Devel opment of t he qual i t y of l i f e of mot hers, spouses, and chi l dren.
Devel opment of st rat egi es f or prevent i on and sol vi ng probl ems at t he
pol i cy l evel and communi t y by t he Thai Nat i onal AIDS Foundat i on.
The TAF i s col l abor at i ng wi t h t he DOH t o i mpl ement t he Enhanci ng HIV-
Rel at ed Car e and Tr eat ment f or HIV Inf ect ed Mot her s and t hei r Par t ner s and
Chi l dr en Communi t y Suppor t Component pr oj ect i n 41 pr ovi nces i n 4
r egi ons. The r esul t s i ncl ude t he cr eat i on of 556 peer l eader s among PLHA
and communi t y vol unt eer s t hr ough 96 sub- pr oj ect s i nvol vi ng 100
gr oups/ or gani zat i ons. Capaci t y was devel oped f or t he car e and assi st ance
f or 9, 934 HIV- i nf ect ed mot her s and 4, 654 chi l dr en t o hel p t hem access
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physi cal and psycho- soci al car e. Thi s act i vi t y i s conduct ed i n col l abor at i on
wi t h 442 l ocal t ambon admi ni st r at i ve or gani zat i ons and t he muni ci pal i t i es.
The f ol l owi ng ar e key l essons l ear ned:
1. Devel opi ng t he capaci t y of PLHA suppor t gr oups r equi r es cont i nuous
at t ent i on. By bui l di ng t hei r capaci t y, soci al accept ance of PLHA i mpr oves
and t hi s r educes st i gma and aver si on t o PLHA. The vi ew of soci et y changes
t owar d a mor e posi t i ve i mage.
2. Assi st i ng chi l dr en af f ect ed by AIDS i n a compr ehensi ve way r equi r es
l i nks among t he hospi t al and communi t y. Ther e needs t o be a soci al saf et y
net f r om t he l evel of t he t ambon, di st r i ct and pr ovi nce i ncl udi ng mul t i -
di sci pl i nar y t eams f r om t he t ambon admi ni st r at i ve or gani zat i ons, l ocal
l eader s, r el i gi ous i nst i t ut i ons, heal t h cent er , heal t h vol unt eer s, school s,
NGOs, and PLHA suppor t gr oups. At t he same t i me, t her e has t o emphasi s
on f ol l ow- up vi si t s and r egul ar meet i ngs wi t h PLHA suppor t gr oups t o
pr ovi de r ef r esher suppor t , t o mai nt ai n mot i vat i on and a sense of spi r i t ,
especi al l y f or chi l dr en of HIV- posi t i ve mot her s, and bui l d l i f e ski l l s i n t hese
chi l dr en.
3. Tr ai ni ng f or t eacher s and car et aker s of chi l dr en i ncl udi ng t he
communi t y heal t h counci l i s essent i al t o hel p t hem under st and AIDS and
modi f y negat i ve at t i t udes and pr ej udi ces agai nst AIDS t o l essen t he adver se
i mpact on AIDS- af f ect ed chi l dr en. In t hi s way, chi l dr en can l i ve mor e
har moni ousl y i n t he communi t y, and a suppor t net wor k i s cr eat ed. A good
exampl e i s t he pr oj ect i n Payao whi ch has act i vi t i es t o r e- ener gi ze and
pr ovi de mor al suppor t f or chi l dr en conduct ed by t he communi t y
st r engt heni ng i nst i t ut i ons. They have cr eat ed a f und f or chi l dr en, an ar t s
camp f or chi l dr en, ar t s f or val ues act i vi t i es whi ch r ef l ect aest het i cs
appr eci at i on and devel opment of t he spi r i t . The l ocal t ambon
admi ni st r at i ve or gani zat i on has a pol i cy t o suppor t AIDS act i vi t i es and
schol ar shi ps f or chi l dr en t o st eer yout h i nt o becomi ng const r uct i ve
adol escent s who can val ue t he r i ght t hi ngs, and have good sel f - est eem, and
can r eal i st i cal l y pl an f or t he f ut ur e j oi nt l y wi t h t he f ami l y.
4. Oppor t uni t i es t o cr eat e sust ai nabi l i t y of car e and suppor t f or AIDS-
af f ect ed chi l dr en occur t hr ough t he i nt egr at i on of AIDS pl anni ng wi t h t he
r out i ne pl an of t he l ocal admi ni st r at i ve or gani zat i ons. A good exampl e of
t hi s i s i n Pa Sak Tambon of Phu Sang Di st r i ct of Payao whi ch cr eat ed t he
Heal t h Net wor k Fund whi ch i s a l ong- t er m pl an si mi l ar t o t he one i n Mae Tha
Di st r i ct of Lampang whi ch does not segr egat e AIDS as separ at e or speci al
i ssue t hey si mpl y t r eat i t as anot her aspect of t he communi t y t o be
consi der ed.
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3. 5 AIDS Vacci ne Devel opment
The year 2009 was one i n whi ch Thai l and announced an i mpor t ant advance
i n t he st udy and devel opment of an HIV vacci ne si nce t hat was t he year i n
whi ch t he r esul t s of a Phase 3 cl i ni cal t r i al wer e r el eased.
Thi s Phase 3 st udy of a candi dat e AIDS vacci ne was t he r esul t of t he ef f or t s
of t he Mi ni st r y of Publ i c Heal t h ( MOPH) t o devel op a vacci ne t hat woul d be
ef f ect i ve agai nst t he l ocal st r ai n of HIV as a measur e t o f ur t her cont r ol t he
spr ead of HIV i n Thai l and. The t r i al was i mpl ement ed accor di ng t o t he
nat i onal AIDS vacci ne devel opment pl an appr oved by t he Nat i onal AIDS
Commi t t ee ( NAC) i n 1993, and whi ch desi gnat ed t he MOPH as t he cor e
i mpl ement at i on agency.
Af t er compl et i on of t he f i r st t wo phases of t he Thai AIDS vacci ne t r i al , t he
MOPH desi gnat ed t he Depar t ment f or Di sease Cont r ol ( DDC) as t he cor e
i mpl ement i ng agency f or Phase 3 i n col l abor at i on wi t h a number of agenci es
and sect or s as f ol l ows:
x The Resear ch Commi t t ee i ncl uded t he Facul t y of Tr opi cal Medi ci ne of
Mahi dol Uni ver si t y, Ar med For ces Resear ch Inst i t ut e f or Medi cal Sci ence,
and t he Pr ovi nci al Chi ef Medi cal Of f i ces of Chol bur i and Rayong.
x The t r i al sponsor i s Wal t er Reed Ar my Inst i t ut e of Resear ch ( WRAIR) ,
of f i ce of Sur geon Gener al , Depar t ment of Def ense, USA
x Fi nanci al Suppor t f or t he r esear ch was pr ovi ded by t he U. S. Nat i onal
Inst i t ut es f or Heal t h and t he U. S. Ar my Medi cal Mat er i el Devel opment
Act i vi t i es, U. S. Ar my Medi cal Resear ch and Mat er i el Command vi a Henr y M.
Jackson Foundat i on.
x Suppor t f or t he candi dat e vacci ne was pr ovi ded by t he sanof i past eur
whi ch devel oped t he ALVAC- HIV ( vCP1521) r ecombi nant canar ypox vect or
vacci ne whi ch was genet i cal l y engi neer ed t o expr ess HIV- 1 gp120 ( subt ype
E: 92TH023) l i nked t o t he t r ansmembr ane anchor i ng por t i on of gp41
( subt ype B: LAI) , and HIV- 1 gag and pr ot ease ( subt ype B: LAI) ; and VaxGen
Company whi ch suppor t ed t he boost vacci ne AIDSVAX B/ E ( cur r ent l y
sponsor ed by GSID - Gl obal Sol ut i ons f or Inf ect i ous Di seases) as a bi val ent HIV
gp120 envel ope gl ycopr ot ei n vacci ne cont ai ni ng a subt ype E envel ope f r om
t he HIV- 1 st r ai n A244 and a subt ype B envel ope f r om t he HIV- 1 st r ai n MN
The pr i nci pal obj ect i ve of t he vacci ne t r i al was t o t est t he pr i me- boost
appr oach usi ng t he candi dat e vacci nes t o measur e t he ef f i cacy agai nst
st r ai ns E ( CRF01_AE) and B of HIV ( t he most pr eval ent st r ai ns i n Thai l and)
among a gr oup of vol unt eer s. In addi t i on, t he t r i al ai med t o assess t he
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ef f ect of t he vacci ne t o r educe HIV vi r al l oad among t hose who became
i nf ect ed af t er r ecei vi ng t he vacci ne.
The r esear ch t eam conduct ed t he t r i al i n Chon Bur i and Rayong Pr ovi nces
among a popul at i on of uni nf ect ed vol unt eer s, mal e and f emal e, aged 18 t o
30 year s. Act i vi t i es wer e conduct ed af t er ensur i ng t he r eadi ness of
pot ent i al vol unt eer and t he associ at ed communi t i es, i ncl udi ng t r ai ni ng and
t est s of r eadi ness of st af f and r el evant i ndi vi dual s t o i mpl ement t he
r esear ch st ar t i ng i n 2001. The f i r st vol unt eer scr eeni ng cent er was opened
on Sept ember 24, 2003 and t he f i r st vol unt eer was r ecr ui t ed on Sept ember
29, 2003. Fr om t hat poi nt , t he mi l est ones of t he t r i al i ncl ude t he f ol l owi ng:
x Admi ni st er ed t he vacci ne t o t he f i r st vol unt eer on Oct ober 20, 2003
x Recr ui t ed 26, 675 vol unt eer s f r om over 60, 000 expr essi ons of i nt er est
x Admi ni st er ed t he vacci ne t o t he 16, 402 per son on December 30, 2005
x 13, 976 vol unt eer s r ecei ved f our ( compl et e set ) vacci ne doses on Jul y 31,
2006
At t he t i me of t hi s r epor t , t he Phase 3 AIDS vacci ne t r i al act i vi t i es wer e
compl et ed and t he r esul t s wer e of f i ci al l y announced on Sept ember 24, 2009.
It was f ound t hat t he st udy vacci nes wer e ef f i caci ous i n r educi ng r i sk of HIV
i nf ect i on by 31. 2% but was not ef f ect i ve i n r educi ng pl asma vi r al l oad.
Al t hough t hi s l evel of ef f i cacy i s not hi gh enough t o al l ow f or gener al use,
t hi s t r i al pr ovi ded cr uci al i nf or mat i on t hat can be used t o i mpr ove t he
devel opment of f ut ur e AIDS vacci nes t o achi eve hi gher l evel s of ef f i cacy.
The r esear ch t eam has est abl i shed f our sci ent i f i c advi sor y commi t t ees
compr i sed of exper t s i n AIDS vacci ne and i mmunol ogy i ncl udi ng commi t t ees
on Cel l ul ar Immuni t y, Humor al and Innat e Immuni t y, Host Genet i cs, and
Ani mal Model s. These commi t t ees ar e t o pr ovi de r ecommendat i ons f or
f ur t her r esear ch act i vi t i es t o expl or e Cor r el at e Pr ot ect i ve Immuni t y, and t o
r ecommend f ut ur e di r ect i ons f or t he devel opment of new gener at i ons of
mor e ef f ect i ve AIDS vacci nes.
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IV. Best Pract i ces
In t he pr epar at i on of t hi s r epor t ( 2010) t he met hod f or sel ect i on of best
pr act i ces i s descr i bed. Pr oj ect st af f s wer e i nvi t ed t o submi t
r ecommendat i ons f or t hei r pr oj ect as a best pr act i ce, t o be sel ect ed by a
commi t t ee of exper t s and t echni cal speci al i st s f r om t he publ i c and ci vi l
soci et y sect or s. A t ot al of seven best pr act i ce pr oj ect s wer e sel ect ed f r om
49 submi ssi ons. The seven nomi nees wer e t hen asked t o submi t a det ai l ed
descr i pt i on of t hei r pr oj ect and t he j ust i f i cat i on f or consi der i ng i t as a best
pr act i ce .
An i mpor t ant cr i t er i on f or sel ect i on i ncl uded t he pr esent at i on of suppor t i ng
dat a i n t he pr oj ect descr i pt i on t o ser ve as an obj ect i ve basi s f or
consi der at i on, and f or st udy and compar i son by ot her pr oj ect s, bot h wi t hi n
and out si de Thai l and.
Anot her key cr i t er i on of sel ect i on concer ned t he degr ee of at t ent i on t o t he
phenomenon of t he f emi ni zat i on of HIV/ AIDS i n Thai l and as r ef l ect ed by t he
i ncr easi ng pr opor t i on of t he t ot al casel oad of HIV- i nf ect ed who ar e women,
and of t he 30% of pr oj ect ed 11, 753 new i nf ect i ons i n 2009 t hat ar e
est i mat ed t o be among wi ves i nf ect ed by t hei r husbands. Ther e ar e f ew
exampl es of pr oj ect s addr essi ng t hi s t r end; ot her t opi c ar eas wer e al so
gi ven pr i or i t y.
Exampl es of best pr act i ce pr oj ect s f or 2010 can be di vi ded i nt o t hr ee ar eas:
( 1) Pr event i on and cont r ol of HIV/ AIDS i n t he cont ext of t he f emi ni zat i on of
HIV/ AIDS i n Thai l and.
x Two pr oj ect s wor ki ng wi t h peopl e l i vi ng wi t h AIDS, t he Tr ue Li ves
Pr oj ect i mpl ement ed by t he nor t her n r egi onal br anch of AIDSNet ; and
t he Voi ces and Choi ces Pr oj ect ( Phase 3) i mpl ement ed by t he Raks
Thai Foundat i on.
x One pr oj ect wor ki ng wi t h HIV- negat i ve pr egnant women wi t h t he
cooper at i on of t hei r par t ner s: The Pr e- nat al Coupl e Car e Pr oj ect
i mpl ement ed by t he Repr oduct i ve Heal t h Di vi si on of t he Depar t ment
of Heal t h and t he Facul t y of Nur si ng of Bur apa Uni ver si t y.
x One pr oj ect wor ki ng on compr ehensi ve sexual i t y educat i on f or
adol escent s: Teenpat h Pr oj ect i mpl ement ed by t he Pr ogr am f or
Appr opr i at e Technol ogy i n Heal t h ( PATH) and par t ner s.
( 2) AIDS r esponse f or mar gi nal i zed peopl e i n Thai l and
x One pr oj ect ent i t l ed Ant i - r et r ovi r al t her apy i n bor der ar eas of t he
Gr eat er Mekong Sub- r egi on: Exper i ence of t he Chi ang Saen Hospi t al
pr i nci pal l y i mpl ement ed by t he Chi ang Saen Di st r i ct Hospi t al and
par t ner s.
x One pr oj ect ent i t l ed Pr event i on of HIV/ AIDS i n mi gr ant l abor er s i n
Thai l and ( PHAMIT) i mpl ement ed by t he Raks Thai Foundat i on and
par t ner s.
( 3) Hol i st i c car e and suppor t f or chi l dr en i n Thai l and, f or whi ch t her e was
one pr oj ect as f ol l ows:
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x The Int egr at ed Psycho- soci al and Medi cal car e Pr oj ect pr i nci pal l y
i mpl ement ed by t he We Under st and gr oup and par t ner s.
Wi t h UNFPA suppor t , t he best pr act i ces sel ect i on commi t t ee pr epar ed a
det ai l ed r epor t of t hese exempl ar y pr oj ect s. The key cont ent of t he r epor t
i s ext r act ed bel ow.
4. 1 Prevent i on and cont rol of HIV/ AIDS i n t he cont ext of t he
f emi ni zat i on of HIV/ AIDS i n Thai l and
4. 1. 1 The True Li ves Proj ect
Thi s pr oj ect i s a col l abor at i ve i mpl ement at i on bet ween per sons l i vi ng wi t h
HIV/ AIDS ( PLHA) f r om t he AIDSNet or gani zat i on and par t ner s. The st r at egy
of t he pr oj ect i s t o i mpr ove t he qual i t y of l i f e of PLHA t o bui l d t hei r
conf i dence and hel p t hem f i nd ways t o have heal t hy and saf e sex l i ves, and
t o avoi d t r ansmi t t i ng HIV or cont r act i ng new st r ai ns of t he vi r us, and STIs.
Pr oj ect benef i ci ar i es devel op posi t i ve out l ooks on t hei r f ut ur e and mai nt ai n
t hei r r epr oduct i ve heal t h and exer ci se opt i ons i n pur sui ng i nt i mat e
r el at i onshi ps and chi l d- bear i ng. The Pr oj ect bui l ds posi t i ve sel f - accept ance
and const r uct i ve r el at i onshi ps wi t h f ami l y member s and t he communi t y.
x Process of i mpl ement at i on
The Pr oj ect i s i mpl ement ed wi t h f ul l par t i ci pat i on f r om t he PLHA
benef i ci ar i es at ever y st age i n t he pr ocess. These st ages i ncl ude pl anni ng,
devel opi ng t he i nt er vent i on model , suppor t i ng t he act i vi t i es of t he PLHA
gr oups, and devel opment of t he Tr ue Li ves t r ai ni ng cur r i cul um whi ch i s used
t o bui l d knowl edge and ski l l s among t he PLHA at t endi ng cl i ni cal moni t or i ng
check- ups or par t i ci pat i ng i n gr oup act i vi t i es at t he l ocal hospi t al or
communi t y.
The pr ocess of l ear ni ng t hr ough t he Tr ue Li ves cur r i cul um r el i es on t r ai ned
peer l eader s who expand t he t eachi ng t o an ever - wi der ci r cl e of PLHA.
Eval uat i on of t he Pr oj ect i s conduct ed by t he gr oups of peer l eader s, t he
net wor k of PLHA and t he Int er nat i onal AIDS Al l i ance as t he donor .
Act i vi t i es under t he Tr ue Li ves cur r i cul um cr eat e a f or um f or exchangi ng
t hought s, conver sat i on, and exper i ence r egar di ng copi ng wi t h HIV i nf ect i on
and how t o l ead a const r uct i ve l i f e f r om a hol i st i c per spect i ve. Ther e ar e
seven modul es t o t he cur r i cul um whi ch cover cont ent such as vi abl e opt i ons
f or pr event i on of HIV, sel f - r i sk assessment , eval uat i ng sympt oms of STIs,
devel opi ng a pl an and r eadi ness f or di scl osur e of ser o- st at us, i dent i f yi ng t he
or i gi n of di scr i mi nat or y pr act i ces, i dent i f yi ng sol ut i ons t o pr obl ems, and
shar i ng exper i ence on choosi ng sexual l y heal t hy l i f est yl es.
x Success
Quant i t at i vel y, t he Tr ue Li ves Pr oj ect was abl e t o r each and suppor t over
5, 000 PLHA. The Pr oj ect was expanded f r om t he Upper Nor t h t o ot her par t s
of t he count r y, i ncl udi ng t he Nor t heast r egi on, t hr ough t he expanded
r epr oduct i ve heal t h i ni t i at i ve f or PLHA of t he Depar t ment of Heal t h of t he
MOPH. In addi t i on, t he par t i ci pant s i n t he Pr oj ect r epor t ed i ncr easi ng
condom use at l ast sex by 20%, and wer e 20% mor e l i kel y t o di scl ose t hei r
ser o- st at us t o t hei r par t ner t han per sons not par t i ci pat i ng i n t he Pr oj ect . A
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smal l er per cent age of Pr oj ect par t i ci pant s ( 12%) sai d i t was di f f i cul t t o
di scl ose t hei r ser o- st at us t han non- Pr oj ect par t i ci pant s ( 21%) .
Qual i t at i vel y, t he Tr ue Li ves Pr oj ect bui l t knowl edge, under st andi ng,
pr event i on and heal t h- seeki ng behavi or , and pr omot ed a gr eat er awar eness
of r i ght s, a way of t hi nki ng and deci si on- maki ng r egar di ng r epr oduct i ve
heal t h among PLHA and t hei r par t ner s, bot h among di scor dant and
concor dant coupl es. In addi t i on, Tr ue Li ves bui l t t he capaci t y and ski l l s of
benef i ci ar i es i n communi cat i on and shar i ng exper i ence wi t h t he peer
l eader s.
x Import ant f i ndi ngs
Because of t he Pr oj ect s pr ocess of par t i ci pat or y l ear ni ng t hr ough a
f r i ends- hel p- f r i ends appr oach t hr ough non- j udgment al di scussi on of
behavi or , t hought s, and at t i t udes, t her e was mor e open di scussi on and
r evel at i on of heal t h mai nt enance behavi or . The i nf or mat i on f r om t he di r ect
exper i ence of Pr oj ect par t i ci pant s was hi ghl y r el evant t o ot her member s of
t he Pr oj ect and mor e easi l y appl i cabl e t o t hei r l i f est yl e t han gener al
i nf or mat i on on pr event i on and heal t h mai nt enance.
By usi ng a par t i ci pat or y l ear ni ng appr oach f or bot h men and women, and
usi ng coupl e- based act i vi t i es, i t was easi er f or t he Pr oj ect t o pr omot e
sexual behavi or adapt at i ons f or heal t hi er and hi gher qual i t y l i f est yl es t han
was t he case bef or e i mpl ement at i on.
4. 1. 2 The Voi ces and Choi ces Proj ect f or HIV-posi t i ve Women
(Phase 3: 2006-2009)
Thi s Pr oj ect i s i mpl ement ed t hr ough a women- cent er ed st r at egy by t he Raks
Thai Foundat i on. A key concept of t he Pr oj ect i s t he i mpor t ance of bui l di ng
t he ski l l s of peer l eader s who ar e HIV- posi t i ve women t hr ough a l ear ni ng
pr ocess t o maxi mi ze pot ent i al , physi cal ener gy, and posi t i ve changes i n
onesel f and one s l i f e.
x Process of i mpl ement at i on
In Phase 3, t he Pr oj ect i s cont i nui ng t he wor k of ear l i er phases whi ch
i ncl uded par t i ci pat or y r esear ch usi ng HIV- posi t i ve women as par t of t he l i f e
f or ce gr oup f ol l owed by act i ve out r each t o r ecr ui t and bui l d t he capaci t y
of a cor e gr oup of peer l eader s t hr ough par t i ci pat or y t r ai ni ng of HIV-
i nf ect ed women. These peer s became i nvol ved wi t h hospi t al - based
counsel i ng ser vi ces as per sons wi t h r el evant exper i ence, and wer e t r ai ned i n
aspect s of counsel i ng ot her women. Now i n Phase 3, t he Pr oj ect i s f ocusi ng
on i ncr easi ng t he sel f - det er mi nat i on of HIV- posi t i ve women concer ni ng sex
and r epr oduct i ve heal t h. The Pr oj ect cont i nues t o t r ai n t he peer l eader s,
and t o pr omot e exchange of exper i ence and t hought s about sex, power , and
mal e- f emal e r el at i onshi ps. Meet i ngs ar e convened i n a saf e space t o cr eat e
an at mospher e f or r el axed openness. Af t er gai ni ng a mor e pr of ound
under st andi ng of one s l i f e ci r cumst ances and t he r oot of per sonal pr obl ems,
t he par t i ci pant s can t hen di scuss and hel p ot her s addr ess t hei r chal l enges
whi ch ar e di f f er ent acr oss t he var i ed r egi ons and cont ext s t hat posi t i ve
women f i nd t hemsel ves i n. Wor ki ng t oget her wi t h t he Pr oj ect st af f , t hey
have cr eat ed a t r ai ni ng cur r i cul um whi ch uses a f r i ends- t each- f r i ends
appr oach t o del i ver t he cont ent i n or der t o hel p women accur at el y addr ess
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pr obl ems i n a way t hat i s appr opr i at e f or each i ndi vi dual . The cur r i cul um i s
bei ng expanded t o ot her gr oups of HIV- posi t i ve women i n di f f er ent r egi ons
of t he count r y.
x Success
Quant i t at i vel y, t he Pr oj ect has expanded t he act i vi t i es t o cover 3, 000
women. Peer l eader s have i ncr easi ngl y been abl e t o i nvol ve t hei r mal e
par t ner s i n t he Pr oj ect t r ai ni ng act i vi t i es.
Qual i t at i vel y, t he peer l eader s and ot her i nf ect ed women who have been
t r ai ned have gr eat er knowl edge and under st andi ng about t hei r per sonal
ci r cumst ances of sex and r epr oduct i ve heal t h r i ght s. They have mor e ski l l s
i n communi cat i ng about sex t o make sex mor e enj oyabl e and saf e. They ar e
abl e t o communi cat e t hei r needs and desi r es t o t hei r par t ner , ser vi ce
pr ovi der s, and ot her r el evant i ndi vi dual s. The Pr oj ect s f r i ends- t each-
f r i ends cur r i cul um has been i nt egr at ed wi t h ot her t eachi ng pr ogr ams. The
Pr oj ect s peer l eader s par t i ci pat ed i n ever y aspect of devel opment of a
cur r i cul um f or r epr oduct i ve heal t h of HIV- i nf ect ed per sons of t he
Depar t ment of Heal t h, and ser ved as r esour ce per sons t o pr ovi de advi ce on
appl yi ng t he cur r i cul um f r om t he out set t o t he nat i onal expansi on phase at
pr esent .
x Import ant f i ndi ngs
The pr ocess of st r engt heni ng t he i nt er nal r esol ve of HIV- posi t i ve women so
t hat t hey have gr eat er sel f - conf i dence, dar e t o communi cat e t hei r t hought s
and make i ndependent deci si ons, and ar e abl e t o accept t he consequences
of t hese act i ons, i s a key concept of t hi s Pr oj ect . The per son f aci ng t he
chal l enges i s her own t eacher and devel ops an abi l i t y t o di agnose and
r esol ve pr obl ems i ndependent l y. Thi s ensur es t hat t he sol ut i on i s t he most
r el evant and appr opr i at e act i on f or t he af f ect ed i ndi vi dual . The Pr oj ect
pr ocess al so st r engt hens t he aut hor i t y and capaci t y of par t i ci pant s t o
exper i ence r eal achi evement s.
4. 1. 3 Proj ect t o prevent i nf ect i on among HIV-negat i ve pregnant women
t hrough Pre-nat al Coupl e Care.
Thi s Pr oj ect at t empt s t o devel op a syst em of ant e- nat al car e ( ANC) t hat
hel ps HIV- negat i ve pr egnant women st ay negat i ve ( despi t e t he f act t hat
t hei r par t ner i s i nf ect ed) usi ng coupl e par t i ci pat i on. By bui l di ng t he
coupl e s knowl edge and under st andi ng about HIV/ AIDS and pr event i on, t hey
can pl an f or t he f ut ur e i n a way t hat i s most appr opr i at e f or t hem. The
pr i nci pl e i mpl ement i ng agenci es f or t hi s Pr oj ect ar e t he Repr oduct i ve
Heal t h Di vi si on of t he Depar t ment of Heal t h and t he Facul t y of Nur si ng of
Bur apa Uni ver si t y.
x Process of i mpl ement at i on
Ini t i al l y, t he pr ecur sor f or t he Pr oj ect was a pi l ot ef f or t at t he ANC and
f ami l y pl anni ng cl i ni cs of si x heal t h pr omot i on hospi t al s whi ch pr omot ed a
mi ni mum r equi r ement of f our j oi nt vi si t s by t he pr egnant woman and her
par t ner . Dur i ng t hese vi si t s t he coupl e r ecei ved i nf or mat i on about t he
heal t h and car e f or t he mot her and i nf ant , STIs and HIV and pr event i on, and
t he separ at e r ol es of t he par ent s of t he pr egnancy. The Pr oj ect pr omot ed
condom use among di scor dant coupl es and r egul ar , vol unt ar y HIV bl ood
checks.
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In t he second phase of t he Pr oj ect ( dur i ng 2007- 2011) t he model act i vi t i es
ar e bei ng expanded t hr ough t he syst em of r egi onal , pr ovi nci al , and di st r i ct
hospi t al s t hr oughout Thai l and. The model advocat es t hat t he f at her of t he
pr egnancy par t i ci pat e i n t he car e of t he pr egnant woman and t he i nf ant ,
and must at t end at l east f our vi si t s t oget her dur i ng t he pr egnancy, t he
del i ver y, and post - par t um. The Pr oj ect has devel oped a coupl e counsel i ng
cur r i cul um f or pr i mar y and secondar y counsel i ng f or di scor dant coupl es.
The Pr oj ect has al so devel oped t echni ques t o hel p hospi t al s mot i vat e
coupl es t o at t end ser vi ces t oget her .
x Success
Dur i ng Phase 2, f r om Jul y 2008 t hr ough Sept ember 2009, 724 di scor dant
coupl es par t i ci pat ed i n t he Pr oj ect , or 19% of al l ANC cl i ent s i n t he Pr oj ect
ar eas.
Impl ement at i on i n 25 heal t h f aci l i t i es i n t hr ee east er n pr ovi nces, Chol bur i
and t he Facul t y of Nur si ng of Bur apa Uni ver si t y dur i ng 2008 r egi st er ed 3, 242
new cases of coupl e counsel i ng wi t h 1, 878 t est i ng HIV- posi t i ve, or 57. 9%.
For f i ve pi l ot pr oj ect hospi t al s i n Chol bur i , t her e wer e 358 new cases of
coupl e counsel i ng, 340 of whi ch bot h par t ner s agr eed t o HIV t est i ng, or 95%.
x Import ant f i ndi ngs
Set t i ng up a syst em of coupl e counsel i ng i s t o cr eat e an open syst em of
par t i ci pat i on f or sexual and r epr oduct i ve heal t h mai nt enance f or bot h
par t ner s i n a r el at i onshi p. Coupl e ANC i s an addi t i onal way t o pr omot e
mor e war mt h and l ove i n t he r el at i onshi p.
4. 1. 4 The Teenpat h Proj ect
The Pr ogr am f or Appr opr i at e Technol ogy i n Heal t h ( PATH) i s t he pr i nci pal
i mpl ement i ng par t ner wor ki ng wi t h t he Mi ni st r y of Educat i on ( MOE) and
Mi ni st r y of Publ i c Heal t h ( MOPH) t o pr omot e compr ehensi ve sexual i t y
educat i on ( CSE) and pr event i on of HIV among school - based adol escent s.
Suppor t f or t hi s Pr oj ect i s pr ovi ded by t he GFATM.
The Pr oj ect at t empt s t o del i ver CSE i n mul t i pl e di mensi ons of human
devel opment : r el at i onshi ps, l i f e ski l l s, sexual behavi or , sexual heal t h, and
soci o- cul t ur al aspect s. The Pr oj ect f ocuses on adol escent s age 12 t o 24
year s.
x Process of i mpl ement at i on
The Pr oj ect uses a syst emat i c st r at egy t o wor k on school pol i cy and wi t h
t eacher s t o become agent s of change t o pr omot e CSE f or adol escent s. PATH
sel ect ed a var i et y of i mpl ement i ng par t ner s i n di f f er ent r egi ons t o cr eat e a
uni t ed f or ce t o br oaden school t eachi ng t o i ncl ude CSE as par t of t he basi c
educat i on cur r i cul um. In par t i cul ar , t he Pr oj ect f ocused on vocat i onal
school s, non- f or mal educat i on i nst i t ut i ons, and br anches of Rachapat
Uni ver si t y. These gr oups wor ked t oget her wi t h t echni cal gui dance f r om
PATH t o devel op t he concept of i nt r oduci ng t he CSE cur r i cul um and t r ai ni ng
t eacher s how t o del i ver i t . PATH hel ped wi t h di r ect i mpl ement at i on i n
Bangkok and over saw coor di nat i on, and over al l di r ect i on of i mpl ement at i on
t hr oughout t he Pr oj ect si t es.
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x Success
In t he f i r st f i ve year s of i mpl ement at i on, t he Teenpat h Pr oj ect had t en
managi ng par t ner s t o cr eat e pi l ot appl i cat i ons of CSE i n model educat i onal
i nst i t ut i ons f or ever y gr ade l evel f r om pr i mar y t o secondar y and post -
secondar y l evel s. The Pr oj ect was abl e t o i nt egr at e CSE i nt o t he st andar d,
f or mal cur r i cul um, and bui l d a net wor k of i nst r uct or s who wer e ski l l ed i n
del i ver y of CSE and posi t i ve devel opment of yout h. The Pr oj ect cr eat ed a
t eam of CSE r esour ce per sons i n t he ar eas of i mpl ement at i on t o hel p
est abl i sh model s of CSE f or var i ous gr ade l evel s i ncl udi ng cur r i cul a f or hi gh
school gr ades M1 t o M6, t he vocat i onal school di pl oma pr ogr am, an act i vi t y
set f or non- f or mal educat i on i nst i t ut i ons, and a cur r i cul um f or educat i on
f acul t y st udent s. Gr oups of adol escent s wer e or gani zed t o hel p pr omot e
under st andi ng of AIDS and sex educat i on i n t he school s and t he communi t y.
The Pr oj ect cr eat ed a cadr e of yout h peer l eader s t o pl ay an act i ve r ol e i n
t he Pr oj ect . Local r esour ces wer e mobi l i zed t o suppor t sust ai ned CSE.
Favor abl e ar t i cl es on CSE f or adol escent s appear ed i n t he medi a mor e of t en,
i ncl udi ng quot es f r om Pr oj ect par t ner s.
x Import ant f i ndi ngs
Havi ng a cl ear pol i cy t o pr omot e i mpl ement at i on of a CSE cur r i cul um f or
adol escent s at al l l evel s on a cont i nuous basi s i s an essent i al i ngr edi ent f or
l ocal accept ance of t he pr ogr am by school s and t he soci et y.
It i s cr uci al l y i mpor t ant t o cr eat e under st andi ng among educat i onal
admi ni st r at or s of t he t ar get s and concept s of CSE so t hat t hey see i t as a
nat ur al l ear ni ng pr ocess f or yout h r egar di ng sex l i f est yl es by usi ng a l ear ner -
cent er ed appr oach. By gi vi ng voi ce t o t hei r t hought s and anal ysi s, yout h
can par t i ci pat e f ul l y i n t he i nf or mat i on- exchange and l ear ni ng pr ocess, and
acqui r e accur at e and f act ual i nf or mat i on t o i nf or m l i f e deci si ons.
4. 2 AIDS responses f or Margi nal i zat i on Peopl e i n Thai l and
Ther e ar e t wo pr oj ect s under t hi s headi ng t hat wer e sel ect ed as a best
pr act i ce.
4. 2. 1 Ant i -ret rovi ral t herapy (ART) i n border areas of t he Great er
Mekong Subregi on: Experi ence of t he Chi ang Saen Hospi t al
Thi s Pr oj ect has pr epar ed and del i ver ed ART i n bor der ar eas of t he gr eat er
Mekong subr egi on f or many year s, t o ser ve bor der popul at i ons of l abor er s
and mi gr ant s, domest i c and f or ei gn, who nor mal l y do not have access t o
subsi di zed t r eat ment f r om ot her sour ces. Many sect or s ar e i nvol ved i n
hel pi ng t hi s Pr oj ect , t hr ough coor di nat i on and t he appl i cat i on of l ocal
wi sdom, t o del i ver a l ocal l y appr opr i at e and accept abl e ser vi ce. Thi s
Pr oj ect pr ovi des an addi t i onal opt i on t o mar gi nal i zed popul at i ons who
ot her wi se cannot r ecei ve t r eat ment .
x Process of i mpl ement at i on
A Thai pi l ot pr oj ect i n 2004 demonst r at ed t he f easi bi l i t y of pr ovi di ng ART t o
et hni c mi nor i t y popul at i ons l i vi ng i n bor der ar eas. But t hat was a shor t -
t er m ef f or t whi l e ART i s l i f e- l ong. Ther ef or e, t he Chi ang Saen Hospi t al
devel oped a model f or a l onger - t er m appr oach. Si nce most of t he per sons
i n need of ART i n t hi s ar ea ar e l ow- i ncome cr oss- bor der mi gr ant s, t he
Chi ang Saen Hospi t al col l abor at ed wi t h Medeci ns Sans Fr ont i er e ( Bel gi um) t o
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devi se a model ART pr ogr am f or cr oss- bor der popul at i ons on t he Thai - Lao
bor der . The model i ncl udes a r eser ve dr ug bank, l abor at or y moni t or i ng,
pat i ent r ef er r al , counsel i ng, and a combi ned pat i ent admi ssi on, cl i ni cal
moni t or i ng and car e f or m.
A r evi ew of r ecor ds of ART pat i ent s at t he Chi ang Saen Hospi t al bot h Thai
and et hni c mi nor i t i es was conduct ed t o st udy si de ef f ect s of ART. It was
f ound t hat t her e was l i podyst r ophy and vascul ar pr obl ems i n 54. 8% of
pat i ent s. Ther ef or e, t he hospi t al devel oped a sel f - car e pr ogr am of l i f est yl e
management and use of l ocal wi sdom t o manage si de ef f ect s and maxi mi ze
heal t h. Lat er t he pr ogr am cur r i cul um was modi f i ed t o i ncl ude Lao and
Bur mese l ocal wi sdom t o be i ncor por at ed f or pat i ent s f r om t hose cul t ur es.
Af t er t r ai ni ng pat i ent s and t hei r r el at i ves i n t hese pr i nci pl es of car e, t he
Pr oj ect conduct ed communi t y f ol l ow- up, and del i ver ed r ef r esher t r ai ni ng
cour ses, and sel ect ed exper i enced pat i ent s t o be ment or s f or new pat i ent s
and ot her vul ner abl e popul at i ons. In addi t i on, t he hospi t al devel oped
educat i onal medi a i n t hr ee l anguages ( Thai , Lao and Bur mese) t o i mpr ove
t he abi l i t y of st af f t o car e f or t he pat i ent s.
x Success
A t ot al of 73 HIV- i nf ect ed Lao and Bur mese wer e bei ng car ed f or by t he
Chi ang Saen Hospi t al dur i ng Jul y 2004 t o June 2007. Of t hese, 98% had
uni nt er r upt ed t r eat ment r ecor ds and a sur vi val r at e at 36 weeks of 96%.
Qual i t at i vel y, al l pat i ent s on ART exper i enced i mpr oved heal t h st at us, coul d
car r y out dai l y act i vi t i es nor mal l y i n t hei r home communi t i es, coul d hel p
ot her i nf ect ed per sons, pr omot ed pr event i on act i vi t i es, and wer e cl osel y
l i nked wi t h Thai count er par t s cont i nuousl y over t i me.
By i ncl udi ng t r adi t i onal l i f est yl e pr act i ces and l ocal wi sdom t o hel p et hni c
mi nor i t i es t o per f or m sel f - car e hel ped pat i ent s and t hei r f ami l i es t o achi eve
a bet t er heal t h r esul t . They gai ned knowl edge, under st andi ng, and a sense
of par t i ci pat i on i n t he car e pr ocess, and wer e dedi cat ed t o t he ART pr ocess,
mor e t han i f t he Pr oj ect never happened. They wer e abl e t o counsel ot her s
and be a sour ce of mor al suppor t t o ot her i nf ect ed i ndi vi dual s.
x Import ant f i ndi ngs
The hear t of t he success of t hi s Pr oj ect i s i t s appr eci at i on of t he val ue and
equal st at us of al l humans, and t he pr omot i on of f ul l and meani ngf ul
par t i ci pat i on of t he mul t i - di sci pl i nar y t eam. By est abl i shi ng a f oundat i on
f or qual i t y devel opment of t he or gani zat i on, t he r esponsi bl e i ndi vi dual s can
easi l y adapt t o changi ng ci r cumst ances over t i me.
ART i s a st r at egy f or cr oss- bor der heal t h ser vi ces t o access mar gi nal i zed
popul at i ons of t he HIV- i nf ect ed. Thi s i s one st ep i n mi t i gat i ng t he i mpact of
AIDS and STIs i n cr oss- bor der ar eas, can r educe di scr i mi nat i on and st i gma,
and can hel p suppor t pr event i on of spr ead of HIV and STIs i n t hese l ocat i ons.
The pol i ci es of Thai l and and i t s nei ghbor s r egar di ng cr oss- bor der
col l abor at i on and goodwi l l ar e f act or s behi nd t he success and f easi bi l i t y of
any cr oss- bor der pr ogr am such as t hi s.
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4. 2. 2 Prevent i on of HIV/ AIDS i n mi grant l aborers i n Thai l and (PHAMIT)
Thi s Pr oj ect has t he obj ect i ve of i ncr easi ng condom use and r epr oduct i ve
heal t h among mi gr ant l abor er s and t hei r f ami l i es, and ot her r el at ed
i ndi vi dual s f r om Lao P. D. R, Cambodi a, and Myanmar . The Pr oj ect f ocuses
on t he l abor er s i n t he f i sher i es and f ood i ndust r y i n 19 coast al pr ovi nces,
and f act or y, agr i cul t ur e and const r uct i on l abor er s i n t hr ee non- coast al
pr ovi nces bor der i ng Myanmar . In addi t i on, t he Pr oj ect gi ves speci al
at t ent i on t o sex wor ker s and st af f of ent er t ai nment est abl i shment s, bot h
Thai and mi gr ant . The Pr oj ect i s pr i nci pal l y i mpl ement ed by t he Raks Thai
Foundat i on and seven par t ner agenci es wi t h f undi ng f r om t he GFATM.
x Process of i mpl ement at i on
The Pr oj ect uses a compr ehensi ve, i nt egr at ed appr oach t hat i s f l exi bl e and
adapt abl e. The Pr oj ect appl i es act i ve out r each t o t he t ar get benef i ci ar i es,
pr ovi des f i el d- based ser vi ces, uses mul t i pl e means of communi cat i ng
Pr oj ect i nf or mat i on, di st r i but es condoms, and conduct s r ef er r al f or
r epr oduct i ve heal t h car e.
The Pr oj ect out r each t eam i s compr i sed of one Thai f i el d coor di nat or , and
at l east one mi gr ant heal t h wor ker ( MHW) . Toget her t hey ar r ange Pr oj ect
act i vi t i es at t he l abor er s r esi dent i al nei ghbor hood, wor k si t e, or pl aces of
r ecr eat i on. The MHW i s sel ect ed f r om t he pr i nci pal mi nor i t y popul at i on of
mi gr ant s i n t he l ocal i t y. The MHW i s gi ven i nt ensi ve t r ai ni ng on HIV and
r epr oduct i ve heal t h, and t hi s t r ai ni ng cont ent i s r ei nf or ced t hr ough a ser i es
of mont hl y meet i ngs wi t h annual r ef r esher t r ai ni ng cour ses.
A key f eat ur e of t he i mpl ement i ng pr ocess i ncl udes mi gr ant heal t h
vol unt eer s ( MHV) who ar e sel ect ed f r om t he communi t y of mi gr ant wor ker s.
The MHV di st r i but es i nf or mat i on t o t he mi gr ant s and pr ovi des r egul ar
r emi nder s t o f ol l ow t he gui dance f r om t he Pr oj ect i nf or mat i on,
r educe/ avoi d r i sk behavi or , and hel ps r each t he ot her wi se har d- t o- r each
gr oups. The PHAMIT Pr oj ect has devel oped educat i onal medi a i n many
f or mat s t o del i ver i nf or mat i on on HIV, AIDS and var i ous r i ght s concer ni ng
heal t h. These medi a ar e i n a l anguage t hat t he mi gr ant s easi l y under st and
and i ncl ude Bur mese, Lao, Khmer , Kar en, Lahu, Hmong, and Shan.
The Pr oj ect est abl i shed dr op- i n cent er s ( Di C) t o pr ovi de ser vi ces and
i nf or mat i on, and ser ve as a meet i ng pl ace f or act i vi t i es. The Di C i s l ocat ed
i n a pl ace t hat i s saf e and conveni ent f or t he mi gr ant s t o access, wher e t hey
can r el ax and f eel comf or t abl e. They ar e encour aged t o f eel a sense of
par t i ci pat i on and owner shi p of t he Di C. The Di C i s al so a r ef er r al axi s f or
mi gr ant s who need t r eat ment f or STIs, mat er nal and chi l d car e, and ot her
r epr oduct i ve heal t h ser vi ces. The Pr oj ect st af f and vol unt eer s f ol l ow up t he
r esul t s of t he r ef er r al .
In coor di nat i ng wi t h t he l ocal hospi t al , some t he PHAMIT par t ner s assi st t he
mobi l e medi cal uni t as i nt er pr et er s ( as needed) t o f aci l i t at e t he cl i ni cal
car e. The ser vi ces i ncl ude f ami l y pl anni ng and t r eat ment f or STIs.
Ther e ar e t wo st r at egi es f or r egul ar di st r i but i on of condoms: t hr ough
condom vendi ng machi nes, and t hr ough t he MHVs and empl oyer s of t he
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mi gr ant l abor er s. Condoms ar e al so di st r i but ed on an ad hoc basi s dur i ng
communi t y campai gns and speci al event s.
x Success
Dur i ng t he past f i ve year s of i mpl ement at i on, t he Pr oj ect has r eached over
442, 260 per sons. In 2008 t he l evel of HIV i nf ect i on among mi gr ant cr ew of
f i shi ng boat s decl i ned t o a l evel i n t he r ange of 0. 7 t o 5%, or an aver age of
1. 96%. Thi s r epr esent s a f i ve per cent decr ease f r om t he l evel i n 2004, and
wher e t he gener al mi gr ant popul at i on had an i nf ect i on l evel i n t he r ange of
0. 4 t o 2. 5%, or an aver age of 1. 38%, whi ch i s gr eat er t han i n t he Thai
gener al popul at i on.
The per cent of mi gr ant s who know t hat condoms ar e ef f ect i ve f or
pr event i ng spr ead of HIV i ncr eased f r om 79%t o 89%. The per cent who sai d
t hey had conf i dence t hat usi ng a condom f or ever y sex woul d hel p pr event
t r ansmi ssi on of HIV i ncr eased si gni f i cant l y i n al l gr oups and was most l y over
80%.
At t he same t i me, among mal e mi gr ant s, sel f - r epor t ed condom use ( one of
t he most cl ear i ndi cat or s of r i sk r educt i on) as measur ed by t he st at ement
Used a condom dur i ng l ast sex wi t h a non- r egul ar par t ner i ncr eased f r om
43% i n 2004 t o 90% i n 2008. At t he end of 2008 PHAMIT had est abl i shed a
t ot al of 38 si t es i n 21 pr ovi nces. MHWs wer e t r ai ned and assi st ed ser vi ces i n
gover nment hospi t al s of t en pr ovi nces whi ch have a l ar ge number of
mi gr ant s seeki ng hospi t al car e.
x Import ant f i ndi ngs
Par t i ci pat i on of t he benef i ci ar i es i s cr uci al t o t he success of t he Pr oj ect
si nce t hi s hel ps sol ve pr obl ems of access and over come l anguage bar r i er s.
AIDS wor k wi t h vul ner abl e and mar gi nal i zed popul at i ons needs t o emphasi ze
r i ght s and communi t y- based appr oaches.
4. 3 Hol i st i c care and support f or chi l dren i n Thai l and
4. 3. 1 The Int egrat ed Psycho-soci al and Medi cal care Proj ect
Thi s Pr oj ect was i mpl ement ed t o devel op a model of psycho- soci al car e
t hr ough t he ar t s, and i nt egr at i ng component s wi t h cl i ni cal car e t o pr event
and mi t i gat e t he i mpact of AIDS i n chi l dr en and yout h l i vi ng wi t h HIV. The
key i mpl ement er s wer e t he We Under st and gr oup, whi ch i s a net wor k of
peopl e wor ki ng i n publ i c and pr i vat e- sect or or gani zat i ons wi t h chi l dr en and
yout h who ar e i nf ect ed wi t h HIV, ar t i st s, mass medi a speci al i st s, and
vol unt eer s. Ther e wer e many par t ner agenci es and i ndi vi dual s i nvol ved as
wel l .
x Impl ement at i on process
The pr ocess of i mpl ement at i on st ar t ed f r om addr essi ng t he psychol ogi cal
st at e of each chi l d by appl yi ng ar t i st i c act i vi t i es such as dr awi ng pi ct ur es,
phot ogr aphy, and pr oduci ng pl ays. Thi s was i nt ended t o hel p chi l dr en know
t hemsel ves bet t er , shar e wi t h f r i ends, and devel op a gr eat er sense of sel f -
wor t h. At t he i ni t i al st age, t he Pr oj ect ar r anged yout h ar t s camps, and used
t he pr oduct s pr oduced by t he chi l dr en as par t of i nf or mat i on campai gns f or
soci et y t o i mpr ove under st andi ng i n t he car e and accept ance of HIV-
i nf ect ed chi l dr en. Ot her act i vi t i es i ncl uded AIDS awar eness, sex educat i on,
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l i f e ski l l s, occupat i onal t r ai ni ng, and f ol l ow- up educat i on af t er compl et i on
of act i vi t i es. In addi t i on, t he Pr oj ect suppor t ed cl i ni cal f ol l ow- up of t he
i nf ect ed chi l dr en, and bui l t t he capaci t y of t he f ami l y t o hel p pr ovi de basi c
car e.
x Success
Quant i t at i vel y, t wel ve yout h f r i ends vol unt eer gr oups wer e est abl i shed,
compr i si ng 200 member s. The obj ect i ve of t he gr oups was t o bui l d t he
qual i t y of l i f e of chi l dr en and yout h l i vi ng wi t h HIV. The gr oups wer e
suppor t ed i n ski l l s devel opment and budget f or conduct i ng act i vi t i es. The
gr oups pl ayed an i mpor t ant r ol e i n suppor t i ng act i vi t i es f or 1, 000 chi l dr en
and yout h l i vi ng wi t h HIV i n t he Pr oj ect ar ea.
Qual i t at i vel y, t he Pr oj ect benef i ci ar i es devel oped i nt er nal l y. Chi l dr en s
st r ess l evel was r educed, and chi l dr en wer e bet t er abl e t o f ocus t hei r
at t ent i on, and t o consi der a wi der r ange of opt i ons t o addr ess per sonal
pr obl ems. The knowl edge gai ned f r om par t i ci pat i ng i n t he Pr oj ect has been
r epr oduced i n t he f or m of a bookl et and DVD f or wi der di ssemi nat i on. The
mat er i al i ncl udes a cur r i cul um f or t hose i nt er est ed per sons who want t o
r epl i cat e t he Pr oj ect model .
x Import ant f i ndi ngs
Ar t s act i vi t y i s one t ool t o hel p chi l dr en t o expl or e t hemsel ves, t o addr ess
pr obl ems t hey ar e f aci ng, and consi der a var i et y of opt i ons t o r educe t he
pr obl ems. The ar t wor k of chi l dr en i s a channel f or communi cat i ng i nt er nal
f eel i ngs t o ot her s, and as way t o hel p ser vi ce pr ovi der s t o mor e ef f ect i vel y
hel p addr ess and mi t i gat e t he i mpact on chi l dr en.
When ar r angi ng t he ar t s act i vi t i es t o addr ess t he psycho- soci al condi t i on of
chi l dr en, i t i s most i mpor t ant t o f ol l ow a pr ocedur e t hat al l ows t he chi l d t o
t hi nk f r eel y and i ndependent l y wi t hout ext er nal i nf l uence or t r yi ng t o st eer
t he pr ocess. Al so, t he pr ocess must cr eat e const r uct i ve r el at i onshi ps among
t he chi l dr en i n t he gr oup and wi t h t he f aci l i t at or s. The ar t wor k shoul d not
be j udged, compar ed or val ued agai nst t he wor k of ot her s. Lear ni ng must
be an on- goi ng pr ocess.
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V. Maj or Chal l enges and Remedi al Act i ons
1. Progress made addressi ng chal l enges ci t ed i n t he 2007
UNGASS report
Law, orders, and regul at i ons not support i ve f or prevent i on and
cont rol of AIDS, and pol i cy advocacy
In t he 2007 r epor t t o UNGASS, t he aut hor s ci t ed chal l enges i n t he ar ea of
l aw, or der s and r egul at i ons t hat do not suppor t t he goal s of t he NAP such
as t he dr af t l aw on pr ot ect i on of PLHA, t he 1966 l aw on commer ci al sex
est abl i shment s (2003 r evi si on), and t he dr af t l aw on et hi cal t r eat ment of
human subj ect s i n r esear ch. The r epor t of f er ed r ecommendat i ons t o r evi ew
t he l aws, or der s, and r egul at i ons t hat ar e not conduci ve t o HIV pr event i on
and cont r ol .
The r epor t of t he r evi ew of l aws and pol i ci es r el at ed t o human r i ght s and
AIDS r i ght s conduct ed by t he Foundat i on f or AIDS Ri ght s i n 2009 st at ed t hat
Thai l and has gener al l y f avor abl e l aws t hat ar e suppor t i ve of HIV/ AIDS
pr ogr ams such as t he 2007 Const i t ut i on ( Measur es 4, 26, 26, and 30; and
Sect i on 3) whi ch assur e t he r i ght s and f r eedoms of Thai ci t i zens, t he Labor
Pr ot ect i on Law, and t he Chi l d Pr ot ect i on Law. Al so, t he nat i onal AIDS
i mpl ement at i on gui del i nes, i ssued on August 21, 2009, ar e f aci l i t at i ng
aspect s of t he l aws, or der s and gui del i nes. Thus, t her e i s no need f or a
separ at e AIDS Law such as t hat dr af t ed i n 2007 and whi ch st i r r ed
consi der abl e debat e gi ven some pr ovi si ons t hat coul d be used t o vi ol at e
r i ght s ( see t he sect i on i n t hi s r epor t on t he ci vi l soci et y vi ewpoi nt ) .
In addi t i on, t her e ar e st r at egi es f or t he pr ot ect i on of t he r i ght s of PLHA as
devel oped by t he Commi t t ee on Human Ri ght s of t he Ri ght s and Li ber t i es
Pr ot ect i on Depar t ment of t he Mi ni st r y of Just i ce. At t he same t i me, ci vi l
soci et y has a st r ong net wor k f or suppor t i ng PLHA, and many NGOs pl ay a
st r ong r ol e i n pol i cy advocacy t hat i s suppor t i ve of AIDS pr event i on and
cont r ol , such as t he Foundat i on f or AIDS Ri ght s, TNCA, TNP+, et c.
Devel opment of t he management of prevent i on and cont rol of AIDS
The 2007 r epor t t o UNGASS ci t ed chal l enges f or management devel opment
f or t he pr event i on and cont r ol of AIDS, bot h i n t er ms of t he nat i onal and
pr ovi nci al coor di nat i on st r at egy f or i mpl ement at i on, capaci t y devel opment
f or l ocal admi ni st r at i ve or gani zat i ons and communi t i es wi shi ng t o conduct
AIDS pr event i on and cont r ol act i vi t i es.
Accor di ng t o t he NAPAC pr ocl amat i on 1/ 2007 i ssued on Apr i l 4, 2007, t he
subcommi t t ee f or advanci ng t he pr event i on pr ogr am ef f or t has t he aut hor i t y
and r esponsi bi l i t y t o di r ect i mpl ement at i on so t hat i t i s consi st ent wi t h
NAPAC di r ect i ves. Dur i ng 2008- 2009 t he sub- commi t t ee, managed by t he
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Coor di nat i on Cent er f or Devel opment of HIV Pr event i on Appr oach and
Mechani sm, has suppor t ed var i ous agenci es, gover nment and NGO, t o
i mpl ement HIV pr event i on t hr ough t hr ee st r at egi es i ncl udi ng ( 1) publ i c
i nf or mat i on campai gns on HIV/ AIDS pr event i on; ( 2) st r engt heni ng of t he HIV
pr event i on net wor ks; and ( 3) f i ndi ng ways t o ensur e sust ai nabi l i t y at t he
pr ovi nci al and l ocal admi ni st r at i ve or gani zat i on l evel s t o accel er at e and
t ake owner shi p of t he HIV/ AIDS pr event i on agenda.
In devel opi ng t he management syst em t he Di r ect or - Gener al of t he
Depar t ment f or Di sease Cont r ol ( DDC) , i n hi s capaci t y as secr et ar y of t he
NAPAC, modi f i ed t he st r uct ur e of t he Nat i onal AIDS Management Cent er
( NAMc) di r ect l y r epor t abl e t o t he D- G and whi ch has r esponsi bi l i t y f or
i mpr ovi ng coor di nat i on of pl anni ng, moni t or i ng and eval uat i on. The
coor di nat i on and r esol ut i on of pr obl ems r el at ed t o AIDS i ncl udes t he
f ol l owi ng t asks:
Nat i onal pol i cy devel opment and st r at egi es f or pr event i on and
cont r ol of AIDS.
Pr ogr am pl anni ng f or pr event i on and cont r ol of AIDS, and
gui del i nes f or pol i cy and st r at egy r ef or m f or i mpl ement at i on.
Devel op a uni f i ed st r at egy and i mpl ement at i on pl an f or
moni t or i ng and eval uat i on of HIV/ AIDS pr event i on and cont r ol at
t he nat i onal l evel , and pr ovi de management and suppor t t o ensur e
t hat t her e i s an accel er at ed pr ogr am st r at egy f or M&E at t he
count r y, zonal , and pr ovi nci al l evel
Manage and i mpl ement a dat a and i nf or mat i on cent er t o hel p
addr ess nat i onal HIV/ AIDS pr obl ems, wi t h l i nkages, compi l at i ons,
anal ysi s, and synt hesi s f or di ssemi nat i on and appl i cat i on t o pol i cy
and i mpl ement at i on act i vi t i es. Thi s cent er shoul d be a r eposi t or y
f or dat a of pr obl ems and chal l enges, so t hat t hese can be
compi l ed i nt o r ecommendat i ons f or pot ent i al sol ut i ons t o t he
pol i cy l evel .
At t he pr ovi nci al l evel , Thai l and i s usi ng a por t i on of t he r esour ces pr ovi ded
by THE GFATM gr ant s f or yout h and hi gh r i sk gr oups t o suppor t t he
Pr ovi nci al Coor di nat i ng Mechani sm ( PCM) t o hel p accel er at e t he pr ovi nci al
AIDS act i vi t i es and i mpr ove coor di nat i on and management of t hese t hr ough
i t s st r uct ur e of subcommi t t ees. Devel opi ng and i mpr ovi ng t he capaci t y of
l ocal admi ni st r at i ve or gani zat i ons ( LAOs) especi al l y at t he t ambon l evel
st i l l i s i n t he f or m of a pi l ot act i vi t y. Fr om t hi s st at us r evi ew, t he LAOs st i l l
onl y pay out t he 500 baht / mont h subsi dy f or PLHA, and t hi s i s al so
pr obl emat i c f or PLHA who do not want t o di scl ose t hei r ser ost at us, but who
need t he subsi dy.
1. 3 Prevent i on of HIV/ AIDS i n t he general popul at i on and speci f i c groups
The 2007 r epor t t o UNGASS ci t ed chal l enges i n t he ar eas of awar eness-
r ai si ng and ski l l s bui l di ng i n pr event i on, pr ovi di ng heal t h ser vi ces, car e and
t r eat ment of t he t ar get popul at i on, and r educt i on of st i gma and pr ej udi ce
agai nst PLHA.
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The f ol l owi ng descr i bes pr ogr ess made i n t hi s ar ea dur i ng t he cur r ent r epor t
per i od.
Ther e has been pr ogr ess i n wor k wi t h most - at - r i sk popul at i on gr oups, f or
exampl e i n t he ar ea of har m r educt i on t hr ough col l abor at i on of many
sect or s, i ncl udi ng t he addi t i on of met hadone mai nt enance t her apy ( MMT) t o
t he package of benef i t s under t he UC pr ogr am st ar t i ng i n Oct ober 1, 2008.
The NAPHA ext ensi ons pr oj ect has i ncr eased access t o ART f or 2, 000
mi gr ant s, et hni c mi nor i t i es and undocument ed per sons i n Thai l and. HIV VCT,
condom di st r i but i on and har m r educt i on have been ext ended t o pr i soner s i n
some pr i sons; t hi s ser vi ce i s st i l l at t he model - devel opment st age, and t her e
ar e cer t ai n oper at i onal obst acl es t o over come.
To addr ess car e f or chi l dr en af f ect ed by AIDS, t he CCM i dent i f i ed gaps i n
i mpl ement at i on and submi t t ed a pr oposal f or t he GFATM Round 9 f undi ng t o
i mpr ove car e and psycho- soci al ser vi ces f or chi l dr en. The pr oposal speci f i es
t hat t he We Under st and NGO and par t ner s i n medi cal ser vi ces and ot her
t echni cal ar eas woul d bui l d capaci t y of chi l dr en and yout h l i vi ng wi t h HIV t o
par t i ci pat e mor e f ul l y i n t he i nt er vent i ons. Unf or t unat el y, t he pr oposal was
r ecommended t o have a maj or r evi si on and encour aged t o r esubmi t .
Pr ogr ess i n PMTCT i s evi dent i n t he i nt r oduct i on of t r i pl e t her apy and
t r eat ment i n accor dance wi t h CD4 l evel s t hr ough pi l ot pr oj ect s i n Zone 7
and f our pr ovi nces. The pi l ot wi l l be expanded t o al l pr ovi nces st ar t i ng i n
Oct ober 2010. In addi t i on, t he St ayi ng Negat i ve pr oj ect was l aunched i n
MCH cl i ni cs whi ch suppor t s coupl e ANC and coupl e counsel i ng t o pr event HIV
t r ansmi ssi on among di scor dant coupl es.
Pr event i on of HIV f or yout h i n school , t he communi t y, and wor k si t es have
not pr ogr essed as wel l as i t shoul d have as i ndi cat ed by t he l ack of
r educt i on i n yout h r i sk i ndi cat or s. The cur r i cul um on AIDS and sex
educat i on, based on l i f e- ski l l s f oundat i on has st i l l not been adopt ed as
nat i onal pol i cy. Some school s l et t he t eacher s i nt r oduce a sex educat i on
component t o t hei r cour ses, but t he t eacher s can modi f y t he cont ent or use
onl y cer t ai n sect i ons t o t ai l or i t t o t hei r l ocal cl assr oom.
Impr oved sex and r epr oduct i ve heal t h ( SRH) ser vi ces t hat ar e yout h- f r i endl y,
f emal e- f r i endl y, and wel comi ng t o vul ner abl e popul at i ons, ar e st i l l under
devel opment . St af f capaci t y i s bei ng bui l t at ser vi ce del i ver y si t es i n 43
pr ovi nces by usi ng t he best - pr act i ce model of t he Lovecar e Pr oj ect of t he
NGO PATH as a t empl at e. The Udor n Thani pr ovi nci al hospi t al has devel oped
a model f or STI di agnosi s and t r eat ment and HIV VCT f or sex wor ker s and
sexual l y di ver se popul at i ons.
1. 4 Treat ment , care and support f or PLHA and af f ect ed f ami l i es
St rengt heni ng qual i t y of HIV counsel i ng and t est i ng
The NHSO has i ncl uded HIV counsel i ng and t est i ng t wi ce a year i n t he
benef i t package of t he Uni ver sal Cover age pr ogr am. However , t he 2008 and
2009 achi evement s have not met t he t ar get . Most of t he cl i ent s r ecei vi ng
HIV counsel i ng and t est i ng wer e i n advance st age wi t h AIDS sympt oms or l ow
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CD4 l evel . Bur eau of AIDS has devel oped an act i ve model t o i ncr ease
cover age of VCT i n communi t y and at t he f aci l i t y l evel . Wi t h t he
col l abor at i on bet ween Bur eau of AIDS, Depar t ment of Di sease Cont r ol and
t he Nat i onal Heal t h Secur i t y Of f i ce, a pr ot ocol t o i ncr ease cover age and
st r engt hen qual i t y of HIV counsel i ng and t est i ng ser vi ces was devel oped i n
2009. Maj or st r at egy i ncl uded st r engt heni ng of qual i t y counsel i ng ser vi ces,
i mpl ement at i on of pr ovi der i ni t i at ed counsel i ng and t est i ng, set up
i nf or mat i on shar i ng r esour ces and publ i c campai gn t o i ncr ease access and
cover age of HIV counsel i ng and t est i ng among per sons wi t h HIV behavi or al
r i sks. However , r emai n chal l engi ng ar ea i ncl ude r ef er r i ng of HIV posi t i ve
per sons f or ear l y and appr opr i at e t r eat ment and car e ser vi ces. .
Expansi on of and devel opi ng t he qual i t y of PLHA support groups, and t he
rol e of f ai t h-based organi zat i ons i n pat i ent care:
Tr ai ni ng and human r esour ce devel opment s on car e and t r eat ment ser vi ces,
as wel l as par t i ci pat i ng r ol es t o suppor t t he ser vi ces have been i mpl ement ed
and bei ng ongoi ng conduct ed. The NHSO has cl ear pol i cy on pr ovi di ng
budget ar y suppor t f or PLHA net wor ks, i n addi t i on t o t he budget ar y suppor t
f r om t he GFATM. Cur r ent l y, t her e ar e 182 cent er s r ecei vi ng NHSO suppor t
( Januar y 2010) . In 20111, NHSO wi l l pr ovi de budget ar y suppor t f or 400
cent er s and 7 r egi onal of f i ces.

Treat ment and care f or pedi at ri c HIV i nf ect i on
Bur eau of AIDS, i n col l abor at i on wi t h t he NHSO and TUC, has expanded t he
pedi at r i c car e and ART ser vi ces t o di st r i ct hospi t al s t hr ough t he bui l di ng
human r esour ce capaci t y of l ocal hospi t al heal t h car e pr ovi der s and st af f of
ci vi l soci et i es.
Preparat i ons f or t he prevent i on of HIV drug resi st ance and t reat ment
f ai l ure
Bur eau of AIDS has col l abor at ed wi t h l ocal speci al i st s and i nt er nat i onal
t echni cal or gani zat i ons t o i mpl ement sur vei l l ance syst em on HIVDR and
moni t or i ng syst em t o moni t or ear l y war ni ng i ndi cat or s of HIVDR and
t r eat ment f ai l ur e. The ongoi ng pr ocess i ncl uded devel opment of gui del i ne
f or i nt er pr et at i on of sur vei l l ance and moni t or i ng dat a f or act i on pl an on
qual i t y i mpr ovement and HIVDR pr event i on. In addi t i on, t he r evi sed
gui del i ne ( 2010- 2011) was wr i t t en by usi ng WHO r ef er ence t o ensur e t he
st andar d and ef f ect i ve t r eat ment pr ot ocol wi l l be i mpl ement ed.
Posi t i ve prevent i on
The model of posi t i ve pr event i on and heal t h pr omot i on f or PLHA has been
pi l ot ed and r evi ewi ng by Bur eau of AIDS. The t r ai ni ng cur r i cul um i s bei ng
pr epar ed by col l abor at i on among ci vi l soci et i es and gover nment al
or gani zat i ons.
Devel opment of management of TB-HIV co-i nf ect i on
Accor di ng t o t he nat i onal pol i cy, t he TB/ HIV pr ogr am has been i mpl ement ed.
The 2008- 2009 pr ogr am goal s wer e achi eved as i ndi cat ed by 93% of HIV
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i nf ect ed pat i ent s r ecei ved TB scr eeni ng and 87. 6% of TB pat i ent s r ecei ved
HIV counsel i ng and t est i ng.
Access t o ART among t hose not eligible t o t he universal healt h
insurance program
Some gr oups of PLHA i ncl udi ng mi gr ant s, et hni c mi nor i t i es ar e not el i gi bl e
f or ART under t he nat i onal heal t h i nsur ance pr ogr am. Ther e i s no nat i onal
pol i cy on suppor t i ng heal t h car e benef i t s under t he UC pr ogr am. A sol ut i on
t o t hi s pr obl em i s pr ovi ded by t he GFATM suppor t ed pr ogr am t o pr ocur e ARV
dr ugs f or t hese popul at i ons. The chal l enge i s how t o sust ai n t hi s suppor t
af t er t he GFATM suppor t ends.
2. Chal l enges f or 2008-2009 and remedi al act i ons
Access t o HIV VCT
A r evi ew of t he cur r ent si t uat i on r eveal s t hat PLHA ar e ent er i ng t he VCT
syst em t oo l at e i n t hei r i nf ect i on. Over hal f of t he i nf ect ed onl y appear f or
di agnosi s and t r eat ment when t hey exper i ence sympt oms of OIs. Thus, t he
chal l enge i s how t o mot i vat e t hese per sons t o seek HIV VCT ear l i er , and t o
i mpr ove t he qual i t y of HIV VCT so t hat i t i s mor e user - f r i endl y and
appr opr i at e f or t he var i ous t ar get popul at i ons.
Li f e af t er i ni t i at i ng ART
Thai l and has been successf ul i n ext endi ng t r eat ment t o PLHA t hr ough t he
UC pr ogr am such t hat 75. 8%of t he est i mat ed el i gi bl e per sons wer e r ecei vi ng
ART as of 2009 ( or 200, 000 per sons) . The maj or i t y of t hese per sons i s
r espondi ng wel l t o t r eat ment , i s f eel i ng st r ong and heal t hy, and can
f unct i on as pr oduct i ve member s of soci et y. A si gni f i cant number of
pedi at r i c AIDS cases ar e al so r ecei vi ng t r eat ment as t hey t r ansi t i on t o
adol escence whi ch i s a chal l engi ng t i me f or t he i nf ect ed yout h who want
t o be accept ed and t r eat ed nor mal l y. Ther e ar e al so i ssues of ART
adher ence and pr event i on of dr ug r esi st ance and pr omot i on of saf e sex f or
adol escent PLHA.
2. 3 St andardi zed AIDS and sex educat i on based on a l i f e ski l l s approach
i n school s and educat i onal i nst i t ut i ons f or al l l evel s.
Thai l and has devel oped many sex educat i on and l i f e ski l l s cur r i cul a i ncl udi ng
t he DoH cur r i cul um, whi ch t he MoE adopt ed f or use i n t he school s as par t of
t he heal t h and physi cal educat i on cour ses i n 2002. However
i mpl ement at i on of t hi s has not been ser i ous. PATH devel oped t he Teenpat h
cur r i cul um f or compr ehensi ve sexual i t y educat i on whi ch uses si x modul es
over 16 hour s dur i ng an academi c year . However , dur i ng t he past 5 t o 6
year s of at t empt s t o i nt r oduce t hi s cur r i cul um i n t he f or mal school pr ogr am
of st udy, compr ehensi ve sexual i t y educat i on i s st i l l used as gui dance onl y;
t eacher s can pi ck and choose what el ement s t o i ncl ude or not i ncl ude i n
t hei r r egul ar cour ses. Thus, t he UNGASS i ndi cat or of 30 hour s of AIDS and
sex educat i on based on l i f e ski l l s f or school st udent s i s st i l l an ur gent
chal l enge.
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2. 4 Care f or chi l dren and mot hers i mpact ed by t he PMTCT program
A new t r end i n PMTCT pr ogr ams i s t he i ncl usi on of t he mal e par t ner
( husband) t o par t i ci pat e i n ANC and coupl e counsel i ng t o hel p t he woman
di scl ose her ser ost at us and encour age t he man t o be t est ed so t hat he can
r ecei ve t r eat ment as appr opr i at e. However , coupl e counsel i ng i s not easy
especi al l y i n t he case of di scor dant coupl es. Ther e ar e al so new chal l enges
i n i nf or mi ng chi l dr en of t hei r HIV i nf ect i on and counsel i ng f or adol escent
PLHA who ar e pr egnant , and pr ovi di ng on- goi ng car e f or i nf ect ed mot her s
and t hei r newbor ns.
2. 5 Access t o user-f ri endl y HIV prevent i on and heal t h care servi ces f or
most -at -ri sk popul at i on groups (MARPs)
At pr esent , t her e ar e at t empt s t o i ncr ease user - f r i endl y ser vi ces f or MARPs
t o i ncr ease up- t ake f or HIV pr event i on and heal t h car e ser vi ces. These
i ncl ude addi t i on of MMT i nt o t he UC benef i t s package, but t her e i s l ow
ut i l i zat i on of t hi s benef i t by t hose el i gi bl e.
In t he vi ew of gr oups wor ki ng wi t h MARPs, t he key chal l enges i n r eachi ng
t hese popul at i ons concer n t he enf or cement of l aws t hat i nhi bi t access t o
ser vi ces, gover nment budget t o NGOs t o conduct out r each, and cr eat i on of
cl i ent - f r i endl y ser vi ces f or MARPs.
2. 6 AIDS work i n t he cont ext of decent ral i zat i on
A r esul t of gover nment r ef or m and decent r al i zat i on of aut hor i t y and
budget i ng t o t he LAOs f or di r ect i mpl ement at i on has l ed t o t he
di sappear ance or r educt i on of AIDS act i vi t i es i n some needy l ocat i ons.
Wher e i t does exi st , t he l ocal l y- managed AIDS act i vi t i es ar e mor e i n t he
f or m of wel f ar e r at her t han i nt ensi ve pr event i on. Thi s i s because t he LAOs
l ack t he r equi si t e knowl edge and under st andi ng of t he pr obl em of HIV/ AIDS
i n t hei r l ocal i t y. They l ack st r at egi c i nf or mat i on, and have no pl an or
gui del i nes and met hods f or i mpl ement at i on t hat ar e appr opr i at e t o t he
cont ext . They l ack t r ai ned st af f and l ocal par t i ci pat i on of t he communi t y.
In addi t i on, t he t ar get ed HIV pr event i on pr ogr am of Thai l and i s over l y
dependent on t he GFATM f undi ng at pr esent . Ther ef or e, Thai l and needs t o
ur gent l y i dent i f y ways t o sust ai n t he essent i al Nat i onal AIDS Pl an
component s i n t he post - GFATM wor l d by mobi l i zi ng l ocal r esour ces i n t he
per i pher y so t hat communi t i es can addr ess AIDS pr obl ems cost - ef f ect i vel y.
3. Concret e Remedi al Act i ons t hat are Pl anned t o Ensure
Achi evement of Agreed UNGASS Target s
3. 1 Accel erat ed Pl an f or HIV Prevent i on
The NAPAC has r esol ved, on Jul y 24, 2009, t hat t her e be an accel er at ed
pl an t o r educe new HIV i nf ect i ons by 2011 wi t h suggest ed st r at egi es as
f ol l ows:
1) Impl ement publ i c i nf or mat i on campai gns t o r ai se awar eness and
concer n about AIDS t o i ncr ease pr event i on of t r ansmi ssi on and suppor t sex
communi cat i on i n t he f ami l y.
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2) Suppor t condom use by i mpr ovi ng t he i mage of condoms t o be seen as
a key t o sexual heal t h, and pr omot e uni ver sal , cont i nuous access of t he
t ar get popul at i ons t o condoms.
3) Expand and devel op pr event i on i nt er vent i ons f or gr oups showi ng
i ncr eased t r ansmi ssi on t endenci es, i ncl udi ng t he f ol l owi ng:
Yout h
A key measur e i s pr ovi di ng educat i onal i nst r uct i on about AIDS based on a
f oundat i on of l i f e ski l l s f or at l east 30 hour s per academi c year by:
Est abl i shi ng a nat i onal and mi ni st er i al pol i cy t o i ncl ude 30 hour s of AIDS
educat i on i n t he academi c year i n school s, and est abl i sh st andar ds f or al l
school s t o have a t eacher ( s) speci f i cal l y r esponsi bl e f or del i ver i ng t he
cour se cont ent .
Devel opi ng a cor e cur r i cul um at t he nat i onal l evel as a st andar d f or t he
30- hour pr ogr am of i nst r uct i on by speci f yi ng t he cor e modul es and
addi t i onal modul es. The i nst r uct i on shoul d not be i nt egr at ed i nt o an
exi st i ng cour se but be di st i nct f r om ot her s. Ther e shoul d be suppor t i ve
act i vi t i es bot h i n and out si de of school such as peer gr oups t o advi se ot her s,
AIDS and l i f e ski l l s gr oups, et c.
Impl ement at i on of pr ogr ams t o bui l d t eacher capaci t y and pr ovi de on-
goi ng suppor t t hr ough admi ni st r at i ve pol i cy f r om t he zonal educat i on of f i ces
i n each r egi on, school admi ni st r at or s, and t echni cal suppor t f r om t he
net wor k of gover nment agenci es i n t he heal t h and educat i on sect or s, NGOs,
and i nt er nat i onal or gani zat i ons.
MARPs i ncl udi ng f emal e sex wor ker s, MSM, IDUs, mi gr ant s, and et hni c
mi nor i t i es
A key measur e f or t hi s gr oup i s t he devel opment of a syst em of cl i ent -
f r i endl y heal t h car e t hat i s HRG- speci f i c, and r emove obst acl es t o access by:
Inst i t ut i ng coor di nat i on st r at egi es t o bui l d under st andi ng among ser vi ce
pr ovi der s t o r educe condi t i ons r el at ed t o l aw and pol i cy t hat cr eat e bar r i er s
t o accessi ng pr event i on and car e ser vi ces f or MARPs. Impr ove coor di nat i on
wi t h r el evant agenci es i n bot h t he publ i c and pr i vat e sect or s t o bui l d a
net wor k f or col l abor at i on.
Incr ease par t i ci pat i on of t he MARPs t o addr ess ser vi ce pr obl ems and t o
hel p r ef i ne t he ser vi ce model so t hat i t i s mor e of a cl i ent - based ser vi ce and
based on a f oundat i on of r espect f or and pr ot ect i on of r i ght s.
Devel opi ng cl i ent - f r i endl y ser vi ces t hat ar e t ai l or ed t o t he MARPs can be
done by adj ust i ng exi st i ng ser vi ces so t hat t hey ar e mor e appr opr i at e t o t he
l i f est yl e of t he benef i ci ar i es. Exampl es i ncl ude openi ng af t er - hour s cl i ni cs
i n l ocat i ons t hat ar e easy t o access; adj ust ment of at t i t udes and devel op
t he capaci t y of ser vi ce pr ovi der s; coor di nat i on wi t h ci vi l soci et y al l i es t o
est abl i sh l i nks i n t he out r each pr ogr am and r ef er r al t o cl i ni c ser vi ces;
consi der one- st op ser vi ces by, f or exampl e, of f er i ng STI t r eat ment i n ART
cl i ni cs.
Labor er s
A key measur e f or t hi s gr oup i s t o expand cover age and qual i t y of t he use of
nat i onal i mpl ement at i on gui del i nes f or pr event i on of HIV/ AIDS i n t he
wor kpl ace.
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3. 2 Devel op pol i ci es wi t h part i ci pat i on of t he vari ous sect ors publ i c and
ci vi l soci et y organi zat i ons t o i ncrease access t o prevent i on and care
among t he hard-t o-reach popul at i on groups
Pol i ci es enabl i ng t hese popul at i ons i ncl ude IDUs, mi gr ant s, and et hni c
mi nor i t i es t o access HIV pr event i on and car e ar e as f ol l ows:
Har m r educt i on pol i cy f or IDUs, i n coor di nat i on wi t h t he ONCB, t he
Depar t ment of Medi cal Ser vi ces, DDC, t he 12D net wor k, t he PSI Foundat i on,
and net wor k of dr ug user s.
Pol i ci es f or pr event i on and car e f or mi gr ant s and et hni c mi nor i t i es, i n
coor di nat i on wi t h t he Bur aeu of AIDS, t he NHSO, t he Of f i ce of t he
Per manent Secr et ar y f or Heal t h, t he Raks Thai Foundat i on, t he Foundat i on
f or AIDS Ri ght s, and TNP+.
3. 3 Devel opment of servi ces and qual i t y of counsel i ng i n t he care of
PLHA
Thi s component has t he obj ect i ve of hel pi ng PLHA r ecei ve di agnosi s of
i nf ect i on as ear l y as possi bl e, and t o hel p PLHA car e f or t hemsel ves as much
as possi bl e t o maxi mi ze qual i t y of l i f e t hr ough t he f ol l owi ng measur es:
Devel op and suppor t access t o counsel i ng f or t he gener al popul at i on
t hr ough publ i c campai gns t o i ncr ease concer n f or AIDS pr event i on, accur at e
sel f - r i sk assessment , and t o gai n knowl edge about t he benef i t of knowi ng
one s ser ost at us. Counsel i ng t hr ough a hot l i ne ser vi ce wi l l be pr ovi ded as
anot her channel f or t he popul at i on t o obt ai n pr el i mi nar y i nf or mat i on i n
or der t o deci ded whet her t hey need t o go f or di agnosi s.
Devel op t he Cl i ent Ini t i at ed Counsel i ng and Test i ng ( CICT) st r at egy; t he
Pr ovi der Ini t i at ed Counsel i ng and Test i ng ( PICT) st r at egy; and coupl e
counsel i ng wi t h an emphasi s on vol unt ar y sel f - det er mi ned deci si on- maki ng.
Devel op coor di nat i on st r at egi es f or ser vi ce syst ems devel opment t o
i mpr ove sust ai nabi l i t y of t hese i mpr ovement s.
Suppor t t he r ol e of gr oups/ net wor ks of PLHA, and devel op t he capaci t y
of PLHA t o del i ver counsel i ng ser vi ces f or ot her PLHA by emphasi zi ng qual i t y
of l i f e devel opment f or PLHA af t er i ni t i at i ng ART by i mpl ement i ng t he
f ol l owi ng measur es:
- Impr ove ser vi ce qual i t y i n t he ar ea of counsel i ng t o i ncr ease
awar eness, under st andi ng and pr epar edness f or t he PLHA bot h bef or e
and af t er i ni t i at i ng ART i n a compr ehensi ve way on t he t opi cs of sel f -
car e, managi ng si de ef f ect s and dr ug r esi st ance, and devel opi ng a
SRH behavi or pl an.
- Pr omot e t he r ol e of Compr ehensi ve Cont i nuum Car e Cent er s, and
bui l d t he capaci t y of peer l eader s of t hese cent er s t o hel p i mpr ove
qual i t y of l i f e ser vi ces f or PLHA i n var i ous di mensi ons i n a way t hat i s
mor e t han j ust gr oup act i vi t i es and home f ol l ow- up vi si t at i on.
- Devel op gui del i nes f or f i el d i mpl ement at i on at t he communi t y
l evel wi t h par t i ci pat i on f r om al l sect or s i n t he ar ea of car e and
assi st ance, and qual i t y of l i f e devel opment of PLHA so t hat t hey can
l i ve har moni ousl y i n t he home communi t y.
- Devel op gui del i nes f or suppor t i ng t he qual i t y of l i f e of pedi at r i c
PLHA who ar e on t he ver ge of adol escence so t hey can devel op
nor mal l y and have an appr opr i at e and sat i sf yi ng sex l i f est yl e.
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3. 4 Prevent i on and mi t i gat i ng t he i mpact on chi l dren and f ami l i es of
PLHA st art i ng wi t h ANC servi ces f or t he pregnant woman, i ncl udi ng t he
f ol l owi ng:
Devel op gui del i nes f or suppor t i ng husbands t o at t end HIV VCT ser vi ces
wi t h t hei r wi f e at t he ANC cl i ni c t o i ncr ease t hei r par t i ci pat i on i n t he
deci si on- maki ng and l i f e pl anni ng deci si ons of t he coupl e, and r educe t he
bur den on t he women i n di scl osi ng her ser ost at us t o her par t ner .
Devel op qual i t y of counsel i ng ser vi ces and ski l l s of counsel or s so t hat
t hey ar e pr epar ed f or new si t uat i ons such as i nf or mi ng chi l dr en of t hei r
ser ost at us, or counsel i ng adol escent s who ar e i nf ect ed and pr egnant .
Devel op t he moni t or i ng and car e f or mot her s and i nf ant s af t er del i ver
cont i nuousl y wi t hout causi ng adver se i mpact t hr ough di scl osur e of
ser ost at us t o t he communi t y.
Devel op gui del i nes f or r epr oduct i ve heal t h ser vi ces f or adol escent s wi t h
and wi t hout HIV i nf ect i on.
3. 5 Accel erat i ng AIDS work t hrough part i ci pat ory ownershi p of t he
agenda by t he provi nce and l ocal communi t y t hr ough t he f ol l owi ng
measur es:
1) Speci f yi ng t he t ar get s f or accel er at ed i mpl ement at i on by anal yzi ng t he
dat a f r om var i ous syst ems of sur vei l l ance, ser vi ce st at i st i cs, est i mat es and
pr oj ect i ons, and ot her st udi es.
2) Int egr at i ng AIDS wor k i n t he pr ovi nce by means of t he f ol l owi ng:
Devel opi ng st r at egi es of t he PCM t o accel er at e act i on of t he r el evant
pr ovi nci al AIDS subcommi t t ees t o i ncr ease under st andi ng and capaci t y
devel opment of t he pr ovi nce and LAOs i n pl anni ng AIDS pr event i on act i vi t i es
by i nt egr at i ng t he wor k i nt o t he st r at egi c pol i cy, pl an and budget of t he
pr ovi nce and LAOs.
Int egr at e HIV pr event i on f or yout h wi t h t he act i vi t i es on sexual heal t h
pr omot i on and pr event i on of dr ug addi ct i on t o st i mul at e i nt er est and
par t i ci pat i on of t he pr ovi nce and LAOs.
3) Bui l di ng capaci t y
Devel op st r at egi es at t he nat i onal l evel i n wor ki ng wi t h t he LAOs t hr ough
coor di nat i on wi t h t he Depar t ment f or Local Admi ni st r at i on and t he
Commi t t ee f or Decent r al i zat i on t o advance t he HIV/ AIDS pr event i on
act i vi t i es t hr ough t he LAOs i n t he l ocal i t i es.
Eval uat e ar eas of good pr act i ce and anal yze t hese t o hel p pl an gui del i nes
f or devel opment and r epl i cat i on of LAO i mpl ement at i on of HIV/ AIDS
pr event i on and cont r ol .
3. 6 AIDS ri ght s prot ect i on
Bui l d under st andi ng on human and sexual r i ght s t hr ough a pr ocess of
l anguage communi cat i on.
Est abl i sh a st r at egy of moni t or i ng and over si ght t o i dent i f y r i ght s
vi ol at i ons i n suppor t of t he pr ot ect i on of AIDS r i ght s.
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VI. Support f rom t he Count ry s Devel opment
Part ners
Thi s sect i on pr esent s over vi ew of suppor t f r om i nt er nat i onal devel opment
par t ner s i ncl udi ng bi l at er al and mul t i l at er al or gani zat i ons t o r educe t he HIV
epi demi c and mi t i gat e t he i mpact of AIDS. In 2008, about 15%of t ot al AIDS
expendi t ur es or 1, 011 mi l l i on Thai baht ( THB) was suppor t ed by
i nt er nat i onal devel opment par t ner s. The suppor t decr eased t o 7% or 482
mi l l i on THB i n 2009, because of compl et i on of t he GFATM Round 3:
pr event i on t ar get i ng mi gr ant wor ker s.
It i s wel l r ecogni zed t hat domest i c f unds ar e t he maj or sour ce of Thai l and
HIV and AIDS pr ogr am suppor t . Al t hough cont r i but i on f r om i nt er nat i onal
devel opment par t ner s i s smal l , i t i s st i l l cr i t i cal t o t he nat i onal r esponse.
Fi r st l y i t f ul f i l l s nat i onal gaps on pr event i on, car e and t r eat ment , and
secondl y i t pl ays r ol e as t echni cal cat al yst i ncl udi ng devel opi ng
r epl i cat i on model s t hat can be adopt ed by t he nat i onal pr ogr am as wel l as
st r engt heni ng ef f ect i veness of nat i onal r esponses and document at i on. And
l ast l y, Thai l and i s consi der ed as an appr opr i at e si t e on devel opment of
st at e- of - t he- ar t appr oaches and has t he pot ent i al and capaci t y t o under t ake
sout h t o sout h shar i ng exper i ences and exper t i se wi t hi n t he r egi on and
gl obal l y. Int er nat i onal devel opment par t ner s wor k cl osel y wi t h gover nment
and ci vi l soci et y t o i mpl ement , eval uat e and document exper i ences and
pr act i ces and di ssemi nat e t hese wi del y. Det ai l s ar e descr i bed i n 3 t opi cs
bel ow; key suppor t was r ecei ved dur i ng 2008- 2009 f r om t he GFATM, ot her
bi l at er al and mul t i l at er al or gani zat i ons and f ut ur e pl an.
1. Key Support Recei ved

1. 1 Support recei ved f rom t he GFATM Grant s on HIV/ AIDS
Thai l and had r ecei ved t GFATM gr ant s f r om Round 1, 2, 3 and 8 f undi ng.
The t ot al amount of US$ 210 mi l l i on has been appr oved. As of Mar ch 2010,
US$ 160 mi l l i on was di sbur sed. At t he end of 2008, t he GFATM Round 2 and
3 wer e compl et ed successf ul l y. Cur r ent l y, Thai l and i s i mpl ement i ng Round
1- RCC and Round 8 f or HIV/ AIDS.
In Round 1- RCC f ocused on pr ovi di ng compr ehensi ve HIV/ AIDS pr event i on
and car e t hr ough pr ovi nce- based and cent r al sect or pr ogr ams t hat cover al l
yout h t ar get popul at i ons i n f our mai n set t i ngs: communi t i es, school s,
wor kpl aces and heal t h ser vi ces. In addi t i on, t he Round 1- RCC pr ogr am
f ocused on sub- popul at i on gr oups consi st i ng of mi gr ant s and et hni c
mi nor i t i es. A t ot al amount of US$ 98 mi l l i on was appr oved f or 6 year s
st ar t i ng f r om 2008.
Round 8 emphasi zed scal i ng up an i nt egr at ed package of HIV pr event i on
ser vi ces t ar get i ng most - at r i sk popul at i ons ( FSW, IDU and MSM) and mi gr ant s
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i n 43 pr ovi nces. Pr oj ect act i vi t i es st ar t ed i n June 2009 wi t h t he t ot al
amount of US$ 106 mi l l i on al l ocat ed f or t he per i od unt i l 2013.
1. 2 Support f rom ot her bi l at eral and mul t i l at eral organi zat i ons
USG ( Thai l and MOPH- US CDC col l abor at i on and USAID) i s a key bi l at er al
donor s i n Thai l and wi t h t he budget f or i nt er vent i ons of appr oxi mat el y US$
2. 5 mi l l i on annual l y. Key suppor t emphasi zes r epl i cat i on of HIV pr event i on,
car e and t r eat ment model s t hat can be adopt ed by t he nat i onal syst em,
i ncr easi ng t he avai l abi l i t y and capaci t y on st r at egi c i nf or mat i on and M&E i n
or der t o demonst r at e t he ef f ect i veness of and i mpr oved per f or mance of HIV
pr ogr ams. Mul t i l at er al or gani zat i ons i n Thai l and consi st of WHO, UNFPA,
UNIFEM, UNODC, UNDP, Wor l d Bank, IOM, ILO, UNHCR and UNAIDS. Tot al
suppor t was US$ 1. 4 mi l l i on i n 2008 and i ncr eased t o US$ 1. 7 mi l l i on i n
2009. The Uni t ed Nat i ons ef f or t i s f ocused mai nl y on pr event i on, st r at egi c
pl anni ng, management and M&E, and account ed f or 70%of over al l suppor t .
Ot her ar eas i ncl uded t r eat ment and car e, r esear ch, enabl i ng envi r onment
and bui l di ng capaci t y and meani ngf ul i nvol vement of ci vi l soci et y.
HIV prevent i on t arget i ng most -at -ri sk popul at i ons (MARPs) and mi grant
workers
HIV and AIDS pr ogr am t ar get i ng of MARPs i s a key pr i or i t y ar ea t hat was
suppor t ed by most of i nt er nat i onal devel opment par t ner s dur i ng 2008- 2009.
Success of Thai l and s GFATM Round 8 appl i cat i on was a key r esul t of good
col l abor at i on of devel opment par t ner s, CCM and l ocal count er par t s. Apar t
f r om t he GF, act i vi t i es suppor t ed f or each MARP ar e l i st ed bel ow: -
y HIV pr ogr am t ar get i ng MSM: TUC pr ovi ded TA f or devel opment of a
r api d HIV t est i ng model , a qual i t y measur ement t ool f or HIV
counsel i ng and t est i ng ( VCT HIVQUAL) , and peer - based HIV pr event i on
model s f or MSM i n 3 pr ovi nces; Phuket , Khon Kaen and Udon. Whi l e
USAID t hr ough FHI and PACT has st r engt hened MSM, CBOs
i mpl ement ed HIV pr event i on and car e t ar get i ng MSM and f ocused
ef f or t s i n t hr ee hot spot s : Bangkok, Chi ang Mai , and Chonbur i
( Pat t aya) . USAID i mpl ement ed communi cat i ons campai gns t o pr ovi de
i nf or mat i on and ser vi ces r el at ed t o HIV and STI pr event i on. WHO
suppor t ed devel opment of cl i ni cal management of STI and l i f e ski l l s
cur r i cul um on HIV and STI pr event i on f or MSM. ILO and UNICEF
devel oped a j oi nt pr oj ect on r educi ng t he HIV vul ner abi l i t i es of MSM
at saunas i n Bangkok.
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y HIV pr ogr am t ar get i ng SW: UNFPA has pr ovi ded suppor t t o i mpr ove
access and i ncr ease ut i l i zat i on of SRH/ HIV ser vi ces among sex
wor ker s and t hei r cl i ent s t hr ough devel opment and ut i l i zat i on of
evi dence- based i nf or mat i on f or pol i cy devel opment and advocacy,
and suppor t i ng Pr ovi nci al Heal t h Of f i ces t o st r engt hen SRH/ HIV
ser vi ces of f emal e sex wor ker s i n Dan Nok di st r i ct of Songkl a and
Lampang. The pr oj ect s have r eached over 2, 000 sex wor ker s t hr ough
out r each educat i on, mobi l e cl i ni cs and qual i t y RH/ STI ser vi ces.
UNFPA al so pr ovi ded suppor t t o Ser vi ce Wor ker s i n Gr oup Foundat i on
( SWING) t o pr ovi de out r each ser vi ce t o f emal e sex wor ker s i n Pat t aya
and t o pr ovi de TA t o devel op an educat i onal t ool on sexual heal t h
and HIV f or sex wor ker s i n kar aoke set t i ngs. UNFPA and TUC
st r engt hened capaci t y of STI/ HIV ser vi ces f or mal e sex wor ker s i n
Bang Rak Hospi t al ( t he nat i onal cent er f or STI) and i mpr ovement of
counsel i ng pr ocesses and out r each, and mappi ng of est abl i shment s.
x The i nt er vent i ons among IDU: UNAIDS, UNODC, WHO, TUC have
suppor t ed devel opment of a compr ehensi ve har m r educt i on pol i cy.
WHO suppor t ed devel opment of compr ehensi ve t echni cal gui del i nes
on HIV pr event i on among IDUs, i ncl udi ng har m r educt i on f or heal t h
car e wor ker s, and t hi s was di st r i but ed t o hospi t al s t hr oughout t he
count r y t o i mpr ove har m r educt i on ser vi ces f or IDUs. WHO, UNAIDS
and UNODC or gani zed a pol i cy st udy t our t o Mal aysi a i n 2009. Wor l d
Bank suppor t ed a har m r educt i on exper t t o under t ake a st at e- of - t he-
ar t r evi ew and pr ovi de r ecommendat i ons t o i mpr ove pol i cy and
pr ogr am pl anni ng.
x The i nt er vent i ons f or mi gr ant wor ker s: Canada s Sout h East Asi a
Regi onal HIV/ AIDS Pr ogr am, wi t h f undi ng f r om t he Canadi an
Int er nat i onal Devel opment Agency ( CIDA) , and Rockef el l er
Foundat i on, suppor t ed st r engt heni ng net wor ks on mi gr ant sexual
heal t h. Inf or mat i on, Educat i on, and Communi cat i on ( IEC) mat er i al s
on HIV/ AIDS wer e di st r i but ed i n mi gr ant concent r at ed ar eas such as
Samut Sakor n and Ranong under t he Mi gr ant Heal t h Pr ogr am ( MHP)
Pr oj ect suppor t ed by IOM. The mat er i al s wer e i n t he mi gr ant s'
l anguages and t he t opi cs cover ed i ncl uded basi c i nf or mat i on about
t he di sease, mode of i nf ect i on, condom use et c. UNHCR suppor t ed
t he pr oduct i on of appr opr i at e HIV IEC Mat er i al s, such as post er s,
l eaf l et s and t ool s t o be di st r i but ed i n t he camps f or di spl aced per sons
al ong t he Thai / Myanmar bor der .
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Int ervent i ons among t he general popul at i on
Apar t f r om t he MARPs, t he i nt er nat i onal or gani zat i ons mai nl y suppor t ed
i nt er vent i ons among yout h and r epr oduct i ve age as f ol l ows: -
x PMTCT: In 2009, UNICEF pr ovi ded f i nanci al suppor t f or t r ai ni ng i n
r epr oduct i ve heal t h f or HIV- i nf ect ed pr egnant women. UNICEF al so
cont r i but ed t owar ds i mpr oved pr ogr am moni t or i ng and i dent i f i cat i on
of pr ogr ammat i c gaps, i ncl udi ng f i nanci al suppor t f or devel opment
and t est i ng of CHILD Pl us moni t or i ng sof t war e t o moni t or chi l dr en
bor n f r om mot her s wi t h HIV.
UNFPA has pr ovi ded suppor t t o Depar t ment of Heal t h ( DoH) t o
i mpl ement a pi l ot pr oj ect on mal e i nvol vement t o pr event i nt i mat e
par t ner t r ansmi ssi on of HIV t hr ough t he MCH pr ogr am i n 6 Regi onal
Heal t h Cent er s of t he Depar t ment of Heal t h and f our pi l ot pr ovi nces
i n Mae Hong Son, Lampang, Songkl a, and Nar at hi wat . The key
st r at egi es of t he pr oj ect wer e f i nal l y accept ed by t he nat i onal MCH
Commi t t ee t o i ncor por at e coupl e counsel i ng i nt o t he PMTCT and MCH
pr ogr am. Thi s pr ogr am wi l l st r engt hen Pr ong One of PMTCT t o
pr event HIV i n pr egnant mot her s and keep t he f ami l y HIV- negat i ve.
Pol i cy on f r ee VCT f or coupl es of pr egnant women at t endi ng
ant enat al car e as par t of t he Uni ver sal Cover age package was
devel oped and was l aunched successf ul l y. The package has been
endor sed i n 2009. UNFPA has al so suppor t ed t he DOH t o devel op and
i mpl ement RH ser vi ces f or peopl e l i vi ng wi t h HIV. The pr oj ect , wi t h
meani ngf ul i nvol vement of PLHA, wi l l r educe t he pr obl ems of
uni nt ended pr egnancy and f or ced cont r acept i on i n PLHA t oget her
wi t h i mpr ovement of l i nkages bet ween HIV and r epr oduct i ve heal t h
ser vi ces. The pi l ot model has been wel l accept ed by t he nat i onal
commi t t ee, and t her e ar e pl ans f or nat i onal scal i ng up i n t he comi ng
year s.
x HIV pr event i on among yout h and r epr oduct i ve age popul at i on: UNFPA
has pr ovi ded suppor t t o t he DoH t o est abl i sh t he nat i onal st andar d f or
yout h f r i endl y heal t h ser vi ces t oget her wi t h t he qual i t y assur ance
syst em, suppor t ed t he Sol ut i on Exchange t o pr ovi de an el ect r oni c
f or um t o t he communi t y of pr act i t i oner s on HIV and young peopl e
t hat r eached t o over 900 member s. UNFPA wor ked cl osel y wi t h NHSO,
t he Thai Heal t h Pr omot i on, t he Round 1- RCC and PATH t o under t ake
a pi l ot model f or VCT/ STI/ FP f r i endl y ser vi ces f or young peopl e i n
vul ner abl e si t uat i ons i n Bangkok ( Love Car e St at i on) . Over 20, 000
cl i ent s have r ecei ved ser vi ces f r om 14 pr i vat e and publ i c cl i ni cs i n
Bangkok, mobi l e counsel i ng ser vi ces, and web based consul t at i on.
UNFPA has pr ovi ded suppor t f or t he 3r d year t o t he Pr ovi nci al Heal t h
Of f i ce i n Lampang pr ovi nce t o i mpr ove access t o gender and
cul t ur al l y sensi t i ve i nf or mat i on, counsel i ng, and ser vi ces f or HIV and
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FP among yout h i n 14 secondar y and vocat i onal school s t hr ough t he
compr ehensi ve appr oach.
UNICEF suppor t ed t he l i f e ski l l s- based educat i on model t ar get i ng
st r eet Musl i m yout hs t hat emphasi zes cul t ur al l y appr opr i at e
appr oaches i n Isl ami c school s. The pr ogr am wi l l be moni t or ed,
eval uat ed, and document ed i n 2010.
UNAIDS t oget her wi t h UNIFEM conduct ed a st udy on t he Femi ni zat i on
of AIDS: Gender Power Dynami cs wi t hi n Mar r i ages and Ser o-
Di scor dant Coupl es Thei r Impl i cat i ons f or Pl ans of Act i on i n
Thai l and , whi ch f ocused on t he pat t er ns of r i sk among mar r i ed
women or women i n st abl e r el at i onshi ps.
Fi nal l y t he nat i onal gui del i nes on t he pr event i on and management of
HIV/ AIDS i n t he wor kpl ace wer e si gned by t he Pr i me Mi ni st er i n
August 2009, The ILO pr ovi ded t echni cal i nput dur i ng i t s devel opment
and al so ensur ed t hey r ef l ect ed a r i ght s- based appr oach.
Support on care, support and t reat ment
x TUC pr ovi ded TA f or devel opment and expansi on of t he HIVQUAL- T
qual i t y car e syst em, devel opment and expansi on of t he pedi at r i c ARV
car e net wor k, devel opment of posi t i ve pr event i on pr ogr am and
l i nkages t o car e f or MSM, devel opment of posi t i ve pr event i on
messages and counsel i ng t ool s f or HIV out pat i ent cl i ni c cl i ent s and
per i nat al l y HIV- i nf ect ed yout h, devel opment of a qual i t y- of - car e
pr ogr am f or STI cl i ni c- based ser vi ces ( STIQUAL) , and devel opment of
a pedi at r i c HIV di scl osur e model .
x UNICEF pr ovi ded t echni cal and f i nanci al suppor t f or pi l ot i ng of
compr ehensi ve pedi at r i c HIV car e and t r eat ment pr ogr ams, i ncl udi ng
psychosoci al suppor t t hr ough i nnovat i ve i nt er vent i ons such as ar t
t her apy f or chi l dr en i nf ect ed wi t h HIV. UNICEF al so pr ovi ded suppor t
t o bui l d capaci t y of TNP+ and PHA gr oups t o pr omot e t hei r suppor t i ng
r ol es i n HIV pedi at r i c car e del i ver y as wel l as pr omot i ng advocacy
r ol es of chi l dr en l i vi ng wi t h HIV t hr ough medi a devel opment t o
r educe st i gma and di scr i mi nat i on t hr oughout t he count r y. UNICEF
suppor t ed t he devel opment of peer suppor t pr ogr ams and sex
educat i on and r epr oduct i ve heal t h t r ai ni ng f or adol escent s l i vi ng wi t h
HIV, t hr ough st r engt heni ng of chi l d and adol escent par t i ci pat i on f or
t hose i nf ect ed and af f ect ed by HIV.
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x USAID suppor t ed pr event i on wi t h posi t i ves among MSM usi ng a peer
appr oach i n Chi ang Mai , home- based car e t o HIV- posi t i ve r esi dent s of
Bangkok, and i ncome- gener at i on act i vi t i es t o r educe st i gma and
di scr i mi nat i on f or PLHA.
x UNIFEM suppor t ed t he HIV posi t i ve women's net wor k ef f ect i ve
cont r i but i on, and t hei r i nput s ar e r ef l ect ed i n t he publ i cat i on ( i ) "
Di amonds- St or i es of Women f r om t he Asi a Paci f i c Net wor k of Peopl e
Li vi ng wi t h HIV ( i i ) par t i ci pat ed i n t he r esear ch on 'Spousal / Par t ner
Tr ansmi ssi on on AIDS ( i i i ) Advocat ed f or i ssues of HIV posi t i ve women
at t he Nat i onal AIDS Conf er ence and semi nar s t hr ough t he l aunch of
t he publ i cat i on 'Di amonds. '
x WHO emphasi zed pol i cy advocacy t o ensur e t hat ART was avai l abl e
and accessi bl e f or non- Thai HIV/ AIDS pat i ent s. Advocacy f or heal t h
car e ser vi ce devel opment f or t hi s under ser ved gr oup i s on- goi ng and
wi l l need col l abor at i ve ef f or t s f r om ot her st akehol der s, i ncl udi ng
t hose i n t he l ocal heal t h car e syst em, t o ensur e t hat t he non- Thai
popul at i on wi l l have access t o appr opr i at e heal t h car e ser vi ces
i ncl udi ng ART.
x UNHCR suppor t ed INGOs t o bui l d t he capaci t y of t hei r VCT cl i ni cs, as
wel l as t he PLHA suppor t gr oups i n 5 camps. UNHCR was a key pl ayer
i n advocat i ng f or t he i ncl usi on of di spl aced per sons i n camps and
ot her per sons of concer n t o UNHCR i n t he Thai Nat i onal ART pl an
( NAPHA Ext ensi on Pr ogr am) . In addi t i on UNHCR suppor t ed Thai
or phans af f ect ed by AIDS i n t he Thai communi t y near Mae Ra Ma
Luang camp. In addi t i on, UNHCR suppor t ed a smal l l i vel i hoods
pr ogr am i n t wo camps f or peopl e l i vi ng wi t h HIV.
Ot her support s:
x A UN Joi nt Pr ogr am suppor t ed AIDS Ri ght s Advocacy and St i gma
Di scr i mi nat i on Index Devel opment . A Repor t t o r evi ew l egal and
pol i cy i ssues r el at ed t o HIV and AIDS and human r i ght s i n Thai l and i s
compl et ed. A r i ght s pr ot ect i on cur r i cul um was devel oped and used i n
t he t r ai ni ng of 100 t r ai ner s who t hen t r ai ned 800 t r ai nees. A
gui del i ne on human r i ght s was pr oduced f or PLHA and wor ker s, and
advocacy mat er i al s on human r i ght s wer e pr oduced and
di ssemi nat ed. A r epor t on St i gma and Di scr i mi nat i on Devel opment
was pr oduced and pr esent ed at t he nat i onal meet i ng t o r ai se publ i c
awar eness on human r i ght s and HIV and AIDS i ssues. WHO pr ovi ded
suppor t on st r engt heni ng t he capaci t y and empower i ng of t eenager s
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l i vi ng wi t h HIV/ AIDS t o mi t i gat e t he i mpact of st i gma and
di scr i mi nat i on.
x Thr ough suppor t f r om UNDP, a case st udy on t he r ol e of Local
Gover nment Uni t s i n f i nanci ng and pr ovi si on of heal t h ser vi ces i n t wo
sel ect ed pr ovi nces, Lampang and Nakor n Phanom, was conduct ed.
The pur pose of t hi s st udy was t o assess t he t r end and cur r ent r ol es of
TAO and Muni ci pal i t i es. Enhanced GF gr ant i mpl ement at i on i n
Thai l and was conduct ed t hr ough l ocal par t ner capaci t y bui l di ng and
i mpr oved mul t i - sect or al l ocal r esponse pr ogr ammi ng f or AIDS on
t hr ee aspect s: ( 1) Assessment of capaci t y needs of l ocal gover nment s;
( 2) Pl anni ng and i mpl ement at i on f or a Compr ehensi ve Local Response
t o HIV; and ( 3) Devel opment of gui del i nes f or capaci t y devel opment .
x UNAIDS suppor t ed capaci t y bui l di ng of ci vi l soci et y or gani zat i ons
t hr ough f aci l i t at i ng meani ngf ul i nvol vement i n t he 2010 Thai l and
UNGASS Repor t , Mi d- t er m Revi ew of Nat i onal St r at egi c Pl an and
Int er nat i onal Har m Reduct i on Conf er ence.
x In 2009, WHO suppor t ed t he 12
t h
Nat i onal AIDS Semi nar at whi ch mor e
t han 2, 000 heal t h st af f , of f i ci al f r om var i ous mi ni st r i es, as wel l as
st af f f r om ci vi l soci et y or gani zat i ons and peopl e l i vi ng wi t h HIV/ AIDS
par t i ci pat ed. The semi nar has been t he f or um f or wor ker s f r om al l
l evel s t o shar e t hei r knowl edge and i nf or mat i on and t o st r engt hen
t hei r net wor ks t o pr ovi de ser vi ce f or cl i ent s i n t he Nat i onal AIDS Pl an.
x UNFPA has pr ovi ded suppor t t o t he DDC t o est abl i sh t he nat i onal
wor ki ng gr oup on compr ehensi ve condom pr ogr ammi ng wi t h
par t i ci pat i on f r om al l key st akehol der s. The commi t t ee has done a
si t uat i on anal ysi s and dr af t ed t he f i r st nat i onal st r at egi c pl an f or
compr ehensi ve condom pr ogr ammi ng ( CCP) whi ch ai ms t o pr omot e
t he condom not onl y as a pr event i ve t ool f or STI/ HIV and uni nt ended
pr egnancy but al so f or heal t hy sexual i t y and hygi ene. The st r at egi c
pl an has al so compr ehensi vel y addr essed t he access t o and ut i l i zat i on
of condoms f or demand cr eat i on as wel l as suppl y; coor di nat i on and
l eader shi p; management and suppor t . UNFPA has al so suppor t ed DDC
t o devel op t r ai ni ng cur r i cul a and modul es, pr ovi de pi l ot t r ai ni ng of
t r ai ner s ( TOT) , and pi l ot t r ai ni ng of st af f f r om l ocal admi ni st r at i ve
or gani zat i ons f or t he management of compr ehensi ve condom
pr ogr ammi ng, and suppor t ed t he i ni t i at i ves t o i nt r oduce t he f emal e
condom i nt o t he condom pr ogr ammi ng i n Thai l and.
x TUC has suppor t ed t r ai ni ng f or heal t h car e st af f i n a var i et y of
t echni cal ar eas i ncl udi ng counsel i ng and t est i ng, pr ovi der sensi t i vi t y
and STI management f or most - at - r i sk popul at i ons ( MARPS) ; syst em
devel opment f or Ext er nal Qual i t y Assessment ( EQA) syst ems f or HIV
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ser ol ogy, CD4 t est i ng, HIV vi r al l oad, oppor t uni st i c i nf ect i ons, and
genot ypi c r esi st ance t est i ng; and t r ai ni ng on l abor at or y di agnost i cs
f or HIV and CD4 t est i ng, f ungal and TB cul t ur es, and mol ecul ar
met hods f or STI exami nat i on, and TA f or expansi on and devel opment
of l abor at or y net wor ks as par t of t he nat i onal l abor at or y
accr edi t at i on pr ogr am.
x UNHCR suppor t ed mai nt enance of a dat abase of al l HIV IEC mat er i al s
whi ch was shar ed wi t h par t ner s and wer e made avai l abl e upon
r equest . In addi t i on, HIV/ AIDS and TB publ i cat i ons wer e shar ed wi t h
al l NGOs and di ssemi nat ed t hr ough t he mont hl y Commi t t ee f or
Coor di nat i on of Ser vi ces t o Di spl aced Per sons i n Thai l and ( CCSDPT)
Heal t h meet i ngs. UNHCR al so net wor ked t hr oughout 2009 wi t h t he
MOPH, UN agenci es, INGOs, nat i onal NGOs, and t he pr i vat e sect or i n
or der t o f i nd ways t o st r engt hen HIV pr ogr ammi ng f or t hose per sons
of concer n.
Support on moni t ori ng and eval uat i on of HIV/ AIDS prevent i on and
al l evi at i on
x TUC i s t he key devel opment par t ner pr ovi di ng t echni cal suppor t on
devel opment and expansi on of HIV i nf ect i on sur vei l l ance syst ems: HIV
i nci dence sur vei l l ance usi ng subt ype BED IgG capt ur ed- based enzyme
i mmunoassay, hand- hel d comput er - based behavi or al sur veys i n yout h
and FSW, advanced sampl i ng t echni ques ( r espondent - dr i ven and
venue- day- t i me) f or sur veys of MSM and FSW, t hr eshol d sur veys f or
HIV r esi st ance and HIV r esi st ance cohor t moni t or i ng, and TA t o Thai
nat i onal M&E pr ogr ams f or use of PMTCT and car e and t r eat ment dat a
as par t of t he Nat i onal AIDS Pr ogr am ( NAP) dat abase.
x USAID t hr ough FHI and PACT wor ked cl osel y wi t h TUC t o devel op an
M&E gui de f or t he MSM pr event i on pr ogr am t hat pr ovi ded
st andar di zat i on of i ndi cat or s t o moni t or t he MSM HIV pr event i on
pr ogr am. Fur t her , TA was pr ovi ded t o devel op a pr ogr am moni t or i ng
t ool i ncl udi ng dat a col l ect i on f or ms and dat abase as wel l as a
moni t or i ng t r ai ni ng modul e. Dat a use t r ai ni ng was conduct ed ear l y i n
2009 f or CBOs i mpl ement i ng MSM pr ogr ams.
x UNFPA suppor t ed t he DDC on conduct i ng t r ai ni ng gover nment st af f on
under t aki ng annual sur vey of sex wor ker s and sex est abl i shment as
wel l as suppor t i ng knowl edge management on synt hesi s appr oach t o
f r eel ance sex wor ker s and venue based sex wor ker s.
x WHO suppor t ed an Epi demi ol ogy Tr ai ni ng Pr ogr am on AIDS f or
Techni cal Heal t h Of f i cer s f r om sever al pr ovi nces who ar e r esponsi bl e
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f or t he anal ysi s of epi demi ol ogi cal dat a on HIV/ AIDS. In t hi s t r ai ni ng
pr ogr am, 20 par t i ci pant s upgr aded t hei r ski l l s t o ensur e good qual i t y
sur vei l l ance, and t o conduct wel l desi gned sur veys and
epi demi ol ogi cal r esear ch i n t hei r own pr ovi nces.
x UNAIDS f i nanci al l y and t echni cal l y suppor t ed t he devel opment of t he
mappi ng of eval uat i on st udi es f or HIV pr event i on t ar get i ng MARPs and
t he M & E pl an f or pr event i on t ar get i ng MARPs.
x UN j oi nt pr ogr am suppor t ed f unct i ons of si xt een nat i onal moni t or i ng
and eval uat i on wor ki ng gr oups t o pr ovi de t echni cal di r ect i on and/ or
i mpl ement M&E f or HIV epi demi c and nat i onal r esponses.
x UN j oi nt pr ogr am and USG pr ovi ded f i nanci al and t echni cal suppor t t o
devel opment of 2010 UNGASS t hat ai med at i ncr easi ng avai l abi l i t y of
key HIV epi demi c r esponses, i mpr ovi ng t he qual i t y of r epor t i ng and
mobi l i zi ng t he f ul l i nvol vement of ci vi l soci et y and sub nat i onal
count er par t s. UNPFA has al so suppor t ed document at i on of best
pr act i ces.
x Wor l d Bank and UNAIDS suppor t ed a t r ai ni ng on si ze est i mat i on si ze
of MARPs.
x Key st udi es compl et ed t hr ough suppor t f r om devel opment par t ner s
ar e as f ol l ows;
WHO and UNAIDS suppor t ed t he mi d- t er m r evi ew of t he
nat i onal st r at egi c pl an 2007- 2011.
WHO suppor t ed a nat i onal sexual behavi or st udy on
chi l dr en ad yout h i n j uveni l e det ent i on and pr ot ect i on
cent er s and a st udy t o est i mat e const ant wei ght
( f r act i on r at e) of chi l d del i ver i es i n Thai l and based on a
sur vey i n f our pr ovi nces. The st udy ai ms t o ver i f y t he
cover age of ant enat al car e ( ANC) and bi r t h del i ver i es
ser vi ce i n Thai l and compar ed t o i ndi cat or s f r om
moni t or i ng t he pr ogr ess of PMTCT act i vi t i es.
USAID compl et ed an eval uat i on st udy on t he pr event i on
wi t h posi t i ves model .
(b) Act i ons t hat need t o be t aken by devel opment part ners t o ensure
achi evement of t he UNGASS t arget s.
Suppor t f r om i nt er nat i onal devel opment par t ner s i s vi t al t o success of t he
HIV and AIDS pr ogr am i n Thai l and. In 2010- 2011, key act i on needs t o be
t aken t o ensur e t hat t he cont r i but i on of devel opment par t ner s can best
ser ve nat i onal needs. At t he same t i me, devel opment par t ner s need t o be
abl e t o manage TA r equest s ef f ect i vel y;
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x St r engt heni ng col l abor at i on on pl anni ng of TA wi t hi n key donor s
and/ or devel opment par t ner s and wi t h nat i onal count er par t s t o
i mpr ove ef f ect i veness of t echni cal assi st ance and yi el d good r esul t s
f or t he nat i onal pr ogr am.
x To ensur e best use of t he cont r i but i on f r om devel opment par t ner s,
nat i onal count er par t s need t o be wel l i nf or med on pr oj ect
devel opment , i mpl ement at i on, r esul t s of model s devel oped,
par t i cul ar l essons l ear ned i n or der t o ensur e best pr act i ces have been
adopt ed and scal ed up by t he nat i onal pr ogr am ef f ect i vel y.
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VII. Moni t ori ng and Eval uat i on Envi ronment
A. An overvi ew of t he current M&E syst em
Est abl i shment of t he Nat i onal M&E uni t and st ruct ure
The Nat i onal M&E syst em, f ol l owi ng t he Thr ee Ones pr i nci pl e, i s an
i mpor t ant t ool f or Thai l and s Nat i onal HIV/ AIDS Pr ogr am t o pr omot e
ef f ect i ve management and account abi l i t y f or t he HIV / AIDS r esponse. In
ear l y 2007, t he Nat i onal AIDS Pr event i on and Al l evi at i on Subcommi t t ee
( NAPAC) endor sed t he devel opment of t he nat i onal HIV/ AIDS M&E syst em as
par t of t he Nat i onal HIV/ AIDS St r at egi c Pl an ( 2007- 2011) . Dur i ng 2008- 2009,
t hr ee key f unct i ons wer e i dent i f i ed and or gani zat i onal r esponsi bi l i t y cl ear l y
assi gned;
1. Moni t or i ng t he nat i onal HIV epi demi c, i ncl udi ng i mpact and out come
moni t or i ng: The Bur eau of Epi demi ol ogy ( BoE) i s t he l ead
or gani zat i on t o devel op and conduct compr ehensi ve HIV and AIDS
sur vei l l ance syst ems.
2. Moni t or i ng t he nat i onal r esponse: The Nat i onal AIDS Management
Cent er ( NAMc) has pl ayed t he r ol e of t he nat i onal HIV/ AIDS M&E uni t
si nce i t s est abl i shment i n 2009. NAMc wi l l devel op, i mpl ement ,
coor di nat e and mai nt ai n t he nat i onal M&E pl an and syst em i n
col l abor at i on wi t h ot her or gani zat i ons wi t hi n t he MOPH such as
Nat i onal Secur i t y and Heal t h of f i ce ( NHSO) , t he Bur eau of HIV/ AIDS,
TB and STI ( BATS) , Depar t ment of Heal t h ( DOH) and ot her mi ni st r i es
such as t he Mi ni st r y of Int er i or , Mi ni st r y of Educat i on, Mi ni st r y of
Labor , Mi ni st r y of Soci al Devel opment and Human Secur i t y, ci vi l
soci et y, bi l at er al donor s and mul t i l at er al or gani zat i ons.
3. Devel opi ng t he nat i onal eval uat i on and r esear ch agenda and pl an f or
use of dat a: The Consor t i um f or Techni cal Assi st ance on Resear ch
and Eval uat i on pl ays t he r ol e of t he t hi nk t ank t o t he nat i onal M&E
uni t and i s managed and coor di nat ed by NAMc. The Consor t i um
consi st s of t echni cal exper t s f r om mul t i - di sci pl i nar y ar eas f r om
academi a ( l ocal and i nt er nat i onal ) , i mpl ement er s, epi demi ol ogi st s,
et c. The Consor t i um wi l l pr ovi de st at e- of - t he- ar t ( SOTA)
met hodol ogi es on t echni cal aspect s f or pr ogr am i mpl ement at i on,
pol i cy devel opment , key st r at egi c i nf or mat i on and M&E.
These t hr ee key mechani sms have wor ked under t he t echni cal di r ect i on
pr ovi ded by t he Nat i onal M&E St eer i ng Commi t t ee. In 2009, M&E Techni cal
Wor ki ng Gr oups ( TWG) have been appoi nt ed. TWGs ar e or gani zed f or each
t echni cal ar ea and key t ar get popul at i ons such as si t uat i on anal ysi s and
Heal t h Inf or mat i on Syst em. The TWGs consi st of r epr esent at i ves f r om
mul t i - sect or al agenci es i ncl udi ng gover nment , CBO, NGO, academi a, PLHA,
MARP r epr esent at i ves, donor s and UN or gani zat i ons.
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Devel opment of t he nat i onal M&E f ramework
A l i st of i ndi cat or s used t o moni t or epi demi c and nat i onal r esponse i s
pr esent ed i n t he nat i onal st r at egi c pl an: 2007 2011 and t he Uni ver sal
Access oper at i onal pl an ( UA pl an) . Fur t her pr ogr ess has been made t o
har moni ze and i nt egr at e al l ef f or t s t o devel op an ef f ect i ve nat i onal M&E
syst em f or obt ai ni ng and ut i l i zi ng hi gh- qual i t y st r at egi c i nf or mat i on f or t he
HIV pr event i on, car e and t r eat ment .
To achi eve t he nat i onal M&E goal , Thai l and cal l s f or devel opi ng and
st r engt heni ng a uni f i ed nat i onal M&E syst em, i nt egr at i ng ef f or t s f r om al l
sect or s and f r om bot h sub- nat i onal and nat i onal l evel s, moni t or i ng t he HIV
epi demi c and nat i onal r esponse on pr event i on, car e and t r eat ment ,
devel opi ng an ef f ect i ve r out i ne heal t h i nf or mat i on syst em i nt egr at i ng
communi t y- based dat a syst em wi t h nat i onal syst em, i mpr ovi ng t he
avai l abi l i t y and qual i t y of t he sur vei l l ance syst ems t o pr ovi de val i d
evi dence f or i mpact and out come moni t or i ng of nat i onal pr ogr ams,
i ncr easi ng t he avai l abi l i t y, qual i t y and use of r esear ch and eval uat i on dat a
t o i mpr ove t he ef f ect i veness and i ncr ease t he cost ef f ect i veness of t he
nat i onal r esponse, devel opi ng capaci t y f or conduct i ng and usi ng hi gh- qual i t y
M&E at t he nat i onal , sub- nat i onal and ci vi l soci et y l evel and f i nal l y
i ncr easi ng t he use of pr ogr am evi dence and r esear ch f i ndi ngs f or ef f ect i ve
nat i onal pol i cy devel opment .
In 2009, t wo M&E pl ans have been devel oped; The nat i onal M&E pl an f or
HIV pr event i on t ar get i ng most -at r i sk popul at i ons and The M&E pl an f or
Tuber cul osi s i ncl udi ng TB/ HIV t hr ough a par t i ci pat or y pr ocess wi t h t he
mul t i - sect or al or gani zat i ons i nvol ved i n i mpl ement i ng t hese pr ogr ams. In
addi t i on, Key Per f or mance Indi cat or s ( KPI) have been devel oped as a
har moni zed t ool among key gover nment or gani zat i ons t o moni t or pr ogr ess of
HIV and AIDS pr ogr ams. Thai l and wi l l devel op a compr ehensi ve nat i onal M&E
pl an al ong wi t h t he new nat i onal st r at egi c pl an f or 2012- 2016.
In ser vi ce of t he shar ed vi si on depi ct ed above, a number of achi evement s
have been accompl i shed i n 2008- 2009 on key st r at egi c i nf or mat i on i ncl udi ng
moni t or i ng and eval uat i on ( M&E) act i vi t i es as f ol l ows;
A. 1 Comprehensi ve HIV and AIDS Survei l l ance Syst em i n Thai l and
Thai l and has devel oped sur vei l l ance syst ems accor di ng t o t he nat ur al and
cour se of di sease. Ther e ar e f our t ypes of sur vei l l ance syst ems t hat ar e used
t o moni t or t he HIV epi demi c, out come and i mpact of nat i onal r esponses ( see
f i gur e VIII - 1) . Det ai l of each syst em i s descr i bed as f ol l ows;
1) Behavi or al Sur vei l l ance Syst em
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a. Behavi or al Sent i nel Sur vei l l ance ( BSS)
b. Int egr at ed Bi ol ogi cal and Behavi or al Sur vei l l ance ( IBBS)
2) HIV ser osur vei l l ance
a. HIV Ser opr eval ence Sur vei l l ance
b. HIV Ser oi nci dence Suvei l l ance
3) Faci l i t y ( hospi t al ) based case r epor t i ng sur vei l l ance
a. HIV newl y di agnosi s
b. HIV i nf ect i on- i mmunol ogi cal cr i t er i a f or ARV
c. Advance AIDS di sease
d. AIDS r el at ed deat hs
4) HIV Dr ug Resi st ance Sur vei l l ance
a. HIVDR Ear l y War ni ng Indi cat or s
b. HIVDR sur vei l l ance among ARV t r eat ed pat i ent s
c. HIVDR Thr eshol d sur vey among FSW and ANC
1) Behavi oral Survei l l ance Syst em
x Behavi or al sent i nel sur vei l l ance (BSS) was f i r st i mpl ement ed i n 1995
among mal e and f emal e f act or y wor ker s, mal e conscr i pt s, st udent i n
secondar y school gr ade 8 and 11, vocat i onal school and FSW. The
i mpl ement at i on f r amewor k of t he nat i onal BSS was compl et ed i n 2006.
Twent y- f our of t he 76 pr ovi nces wer e r andoml y sampl ed t o be t he nat i onal
r ef er ence sent i nel pr ovi nces.
Care&Support/ARVtreatment
Preventioninterventions
RiskExposure
Noninfected HIVinfectedpersons(allclinicalstages)
HIVRecentInfection
(seroconversion) Asymptomatic
HIVinfection
Advance
HIVinfection
Deaths
1and2
3
4
4
Figure32:ComprehensiveHIV/AIDSSurveillanceSystemThailand
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x Int egr at ed bi ol ogi cal and behavi or al sent i nel sur vei l l ance (IBBS):
Gi ven t he evol vi ng of epi demi c, new appr oaches have been devel oped wi t h
t echni cal assi st ance f r om TUC t o appr opr i at el y moni t or t he HIV epi demi c
and pr ovi de dat a f or pl anni ng nat i onal r esponses. IBBS i s t he mai n dat a
sour ce t o moni t or cor e nat i onal pr event i on i ndi cat or s and wi l l be conduct ed
ever y t wo year s. In 2009- 2010, t he Nat i onal AIDS Management Cent er
( NAMc) and BoE have wor ked wi t h pr event i on pr ogr am i mpl ement er s t o
har moni ze and st andar di ze key quest i ons used i n t he IBBS acr oss MARPs and
MWs cover i ng behavi or change, cover age and i nt ensi t y of exposur e f or
communi t y out r each act i vi t i es, and use of HIV t est i ng and counsel i ng and
STI scr eeni ng ser vi ces. The IBBS i n Thai l and f or FSW, MSM and IDU uses sel f -
r epor t ed hand- hel d comput er - assi st ed st r uct ur ed i nt er vi ews t o i ncr ease
conf i dent i al i t y and i mpr ove t he r el i abi l i t y of dat a r el at ed t o sensi t i ve i ssues
i ncl udi ng sexual and ot her r i sky behavi or s.
IBBS among FSW: The f i r st r ound of IBBS f or FSW was conduct ed i n 2003
among venue- based sex wor ker s i n sel ect ed pr ovi nces. Because of t he shi f t
i n pr omi nence f r om di r ect t o i ndi r ect sex est abl i shment s, i t was r ecogni zed
t hat i nst i t ut i onal l y- based sampl i ng i s not suf f i ci ent t o f ul l y measur e t he HIV
epi demi c among FSW i n Thai l and. Recent l y, t he BoE under t ook a pi l ot of an
i nt egr at ed Bi ol ogi cal and behavi or al r i sk sur vei l l ance syst em usi ng
r espondent - dr i ven sampl i ng ( RDS) i n t hr ee t our i st pr ovi nces. Thi s sampl i ng
met hodol ogy al l ows Thai l and t o accur at el y capt ur e t r ends i n t he HIV
epi demi c f or bot h venue and non- venue based FSW. The BoE pl ans t o
i mpl ement RDS i n al l si t es st ar t i ng f r om 2012.
IBBS among MSM (MSM, MSW and Tr ansgender : Thai l and has conduct ed HIV
ser o- sur vei l l ance among mal e sex wor ker s si nce 1997. A combi ned HIV
pr eval ence and behavi or al st udy i ni t i at ed among MSM i n Bangkok i n 2003
r eveal ed ver y hi gh pr eval ence of HIV among MSM ( 17%) . Si nce t hen t he BoE
has i ncor por at ed si mi l ar met hods i n t he nat i onal sur vei l l ance syst em and
expanded dat a col l ect i on t o i ncl ude Chi ang Mai and Phuket Pr ovi nces i n
2005 and 2007 and Udon Thani and Pat t al ung Pr ovi nces i n 2008. The IBBS
among MSM wi l l be expanded t o 13 pr ovi nces i n 2009 onwar ds, usi ng venue-
day- t i me sampl i ng f or al l r ounds of dat a col l ect i on.
IBBS among IDU: In 2007- 2008, t he BoE conduct ed Behavi or al Sent i nel
Sur vei l l ance ( BSS) of IDUs i n Bangkok, Chi ang Mai and Samut Pr akar n. Wi t h
suppor t f r om t he GFATM r ound 8, BoE and PSI pl ans t o under t ake t he IBBS
among IDU i n 8 pr ovi nces i n 2010, 2012 and 2014. Wi t h cl ose col l abor at i on
bet ween BoE and PSI, t he IBBS of IDUs has col l ect ed br oad i nf or mat i on on
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t he pr ocess of behavi or change i ncl udi ng at t i t udes, bel i ef s, t he accessi bi l i t y
and avai l abi l i t y of condoms and needl es/ syr i nges.
IBBS among mi gr ant wor ker s: The BoE has conduct ed annual HIV ser o
sur vei l l ance among f i sher men and mi gr ant wor ker s i n seven pr ovi nces si nce
1989. The IBBS among mi gr ant wor ker s wi l l be f i r st i nt r oduced i n 2010 and
i mpl ement ed i n 10 pr ovi nces. Subsequent r ounds wi l l be under t aken i n 2012
and 2014 t o moni t or changes i n t he epi demi c and HIV r esponses among MWs.
The pr i mar y cr i t er i a f or sel ect i on of t hese 10 pr ovi nces i s t he hi gh densi t y of
mi gr ant wor ker s, most f r om Myanmar , Cambodi a and Laos PDR, and t he hi gh
capaci t y of pr ovi nci al heal t h of f i ce t o under t ake t he i ni t i at i ve.
IBBS among yout hs: Thai l and i s conduct i ng IBBS among mal e mi l i t ar y
conscr i pt s as pr oxy f or mal e yout hs si nce 2009. Lessons l ear ned of i t s
i mpl ement at i on wi l l be cl osel y moni t or ed f or pot ent i al scal i ng up i n f ut ur e.
2) HIV serosurvei l l ance
x HIV ser o-pr eval ence sur vei l l ance (HSS): The HSS syst em has been used t o
moni t or HIV epi demi c i n Thai l and si nce 1989. It was expanded t o al l
pr ovi nces i n June 1990 among 9 sent i nel popul at i ons, i ncl udi ng bl ood donor s,
pr egnant women at ANC cl i ni cs, mal e mi l i t ar y conscr i pt s, mal e cl i ent s at STI
cl i ni cs, mal e and f emal e sex wor ker s i n venues, i nj ect i ng dr ug user s at
t r eat ment cl i ni cs, f i sher man and mi gr ant wor ker s. In 2006, t he nat i onal
sur vei l l ance f r amewor k has been devel oped wi t h t he maj or r evi si on of
St andar d Oper at i on Pr ocedur e ( SOP) and sampl i ng met hodol ogy among
pr egnant women and FSW. However , wi t h evol vi ng r i sk behavi or s and t he
changi ng nat ur e of t he HIV epi demi c, i nst i t ut i onal - based sent i nel
sur vei l l ance has l i mi t at i ons si nce i t does not capt ur e t he HIV epi demi c
among non- venue based sex wor ker s and IDU i n t he communi t i es.
x HIV ser o-i nci dence sur vei l l ance- HIV BED IgG capt ur e Immunoassay (BED
CEIA) f or HIV i nci dence sur vei l l ance: The HIV i nci dence sur vei l l ance usi ng
BED- CEIA has been i mpl ement ed as a par t of HIV sent i nel sur vei l l ance
syst em i n 24 pr ovi nces si nce 2004 among ANC and FSW whi l e mal e mi l i t ar y
conscr i pt s has st ar t ed i n 2006. Because BED r esul t s ar e st i l l of quest i onabl e
accur acy, Thai l and uses t he i nf or mat i on car ef ul l y and t r i angul at es wi t h
ot her sur vei l l ance i nf or mat i on t o cl ear l y under st and HIV epi demi c.
3) Faci l i t y (hospi t al ) based case report i ng survei l l ance
HIV, AIDS case r epor t i ng syst em (Passi ve sur vei l l ance syst ems) : Wi t h good
col l abor at i on of NHSO and BoE, Thai l and has devel oped an i nt egr at ed HIV
sympt omat i c and AIDS case r epor t i ng syst em. Al l hospi t al s par t i ci pat i ng i n
nat i onal heal t h i nsur ance scheme have r epor t ed HIV dat a t hr ough t he
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Nat i onal AIDS Pr ogr am ( NAP) . Thi s comput er i zed syst em can pr ovi de
i nf or mat i on on t he number and char act er i st i cs of newl y di agnosed HIV
i nf ect i on, HIV i nf ect i on- i mmunol ogi cal cr i t er i a f or ARV, advance AIDS cases
and AIDS r el at ed deat hs.
4) HIV Drug Resi st ance Survei l l ance
x HIVDR Ear l y War ni ng Indi cat or s: NHSO and BoE have desi gned and
devel oped t he Nat i onal AIDS Pr ogr amEar l y War ni ng Indi cat or s ( NAP- EWI) .
EWI can be anal yzed f r om t he NAP dat abase. Thai l and has adopt ed WHO
met hodol ogy and r ecommendat i ons t o moni t or appr opr i at e ART pr escr i bi ng
pr act i ces, f ol l ow- up of r et ent i on t o ART r egi mens, dr ug adher ence, cl i ni cal
appoi nt ment s and t r eat ment out comes.
x HIVDR sur vei l l ance among ARV t r eat ed pat i ent s: i s ai med t o moni t or
pr eval ence of ARV dr ug r esi st ance f r om ARV pat i ent cohor t s of t r eat ment
ser vi ces i n 4 sent i nel si t es, and has been oper at i onal si nce 2006.
x HIVDR Thr eshol d sur vey: Thai l and has under t aken t hi s met hod among
FSW as an i ndi r ect measur e of t he ef f ect i veness of pr event i on- wi t h- posi t i ves
pr ogr am. The nat i onal advi sor y commi t t ee has been est abl i shed t o
i mpl ement ARV r esi st ance sur vei l l ance act i vi t i es. The sur vei l l ance
f r amewor k and pr ot ocol have been devel oped. Thai l and has i mpl ement ed
ARV r esi st ance sur vei l l ance among nave r ecent l y- i nf ect ed per sons by
i nt egr at i ng t hr eshol d sur veys i nt o t he exi st i ng nat i onal HSS among FSW si nce
2006.
A. 2 Rout i ne Heal t h Inf ormat i on Syst em (RHIS)
Ther e ar e number of key RHIS i n Thai l and t o moni t or pr ogr ess of act i vi t i es i n
di f f er ent pr ogr am ar eas;
1) Care and t reat ment moni t ori ng syst em
The Nat i onal Heal t h Secur i t y Of f i ce ( NHSO) i nt r oduced t he Nat i onal AIDS
Pr ogr am (NAP) Dat abase i n 2007 whi ch i s a paper l ess syst em t o moni t or
PLHA car e and t r eat ment t hr oughout t he count r y. The management
f r amewor k of t he pr ogr am consi st s of t wo par t s: benef i t package and
suppor t syst em. The benef i t package i ncl udes dr ugs, l abor at or y ser vi ces,
counsel i ng and condoms. The suppor t syst em f ocuses on per sonnel t r ai ni ng,
qual i t y i mpr ovement and M&E.
The NAP syst em consi st s of f our cor e modul es: r egi st r at i on, f ol l ow up,
aut hor i zat i on ( 2nd l i ne ARV) , l abor at or y r equest s and r epor t s, and f our
addi t i onal modul es: VCT, PMTCT, PEP and r epor t i ng syst ems. Dat a i n each
modul e can be l i nked t oget her by NAP ID number . The NAP syst em connect s
al l f aci l i t i es by a web appl i cat i on r unni ng i n r eal - t i me on Int er net Expl or er
wi t h cent r al i zed dat abase. Al l dat a i s sent t o t he Nat i onal Heal t h Secur i t y
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Of f i ce el ect r oni cal l y. The syst em uses a PID ( Per sonal Ident i f i cat i on number )
as a uni que i dent i f i er .
NAP shar es t he dat a wi t h VMI of t he Gover nment Phar maceut i cal
Or gani zat i on so t hey can send t he dr ugs t o t he hospi t al s as t hey ar e needed.
Thi s means communi t y hospi t al s do not have t o car r y l ar ge st ocks of dr ugs.
The dr ugs wi l l be sent t o t he communi t y hospi t al s wi t hi n t wo weeks of t he
r equest . Dat a i s al so used wi t h HIVQUAL t o moni t or per f or mance of car e and
t r eat ment ser vi ces as wel l as ear l y war ni ng i ndi cat or s ( EWI) .
Cur r ent l y, t he NAP syst em i s i n pr ocess of modi f i cat i on t o i mpr ove capaci t y
t o di saggr egat e VCT, car e and t r eat ment i nf or mat i on by most at r i sk
popul at i ons. In addi t i on, t he syst em has l i mi t at i ons t o i nt egr at e communi t y
based ser vi ces t o i t s syst em t hat need t o be i mpr oved i n t he f ut ur e.
It i s est i mat ed t hat NAP cover s about 60% of r egi st er ed ART pat i ent s i n
Thai l and. The r est of t he ART pat i ent s ar e r epor t ed t hr ough ot her syst ems
(t he soci al wel f ar e, ci vi l ser vant and ot her dat abases). Fr agment at i on of
car e and t r eat ment i nf or mat i on syst em has been r ecogni zed by key
st akehol der s and has been i dent i f i ed as a pr i or i t y t ask t hat cal l s f or
i nt egr at i on of t he syst em t o i mpr ove ef f ect i veness of car e and t r eat ment
pr ogr am management .
2) Prevent i on of Mot her-t o-Chi l d Transmi ssi on (PMTCT) moni t ori ng
syst em
Ther e ar e number of PMTCT moni t or i ng syst ems used i n Thai l and. The
Per i nat al HIV Int er vent i on Moni t or i ng Syst em ( PHIMS) , oper at ed by t he DOH,
moni t or s PMTCT act i vi t i es i n 900 gover nment hospi t al s, 76 pr ovi nci al heal t h
of f i ces and 12 heal t h pr omot i on cent er s. The Per i nat al HIV Out come
Moni t or i ng Syst em ( PHOMS) , oper at ed by t he BoE, moni t or s HIV- i nf ect i on
out comes i n exposed chi l dr en i n 28 pr ovi nces. In 2007, USG suppor t ed DoH
t o devel op a new moni t or i ng syst em cal l ed PHIMS pl us. The var i abl es i n
t hi s syst em cover bot h PHIMS and PHOMS var i abl es, and i ncl ude var i abl es on
PMTCT- pl us ser vi ces and l i nkages t o HIV car e pr ogr ams. DoH pl ans t o use
PHIMS pl us i n sel ect ed sur vei l l ance pr ovi nces onl y. And f i nal l y, t he CHILD
moni t or i ng syst em i s used t o moni t or chi l dr en i nf ect ed wi t h HIV f r om t hei r
mot her . The CHILD syst em i s i mpl ement ed i n Heal t h Pr omot i on Cent er s Nos.
9 and 10.
Pr evi ousl y, ARVs f or PMTCT and i nf ant f or mul a wer e suppor t ed by t he DoH.
However , st ar t i ng f r om 2007, ARVs f or PMTCT and f or mul a wi l l be suppor t ed
by NHSO, whi ch has a separ at e moni t or i ng syst em cal l ed Nat i onal AIDS
Pr ogr am ( NAP) . The change has i mpact ed on compl et eness of cover age of
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PHIMS moni t or i ng r epor t s whi ch has decl i ned f r om 97% i n 2001 t o 75% i n
2007. Fur t her wor k i s needed t o be done t o have ef f ect i ve consol i dat ed
syst ems f or PMTCT i n Thai l and.
3) STI program moni t ori ng syst em
The STI cl ust er , Bur eau of AIDS, MOPH i s t he mai n or gani zat i on r esponsi bl e
f or devel opi ng and i mpl ement i ng t he syst em t o r epor t key i ndi cat or s on STI
ser vi ces i ncl udi ng STI scr eeni ng, STI r epor t ed cases and STI t r eat ment . To
ef f ect i vel y moni t or pr event i on ef f or t s f or t ar get ed MARPs, NAMc and Bur eau
of AIDS ar e wor ki ng cl osel y t o i mpl ement a number of act i vi t i es t o
st r engt hen t he STI r epor t i ng syst em, i n par t i cul ar , t o devel op a uni f i ed STI
moni t or i ng syst em by i nt egr at i ng STI act i vi t y and ser vi ce and an STI case
r epor t i ng syst em t oget her . The STI Recor d i s now a comput er i zed syst em
and i s used t o st or e i ndi vi dual dat a of cl i ent s. Ther e ar e si x component s of
t he i nf or mat i on r ecor d: demogr aphi c, r i sk behavi or assessment , past
hi st or y/ pr esent si gns and sympt oms, physi cal exami nat i on, STI management ,
and l abor at or y t est i ng. HIV counsel i ng and t est i ng i nf or mat i on i s i ncl uded i n
t he r i sk assessment , STI management , and l abor at or y component s of t he
r ecor d. Out put s f r om t he STI Recor d ar e t he STI case r epor t and t he STI
cl i ni c per f or mance r epor t f or each popul at i on gr oup. In 2009 t hi s syst em
was l aunched i n 19 pr ovi nces. Expansi on of t he syst em wi l l be i mpl ement ed
i n 43 pr ovi nces under t he GFATM Round 8 i n 2010- 2011.
4) TB/ HIV moni t ori ng syst em
The Smar t TB pr ogr am has been i nt r oduced and used by al l heal t h f aci l i t i es
under NHSO i n or der t o moni t or TB pat i ent s and co- i nf ect i ons of TB among
PLHA i ncl udi ng TB as an HIV/ AIDS car e and t r eat ment ser vi ces. Si nce t he
syst em has been i mpl ement ed r ecent l y, cover age of r epor t i ng and
compl et eness of i nf or mat i on st i l l needs t o be i mpr oved.
5) OVC program moni t ori ng syst em: Cur r ent l y, t he OVC moni t or i ng syst em
i s st i l l f r agment ed. The nat i onal syst em does not exi st except at t he pr oj ect
l evel . It i s ver y di f f i cul t t o use moni t or i ng dat a t o moni t or pr ogr ess of t he
nat i onal r esponse on OVC.
6) Int egrat ed communi t y based moni t ori ng f or HIV prevent i on t arget i ng
of MARPs i nt o t he nat i onal rout i ne heal t h i nf ormat i on syst em
Ci vi l soci et y i ncl udes CBO, NGOs and t he MARPs and MWs t hemsel ves who
have a cr i t i cal r ol e i n t he pr event i on and car e pr ogr am and M&E syst em.
Ci vi l soci et y i s not a separ at e l evel of t he M&E i nf r ast r uct ur e, but must be a
par t ner at al l l evel s. Wi t h suppor t f r om t he GFATM Round 8 i n 2009, NGOs
have devel oped and har moni zed t hei r own pr ogr am moni t or i ng syst em f or
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speci f i c MARP and MW. As par t of t he ef f or t t o i mpr ove dat a qual i t y i n t he
M&E syst em, NAMc wor ked i n col l abor at i on wi t h i mpl ement i ng par t ner s f or
har moni zed i ndi cat or def i ni t i on and devel oped dat a col l ect i on. The Uni que
Ident i f i er Code ( UIC) was devel oped and i nst i t ut ed as par t of t he RHIS t o
mi ni mi ze doubl e count i ng. Thai l and al so made an ef f or t t o use t he syst em
t o moni t or i nt ensi t y of exposur e i n or der t o i mpr ove ef f ect i veness of
i nt er vent i ons.
Movi ng f or war d, Thai l and wi l l devel op an i nt egr at ed RHIS usi ng ar ea based
appr oach. An i nt egr at ed RHIS ai ms t o bui l d a communi t y based moni t or i ng
syst em and i t s i nt egr at i on i nt o t he nat i onal syst em. It wi l l be an i nt er f ace
syst em t hat al l ows di f f er ent dat aset s i ncl udi ng sur vei l l ance, NAP, STI,
communi t y based dat a syst em et . al . t o communi cat e wi t h one anot her and
be abl e t o demonst r at e t he bi g pi ct ur e of HIV/ AIDS r esponses at sub-
pr ovi nci al , pr ovi nci al , r egi onal and nat i onal l evel .
A. 3 Eval uat i on and research
Dur i ng past t wo year s, a number of key st udi es and sur veys,
assessment s/ r evi ews and eval uat i on ef f or t s have been compl et ed, and t hese
pr ovi de key empi r i cal dat a f or pr ogr am i mpr ovement and pol i cy
devel opment as f ol l ows;
x Mi d- t er m assessment of nat i onal st r at egi c pl an ( 2007- 2011)
x Compl et ed t he vacci ne t r i al phase III
x PMTCT nat i onal eval uat i on conduct ed i n 2008 and compl et ed i n 2009
x The GFATM pr ogr am eval uat i on; Pr event i on t ar get i ng mi gr ant wor ker s
( PHAMIT) , school based pr ogr am, communi t i es and wor kpl ace pr ogr am
and eval uat i on of ART t r eat ment pr ogr am.
x Nat i onal sur vey of r i sk behavi or among yout h i n j uveni l e cent er s
x Pr ogr am Eval uat i on such as pr event i on wi t h posi t i ves ( PWP) suppor t ed by
USAID, and IDU peer dr i ven appr oach by Thai dr ug user net wor k .
x Nat i onal M&E syst em assessment has been done i n 2008.
A. 4 Capaci t y bui l di ng on st rat egi c i nf ormat i on i ncl udi ng M&E
Thai l and has been successf ul l y i mpl ement i ng a 3- mont h shor t cour se
t r ai ni ng on AIDS epi demi ol ogy f or pr ovi nci al sur vei l l ance manager s si nce
2003. At t he end of 2009, mor e t han 150 pr ovi nci al manager s compl et ed t he
t r ai ni ng. Al umni f r om AIDS epi demi ol ogy cour se have become a good asset
and net wor k t o manage and i mpl ement sur vei l l ance act i vi t i es.
NAMc and PR t he GFATM wi t h suppor t by USAID f ocus t hei r ef f or t s t o
i mpr ove M&E capaci t i es among NGOs and CBOs as a cr i t i cal component of
t he Communi t y- based Syst em St r engt heni ng ( CSS) , par t i cul ar l y t he GFATM
Round 8 par t ner s. In 2008- 2009, USAID t hr ough PACT and FHI have
compl et ed t he devel opment of st andar di zed MSM pr ogr am moni t or i ng gui de
178
f or Thai l and and t he devel opment of uni f i ed dat a col l ect i on f or ms. PACT
al so has desi gned and i mpl ement ed or gani zat i onal st r engt heni ng act i vi t i es
wi t h each par t ner t hat r esul t ed i n t he use of st andar di zed def i ni t i ons, cl ear
dat a col l ect i on pr ot ocol s, and enhanced use of dat a t o i mpr ove t he qual i t y
of ser vi ce del i ver y. Thi s was achi eved by l i nki ng coachi ng and syst ems
devel opment i n M&E wi t h br oader or gani zat i onal st r engt heni ng st r at egi es
t hat suppor t qual i t y of ser vi ces i ncl udi ng t eamwor k, st andar d set t i ng, and
st r at egi c pl anni ng.
A. 5 Dat a use
Dat a and i nf or mat i on ar e of most val ue when t hey ar e used t o i nf or m
deci si ons, and Thai l and has ai med t o devel op t ool s and f aci l i t at e dat a use t o
enhance evi dence- based deci si on maki ng. Accompl i shment s on dat a use i n
2008- 2009 as f ol l ows:
1. Dat a use t o enhance nat i onal st rat egy and pol i cy pl anni ng and
i mprovement
x Thai l and has l aunched a campai gn namel y Reduced new i nf ect i ons
by hal f i n 2011 r esul t i ng f r om t he i n- dept h anal ysi s and advocacy pr oj ect
( t he A2) as a dat a use t ool f or pol i cy maker s t o cl ear l y under st and what
cur r ent l y dr i ves t he Thai epi demi c and what t he f ut ur e di r ect i ons ar e, as
wel l as pr ovi di ng t he best case scenar i o f or t he nat i onal r esponse.
x Revi ew St at e of t he Ar t of sur vei l l ance syst ems i n Thai l and and
synt hesi s of Thai epi demi c have been under t aken by TWG on HIV si t uat i on.
Thi s became cr i t i cal i nf or mat i on used f or t he 2010 UNGASS r epor t as wel l as
devel opment of t he accel er at i on pl an 2010 t ar get i ng HIV pr event i on.
x Devel opment of HIV counsel i ng and t est i ng benef i t s package under
t he nat i onal i nsur ance scheme due t o i n- dept h anal ysi s of NAP moni t or i ng
dat a.
x Thai l and has est abl i shed a pr ocess t o r evi ew l i t er at ur e, l essons
l ear ned f r om f i el d exper i ences and exper t s f r om mul t i - di sci pl i nar y ar eas
t hr ough a par t i ci pat or y pr ocess i n or der t o i dent i f y nat i onal gaps.
x Devel opment a mechani sm t owar ds Uni ver sal Access at nat i onal and
sub- nat i onal l evel t o ent ai l meani ngf ul i nvol vement of ci vi l soci et y f or dat a
col l ect i on and t o use UNGASS i nf or mat i on f or pr ogr am pl anni ng and
i mpr ovement . Thr ough t he pr ocess of devel opi ng t he 2010 UNGASS, Thai l and
ai ms at devel opi ng a mechani sm t o i nvol ve ci vi l soci et y and sub- nat i onal
admi ni st r at i on f or dat a col l ect i on and t o use UNGASS i nf or mat i on f or
pr ogr am i mpr ovement and pl anni ng. The pr oj ect has been pi l ot ed i n 26
pr ovi nces. Pr ovi nci al key st akehol der s i ncl ude gover nment or gani zat i ons,
l ocal aut hor i t i es, NGOs, CBOs, PLHA gr oups and net wor ks whi ch wor k
t oget her t o col l ect and anal yze dat a as wel l as devel op pr ovi nci al UNGASS
r epor t s.
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2. Dat a use f or program i mprovement
x Qual i t y Improvement i n HIV Care and Treat ment : HIVQUAL-T
The HIVQUAL pr oj ect i n Thai l and, known as HIVQUAL- T, was i mpl ement ed as
a pi l ot pr ogr am i n 2003 wi t h 12 hospi t al s, and now has been expanded t o
914 l ocat i ons t hr oughout t he count r y. The pr oj ect has been i mpl ement ed by
Bur eau of AIDS , NHSO and t he i nst i t ut e of Hospi t al Qual i t y Impr ovement
and Accr edi t at i on ( HA) t hr ough t echni cal assi st ance by TUC. The HIVQUAL- T
i s a per f or mance measur ement t ool t o f aci l i t at e anal ysi s and use of exi st i ng
cl i ni cal i nf or mat i on f or i mpr ovi ng HIV car e and t r eat ment ser vi ces. Gi ven i t s
successf ul i mpl ement at i on, t he t ool has been i nt egr at ed i nt o Nat i onal AIDS
Pr ogr am dat abase ( NAP) . To dat e, benchmar k of HIVQUAL- T per f or mance
measur ement r esul t s goes beyond hospi t al set t i ng and has been expanded at
t he pr ovi nci al , r egi onal and nat i onal l evel . HIVQUAL- T has al so been
expanded t o i ncl ude pedi at r i c HIV/ AIDS i ndi cat or s began i n 2006. About 100
pr ovi nci al hospi t al s wi t h hi gh number s of pedi at r i c cases have par t i ci pat ed.
x Qual i t y Improvement i n STI servi ces: STIQUAL
STIQUAL i s a qual i t y i mpr ovement model f or STI and VCT ser vi ces at t he
f aci l i t y l evel . The mai n concept of t he model i s t he measur ement of ser vi ce
per f or mance f or t he i mpr ovement of qual i t y of car e by i nt egr at i on of cl i ent
dat a wi t h t he hospi t al qual i t y management pr ogr am. Heal t h f aci l i t i es wi l l
set STI per f or mance t ar get s accor di ng t o t he nat i onal st andar d. The
STIQUAL sof t war e i s a t ool f or measur ement of cover age of STI and VCT
ser vi ces f or qual i t y i mpr ovement . The i nput i s ext r act s f r om exi st i ng
medi cal r ecor d f or ms and/ or i mpor t ed dat a f r om t he STI Recor d dat abase.
The measur ement can be done per i odi cal l y but at l east once a year . Out put s
f r om t he sof t war e ar e cover age of STI scr eeni ng among r i sk gr oups, STI case
management , and HIV counsel i ng and t est i ng.
The STIQUAL has been successf ul l y pi l ot ed i n 5 pr ovi nces, begun i n 2009
under t he col l abor at i on of t he STI cl ust er and TUC. Now i t i s cur r ent l y bei ng
i mpl ement ed i n 19 pr ovi nces and t her e ar e pl ans t o expand t o 43 pr ovi nces
as par t of t he GFATM Round 8.
x MSM organi zat i ons t o anal yze and use moni t ori ng dat a f or program
i mprovement
Impr ovi ng t he use of pr ogr am moni t or i ng dat a i s a cr i t i cal ef f or t . USAID and
i t s par t ner s ( FHI and PACT) have under t aken t r ai ni ng t o MSM- CBOs and
conduct r egul ar anal ysi s and synt hesi s of moni t or i ng dat a of communi t y
based dat a and pr ovi de f eedback t o i mpl ement i ng par t ner s and key
st akehol der s. Thai l and has a l ong t er m goal of bui l di ng t he capaci t y of CBOs
i n or der t o enabl e t hem t o have t he ski l l set s t o be abl e t o anal yze and
i nt er pr et t hei r own pr ogr am moni t or i ng dat a ef f ect i vel y and r out i nel y.
180
B. Chal l enges f aced i n t he i mpl ement at i on of a comprehensi ve M&E
syst em
The f ol l owi ng i s a summar y of key pr ogr ess made t o over come chal l enges
dur i ng l ast t wo year s:
x Si xt een of TWGs wer e est abl i shed i n 2009. Most TWGs met r egul ar l y.
Key st akehol der s act i vel y par t i ci pat ed t hr oughout t he pr ocess f or
devel opment of t he 2010 UNGASS r epor t . Mor eover , TWG on si t uat i on
anal ysi s has devel oped t wo synt hesi s r epor t s t hat pr ovi ded cr i t i cal f i ndi ngs
f or enhanci ng t he HIV/ AIDS st r at egy, i mpr ovi ng t he nat i onal M&E syst em and
t he 2010 UNGASS r epor t .
x The M&E pl an f or HIV pr event i on t ar get i ng MARPs and TB/ HIV wer e
compl et ed.
x Wi t h success of t he GFATM Round 8 appl i cat i on, si gni f i cant f i nanci al
suppor t has now been al l ocat ed f or Thai l and t o st r engt hen nat i onal st r at egi c
i nf or mat i on i ncl udi ng M&E act i vi t i es i n 2009.
i . Thai l and i s conduct i ng t he MARP popul at i on si ze est i mat i on st udy
t hat i s i mpor t ant i nf or mat i on f or i mpl ement er s t o moni t or t hei r
pr ogr ess on cover age. In addi t i on, i t i s a cr i t i cal par amet er t o
i mpr ove accur acy of est i mat i on and pr oj ect i on of HIV and AIDS i n
Thai l and.
i i . Scal ed up of IBBS among MARPs
i i i . Ar ea based appr oach f or a compr ehensi ve M&E has been endor sed
and wel l accept ed by key st akehol der s. An oper at i onal f r amewor k,
dat a war ehouse/ syst em, oper at i onal gui de and t r ai ni ng cur r i cul um
wi l l be devel oped by t he end of 2010.
i v. Ther e wi l l be a l aunchi ng of a pr ovi nci al coor di nat i on mechani sm
( PCM) as key M&E mechani sm at t he sub- nat i onal l evel t o dr aw
upon col l abor at i on, coor di nat i on and st r engt hen M&E capaci t y t o
r el evant st akehol der s i ncl udi ng l ocal admi ni st r at i ons t o bet t er use
of i nf or mat i on f or pr ogr am and pr ogr am pl anni ng.
Even t hough, Thai l and has made a l ot of pr ogr ess dur i ng t he l ast 2 year s i t
st i l l f aces a number of key chal l enges as f ol l ows:
x A compr ehensi ve nat i onal M&E pl an i s needed t o be devel oped as par t
of t he new nat i onal HIV and AIDS st r at egi c pl an. Thi s ef f or t i s vi t al f or
devel opi ng a uni f i ed M&E f r amewor k f or t he count r y.
x Sur vei l l ance and sur veys
o Whi l e a compr ehensi ve HIV/ AIDS sur vei l l ance f r amewor k exi st s,
Thai l and cal l s f or i mpr oved qual i t y of sur vei l l ance dat a
i ncl udi ng sampl e si zes, sampl i ng t echni que and scal e up of
sent i nel si t es, i ncr easi ng ut i l i zat i on of dat a, devel opi ng t ool s
and st r engt heni ng human capaci t y on anal ysi s and
i nt er pr et at i on of dat a as wel l as t echni cal ski l l s t o t r i angul at e
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di f f er ent dat aset s and t ypes of dat a i n or der t o get a cl ear er
pi ct ur e of t he epi demi c at nat i onal and sub- nat i onal l evel s.
o Incr eased r el i abi l i t y and accur acy of HIV i nci dence
measur ement i s cr i t i cal t o moni t or nat i onal pr event i on ef f or t s.
o A sur vey of t he gener al popul at i on i n r epr oduct i ve age and
yout h sur vey i s needed t o consol i dat e and har moni ze ef f or t s. It
cal l s f or st r ong coor di nat i on on pl anni ng and a t i mel i ne f or
conduct i ng a cont r acept i ve and r epr oduct i ve and heal t h sur vey,
nat i onal heal t h sur vey and t he mul t i pl e i ndi cat or s cl ust er
( MICS) et al .
x Rout i ne Heal t h Inf or mat i on Syst em ( RHIS)
To devel op an i nt egr at ed and compr ehensi ve Rout i ne Heal t h
Inf or mat i on Syst em f or Thai l and i s a chal l enge f or many r easons.
Si nce a l ot of i nf or mat i on syst ems exi st i n di f f er ent phases of
devel opment , i n or der t o devel op a uni f i ed moni t or i ng syst em t her e
needs t o be f ul l col l abor at i on f r om key st akehol der s and t i me t o
make t he new syst em f ul l y f unct i onal .
o St r engt heni ng NAP syst em i s needed as t he mai n dat a sour ce
f or nat i onal car e and t r eat ment syst em by i nt egr at i ng ot her
dat a sour ces such as soci al wel f ar e dat a syst em, MTCT syst em
( PRIM and PROM) and ot her s.
o Car e and t r eat ment i nf or mat i on syst em f or mi gr ant popul at i on
i s st i l l uncl ear of i t s i mpl ement at i on f or t he f ut ur e. Now i t
r epor t s under t he NAPHA ext ensi on pr oj ect moni t or i ng syst em.
o NAP syst em i s not sensi t i ve t o di saggr egat i on by MARPs.
o Or phans and HIV i nf ect ed and af f ect ed chi l dr en moni t or i ng
syst em i s st i l l f r agment ed and needs t o be devel oped as a
uni f i ed dat a col l ect i on and i nt egr at ed syst em.
o Communi t y based i nf or mat i on f or pr event i on, car e and OVC
t hat i s most l y i mpl ement ed by CBOs and NGOs i s di sconnect ed
f r om t he nat i onal syst em.
o Di scl osur e of most at r i sk popul at i on moni t or i ng dat a i s a
maj or concer n of ci vi l soci et y.
o Inf or mat i on f r om pr i vat e heal t h ser vi ces and medi cal t eachi ng
uni ver si t i es i s not i ncl uded i n t he nat i onal syst em.
182
x Eval uat i on and Resear ch
Thai l and i s r ecogni zed as havi ng hi gh capaci t y f or r esear ch. However l i nkage
of usi ng r esear ch f i ndi ngs t o gui de i mpl ement at i on and pol i cy devel opment
i s l i mi t ed. In addi t i on, t her e i s a cl ear need f or empi r i cal dat a on what
i nt er vent i on wor ks and what doesn t t o suppor t t he nat i onal scal i ng up pl an.
Thai l and needs t o devel op a pr i or i t y nat i onal eval uat i on and r esear ch
agenda i n col l abor at i on wi t h key st akehol der s t o i ncr ease avai l abi l i t y and
i mpr ove qual i t y of eval uat i on and r esear ch as wel l as ensur e use of dat a at
al l l evel s. Resul t i ng f r om t he pr ocess, Thai l and wi l l use t he l i st of pr i or i t y
eval uat i on and r esear ch t o l ever age f i nanci al suppor t , and t hen set up a
pr ocess t o det er mi ne appr opr i at e met hodol ogi es ( quant i t at i ve and/ or
qual i t at i ve, exper i ment al desi gn ver sus non- exper i ment al desi gn) and
cont r ol qual i t y of t he st udi es.
x Capaci t y bui l di ng on st r at egi c i nf or mat i on i ncl udi ng M&E and dat a use
St r engt heni ng st r at egi c i nf or mat i on i ncl udi ng M&E capaci t y i s l ong t er m goal .
Thai l and i s put t i ng emphasi s on st r engt heni ng capaci t y of dat a use at al l
l evel s i n t he next 2 year s. At t he poi nt of ser vi ces del i ver y ( f aci l i t y and
communi t y l evel ) , pr oj ect st af f need t o have capaci t y t o use t he pr ogr am
moni t or i ng syst em ef f ect i vel y t o moni t or t he pr ogr ess of cover age and
qual i t y of pr ogr ams. At decent r al i zed uni t s such as t he Tambol
Admi ni st r at i ve Or gani zat i ons ( TAO) , t he pr ovi nci al and r egi onal l evel has
l i mi t ed use of cor e nat i onal moni t or i ng dat a ( pr ogr am, out come and i mpact
moni t or i ng) t o gui de devel opment of annual oper at i onal pl ans. At t he
nat i onal l evel t her e i s a need t o ensur e nat i onal ent i t i es ar e wel l equi pped
t o under t ake synt hesi s and t r i angul at i on of dat a and use i t f or devel opi ng
nat i onal pol i cy and st r at egi es.
4) Remedi al act i ons pl anned t o overcome t he chal l enges
x Suppor t M&E TWGs t o be act i ve and wel l - f unct i oni ng t hr ough
devel opi ng a concr et e act i vi t y pl an t o suppor t M&E act i vi t i es i n
2010- 2011. Key act i vi t i es of TWGs shoul d i ncl ude:
o Devel op a compr ehensi ve nat i onal M&E pl an f or pr event i on,
car e and t r eat ment by 2011.
o Devel op nat i onal t ar get s.
o Impl ement pr i or i t y M&E act i vi t i es as i dent i f i ed by each TWG i n
l i ne wi t h t he nat i onal M&E pl an.
x Wi t h suppor t f r om t he GFATM, BoE i s expandi ng IBBS sent i nel si t es t o
bet t er under st and t he sub- nat i onal HIV epi demi c among MARPs as
wel l as i mpr ovi ng qual i t y of dat a. Anal ysi s t ool s f or IBBS wi l l be
devel oped i n or der t o i mpr ove anal yt i cal ski l l among st af f at di f f er ent
l evel s who ar e i nvol ved wi t h t he IBBS i mpl ement at i on.
183
x In 2010- 2011, t her e ar e number of act i vi t i es t hat wi l l be done t o
st r engt hen t he r out i ne pr ogr am moni t or i ng syst ems;
o Consol i dat e t he car e and t r eat ment dat abase
o Devel op an OVC pr ogr am moni t or i ng syst em
o St r engt hen t he Smar t TB pr ogr am
o Devel op an i nt egr at ed Rout i ne Heal t h Inf or mat i on Syst em
( RHIS) usi ng ar ea based f r amewor k i ncl udi ng t he communi t y
based moni t or i ng syst em and i t s i nt egr at i on i nt o t he nat i onal
syst em. In next 2 year s Thai l and wi l l f ocus on devel opi ng an
i nt egr at ed RHIS on pr event i on t ar get i ng f or MARPs. As par t of
t he ef f or t , a dat a war ehouse wi l l be est abl i shed t o i nt egr at e
al l di f f er ent t ypes of dat a f or anal ysi s. An RHIS pr ocedur e and
t r ai ni ng manual on dat a qual i t y and dat a use wi l l be a par t of
t he devel opment .
x Thai l and wi l l i mpl ement pr ocesses t o devel op nat i onal pr i or i t y of
eval uat i on and r esear ch agenda on pr event i on, car e and t r eat ment by
2010. Wi t h t hi s pr ocess eval uat i on and/ or r esear ch mappi ng of
compl et ed, on- goi ng and pl anned st udi es wi l l be under t aken i n or der
t o i dent i f y i nf or mat i on gaps and needs f or use of dat a t o suppor t
nat i onal st r at egy.
Thai l and wi l l l ever age f unds f r om di f f er ent sour ces t o i mpr ove
avai l abi l i t y eval uat i on st udi es. In addi t i on, pr ocesses wi l l be
est abl i shed t o ensur e st udi es meet wi t h mi ni mum st andar ds.
Advocacy f or pol i cy maker s t o use dat a ef f ect i vel y f or pol i cy
devel opment and deci si on maki ng wi l l be i mpl ement ed.
x A ser i es of capaci t y bui l di ng i ncl udi ng t r ai ni ngs and ment or shi p wi l l
be pr ovi ded t o CBOs, NGOs, sub- pr ovi nci al and pr ovi nci al , r egi onal
st af f f or ef f ect i ve i mpl ement at i on of a f unct i onal M&E syst em and
use of dat a f or i mpr ovi ng pr ogr am i mpl ement at i on and devel opi ng
oper at i on pl ans and t he nat i onal st r at egy. Over t he next 2 year s,
NAMC wi l l pl ay speci al at t ent i on t o bui l di ng M&E capaci t y of t he l ocal
admi ni st r at i on by wor ki ng i n cl ose col l abor at i on wi t h t he Pr ovi nci al
Coor di nat i on Mechani sm ( PCM) i n 43 pr ovi nces.
Fi nal l y, Thai l and wi l l under t ake a Moni t or i ng and Eval uat i on Syst ems
St r engt heni ng assessment i n 2011 t o moni t or pr ogr ess of t he nat i onal
M&E syst em as compar ed t o t he assessment i n 2008. Inf or mat i on wi l l
be used t o devel op a compr ehensi ve nat i onal M&E pl an 2012- 2016.
5) The need f or M&E t echni cal assi st ance and capaci t y- bui l di ng
x St at e of t he Ar t of eval uat i on met hodol ogy on pr event i on t ar get i ng
f or MARPs.
x Exper t i se t o devel op communi t y based heal t h i nf or mat i on syst em and
i t s i nt egr at i on wi t h t he nat i onal syst em i ncl udi ng pr event i on, car e
and OVC pr ogr am.
x HIV Inci dence measur ement .
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Annex 1
Consul t at i on/ preparat i on process f or t he Count ry Progress
Report on moni t ori ng t he f ol l ow up t o t he Decl arat i on of
Commi t ment on HIV/ AIDS
1) Whi ch i nst i t ut i ons/ ent i t i es wer e r esponsi bl e f or f i l l i ng out t he i ndi cat or
f or ms?
a) NAC or equi val ent Yes No
b) NAP Yes No
c) Ot her s Nat i onal AIDS Management Cent er 9Yes No
2) Wi t h i nput s f r om
Mi ni st r i es :
Educat i on 9Yes No
Heal t h 9Yes No
Labour 9Yes No
For ei gn 9Yes No
Ot her s 9Yes No
Tr anspor t
Def ense
Int er i or
Just i ce
Tour i sm and spor t
Soci al Devel opment and Human Secur i t y
Nat i onal Heal t h Secur i t y Of f i ce
At t or ney Gener al
Pr i me Mi ni st er
Of f i ce of t he Nar cot i cs Cont r ol Boar d
Depar t ment of Local Admi ni st r at i on
3) Was t he r epor t di scussed i n a l ar ge f or um 9Yes No
4) Ar e t he sur vey r esul t s st or ed cent r al l y? Yes 9No
5) Ar e dat a avai l abl e f or publ i c consul t at i on? 9Yes No
6) Who i s t he per son r esponsi bl e f or submi ssi on of t he r epor t and f ol l ow- up
i f t her e ar e quest i ons on t he Count r y Pr ogr ess Repor t ?
Name / t i t l e : Dr . Pet chsr i Si r i ni r und
Dat e : 31 Mar ch 2010
Si gnat ur e
Pl ease pr ovi de f ul l cont act i nf or mat i on :
Addr ess: Depar t ment of Di sease Cont r ol , Mi ni st r y of Publ i c Heal t h
Ti wanond Road, Nont habur i , 11000
Emai l : spet chsr i @gmai l . com
Tel ephone : 081- 603- 4423
185
Annex 2
Cover sheet : Nat i onal Composi t e Pol i cy Index (NCPI) 2010
COUNTRY: Thai l and
Name or t he Nat i onal AIDS Commi t t ee Of f i cer i n Char ge of NCPI submi ssi on
and who can be cont act ed f or quest i ons, i f any :
Nat i onal AIDS Management Cent er ( NAMc)
Post al addr ess:
Depar t ment of Di sease Cont r ol , Mi ni st r y of Publ i c Heal t h
Ti wanond Road, Nont habur i , 11000
Tel : 02- 590- 3828 , 02- 590- 3829
Fax: 02- 965- 9153
Emai l : spet chsr i @gmai l . com
Dat e of submi ssi on 31 Mar ch 2010
186
NCPI Dat a Gat heri ng and Val i dat i on Process
St eps f or compl et i ng t he NCPI quest i onnai r e i ncl uded:
1. The f i r st st ep was t o desi gn t echni cal coor di nat or s f or dat a gat her i ng:
NAMc f or par t A, and a r epr esent at i ve Thai Net wor k Col i at i on on AIDS f or
par t B.
2. The t echni cal coor di nat or s under t ook t he desk r evi ew on r el evant
document s i ncl uded NCPI quest i onnai r es, Nat i onal AIDS Pl an, Nat i onal soci o-
economi c pl an, HIV/ AIDS r el at ed pol i cy and measur es and Decl ar at i on of
Commi t ment on HIV/ AIDS.
3. Ident i f i cat i on of key gover nment par t ner s. t hese i ncl uded
- MOH, Mi ni st r y of Educat i on
- Mi ni st r y of Labour and Soci al Wel f ar e
- Mi ni st r y of Tr anspor t at i on
- Mi ni st r y of Def ense
- Nat i onal Pol i ce Of f i ce
- Mi ni st r y of Soci al and Secur i t y Devel opment
- Mi ni st r y of Int er i or and Local Admi ni st r at i ve Or gani zat i on
- Nat i onal Economi c and Soci al Devel opment Counci l
- Mi ni st r y of Just i ce
- Mi ni st r y of Tour i sm and Spor t
- Mi ni st r y of Int er nat i onal i t y
- Mi ni st r y of Cul t ur e
- Publ i c Rel at i on Depar t ment
- Of f i ce of t he At t or ney Gener al
- Of f i ce of Nar cot i cs Cont r ol and Pr event i on
- Nat i onal Heal t h Secur i t y Of f i ce
4. Int r oduct or y meet i ng among key gover nment par t ner s was or gani zed on 2
Feb 2010 t o over vi ew NCPI pr ocess, t o cl ar i f y NCPI quest i onnai r es and t o
descr i be how t o obt ai n t he NCPI dat a.
(To obt ai n an over vi ew of how t he NCPI dat a wer e obt ai ned, al l
gover nment par t ner s wer e r equest ed t o pr ovi de t he f ol l owi ng i nf or mat i on
on al l i ndi vi dual s who wer e i nt er vi ewed i ncl udi ng t he or gani zat i on t hey
r epr esent , t hei r name and posi t i on and t he par t ( s) of t he NCPI t hey
r esponded t o.
5. Revi ew al l r esponses t o det er mi ne i f addi t i onal i nf or mat i on or document s
ar e needed. Anal ysi s and i nt er pr et at i on wer e done t oget her among NAMc
t eam, wr ot e up of t he mai n f i ndi ngs.
6. NAMc or gani zed a f or um t o di scuss and endor se t he maj or f i ndi ngs of t he
UNGASS Count r y Pr ogr ess Repor t , i ncl udi ng t he r esul t s f r om t he NCPI.
187
NCPI Respondent s
[ Indi cat e i nf or mat i on f or al l whose r esponse wer e compi l ed t o f i l l out ( par t
of ) t he NCPI i n t he bel ow t abl e ; add as many r ows as needed]
NCPI Part A [ t o be a admi ni st ered t o government of f i ci al s]
Respondent s t o Part A
[ i ndi cat e whi ch part s each
respondent was queri ed on] Organi zat i on Names/ posi t i ons
A. I A. II A. III A. IV A. V
Of f i ce of t he Basi c
Educat i on Commi ssi on
Ms. Kor nkaew
Kanomekr an
9 9 9 9 9
Vocat i onal Educat i on
Commi ssi on
Ms. Suchi t r a
Pr ongseang
9 9 9 9 9
Depar t ment of Labour
Pr ot ect i on and Wel f ar e
Ms. Wi l ai wan
Koi keawpr i eng
9 9 9 9 9
Royal Thai Ai r For ce MS. Jumr ung
Chal adki d
9 9 9 9 9
Naval Medi cal
Depar t ment
Mr . Ngean
9 9 9 9 9
Royal Thai Ar my Medi cal
Depar t ment
Ms. Kani dt a Thongbun
9 9 9 9 9
Royal Thai Pol i ce Ms. Jant anee
Wi t chawasi r i
9 9 9 9 9
Mi ni st r y of Tour i sm &
Spor t s
Ms. Panpi mol
Chayaj i t chayawat
9 9 9 9 9
Depar t ment of Labour Ms. Achar a Ngamsomj i t 9 9 9 9 9
Thanyar ak Inst i t ut e Ms. Nut cha Sr i r ung 9 9 9 9 9
Depar t ment of Juveni l e
Obser vat i on and
Pr ot ect i on
Ms. Wanee Konsuwan
9 9 9 9 9
Bur eau of AIDS,
t uber cul osi s and
sexual l y t r ansmi t t ed
di seases.
Ms. Thongkon
Yanr ungsr i
9 9 9 9 9
Of f i ce of t he At t or ney
Gener al i n Thai l and
Ms. Ni dt a
suj ar i dwor akul
9 9 9 9 9
Spor t s Medi ci ne
Di vi si on.
Ms. Aur asr i Jayapum
9 9 9 9 9
Of f i ce of t he Nat i onal
Economi c and Soci al
Devel opment Boar d
Ms. Par anee Wat ana
9 9 9 9 9
Bur eau Of Ment al Heal t h
Techni cal Devel opment .
Ms. Saowal uk
Suwanmai t r e
9 9 9 9 9
188
Respondent s t o Part A
[ i ndi cat e whi ch part s each
respondent was queri ed on] Organi zat i on Names/ posi t i ons
A. I A. II A. III A. IV A. V
Of f i ce of t he Nar cot i cs
Cont r ol Boar d
Ms. Supodj anee
Chut i damr ong
9 9 9 9 9
The Depar t ment of
Local Admi ni st r at i on
Mr . Thana Yunt ar akovi t
9 9 9 9 9
NCPI Part B [ t o be a admi ni st ered t o ci vi l soci et y organi zat i ons, bi l at eral
agenci es, and UN organi zat i on]
Respondent s t o Part A
[ i ndi cat e whi ch part s each
respondent was queri ed on] Organi zat i on Names/ posi t i ons
B. I B. II B. III B. IV B. V
Thai NGO coal i t i on on
AIDS ( TNCA)
Ms. Supat r a
Nakapi ew
9 9 9 9 9
Thai Net wor k of
Peopl e Li vi ng wi t h
HIV/ AIDS ( TNP+)
Mr . Bor i pat
Donmon 9 9 9 9 9
Thai NGO coal i t i on on
AIDS ( TNCA)
Mr . Udom
Li ki t wannawut
9 9 9 9 9
AIDS access
f oundat i on
Mr . Ni mi t
Teanaudom
9 9 9 9 9
AIDS access
f oundat i on
Ms. Sengsi r i
Tr eemakkha
9 9 9 9 9
AIDS access
f oundat i on
Ms. Nampung
pengr uen
9 9 9 9 9
Women wor ki ng gr oup
on HIV/ AIDS
Ms. Sur eer at
Tr eemakkha
9 9 9 9 9
Women wor ki ng gr oup
on HIV/ AIDS
Ms. Sul ai por n
Chonwi l ai
9 9 9 9 9
We under st and Ms. Chut i ma
Sai sangj an
9 9 9 9 9
Phayao Devel opment
f oundat i on
Ms. Suphapor n
Ti nwat t anakul
9 9 9 9 9
Rakst hai f oundat i on Ms. Sunee Tal awat 9 9 9 9 9
Rakst hai f oundat i on Ms. Supeecha
Baot i p
9 9 9 9 9
Thai NGO coal i t i on on
AIDS ( TNCA)
Mr . Ni vat
Suwanphat dhana
9 9 9 9 9
Thai NGO coal i t i on on
AIDS ( TNCA)
Ms. Kanj ana
t hal engki t
9 9 9 9 9
PATH Ms. Usasi nee
r eawt ong
9 9 9 9 9
189
Annex 3
Nat i onal Composi t e Pol i cy Index: Vi ewpoi nt of Ci vi l Soci et y
Progress Report t o UNGASS
Mar ch 20, 2010
NGO Coal i t i on on AIDS
A. Human right s: support f or right s and respect f or humanit y
Chal l enges i n t he past report peri od (2006-7)
In t he pr evi ous r epor t per i od f or Thai l and ( 2006- 7) many chal l enges wer e
i t emi zed concer ni ng human r i ght s i ncl udi ng pr obl ems of access, t he dr af t
l aw f or pr ot ect i on of PLHA, t he 1966 l aw on sex est abl i shment s ( r evi sed i n
2005) , t he dr af t l aw on pr ot ect i on of human subj ect s i n r esear ch, pl us
r ecommendat i ons f or r evi ewi ng l aws and measur es t hat do no f aci l i t at e t he
pr event i on and cont r ol of AIDS. Ther e was al so a st at ement on pol i cy
advocacy f or suppor t and pr ot ect i on of r i ght s t o heal t h ser vi ces such as
access t o al t er nat i ve r egi mens, access t o ser vi ces by mi gr ant l abor er s and
t hei r dependent s, and IDUs, l ack of access t o ART f or t hose not cover ed by
t he Nat i onal Heal t h Secur i t y Pr ogr am, and r ecommendat i ons f or cl osi ng t he
gaps and di f f er ent i al s i n access t o heal t h ser vi ces, and suppor t f or
devel opi ng st r at egi es t o campai gn f or r i ght s, based on r espect f or di ver si t y
of et hni ci t y, r el i gi on, cul t ur e/ bel i ef s, age gr oup, and sex/ sex l i f est yl e/ sex
or i ent at i on.
Success and f i ndi ngs (2008-9)
Ther e i s consi der abl e success t o r epor t . Fr om t he 2009 r evi ew by t he
Foundat i on f or AIDS Ri ght s, i t can be sai d t hat Thai l and has f avor abl e l aws
t hat pr omot e t he pr event i on pr ogr am ef f or t s. The Thai Const i t ut i on ( as
r evi sed i n 2007) has var i ous suppor t i ve measur es, such as Measur e 4
r egar di ng pr ot ect i on of human r i ght s and f r eedom, Measur e 26 r egar di ng
pr ovi si on of ser vi ce t hat r espect s humani t y, r i ght s and f r eedom of t he
popul at i on, Measur e 28 r egar di ng t he r i ght of ci t i zens t o i nvoke aspect s of
t he const i t ut i on t o f i l e l aw sui t s, Measur e 30 pr ohi bi t i on of unf ai r
di scr i mi nat i on based on pl ace of bi r t h, et hni ci t y, l anguage, sex, age,
di sabi l i t y, physi cal char act er i st i c or st at e of heal t h, i ndi vi dual st at us, soci o-
economi c st at us, r el i gi ous bel i ef s, educat i on, or pol i t i cal opi ni on. Al so
not ewor t hy i s Sect i on 3 of t he Const i t ut i on whi ch br oadl y pr ot ect s t he r i ght s
and f r eedoms of t he Thai popul at i on i ncl udi ng r i ght s r el at ed t o l i f e, body,
i ndi vi dual , j ust i ce, devel opment , educat i on, heal t h ser vi ce, and f r eedom t o
wor shi p, expr ess opi ni ons. In addi t i on, cr i mi nal , ci vi l and commer ci al l aws
ar e al so r el evant i ncl udi ng: t he Nat i onal Heal t h Secur i t y Pr ogr am ( NHSP) ,
Nat i onal Heal t h Law, Pat ent Law, Labor Law, and Chi l d Pr ot ect i on Law.
Ther e ar e al so nat i onal gui del i nes f or pr event i on and cont r ol of AIDS i n
var i ous t ypes of wor k si t es, as announced on August 21, 2009.
190
Al l of t hi s shows t hat Thai l and has l egal st r at egi es and pol i ci es t hat ar e
f avor abl e f or AIDS cont r ol wor k, and el i mi nat es t he need f or a separ at e AIDS
l aw, such as t he dr af t l aw t hat was pr epar ed i n 2007 and whi ch was opposed
because i t coul d be used t o vi ol at e cer t ai n r i ght s.
The Nat i onal AIDS Pr ogr am ( NAP) pl an f or 2007- 11 speci f i ed t hat t her e be a
3
r d
phase st r at egy f or pr ot ect i on of AIDS r i ght s r el at ed t o di ssemi nat i on and
awar eness r ai si ng about t hese human r i ght s pr ovi si ons at t he i ndi vi dual and
gr oup l evel . At t he same t i me, t he Uni ver sal Access Pl an emer ged, and t hi s
i nf or med t he r ef i nement of pol i cy, measur es, and var i ous pr oj ect s such as
t he pol i cy t o r educe HIV i nci dence by hal f by t he year 2011. Pr oj ect
devel opment f r om Round 1 and Round 8 suppor t shows t hat Thai l and has
gi ven i mpor t ance t o mar gi nal i zed popul at i ons, and has i mpl ement ed a wi de
r ange of act i vi t i es wi t h ext er nal f undi ng.
St r at egi es t o advance t he cause of r i ght s have been devel oped t o add t o t he
pr ot ect i ons t hat al r eady exi st ed. The Ri ght s and Li ber t i es Pr ot ect i on
Depar t ment ( RLPD) of t he Mi ni st r y of Just i ce j oi ned t he net wor k on r i ght s
pr ot ect i on and has addr essed r i ght s vi ol at i ons i n col l abor at i on wi t h t he
PLHA net wor k gr oups and t he Foundat i on f or Ri ght s Pr ot ect i on. Ot her
const r uct i ve r i ght s pr omot i on act i vi t i es i ncl ude t he sub- commi t t ee on
cont r ol and advocacy of AIDS pr event i on under t he Nat i onal AIDS Commi t t ee
( NAC) .
In 2009, NGOs, t hr ough t he Foundat i on f or AIDS Ri ght s, r epor t ed on t he
st at us of human r i ght s r el at ed t o HIV/ AIDS i n Thai l and f or 2007- 8. The PLHA
net wor k conduct ed a sur vey of st i gma and di scr i mi nat i on agai nst PLHA i n
2009, and t he NGO Coal i t i on on AIDS ( NCA) i ssued a r epor t anal yzi ng pol i cy
r el at ed t o AIDS t hr ough t he vi ew of sexual and r epr oduct i ve heal t h r i ght s.
In pr oduci ng t hese r epor t s, t her e has been l i vel y di scussi on, debat e and
exchange of i nf or mat i on on pol i cy, i mpl ement at i on and heal t h ser vi ces,
suppor t f or knowl edge i ncl udi ng t he wor di ng, i n l egal t er ms, pol i cy and
medi cal measur es whi ch of t en ar e not sensi t i ve t o t he need f or r espect and
honor i ng humani t y. The r esul t i s st i gma and soci al di scr i mi nat i on, f or
exampl e i n usi ng t he t er ms r i sk gr oup; mot her - t o- chi l d t r ansmi ssi on
et c. Thi s shows t he need t o r evi ew our knowl edge base t hat i s used i n
i mpl ement at i on on AIDS, and t o wor k i n gr eat er har mony wi t h r espect f or
r i ght s, absent of pr ej udi ce.
In addi t i on, t her e has been i mpor t ant pr ogr ess i n t he ar ea of suppor t of
r i ght s t o accessi ng t r eat ment , such as t he addi t i on of VCCT f unds as par t of
t he benef i t s of t he NHSP, t he addi t i on of met hadone mai nt enance t her apy
t o t he NHSP benef i t s package, and t he NAPHA ext ensi on pr oj ect t o ext end
t r eat ment f or 2, 000 cr oss- bor der mi gr ant l abor er s, et hni c mi nor i t i es, and
undocument ed per sons.
Chal l enges/ recommendat i ons f or t he next report peri od (2009-10)
Regar di ng t he Cabi net Resol ut i on of Oct ober 20, 2009 whi ch appr oved t he
nat i onal human r i ght s pl an, Ver si on 2 f or 2009- 2013, ci vi l soci et y has t he
vi ew t hat t her e ar e st i l l chal l enges r emai ni ng i n ensur i ng good appl i cat i on of
t he pol i ci es and l aws. Ci vi l soci et y t hus r ecommends t hat t her e be a
191
pr ocess f or coor di nat ed pl anni ng t o bui l d t he st r uct ur e/ st r at egi es so t hat
t he var i ous component s of t he human r i ght s package of ser vi ces ar e
i nt egr at ed wi t h t he NAP pl an. It i s al so r ecommended t hat t her e be
coor di nat ed i mpl ement at i on bet ween t he Nat i onal Human Ri ght s
Commi ssi on ( NHRC) and t he RLPD of t he Mi ni st r y of Just i ce i n t hei r r ol es and
r esponsi bi l i t y t o advance t he nat i onal human r i ght s pl an Ver si on 2 f or 2009-
2013. Ther e shoul d be a sub- commi t t ee t o moni t or r i ght s pr ot ect i ons
r el at ed t o AIDS by havi ng t he RLPD under t he pl an moni t or i ng commi t t ee
pl ay t he r ol e of wat ch- dog f or r i ght s vi ol at i ons i n t he gover nment sect or .
Ci vi l Soci et y f i nds t hat , even t hough Thai l and has f avor abl e pol i ci es i n many
ar eas, t her e st i l l ar e obst acl es t hat ar e not bei ng addr essed. The human
r i ght s st r at egy i s st i l l not ver y i nf l uent i al i n t he ar ea of AIDS and, at t he
i mpl ement at i on l evel , i t has not advanced i n a way t hat i s consi st ent wi t h
t he changi ng ci r cumst ances. The r i ght s moni t or i ng st r at egy needs t o be
st r engt hened i n t he ar ea of AIDS, i ncl udi ng syst em st r engt heni ng f or r i ght s
pr ot ect i on at t he st r uct ur al and i mpl ement at i on l evel s so t hat t hey ar e
har moni zed.
In addi t i on, t he st af f i mpl ement i ng t he r i ght s pr ot ect i on st r at egy st i l l l ack
knowl edge and under st andi ng about AIDS; t hi s shoul d be addr essed. Thi s i s
especi al l y r el evant f or st af f of t he RLPD and t he NHRC. Ther e shoul d be
gui del i nes f or i mpl ement i ng t he pol i ci es and l aws so t hat t her e i s concr et e
act i on.
As f or i mpl ement at i on of t he Phase 3 st r at egy f or AIDS r i ght s pr ot ect i ons, as
speci f i ed i n t he NAP pl an f or 2007- 11, t he i mpl ement at i on shoul d be st eer ed
mor e t owar d a r i ght s- based appr oach t hr ough t he i nt egr at i on of
knowl edge and act i on based on a f oundat i on of t hought and consi der at i on of
t he medi cal , soci o- cul t ur al , and r i ght s di mensi ons. For t hi s t o wor k, t her e
needs t o be a pr ocess of l ear ni ng and t r ai ni ng i n usi ng a r i ght s- based
appr oach f or t he r el evant uni t s and of f i ces. Al so, t her e needs t o be some
pr omot i on campai gns by r ecogni zi ng t hose agenci es t hat pr oper l y use a
r i ght s- based appr oach and t hose t hat don t . Those usi ng t he pr oper
appr oach woul d r ecei ve publ i c r ecogni t i on and a cer t i f i cat e. Thi s shoul d be
done as a col l abor at i on bet ween t he NHRC, t he RLPD and NGOs.
Ther e wi l l be a need i mpr ove under st andi ng t hat t he i mpl ement at i on of
human r i ght s wi t h AIDS act i vi t i es i s not t o conf er speci al pr i vi l eges f or
anyone or any gr oup. Inst ead, i t needs t o be seen as a f or m of ensur i ng t hat
af f ect ed peopl e ar e t r eat ed f ai r l y, wi t hout di scr i mi nat i on. Ther e wi l l need
t o be a compr ehensi ve under st andi ng of r i ght s i n t he var i ous di mensi ons of
l aw, t he pol i t i cal r eal m, and cul t ur e, and emphasi ze t he cor r ect i on of
at t i t udes and mi sunder st andi ngs. Thi s wi l l i ncl ude aspect s of l aw, pol i cy,
and r educt i on of pr ej udi ces agai nst AIDS t hat ar e l i nked wi t h ot her
at t r i but es such as sex, age, et hni ci t y, and r ace.
In addi t i on, t her e shoul d be r ef i nement s of t he st r at egi c pl an i n t he ar ea of
moni t or i ng and eval uat i on t o i nt egr at e sex r i ght s, knowl edge about sex,
gender and sexual i t y.
192
The sur vey of exper i ence of st i gma and di scr i mi nat i on r el at ed t o AIDS
conduct ed by t he PLHA net wor k shows t hat any t i me t her e i s
mi sunder st andi ng about AIDS, t her e wi l l be t he vi ew t hat PLHA have a
di f f er ent set of r i ght s t han t he uni nf ect ed. Thi s t ouches on t he ar ea of AIDS
r i ght s and si t uat i ons i n whi ch of f i ci al s and i ndi vi dual s vi ol at e t he r i ght s of
and di scr i mi nat i on agai nst PLHA even t hough t hey know t hey have r i ght s but
do not accept t hi s or have mi sconcept i ons about AIDS. They st i l l have
pr ej udi ces and make val ue j udgment s whi ch di scr i mi nat e. Ther ef or e, t her e
needs t o be act i on on t hi s mat t er cont i nuousl y as an i ndi cat or of pr ogr ess
t owar d t he goal of el i mi nat i ng st i gma and di scr i mi nat i on based on
someone s HIV i nf ect i on. Ther e shoul d be suppor t f or accept ance and
i ncl usi on of PLHA har moni ousl y i n soci et y. Ther e shoul d be a r evi ew of t he
i ncr ease i n knowl edge and under st andi ng about AIDS, t owar d bui l di ng a
f oundat i on f or AIDS under st andi ng over t he l ong- t er m f or ever yone i n
soci et y.
The st at e of AIDS knowl edge i n Thai l and i s st i l l not st abl e and t her e i s l ack
of consensus on cer t ai n i ssues. Thi s i mpedes i ncr easi ng under st andi ng,
vi ewpoi nt s, expl anat i ons, and communi cat i on of f act s and var i ous measur es.
Thi s al so appl i es t o ser vi ce pr ovi der s i n bot h t he heal t h and l egal sect or
r egar di ng HIV i nf ect i on and t r ansmi ssi on. Thus, t her e shoul d be a pr ocess of
knowl edge r evi ew f r om mul t i pl e di mensi ons i n or der t o devel op a
knowl edge base whi ch i s consi st ent wi t h t he st at e of soci al ser vi ces and
t echnol ogi cal pr ogr ess i n medi ci ne t hat evol ves r api dl y. Thi s i nvol ves
t r ai ni ng i n HIV/ AIDS wi t h a speci al vi ew t owar d at t i t udes, deci si ons, val ue
j udgment s, st i gma, and human r i ght s. The t r ai ni ng woul d be f or ser vi ce
pr ovi der s and medi cal and publ i c heal t h st af f .
In t he pr ocess of pr esent i ng t he r epor t of pol i cy anal ysi s of t he r esponse t o
AIDS by t he NCA i n 2009, t her e was r ef er ence t o t he chal l enge of suppor t i ng
t he r espect f or humani t y and el i mi nat i on of st i gma and di scr i mi nat i on by no
l onger vi ewi ng or usi ng t he t er m r i sk gr oup or hi ghest r i sk gr oup . Thi s
st i gmat i zes t hose i ndi vi dual s as spr eader s of HIV and a soci al enemy. Thi s
r esul t s i n t hei r bei ng vi ewed unequal l y, and causes t hem t o suf f er
di scr i mi nat i on i n a way t hat pr event s t hem f r om exer ci si ng f r ee wi l l i n
maki ng t hei r l i f e deci si ons i n a saf e and const r uct i ve way.
Al so, t her e needs t o be a cessat i on of any act i on t hat cr eat es soci al st i gma
or segr egat i on and di scr i mi nat i on, or t hat l eads t o di f f i cul t y i n management
of t he l i ves of vul ner abl e and mar gi nal i zed popul at i ons. These act i ons
shoul d be made i l l egal . The goal shoul d be r egul at i ons or cust oms t hat
f aci l i t at e access t o ser vi ces, abi l i t y t o conduct sel f - car e and pr event i on i n a
way t hat i s equal t o ot her s. They need t o be empower ed t o enj oy equal
r i ght s t o heal t h, educat i on, domi ci l e, empl oyment as al l ot her s i n soci et y.
Ci vi l soci et y f eel s t her e i s a need f or a subcommi t t ee ( under t he NAC) f or
cont r ol and moni t or i ng st i gma and di scr i mi nat i on of PLHA i ncl udi ng t hose
af f ect ed by AIDS and t hei r f ami l i es. Fi nal l y, t her e shoul d be suppor t f or
ci vi l soci et y t o pr epar e r epor t s and conduct publ i c campai gns t o di ssemi nat e
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t he st at us of r i ght s, and pr omot e human r i ght s, i ncl udi ng mor e st udy r epor t s
f or anal ysi s as a basi s f or f ut ur e pl anni ng of t he NAP.
B. Implement at ion of healt h services
Chal l enges i n t he previ ous report peri od (2006-7)
The pr evi ous r epor t speci f i ed cer t ai n chal l enges r el at ed t o heal t h ser vi ces
as par t of t he Uni ver sal Access Pl an especi al l y r egar di ng pr event i on i n
cer t ai n gr oups and access t o t r eat ment , i ncr easi ng user - f r i endl y ser vi ces,
r educt i on of pr ej udi ce, bel i ef s, t hat l ead t o val ue j udgment s, st i gma or
di scr i mi nat i on, i ncl udi ng t he vi ews of soci et y and cul t ur e i n wor ki ng on
AIDS.
Success and f i ndi ngs i n t he report peri od (2008-9)
Ther e wer e many successf ul ar eas of achi evement i n t he pr evi ous r epor t
per i od. Thai l and has a cl ear pol i cy and i ncr eased suppor t f or pr event i on.
Thi s i ncl udes t he cr eat i on of a subcommi t t ee t o accel er at e HIV pr event i on
and t he pol i cy t o r educe i nci dence by hal f by 2011, and t he addi t i onal
f undi ng t o make t hi s happen f r om t he GFATM Round 8 t o cont i nue act i vi t i es
st ar t ed under pr evi ous r ounds and pr ovi de gr eat er emphasi s t o t he
vul ner abl e popul at i ons of IDU, MSM, SWs, and mi gr ant l abor er s.
Repr esent at i ves f r om t he benef i ci ar y popul at i ons pl ayed a gr eat er r ol e i n
st r at egi c pl anni ng or pol i cy f or mul at i on and i mpl ement at i on at t he nat i onal
and pr ovi nci al l evel .
In t he ar ea of PMTCT, t he ART r egi men was i mpr oved t o i ncl ude t r i pl e
t her apy wi t h expansi on f r om pi l ot t o nat i onal cover age st ar t i ng i n Oct ober
2010. The St ayi ng Negat i ve Pr oj ect was l aunched i n MCH cl i ni cs whi ch
advocat ed coupl e counsel i ng. These devel opment s r ef l ect a gr eat er
at t ent i on t o t he mot her / wi f e i n t he f ami l y. Qual i t y of l i f e pr omot i on was
al so f eat ur ed al ong wi t h sex and r epr oduct i ve heal t h r i ght s f or PLHA,
st ar t i ng wi t h t hose i ni t i at i ng ART and women appear i ng f or ANC who l ear n
t hat t hey ar e i nf ect ed. Thi s ef f or t i s bei ng expanded t o nat i onal cover age.
Suppor t f or access t o VCCT i mpr oved t hr ough t he i ncl usi on of t he VCCT f und
i nt o t he benef i t s package of t he NHSP i ncl udi ng a hot l i ne f or AIDS, heal t h
and sex t o i ncr ease access t o ser vi ces.
Har m r educt i on i nvol ves many sect or s and pl ayer s, i ncl udi ng t he l egal and
j ust i ce syst em. Nat i onal l evel commi t t ees wer e f or med and l ear ned mor e
about t he act ual si t uat i on of vul ner abl e popul at i ons, and t hi s i ncr eased
concer n f or t he need f or ser vi ces. Met hadone mai nt enance t her apy ( MMT)
was added t o t he benef i t s of f er ed by t he NHSP st ar t i ng i n Oct ober 1, 2008.
The NAPHA ext ensi on pr oj ect i mpr oved t r eat ment access f or 2, 000 mi gr ant
l abor er s, et hni c mi nor i t i es and undocument ed per sons. HIV VCT, condom
r e- suppl y and har m r educt i on was i nt r oduced i nt o pr i son popul at i ons on a
pi l ot basi s and t he ser vi ce model i s bei ng r ef i ned.
For chi l dr en, t her e i s a commi t t ee t hat moni t or s t he r i ght s of t he chi l d
under t he Mi ni st r y of Soci al Wel f ar e and Human Secur i t y. The f ocus i s on
chi l dr en af f ect ed by AIDS bot h i nf ect ed and uni nf ect ed. In addi t i on, t her e
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has been model devel opment by t he We Under st and gr oup i n col l abor at i on
wi t h cl i ni cal and t echni cal medi cal ser vi ces t o bui l d t he capaci t y of chi l dr en
and yout h wi t h HIV so t hat t hey can act i vel y par t i ci pat e i n AIDS wor k.
Chal l enges and recommendat i ons f or t he next peri od (2010-11)
Ther e has been pr ogr ess i n many ar eas i ncl udi ng pr ovi di ng compr ehensi ve
and i nt egr at ed ser vi ces f or pr event i on, car e and t r eat ment and mi t i gat i ng
t he i mpact i n a way t hat does not di scr i mi nat e and bui l ds on a f oundat i on of
r espect f or humani t y and i s consi st ent wi t h t he NAP Pl an f or 2007- 11.
Never t hel ess, ci vi l soci et y vi ews t he t ar get t o r educe i nci dence by hal f by
2011 as st r at egy t hat pl aces undue emphasi s on r i sk gr oups and i s dr i ven
by epi demi ol ogi cal consi der at i ons and i s onl y a shor t - t er m appr oach t o
cont r ol . Indeed, i t wi l l have l ong- t er m negat i ve ef f ect s f or t he popul at i ons
cl assi f i ed as hi ghest r i sk gr oups who wi l l be st i gmat i zed, segr egat ed and
di scr i mi nat ed agai nst , and whi ch wi l l make i t har der t o r each t hem wi t h
ser vi ces, t o pr ot ect t hei r r i ght s and i ndi vi dual l i ber t i es.
It al so cr eat es conf usi on t o deconst r uct r i sk behavi or and vi ew i t i n
i sol at i on i nst ead of bei ng a par t of a const el l at i on of f act or s/ condi t i ons
r el at i ng t o power , i nequal i t y, sexual r el at i ons, and et hni ci t y. Thus, t her e
needs t o be mor e of a mul t i - di mensi onal vi ew of r i sk i ncl udi ng
epi demi ol ogy, soci o- cul t ur al f act or s, and human r i ght s. The ser vi ces and
ser vi ce pr ovi der s need t o be adapt abl e and adapt ser vi ces so t hat t hey ar e
mor e r espect f ul and honor humani t y. Ther e shoul d be a di scont i nuat i on of
t he use of t he t er ms r i sk gr oup and gr oup of hi ghest r i sk t o l ead soci et y
t owar d a posi t i ve out l ook of a heal t hy sex l i f e bui l t on r espect ,
under st andi ng, saf et y and happi ness.
Ci vi l soci et y r ecommends t hat t her e be mor e pol i ci es, measur es and
ser vi ces t hat addr ess r espect f or human r i ght s, and accept ance of t he
di ver si t y of sex, gender , and sexual i t y. They need t o vi ew i ssues l ess i n
t er ms of f emal e, mal e, or mascul i ne, f emi ni ne and mor e i n t er ms of peopl e
who f i nd t hemsel ves al ong a cont i nuum of sex, gender and sexual i t y not
somet hi ng t hat i s r i ght or wr ong, or l ess human or r espect abl e i n any way.
Ther e shoul d be no act i ons t hat make t hi s di ver si t y i l l egal ; t hi s wi l l make i t
onl y har der t o r each t hem so t hat t hey can be equal and pr oduct i ve
member s of soci et y.
AIDS ser vi ce pr ovi der s and r el at ed per sons shoul d r ecei ve t r ai ni ng t o bet t er
under st and sexual di ver si t y, gender and sexual i t y so t hat t hey can pr ovi de
ser vi ces t hat ar e based on a f oundat i on of r espect and honor of one s
humani t y.
Impl ement i ng t hese measur es r equi r es cour age t o cr eat e new pol i ci es and
ser vi ces t hat gi ve mor e i mpor t ance t o women s r epr oduct i ve heal t h r i ght s,
as t hose wi t h l ess soci al power , bet ween gender s, and coupl e dynami cs,
f ami l y r el at i onshi ps, t he communi t y and soci et y. Thi s i s needed t o hel p
women communi cat e about sex, t hei r bodi es, sel ect i ng a par t ner , havi ng
chi l dr en or t er mi nat i ng a pr egnancy i n ways t hat ar e saf e and sat i sf act or y.
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Ci vi l soci et y f eel s t hat , over t he past 10 year s, t he PMTCT pr ogr am st i l l
over l y emphasi zes t he heal t h of t he i nf ant . It does not l ook at t he soci al
di scr i mi nat i on suf f er ed by t he mot her as someone who has i nf ect ed her
newbor n. It does not consi der t he woman s body, her deci si on opt i ons, and
pr egnancy pl anni ng, car r yi ng t he pr egnancy, or choosi ng abor t i on. These
deci si ons need t o be based on compr ehensi ve i nf or mat i on f or t he pr egnant
woman and her par t ner .
VCT ser vi ces i n MCH cent er s f or pr egnant women ar e not yet t ot al l y
vol unt ar y. Thi s i s because st af f ar e t oo eager t o scr een women f or PMTCT
ser vi ces. Thi s shor t - cut s t he deci si on- maki ng pr ocess f or t he woman.
Ther ef or e, ci vi l soci et y f eel s t her e i s a need f or gr eat er r espect f or t he
r epr oduct i ve heal t h r i ght s of t he woman based on user - f r i endl y sexual
heal t h ser vi ces, wi t h pr omot i on of mor e coupl e- based ser vi ces f or ANC
cl i ent s t o hel p women communi cat e t hei r f eel i ngs and wi shes t o t hei r
par t ner .
The pol i cy t o pr omot e gr eat er cover age of VCT i s shi f t i ng mor e t o Pr ovi der
Ini t i at ed Counsel i ng and Test i ng ( PICT) . Whi l e, ost ensi bl y, t he pur pose i s t o
i ncr ease ser vi ce opt i ons and choi ce, i f t he pol i cy i s used f or mor e aggr essi ve
case- f i ndi ng t o pr event t r ansmi ssi on or t o speed per sons i nt o ART t her e i s
t he oppor t uni t y f or abuse and i nf r i ngement of t he r i ght s of t he cl i ent , who
needs t o exper i ence a compr ehensi ve i nf or mat i on and deci si on- maki ng
pr ocess at her own pace.
An i mpor t ant mi ssi ng pi ece of t he pol i cy mosai c i s t he need f or r espect of
r eadi ness, i nf or med wi l l i ngness, and i ndi vi dual - det er mi ned deci si on- maki ng.
A per son comi ng f or counsel i ng needs t he f ul l spect r um of i nf or mat i on t o
assess act i ons and opt i ons i n t he cont ext of t hei r vul ner abl e r i sk si t uat i ons
so t hey can make sel f - det er mi ni ng deci si ons; so t hat t hey can accept or
deny HIV bl ood t est i ng. The st af f must suppor t and accept t hi s deci si on and
mai nt ai n t ot al conf i dent i al i t y of t he pat i ent r ecor d as a basi c r i ght of t he
cl i ent .
At t he same t i me, whi l e VCT i s a benef i t under t he NHSP, most of t he
el i gi bl e per sons ar e not awar e of t hi s, and so t her e i s under ut i l i zat i on. In
addi t i on, HIV t est i ng of yout h under 18 i s pr obl emat i c because i t conf l i ct s
wi t h t he gui del i nes f or doct or s on AIDS ( Thai Medi cal Counci l , 2002) whi ch
speci f i es t hat i n t er ms of r espect i ng t he conf i dent i al i t y f or t he cl i ent and
i nf or mi ng of bl ood t est r esul t s t o a cl i ent under 18 who i s si ngl e. . . needs t he
i nvol vement and consent of t he par ent / guar di an. An i mpor t ant chal l enge
i s t o f i nd ways so t hat yout h have mor e access t o HIV VCT and r ef er r al t hat
i s appr opr i at e and accept abl e t o t hem and whi ch i s l egal and i s i n t he best
i nt er est s of t he yout h. Ci vi l soci et y, t hr ough t he NGO PATH has
assembl ed t he r el evant l aws or r egul at i ons and summar i zed t hese f or t he
subcommi t t ee f or pr epar i ng gui del i nes f or consi der at i on by t he Thai Medi cal
Counci l .
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Pr omot i ng r i ght s of access t o ser vi ces f or undocument ed per sons i s l acki ng
suppor t i ve pol i cy, and t hi s i s an obst acl e t o access t o ser vi ces such as l ack
of a compr ehensi ve har m r educt i on pol i cy. Use of t he l aw on pr ost i t ut i on t o
har ass and ar r est pr ost i t ut es or MSM who car r y condoms as evi dence of
cr i me i s count er pr oduct i ve. For ei gn mi gr ant l abor er s or et hni c mi nor i t i es or
ot her s who ar e i n Thai l and i l l egal l y ar e al so har d t o r each and can t access
t r eat ment si nce t hey ar e not el i gi bl e f or t he ART pr ogr am under t he NHSP,
or because t he NAPHA ext ensi on quot a of 2, 000 was al r eady f i l l ed.
Et hni c mi nor i t i es, or hi l l peopl e, bot h document ed and undocument ed,
can t of t en exer ci se t hei r r i ght s t o ser vi ce under t he NHSP, or t hey r ecei ve
di sr espect f ul ser vi ce. Ther e shoul d be a heal t h f und t o suppor t ART f or t hi s
gr oup and accel er at e t he Thai document at i on pr ocess f or t he
undocument ed. It has been pr oposed t hat 50 baht of t he 1, 300 baht heal t h
i nsur ance payment f or mi gr ant l abor er s be used t o seed t he f und f or t he
undocument ed mi gr ant s.
Concer ni ng ser vi ces i n pr i sons i t i s f ound t hat most pr i soner s don t
under st and t hei r r i ght s, and aut hor i t i es usual l y over l ook t hese gaps and
don t want t he pr i soner s t o know what t hey ar e ent i t l ed t o. Tr eat ment i s
sl ow t o ar r i ve and pr i soner s wi t hout t he 13- di gi t ID car d ar e not el i gi bl e f or
subsi di zed car e. Some ar e f or ei gn PLHA and can t access l ocal t r eat ment .
Thei r embassi es shoul d t ake a mor e act i ve r ol e i n hel pi ng t hese i nmat es.
Car e f or chi l dr en af f ect ed by AIDS i n or phanages ( publ i c and pr i vat e) i s
under st andar d i n some cases and can be consi der ed a r i ght s vi ol at i on.
These i ncl ude segr egat i on of sl eepi ng quar t er s, and i nappr opr i at el y usi ng
chi l dr en f or f und- r ai si ng. Ther e shoul d be t r ai ni ng and i nf or mat i on
di ssemi nat i on f or t he r el evant st af f wi t h t he Mi ni st r y of Soci al Wel f ar e as
t he r esponsi bl e agency.
C. Promot ing knowledge and educat ion
Chal l enges i n t he previ ous report peri od (2006-7)
Impor t ant chal l enges wer e r ai sed i n t he pr evi ous r epor t i n t he ar ea of
compr ehensi ve sexual i t y educat i on ( CSE) and access t o yout h- f r i endl y heal t h
ser vi ces f or adol escent s.
Success and f i ndi ngs i n t he current peri od (2008-9)
The DOH of t he MOPH has st udi ed t he cont ent of sex educat i on and
i mpr oved t hi s so t hat i t i s mor e compr ehensi ve, and submi t t ed t hi s t o t he
Mi ni st r y of Educat i on f or i nt egr at i on i nt o t he f or mal school heal t h educat i on
cur r i cul um over a per i od of t i me st ar t i ng i n 2002. The cur r i cul um has si x
modul es: ( 1) human sexual devel opment ; ( 2) i nt er per sonal r el at i onshi ps; ( 3)
per sonal and communi cat i on ski l l s; ( 4) sexual behavi or ; ( 5) sexual heal t h;
and ( 6) soci et y and cul t ur e. Yet t he r esul t s of t hi s ar e not yet sat i sf act or y.
The Teenpat h pr oj ect has t aken sex educat i on f ur t her t o cr eat e a CSE
cur r i cul um bui l t on t he or i gi nal si x modul es wi t h a new emphasi s on t hr ee
di mensi ons: ( 1) sexual i t y i n al l i t s human di mensi ons; ( 2) posi t i ve yout h
devel opment ; and ( 3) usi ng a l ear ner - cent er ed appr oach t o t eachi ng.
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However , t he cur r i cul um i s st i l l most l y used as gui dance, and i t i s up t o t he
di scr et i on of t he t eacher whet her and how t o appl y i t . The Mi ni st r y of
Educat i on has st i l l not adopt ed t he CSE appr oach i nt o t he f or mal
cur r i cul um.
Chal l enges and recommendat i ons f or t he comi ng peri od (2010-11)
Ci vi l soci et y r ecommends t hat t her e be suppor t f or CSE on a cont i nuous
basi s wi t h gr eat er cover age i n t he f or mal and non- f or mal educat i onal
syst ems. The t eacher s capaci t y and at t i t udes need st r engt heni ng. The
NAC needs t o char ge t he subcommi t t ee f or accel er at ed HIV pr event i on t o
consi der measur es t o advance t hi s as par t of t he human r i ght s appr oach, as
an adol escent s r i ght t o accur at e and pr act i cal i nf or mat i on about sex
t hr ough CSE.
Compr ehensi ve sexual heal t h ser vi ces ar e needed, i n a si t e t hat i s yout h-
f r i endl y and t hat ar e sensi t i ve t o gender - speci f i c i ssues and pr ovi de
oppor t uni t y f or counsel i ng and ot her i nf or mat i on as needed. The si t e shoul d
be a pl ace f or r el axat i on f or yout h and poi nt of f i r st cont act f or r ef er r al i f
heal t h pr obl ems ar i se. The si t e can hel p educat e par ent s, t he f ami l y and
soci et y about t he needs of adol escent s t o cr eat e a br oader envi r onment f or
l ear ni ng CSE. Thi s i s a f undament al adol escent r i ght . The DOH can wor k
wi t h t he r el evant NGOs, Foundat i on f or Chi l dr en, adol escent net wor ks as a
wor ki ng gr oup t o advance t hese pr i nci pl es and pr act i ces.
At t he same t i me, t her e i s a need f or soci al campai gns on CSE not t o
pr omot e anyt hi ng i mmor al but t o bui l d heal t hy val ues i n yout h about
sexual choi ce and l i f est yl es t hat r ef l ect r eal i t y yet ar e consi st ent wi t h
nat ur e, soci et y, cul t ur e, and t he economy whi ch ar e changi ng r api dl y. The
MOPH and NGOs who ar e GFATM gr ant ees can t ake act i on wi t h yout h and
ot her popul at i ons on t hi s t opi c t o make i t a par t of r out i ne soci al pol i cy i n
t he year s ahead.
D. St ruct ure and st rat egies f or policy development , planning and
implement at ion
Si t uat i on i n t he previ ous pl an peri od (20006-7)
The pr evi ous pr ogr ess r epor t ci t ed a chal l enge i n t he moni t or i ng and
eval uat i on syst em and management devel opment of t he NAP bot h i n t er ms
of t he st r at egy of coor di nat i on at t he nat i onal and pr ovi nci al l evel s, and t he
capaci t y of l ocal admi ni st r at i ve or gani zat i ons and t he communi t i es t o
conduct AIDS pr event i on and cont r ol .
Success and f i ndi ngs i n t he current report peri od (2008-9)
Ther e was pr ogr ess i n r ef or mi ng t he st r uct ur e t o i ncr ease st r at egi es f or
accel er at ed act i on such as Or der 1/ 2007 of t he NAC on Apr i l 4, 2007 t o
cr eat e t he subcommi t t ee f or cont r ol and accel er at i on of AIDS pr event i on
whi ch has t he aut hor i t y t o moni t or consi st ency of i mpl ement at i on wi t h t he
gui del i nes such as mor e i nt egr at ed and t r anspar ent i mpl ement at i on t o
i ncr ease cost - ef f ect i veness. The subcommi t t ee al so pr ovi des over si ght f or
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f unds mobi l i zat i on t o augment Round 1 and 8 GFATM assi st ance i n
accor dance wi t h t he NAP pl an f or 2007- 11.
At t he same t i me t her e wer e modi f i cat i ons t o t he st r at egy f or accel er at ed
act i on at t he pr ovi nci al l evel t hr ough t he Cent er f or AIDS Coor di nat i on
whi ch can be consi der ed a new el ement of t he pr ovi nci al st r uct ur e t o
manage nat i onal budget and l ocal r esour ces f or AIDS pr event i on and cont r ol .
Chal l enges and recommendat i ons f or t he comi ng peri od (2010-11)
Ther e i s a need, at t he nat i onal and pr ovi nci al AIDS commi t t ee l evel s, f or
i ndependent deci si on- maki ng and l ocal par t i ci pat i on f r om var i ous sect or s i n
accor dance wi t h decent r al i zat i on of aut hor i t y t o mor e aggr essi vel y addr ess
t he pr obl ems of AIDS i n a mor e par t i ci pat or y and cost - ef f ect i ve way.
Ther e i s a need f or r ef or mi ng t he nat i onal and pr ovi nci al st eer i ng
commi t t ee pr ocess so t hat l eader shi p i s not conduct ed si ngl e- handedl y ( by
t he chai r per son) . That i s an ant i quat ed f or m of management . The CCM i s a
mor e moder n way of col l abor at i ve management , wi t h cor r espondi ng
devel opment of t he PCM ( whi ch i s on- goi ng) . These pr oposed changes need
t o be moni t or ed t o assur e t hat t her e i s cost - ef f ect i ve i mpl ement at i on of
accel er at ed pr event i on and cont r ol .
An i mpor t ant cog i n t he wheel of accel er at ed pr ogr ammi ng i s t he cog of
t echni cal suppor t f r om t he var i ous t echni cal agenci es at t he nat i onal and
pr ovi nci al l evel whi ch needs t o addr ess t echni cal capabi l i t i es mor e st r ongl y
and compr ehensi vel y t han cur r ent l y i s t he case.
As mor e accel er at ed pr ogr ammi ng occur s, ci vi l soci et y has t he vi ew t hat t he
st r at egy needs t o be modi f i ed t o i ncl ude mor e of a human r i ght s pr ot ect i on
f ocus, especi al l y sex r i ght s, t o cr eat e a new model of pr event i on t hat
r espect s r i ght s and honor s humani t y, and whi ch i s sensi t i ve t o sexual
di ver si t y. Thi s wi l l hel p move away f r om t he compar t ment al i zed appr oach
t o pr event i on t hat has boxes f or gr oup- speci f i c act i vi t i es, AIDS knowl edge
cr eat i on, condom and l ubr i cant di st r i but i on, et c. Inst ead, t he new
appr oach, based on human r i ght s, wi l l bl end al l t he el ement s t oget her i n a
way t hat i s appr opr i at e and r el evant f or a gi ven benef i ci ar y so t hat
deci si ons ar e i nf or med, and made at t he pace of deci si on- maker i n a way
t hat i s best - sui t ed t o t hemsel ves i n or der t o enj oy a heal t hy and saf e sex
l i f e.
Ci vi l soci et y r ecogni zes t hat t he GFATM assi st ance has gal vani zed pr event i on
i nt er vent i ons at t he communi t y l evel wi t h mor e gr assr oot s agenci es
i nvol ved, however t her e i s i nadequat e shar i ng of exper i ence acr oss t hese
agenci es. Thi s i s par t l y due t o t he st yl e of management of gr ant s by t he
Pr i nci pal Reci pi ent whi ch does not encour age shar i ng among t he sub-
r eci pi ent s.
Anot her ar ea of concer n i s t hat t he Thai pr ogr am ( i ncl udi ng ci vi l soci et y) i s
now t oo dependent on GFATM assi st ance. Ther ef or e, t he gover nment and
ci vi l soci et y need t o br ai nst or m t oget her on how t o pr oceed i n a post -
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GFATM wor l d and how t hat wi l l af f ect i nt er vent i ons, and devi se an
appr opr i at e st r at egy f or mobi l i zi ng f unds t o cont i nue t he success and cost -
ef f ect i ve i mpl ement at i on t hat has occur r ed so f ar .
Ci vi l soci et y r ecommends t hat t her e needs t o be f ur t her devel opment of t he
l ong- t er m pl an whi ch addr esses sexual and r epr oduct i ve heal t h, and
pr ot ect s and r espect s sexual and human r i ght s. The l ong- t er m vi ew wi l l
pr ovi de consi der at i on f or sexual di ver si t y, gender and sexual i t y whi ch i s a
basi c human r i ght and shoul d be par t of t he nat i onal AIDS pl an.
At t ent i on must be pai d t o pol i cy, pl ans and measur es addr essi ng AIDS as
t hey r el at e t o ot her pol i ci es and l aws whi ch i mpact on i ndi vi dual sexual
r i ght s so t hat genui ne pr ogr ess i n t hi s ar ea can be made.
In t he ar ea of moni t or i ng and eval uat i on, even t hough t her e have been
ef f or t s t o i nvol ve ci vi l soci et y, t her e i s st i l l t oo much cl assi f i cat i on and
segr egat i on by gr oups, especi al l y t he vul ner abl e popul at i ons. Ther e i s t oo
much of a nar r ow f ocus on t he out put s and out comes of a gi ven act i vi t y,
wi t hout at t ent i on t o t he br oader i mpact . Thi s i s an ar ea wher e ci vi l soci et y
can cont r i but e t o hel p eval uat or s see t he i ndi r ect r ami f i cat i ons of var i ous
i nt er vent i ons.
The NAC and i t s subcommi t t ees need t o ensur e t hat t her e i s r i ght s
pr ot ect i on and t o cont i nue t o push f or pol i ci es and l aws t o el i mi nat e
obst acl es t o r i ght s pr ot ect i on.
In addi t i on, t her e needs t o be adequat e sur vei l l ance and moni t or i ng of t he
pr obl ems and i mpact of st i gmat i zat i on and di scr i mi nat i on r egar di ng sex and
AIDS. A subcommi t t ee t o moni t or and er adi cat e st i gma and di scr i mi nat i on
of PLHA and af f ect ed per sons and t hei r f ami l i es woul d be anot her st r at egy
t o hel p t he accel er at ed pr ogr am t o r espond t o t he AIDS pr obl em i n
Thai l and.

200
Annex 4
Report on St i gma Index Survey
10 December 2009
Background
St i gma i ndex sur vey i s a maj or act i vi t y under t he pr oj ect on AIDs Ri ght s
Advocacy and St i gma Index Devel opment , especi al l y t he component on
st i gma-di scri mi nat i on i ndex survey whi ch was desi gned based on t he
st i gma i ndex user gui de and quest i onnai r e gl obal l y i nt r oduced t hr ough
r egi onal wor kshops f aci l i t at ed by IPPF, UNAIDS and var i ous i nt er nat i onal
NGOs. Ther e wer e ni ne count r i es par t i ci pat i ng i n t hi s gl obal i ni t i at i ve.
Thai l and i s one of t he count r i es has par t i ci pat ed i n t hi s i ni t i at i ve.
Wi t h t he t wo component s on AIDS r i ght s advocacy pr ogr am and st i gma-
di scr i mi nat i on i ndex sur vey, t he pr oj ect was devel oped acr oss mul t i -
par t ner shi p wi t h key nat i onal and i nt er nat i onal par t ner s such as Thai l and
Net wor k of Peopl e l i vi ng wi t h HIV/ AIDS( TNP+) , Thai NGO Coal i t i on
AIDS( TNCA) , Mi ni st r y of Just i ce( MOJ) s Depar t ment of Ri ght s and Li ber t y
Pr ot ect i on, FAR, Mi ni st r y of Publ i c Heal t h( MOPH) s Depar t ment of Di sease
Cont r ol , Publ i c Medi a, Academi c Inst i t ut i on, Nat i onal Human Ri ght s
Commi ssi on( NHRC) and UNAIDS as wel l as key UNAIDS cosponsor i ng agenci es,
namel y UNDP, UNICEF, UNFPA and UNESCO. The pr oj ect was i mpl ement ed
by t he Foundat i on f or AIDS Ri ght s( FAR) t oget her wi t h TNP+ t hat l ooked af t er
t he component on t he st i gma- di scr i mi nat i on sur vey. The pr oj ect was
i mpl ement ed bet ween Febr uar y 2009 Januar y 2010.
The st i gma- di scr i mi nat i on sur vey component was i mpl ement ed wi t h t hr ee
maj or act i vi t i es: t r ai ni ng of r esear ch assi st ant s; f i el d dat a col l ect i on; and
l ocal and nat i onal wor kshops or meet i ngs t o anal yze t he dat a and t o
di ssemi nat e t he r esul t s.
The t r ai ni ng of r esear ch assi st ant s was conduct ed i n Apr i l and May 2009
i nvol vi ng 13 r esear ch assi st ant s who wer e t he peopl e l i vi ng wi t h HIV and
vol unt eer ed t o ser ve t he pr oj ect t o assi st t he r esear ch pr i nci pal i n dat a
col l ect i on and anal ysi s. The t r ai ni ng was a ser i es of wor kshops conduct ed by
t he r esear ch pr i nci pal f r om Ubobr achat hani Uni ver si t y t oget her wi t h TNP+
and FAR t eam. The wor kshops wer e or gani zed t o make t he r esear ch t eam t o
under st and about t he pr oj ect concept and backgr ound, r esear ch t ool s( user
gui de and quest i onnai r e) , r esear ch t heor i es, r esear ch met hodol ogy and dat a
col l ect i on and anal ysi s. Fi el d exer ci se and pr e- t est wer e al so i ncl uded i n
t he t r ai ni ng pr ocess.
Dat a col l ect i on was under t aken by t he r esear ch t eam composed of t he
r esear ch pr i nci pal and 13 r esear ch assi st ant s bet ween June and August . In
t hi s pr ocess, 233 r espondent s wer e i nt er vi ewed.
Dat a anal ysi s was t hen under t aken i n Oct ober and November by t he
r esear ch t eam, t hough a ser i es of meet i ngs wer e convened t o al l ow t he
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r esear ch assi st ant s t o par t i ci pat e i n t he i ni t i al anal yzi ng pr ocess af t er f i el d
dat a col l ect i on, especi al l y t he st age of cl eani ng t he r aw dat a and def i ni ng
key t er mi nol ogy r el at ed t o t he r esear ch f r amewor k.
In t he meant i me, t he r esear ch t eam and FAR or gani zed meet i ngs i n 7
r egi ons ai mi ng t o di ssemi nat e t he i ni t i al r esul t s and gai n f eedback on t he
r esear ch f i ndi ngs f r om var i ous gr oups of par t i ci pant s. The meet i ngs wer e
at t ended by key r epr esent at i ves f r om t he net wor ks/ gr oups of t he peopl e
l i vi ng wi t h HIV, MOPH of f i cer s and CSOs at pr ovi nci al and l ocal l evel s. In t hi s
r egar d, each meet i ng was at t ended by about 100 par t i ci pant s.
In addi t i on, FAR and key par t ner s or gani zed 4 addi t i onal meet i ngs f unded by
UNDP( as an addi t i onal f undi ng suppor t f or t hese par t i cul ar meet i ngs) i n
November t o i nvol ve wi der audi ences f ocusi ng and t o bui l d a campai gni ng
f oundat i on f or Wor l d AIDS Day( WAD) event ( In Thai l and TNCA, FAR and
par t ner s or gani zed WAD event and act i vi t i es on 28- 29 November ) t hat woul d
j oi nt l y addr ess WAD t heme on Uni ver sal Access and Human Ri ght s at t he
count r y l evel . The meet i ngs wer e act ual l y at t ended by t hose who wer e t he
key act or s t o addr ess t he i ssues and cases r el at ed t o st i gma and
di scr i mi nat i on as wel l as bui l d net wor ks and par t ner shi p. These i ncl uded
TNP+ member s, l awyer s, NHRC member s, MOJ of f i cer s, academi a, l ocal
gover nment or gani zat i ons and CSOs at l ocal l evel s. The at t endance was
r angi ng bet ween 70- 200 par t i ci pant s.
Nat i onal Launch of t he Report .
As pl anned under t he pr oj ect ment i oned above and as a par t of nat i onal
AIDS campai gni ng pr ocess and as an event t o cel ebr at e t he Int er nat i onal Day
of Human Ri ght s, t he l aunch of t he r epor t on st i gma- di scr i mi nat i on i ndex
sur vey was or gani zed on 10 December . It was a nat i onal wor kshop t o pr esent
f i nal r esul t s of t he i ndex sur vey and seek f i nal comment s f r om key nat i onal
mechani sms bef or e t he compl et i on of t he pr oj ect . The l aunch was at t ended
by 115 par t i ci pant s f r om var i ous l evel s and t ypes of key concer ned
gover nment agenci es, non- gover nment al or gani zat i ons, publ i c i ndependent
i nst i t ut i ons, UN agenci es, publ i c medi a and academi a. In t hi s r egar d, hi gh
l evel of f i ci al s at Di r ect or - Gener al l evel f r om 3 key depar t ment s under MOJ
and MOPH at t ended t he meet i ng and pr ovi ded ver y good comment s. A
number of gover nment depar t ment s concer ni ng human r i ght s and HIV sent
t hei r t echni cal st af f t o at t end t he meet i ng and made usef ul comment s ( See
appendi x 1) . Speci al guest s who f unct i oned as t he comment at or s came f r om
pr omi nent backgr ound and popul ar i t y i ncl udi ng Magsaysay Awar dees and
member Thai PBS TV Boar d, Di r ect or Gener al , Depar t ment of Ri ght s and
Li ber t y Pr ot ect i on and Di r ect or - Gener al of Pr osecut or s Legal Assi st ance
Di vi si on.
Key agenda wer e wel comi ng addr ess by UNAIDS Count r y Coor di nat or ,
i nt r oduct or y r emar k by TNP+ r epr esent at i ve, Openi ng r emar k by
Repr esent at i ve of UN Hi gh Commi ssi on on Human Ri ght s, HIV/ AIDS st i gma
and di scr i mi nat i on pl ay by r esear ch assi st ant s and TNP+ vol unt eer s,
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Pr esent at i on on sur vey r esul t s by r esear ch pr i nci pal , comment s by speci al
guest s and open di scussi on.
Key act i vi t i es
Af t er t he of f i ci al cer emony, t he l aunch st ar t ed wi t h an HIV/ AIDS st i gma and
di scr i mi nat i on r ol e- pl ay. The pl ay was consi st ed of a ser i es of 10 scenes i n
whi ch each scene showi ng a di f f er ent f or m of HIV/ AIDS st i gma and
di scr i mi nat i on was pl ayed out ( Appendi x 2) .
Present at i on of research resul t s
Resear ch obj ect i ves: Thi s sur vey r esear ch ai ms 1) t o obt ai ned r el evant dat a
as a nat i onal set on HIV/ AIDS st i gma and di scr i mi nat i on f or t hose who ar e
i nf ect ed i n Thai l and i n t er ms of t ypes, occur r ences and i mpact ; 2) t o
devel op an under st andi ng of HIV/ AIDS st i gma of di scr i mi nat i on and t he
r i ght s of t hose who ar e HIV posi t i ve and t hose who ar e af f ect ed; and 3) t o
devel op an i ndex on HIV/ AIDS st i gma and di scr i mi nat i on, whi ch coul d be
used t o det er mi ne t he ext ent of t he pr obl em and what changes t ake pl ace
over t i me.
Resear ch t eam: The r esear ch t eam was composed of one r esear ch pr i nci pal
f r om Ubonr achat hani Uni ver si t y and 13 r esear ch assi st ant s who wer e t he
peopl e l i vi ng wi t h HIV( PLHA) i ncl udi ng 10 mal es and 3 f emal es, but
r epr esent i ng di f f er ent sexual i dent i t i es. These 13 peopl e came f r om t he
di f f er ent r egi ons of t he count r y.
The Quest i onnai r e : The quest i onnai r e was gl obal l y devel oped i n
col l abor at i on wi t h f our or gani zat i ons: GNP, ICW, IPPF and UNAIDS. The
quest i onnai r e was t r ansl at ed by UNAIDS Thai l and and t hen f ur t her adapt ed
t o t he Thai si t uat i on.
Tar get gr oup of t he r esear ch and char act er i st i cs of r espondent s:
In t ot al , 233 PLHAs wer e i nt er vi ewed. These peopl e bel ong t o t he TNP+
net wor k and wer e di st r i but ed t hr oughout t he count r y.
The di st r i but i on by sex and gender wer e: 57 mal es, 148 f emal es and 28
member s of t he t hi r d sex .
Age di st r i but i on: 57. 5%wer e aged 30- 39 and 26. 2%wer e aged 40- 49.
Per i od of t i me i nf ect ed wi t h HIV: 35. 2%bel i eved t hey wer e i nf ect ed f or 10-
14 year s; 29. 2%f or 5- 9 year s; and 6. 9%f or l ess t han one year .
Mi nor i t y st at us: Cl ose t o hal f of t he par t i ci pant s ( 43. 8%) bel onged t o a
mi nor i t y gr oup t hey wer e gay, MSM, i nj ect i ng dr ugs, bel onged t o an et hni c
mi nor i t y gr oup or had been or wer e pr i soner s. 11. 6%had a di sabi l i t y
Educat i on: 52. 3% had onl y had pr i mar y educat i on. 30. 5% had secondl y
educat i on
Empl oyment : The maj or i t y of t he r espondent s l acked secur e empl oyment .
Onl y 16. 3%had a f ul l - t i me empl oyment . 20. 6%wer e unempl oyed.
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Research f i ndi ngs
St i gma caused by out si der s or sur r oundi ng f act or s:
Over a t hi r d ( 34. 3%) of t he cor r espondent s i ndi cat ed t hat t hey ar e
r est r i ct ed f r om par t i ci pat i ng i n communi t y act i vi t i es. Of t hese
peopl e, 57. 8%bel i eved t hi s was because t hei r HIV st at us was known.
Based on t he quest i onnai r e, 94. 9%of t he r espondent s i ndi cat ed t hat
t hey wer e excl uded f r om r el i gi ous act i vi t i es.
A t hi r d of t he r espondent s ( 32. 2%) i ndi cat ed t hat t hey had l ost t hei r
j obs because of t hei r HIV st at us.
Over a quar t er ( 26. 2%) of t he r espondent s had been r ej ect ed f r om
t aki ng on new empl oyment because of t hei r HIV st at us.
A f i f t h of t he r espondent s had been deni ed access t o medi cal ser vi ces
( many ot her r espondent s i ndi cat ed t hat t hey wer e not deni ed access
t o medi cal ser vi ces but t hey had t o queue up or under t ake ot her
act i vi t i es i n or der t o gai n medi cal ser vi ces, whi ch wer e per cei ved t o
be di f f er ent f r om t hose who ar e not i nf ect ed wi t h HIV) .
Sel f - st i gma:
64%f el t embar r assed bei ng HIV posi t i ve
47. 6%f el t gui l t y t hat t hey wer e HIV posi t i ve
42. 9%bl amed t hemsel ves f or bei ng HIV posi t i ve
43. 8%l acked a sense of bel i ef i n t hemsel ves
16. 7%want ed t o commi t sui ci de
21. 9%f el t t hat t hey shoul d be puni shed f or bei ng HIV posi t i ve
64. 4%wer e af r ai d of gossi p
57. 5%wer e af r ai d of har assment by ver bal abuse or har assment
54. 5% t hought t hat peopl e wer e af r ai d t o have sex wi t h t hem, because of
t hei r HIV.
Mai n i ssues wer e di scussed:
St i gma and di scr i mi nat i on f aced by chi l dr en i nf ect ed and af f ect ed by
HIV/ AIDS i n school
Thi s was a t heme t hat was pr esent ed i n t he pl ay about st i gma and
di scr i mi nat i on and was pi cked up by t he audi ence as an i mpor t ant i ssue.
Di scussi on f ocused on t he pr obl em of ei ght HIV posi t i ve chi l dr en who wer e
r ef used ent r y t o st udy at a school . These chi l dr en wer e l i vi ng at a Chr i st i an
Home f or chi l dr en, and t hus r ecei ved i nst i t ut i onal suppor t . But despi t e t hat
t hey wer e deni ed access t o t hei r l ocal school , because of t hei r HIV st at us.
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Pr obl ems of har assment of sex wor ker s by pol i ce
A r epr esent at i ve f r om t he sex wor ker s or gani sat i on SWING compl ai ned t hat
pol i ce of f i cer s wer e har assi ng mal e and t r ansgender sex wor ker s. They wer e
sear chi ng t he sex wor ker s t o see i f t hey had condoms and i f t hey di d t hey
woul d t hen accuse t hem of bei ng sex wor ker s and t hen woul d demand
money f r om t hem. The sex wor ker s di d not f eel t hey wer e i n a posi t i on t o
compl ai n, as t hey f eel t hey need t o mai nt ai n good r el at i ons wi t h t he pol i ce,
despi t e what i s goi ng on.
St i gma and di scr i mi nat i on at wor k
A number of par t i ci pant s compl ai ned about f act or i es demandi ng heal t h
check ups, i ncl udi ng a HIV t est f or f ut ur e empl oyees. The ar ea ar ound
Rayong pr ovi nce i s an i ndust r i al ar ea, wi t h numer ous f act or i es, empl oyi ng
l ar ge number s of peopl e. PLHA ar e bei ng di scr i mi nat ed agai nst as t hey ar e
bei ng deni ed empl oyment oppor t uni t i es.
St i gma and di scr i mi nat i on t hat HIV posi t i ve peopl e r ecei ve at
hospi t al s
Thi s was anot her i ssue pr esent ed i n t he pl ay about st i gma and
di scr i mi nat i on. A number of gover nment of f i ci al s f el t t hat what was
pr esent ed i n t he pl ay was ext r eme and t hat t o some ext ent was past
hi st or y. However , PLHA r epr esent at i ves at t he meet i ng i ndi cat ed t hat
pr esent l y, medi cal st af f was st i l l t r yi ng t o per suade HIV posi t i ve women not
t o have chi l dr en, t o get st er i l i zed and t o have abor t i ons i f t hey wer e
pr egnant .
HIV posi t i ve mi gr ant wor ker s and t hei r access t o ARVs and f or OI car e
Ref l ect i ng t he l ar ge number of mi gr ant wor ker s i n t he Sout h of Thai l and t he
par t i ci pant s expr essed t hei r concer n f or t hese peopl e and t hei r access t o
car e and t r eat ment . Mi gr ant wor ker s, whet her r egi st er ed or not , have
numer ous pr obl ems accessi ng car e. Unl ess t hei r heal t h pr obl ems have
become ser i ous, many mi gr ant wor ker s wi l l not want t o vi si t a Thai
gover nment hospi t al . They f i nd i t di f f i cul t communi cat i ng t o hospi t al st af f
because of l anguage di f f i cul t i es and because of cul t ur al mi sunder st andi ngs.
Al so, because of t he l anguage bar r i er s t hey may not f ul l y under st and t he
t r eat ment r egi me, and t hus not f ul l y t aki ng t hei r medi cat i ons. Fur t her ,
mi gr ant wor ker s of t en f ear ar r est , depor t at i on or t he need t o pay br i bes t o
r each t he hospi t al , even f or t hose who ar e r egi st er ed as many empl oyer s
keep t hei r l egal document s. Fi nal l y, mi gr ant wor ker s and t hei r f ami l y
member s who ar e HIV posi t i ve ar e deni ed access t o ARV medi cat i ons. It i s
not cl ear what can be done f or t hese peopl e. The meet i ng, however , not ed
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t hat t he si t uat i on has i mpr oved wi t h changi ng gover nment pol i ci es i n
al l owi ng t hese peopl e access t o t hese medi cat i ons f or at l east t hose who
ar e r egi st er ed mi gr ant s. For unr egi st er ed mi gr ant s, a l i mi t ed number of
t hem had access t o ART onl y under t he pr oj ect f unded by t he Gl obal Fund t o
f i ght agai nst AIDS, TB and Mal ar i a ( GF- ATM) .
Fi sher men
Accessi ng f i sher men wi t h heal t h messages and car e i s di f f i cul t . The
f i sher men may appear at a por t f or a shor t whi l e, bef or e goi ng back out f or
a l ong per i od of t i me. At t i mes t he f i sher men ar e away f r om a Thai por t f or
up t o a year or mor e. Dur i ng t hat t i me t he f i sher men ar e known t o
under t ake r i sk behavi our s such as pi eci ng t hei r peni ses, t at t ooi ng and
vi si t i ng sex wor ker s whenever t hey ar r i ve ashor e.
Lack of ID Car ds
Thi s t heme was r el at ed t o t he mi gr ant wor ker s; however gover nment
of f i ci al s at t he meet i ng i ndi cat ed t hat t hey wer e comi ng acr oss a smal l
number of Thai s who di d not have ID car ds, f or one r eason or t he ot her .
Wi t hout t hi s car d i t was ver y di f f i cul t t o pr ovi de any ser vi ces f or t hem.
Lack of awar eness among gover nment of f i ci al s of t hei r dut i es
The meet i ng not ed t hat at t i mes gover nment of f i ci al s wer e unawar e of t hei r
dut i es i n r el at i on t o pr ovi di ng ser vi ces t o PLHAs. Thi s was of t en r esul t i ng i n
f or ms of HIV/ AIDS st i gma and di scr i mi nat i on. Exampl es of t hi s i ncl uded
gover nment of f i ci al s announci ng t he HIV st at us of PLHA, wi t hout seeki ng t he
appr oval of t he per sons i n quest i on.
For ced bl ood t est i ng
A di scussi on t ook pl ace about appl i cant s f or a hot el posi t i on bei ng f or ced t o
t ake a HIV bl ood t est . Thi s r esul t ed i n t he or gani ser s of t he meet i ng
pr ovi di ng i nf or mat i on about t he ASO pr oj ect t hat i s bei ng l ed by TBCA.
St at ement t hat cr eat ed t hi s debat e concer ned PLHAs havi ng chi l dr en.
A par t i ci pant f el t t hat PLHAs who wer e havi ng chi l dr en wer e not bei ng
r esponsi bl e t o t hei r chi l dr en or t o t he soci et y as a whol e. She ar gued t hat
f ut ur e par ent s shoul d t hi nk ser i ousl y about havi ng chi l dr en, t hat t hey shoul d
onl y have chi l dr en i f t hey had t he economi c means t o do so and al so wer e
abl e t o physi cal l y l ook af t er t hem. She cl ai med t hat she and her non-
gover nment al or gani sat i on wer e l ooki ng af t er t oo many chi l dr en, as a r esul t
of PLHA havi ng chi l dr en and not bei ng abl e t o l ook af t er t hem due t o
economi c f act or s, heal t h i ssues or because of t he deat h of one or bot h of
t he par ent s.
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Anot her st at ement t hat cr eat ed a debat e was about t he
cr i mi nal i zat i on of HIV/ AIDS
A l awyer i n t he meet i ng st at ed t hat l aws about HIV/ AIDS woul d i mpl y t hat
t her e ar e t he gui l t y and t he i nnocent i n r el at i on t o HIV/ AIDS. Thi s l ed t o
st at ement s i ndi cat i ng t hat HIV posi t i ve peopl e shoul d not have sex or t hat
t hey shoul d have onl y sex wi t h an i nf or med par t ner .
Ot her s i n t he audi ence i ndi cat i ng t hat such an appr oach woul d onl y l ead t o
gr eat er HIV/ AIDS st i gma and di scr i mi nat i on and t hat peopl e woul d not
di scl osur e t hei r HIV st at us, or woul d not want t o be t est ed f or HIV. It was
al so poi nt ed out t hat t he l ogi cal concl usi on of such an appr oach was t hat i t
shoul d be i l l egal f or anyone wi t h any sexual l y t r ansmi t t ed i nf ect i on t o have
sex.
A f ur t her st at ement t hat cr eat ed debat e was t he use of t he phr ase of
PLHA i nf ect i ng t hose who wer e pur e.
For many peopl e i n t he meet i ng t hi s st at ement i ndi cat ed t hat PLHA wer e
gui l t y and t hose who wer e not i nf ect ed wer e pur e and i nnocent . It i mpl i ed
t hat PLHA had HIV because of t hei r bad behavi our ; t hey had been dr ug
user s, sex wor ker s or homosexual s or had done somet hi ng el se whi ch t hey
had been puni shed f or .
Anot her st at ement dur i ng t he meet i ng i ndi cat ed t hat some
par t i ci pant s f el t t hat PLHA had mor e r i ght s t han t hose who wer e HIV
negat i ve
Some par t i ci pant s bel i eved t hat PLHA wer e get t i ng mor e r i ght s t han ot her
peopl e. They wer e get t i ng t hei r medi cat i ons and ot her medi cal expenses
f r ee whi l e ot her s i n t he communi t y wi t h ot her medi cal pr obl ems wer e not
get t i ng t he same condi t i ons.
Key concl usi ons and r ecommendat i ons
1. The meet i ng f ound t he r epor t r ef l ect ed t hat t her e wer e st i l l st i gma
and di scr i mi nat i on agai nst t he peopl e l i vi ng wi t h HIV i n Thai soci et y,
t hough r esponses t o HIV and AIDS have been i mpl ement ed f or mor e
t han 25 year s.
2. The occur r ences f ound i n t he f i ndi ngs of t he r epor t poi nt ed out t hat
st i gma and di scr i mi nat i on agai nst var i ous gr oups of popul at i on st i l l
r emai n no mat t er how di f f er ence t hey ar e: heal t h, r ace, r el i gi on,
cul t ur e, educat i on et c.
Those who ar e par t of t he HIV net wor k ( PLHA) and t hose wor ki ng on i ssue of
HIV and AIDS i n Thai l and shoul d be i nvol ved i n a pr ocess of ensur i ng t hat
207
t her e i s a bet t er under st andi ng of r i ght s . Thi s under st andi ng shoul d be of
al l di mensi ons of r i ght s, whet her i t i s l egal , pol i t i cal , or cul t ur al .
3. The meet i ng f ound t hat st i gma and di scr i mi nat i on agai nst PLHAs i s a
st r uct ur al pr obl em i n associ at i on wi t h ot her pr obl ems such as
mi gr at i on and dr ug.
4. The i mpor t ant r oot of pr obl em i s at t i t ude t owar d HIV/ AIDS l eadi ng t o
at t i t ude agai nst PLHAs. It has become an i l l usi on r esul t i ng i n act i ons
t hat have t o cont r ol and r est r i ct . If ser vi ce pr ovi der s ar e t r apped i nt o
t hi s at t i t ude, i t woul d make t hei r ser vi ces come out wi t h st i gma and
di scr i mi nat i on.
5. Knowl edge and under st andi ng about human r i ght s f or t hose who ar e
r esponsi bl e at pol i cy and i n t hei r mechani sms and wor ki ng l evel ,
especi al l y i n gover nment agenci es ar e not suf f i ci ent . Ther e i s a need
f or bui l di ng under st andi ng and awar eness r ai si ng.
6. Thi s r epor t i s j ust a st ar t up and not abl e t o sol ve al l pr obl ems. Ther e
i s a need f or f ur t her st udy t o gai n mor e knowl edge, i dent i f y measur es
and devel op mor e t ool s t o sol ve pr obl ems mor e ser i ousl y.
7. The gr oups t hat ar e f aci ng mor e ser i ous st i gma and di scr i mi nat i on ar e
pr i soner s as af t er t hey ar e r el eased f r om t he pr i sons, t hey ar e har dl y
of f er ed a j ob. Or , dr ug user s who do not have access t o t ool s t o
pr event t hem f r om HIV i nf ect i on such as needl e and syr i nge.
8. Thi s sur vey and t he f i ndi ngs assi st ed t he TNP+ i n movi ng f or war d t he
human r i ght s wor ks wi t hi n t hei r net wor ks. Wi t h FAR, TNP+ t eam on
human r i ght s i n 7 r egi ons have been devel oped. Key mi l est ones ar e
devel opi ng out r each t eam and set t i ng up hot l i ne cent er s.
208
Annex 5
Pol i cy on Impl ement i ng Reproduct i ve Heal t h: Vi ew of Ci vi l
Soci et y
Repr esent at i ves of ci vi l soci et y ar e member s of t he wor ki ng gr oup on
moni t or i ng pol i cy on i mpl ement i ng PMTCT and have r ef l ect ed on gener al
pol i cy and i mpl ement at i on i ssues i n anot her sect i on of t hi s r epor t . In
addi t i on, t en of t he NGOs combi ned t hei r voi ces
50
t o expr ess t he opi ni on on
t he i mpor t ance of moni t or i ng pol i cy on r epr oduct i ve heal t h ( RH) i n par al l el
wi t h t he f ol l owi ng obj ect i ves: ( 1) moni t or pr ogr ess i n sexual and
r epr oduct i ve heal t h ( SRH) by compar i ng t he pl an wi t h accompl i shment s; ( 2)
emphasi ze st udi es t hr ough t he vi ew of i mpact ed i ndi vi dual s of pol i cy maker s
t o f i l l i n gaps bet ween pr act i ce and pol i cy; and ( 3) pr esent
r ecommendat i ons f or mor e compr ehensi ve act i on i n subsequent phases.
Thi s st udy f ocused on UNGASS t ar get s r el at ed t o SRH i n t he pr event i on
sect i ons 52, 53, 54, human r i ght s i n sect i ons 59, 60, 61, and i n r educed
vul ner abi l i t y of cer t ai n popul at i ons i n sect i ons 62, 63, and 64 of UNGASS
t ar get s. Thi s st udy al so f ocused on SRH of PLHA and gener al ser vi ce
r eci pi ent s, suppor t f or compr ehensi ve sexual i t y educat i on ( CSE) and
vi ol ence agai nst women. Thi s f ol l ow- up st udy used dat a f r om ( 1) f i el d dat a
col l ect i on; ( 2) use of secondar y dat a sour ces r el at ed t o SRH pol i cy; and ( 3)
UNGASS f or um meet i ng pr oceedi ngs on pr obl em anal ysi s and
r ecommendat i ons at t hr ee t i mes dur i ng 2009- 10.
Sour ce of f i el d dat a
I. Int er vi ews on UNGASS pr ogr ess f or t he 2008- 9 r epor t per i od
1. Int er vi ews on SRH wi t h 21 per sons f r om 15 NGOs/ agenci es
a. St af f of t he MOPH ( pol i cy l evel ) 1 per son
b. Adol escent AIDS exper t ( i nt er nat i onal ) 1 per son
c. NGO wor ker s i n yout h pr ogr ams 8 per sons
d. Repr esent at i ves f r om yout h net wor ks 11 per sons
2. Int er vi ews on SRH i n f i ve r egi ons, one pr ovi nce per r egi on i ncl udi ng
Tr ad ( East ) , Nakor n Si Thammar at ( Sout h) , Payao ( Nor t h) , Ubol
( Nor t heast ) , and Ayut haya ( Cent r al ) f or a t ot al of 326 i nt er vi ews.
a. Ser vi ce pr ovi der s ( counsel i ng i n ANC, ARV, FP) 24 per sons
b. Coupl e counsel i ng cl i ent s at ANC cl i ni c 238 per sons
c. Mal e or f emal e PLHA wi t h a chi l d under 2 64
per sons
II. Int er vi ews conduct ed under t he Voi ces and Choi ces Pr oj ect wi t h HIV+
women
50
Comprised of members from Raks Thai Foundation, Foundation for Women, PATH, Women AIDS
Network, NCA, TTAG, Foundation for Understanding Womens Health, PPAT, PDA, and SWING

209
3. In- dept h i nt er vi ews wi t h 64 per sons on SRH pol i ci es on PMTCT
a. Heal t h st af f ( PH nur ses at t he pr ovi nci al heal t h of f i ce) 46
per sons
b. 6 PLHA net wor k coor di nat or s and 12 PLHA peer l eader s
4. In- dept h i nt er vi ews ( IDI) f r om t he Voi ces and Choi ces Pr oj ect
a. St af f and nur ses who wer e t r ai ned 18 per sons
b. PLHA 110 per sons
5. Int er vi ews on SRH and sex communi cat i on among 934 PLHA ( Voi ces
and Choi ces Pr oj ect ) i ncl udi ng 652 women and 282 men i n 15
pr ovi nces.
Locat i ons of dat a col l ect i on under t he Voi ces and Choi ces Pr oj ect
Heal t h st af f and AIDS nur ses i n 9 pr ovi nces: Chi ang Mai , Lamphun, Ubol ,
Pat al ung, Yal a, Tr ad, Chol bur i , and Bangkok
PLHA f r om 15 pr ovi nces: Chi ang Rai , Chi ang Mai , Payao, Lamphun, Ubol ,
Khon Kaen, Udor n, Sr i saket , Pat al ung, Nakor n Si Thamar at , Sur at
Thani , Ranong, Tr ad, Chant abur i
Resul t s of t he st udy
51
ar e summar i zed i n t he f ol l owi ng par agr aphs.
1. SRH ser vi ces f or PLHA and gener al cl i ent s
52
: PMTCT
Pr e- t est counsel i ng
The pol i cy of t he DOH i s t hat t est i ng be vol unt ar y. The r esul t s of t he
moni t or i ng st udy f ound t hat most pr ovi der s ( 63. 6%) had not hear d of PICT.
Onl y 36. 4% under st ood t he di f f er ence bet ween VCT and PICT; 40. 9%
under st ood t hat VCT i s vol unt ar y and PICT i s t o per suade someone t o be
t est ed. The benef i t of PI t est i ng i s t hat i t i ncr eases ser vi ce cover age, but
some cl i ent s ar en t r eady t o know t he r esul t s. The advant age of VCT i s t hat
t her e i s vol unt ar y accept ance t o be t est ed. Most pr ovi der s ( 70%) t hought
t hat most ser vi ces at pr esent use VCT and most ( 45%) used appr oxi mat el y 15
t o 20 mi nut es f or t he counsel i ng sessi on. They f el t t hat onl y 5% of f er ed
PICT; and ot her ser vi ces ( 25%) . Most of t he ser vi ce pr ovi der s had counsel ed
bef or e ( 91. 3%) and most ( 90. 5%) had been t r ai ned but needed r ef r esher
t r ai ni ng ( 45. 8%) . Most f el t t hat pr egnant women ( 77. 3%) deci ded t o have
t he HIV t est vol unt ar i l y. Onl y 22. 7%t hought t hat i t was i nvol unt ar y. In any
event , i n t he meet i ng of t he PMTCT wor ki ng gr oup of UNGASS, i t was f el t
t hat HIV t est i ng of pr egnant women i s r out i ne PICT and not pur el y VCT.
Counsel i ng can hel p t he cl i ent accept t he t est r esul t s. Ful l y 69. 5%of PLHA
t hought t hat pr e- t est counsel i ng hel ped a l ot , whi l e 22% t hought i t hel ped
somewhat . But 64%f el t t he mor e i mpor t ant t hi ng i s t o gi ve t he cl i ent t i me
51
Full report of Civil Society is part of a comparative study of policy and RH services among nine countries Argentina, Belize,
Brazil, Indonesia, Kenya, Peru, South Africa, Thailand, Uganda as implemented by GESTOS, Brazil, with support from the Ford
Foundation.
52
These data are percents of RH, from UNGASS surveys by Civil Society for the 2008-9 report period (totals can be seen for each
group).

210
t o deci de, whi l e 6% sai d t hat l i st eni ng t o t he cl i ent needed i mpr ovement ,
al ong wi t h r i sk assessment ( 35. 4%) .
Counsel i ng f or PMTCT
In t he 2008- 9 r epor t t o UNGASS, Ci vi l Soci et y ci t ed some pr obl ems wi t h t he
PMTCT pr ogr am i n t hat t her e seemed t o be an over - emphasi s on t he heal t h
t he i nf ant . Mot her s needed mor e compr ehensi ve i nf or mat i on, especi al l y
about t r eat ment si nce t hey di dn t know enough about t he si de ef f ect s and
ot her aspect s. A st udy
53
af f i r med t hat si ngl e- dose Nevi r api ne i s associ at ed
wi t h t r eat ment f ai l ur e post - par t um, bot h i n t he mot her and i nf ant . In t hi s
st udy, 62. 5% sai d t hat Nevi r api ne was ef f ect i ve; onl y 45. 8% ment i oned t he
pr obl em wi t h r esi st ance, or dr ug r eact i ons ( 54. 2%) , and t he name of t he
dr ug and met hod of consumpt i on ( 50. 0%) .
Post - t est coupl e counsel i ng
Ther e i s anot her ar ea of di scr epancy bet ween ser vi ce pr ovi si on and needs of
PLHA i n t he ar ea of l ear ni ng t est r esul t s when appear i ng f or coupl e and
f ami l y counsel i ng. Thi s st udy f ound t hat most PLHA women t ol d t hei r
ser ost at us t o t hei r par t ner ( 82. 7%) whi l e al l mal es ( who came wi t h t hei r
wi f e f or ANC) t ol d t hei r wi ves t hei r ser ost at us. Ful l y 24. 5% of women
encount er ed pr obl ems af t er di scl osur e, such as physi cal abuse ( 9. 4%) ; and
26. 9% sai d t hey wer e not abl e t o di scl ose t hei r ser ost at us. Bot h mal e and
f emal e PLHA r epor t ed pr obl ems of di vor ce af t er di scl osur e of ser ost at us
dur i ng coupl e counsel i ng (20%) i n cont r ast t o t he opi ni on of ser vi ce
pr ovi der s t hat coupl e counsel i ng wor ks (45%). What t he PLHA say t hey
want hel p wi t h i s mor al suppor t (67. 9% of women and 75% of men). They
al so want someone t o l i st en t o t hei r f eel i ngs mor e t han hear i ng someone
t al k about t he t est r esul t s and i mpact . In addi t i on, t hey don t want any
one t o di scl ose t hei r st at us i n t hei r st ead ( onl y 5. 7%of women and 16. 7%of
men want ed t he ser vi ce pr ovi der t o t el l someone el se t hei r ser ost at us. )
Bei ng pr epar ed t o hear t he r esul t s of t he chi l d s ser ost at us PLHA ar e
concer ned t hat t hei r i nf ant i s i nf ect ed. To pr epar e t hemsel ves, t he PLHA
sai d t hey needed bot h i nf or mat i on and mor al suppor t bef or e hear i ng t he
r esul t s. But af t er knowi ng t he t est r esul t , t hey want mor al suppor t mor e
t han i nf or mat i on. By cont r ast , t he counsel or f eel s t hat i nf or mat i on i s mor e
i mpor t ant and t hat f ami l i es ar e pl ayi ng a mor e i mpor t ant r ol e i n accept i ng
t he r esul t s. Never t hel ess, 68%of counsel or s never had t r ai ni ng on i nf or mi ng
cl i ent s of t hei r chi l d s bl ood t est r esul t , t hough 63%had gi ven counsel i ng t o
post - par t um women. So t her e i s a need f or st r engt heni ng pr ovi der ski l l i n
t hi s ar ea.
53
Progress of medical science in treatment and prevention. Dr. Teera Worathanarat, Department of
Community and Social Medicine, Faculty of Medicine, Chulalongkorn University. Summary of the 12
th

National AIDS Seminar.

211
Unpl anned pr egnancy
In t he vi ew of counsel or s, unpl anned pr egnancy among PLHA ar i ses f r om
mul t i pl e f act or s. An i mpor t ant mot i vat i on i s t hat t her e i s f ami l y pr essur e t o
have a chi l d, or t he woman was not abl e t o deny unpr ot ect ed sex because
she was st i l l dependent on t he husband, or t he woman want ed t o ensur e t he
commi t ment of t he husband. Onl y 54%of t he counsel or s f el t t hat t hey had
r ecei ved adequat e i n- ser vi ce t r ai ni ng on cont r acept i on t o advi se PLHA. But
79. 2%f el t conf i dent i n advi si ng women about cont r acept i ve choi ce whi l e on
ART, and coul d advi se on unpl anned pr egnancy. Hospi t al s don t separ at e
t hei r dat a as t o whet her t he PLHA pr egnancy was pl anned or unpl anned.
Ful l y, 66. 7% of ser vi ce pr ovi der s f el t t hat t he woman shoul d abor t an
unpl anned pr egnancy but al l t hey advi se i s t o seek ser vi ce el sewher e and
advi se t hem t o t ake good car e of t hei r chi l d.
Pr event i on of unpl anned pr egnancy:
The ser vi ce pr ovi der s sai d t hat t hei r hospi t al ( 86. 4%) had a pol i cy t o
suppor t st er i l i zat i on f or women wi t h t wo chi l dr en, and pr ovi ded t he ser vi ce
as a benef i t under t he NHSP. They advi se st er i l i zat i on as t he 5
t h
choi ce f or
post - par t um cont r acept i on f ol l owed by condoms, or al cont r acept i ves,
i nj ect abl e, and sub- der mal i mpl ant . PLHA r epor t ed t hat t hey r ecei ved
encour agement t o have st er i l i zat i on as t he 2
nd
choi ce af t er condoms.
About hal f of f emal e PLHA sai d t hey f el t pr essur ed t o have a st er i l i zat i on
( 58. 5%) and 43%act ual l y agr eed t o a st er i l i zat i on. Counsel or s f el t t hat t he
mal e par t ner shoul d have t he st er i l i zat i on r at her t han t he women ( 45. 5%
ver sus 42. 9%) but , i n pr act i ce, i t i s mor e l i kel y t hat t he f emal e PLHA wi l l
have t he st er i l i zat i on.
Advi ce on cont r acept i on f or PLHA and non- i nf ect ed women i s not i dent i cal .
PLHA ar e advi sed t o use condoms, get st er i l i zat i on, have an i mpl ant , or
abst ai n f r om sex mor e t han gener al popul at i on women. For t he l at t er t he
advi ce i s usual l y or al cont r acept i ves or t he i nj ect abl e. PLHA most l y use
condoms, st er i l i zat i on or or al cont r acept i ves, i ncl udi ng some who abst ai n
f r om sex.
A f i ndi ng t hat i s not ewor t hy concer ni ng PLHA pr egnancy i s t hat 59. 6% of
women sai d t hat t hey knew t hat t hey wer e HIV+ bef or e get t i ng pr egnant ,
and t hat t he counsel or i s conf i dent i n advi si ng about cont r acept i on ( 79. 2%) .
However , i f t he PLHA want s t o have a chi l d, onl y 4. 5% of counsel or s ar e
ver y conf i dent t hat t hey can gi ve good advi ce ( 47. 8% wer e conf i dent
and 39. 1% somewhat conf i dent ) .
Pr event i on counsel i ng
For t he gener al popul at i on, 77% of pr event i on counsel i ng i s gr oup f or mat .
The counsel or t r i es t o el i ci t par t i ci pat i on of t he mal e par t ner s t hr ough a
par ent s school st r at egy. Even t hough t he gover nment f eel s t he coupl e
ANC appr oach i s wor ki ng, t hi s st udy f ound t hat onl y 69% of mal e par t ner s
j oi ned t he ANC and onl y 50% r ecei ved i nf or mat i on and par t i ci pat ed i n
coupl e act i vi t i es. About 93% of pr egnant women and t hei r husbands f el t
t hat t hey r ecei ved adequat e i nf or mat i on f r om t he coupl e counsel i ng, but
212
62% of men had a r i sk assessment , whi ch was l ess t han f or t hat of women
(82%). Ful l y 78%of men and 64%of women f el t t hey wer e not at r i sk of HIV.
Over 80%of bot h men and women ar e conf i dent t hey wi l l not acqui r e HIV i n
t he f ut ur e, even t hough condom use i s ver y l ow: 23. 1%of men and 16. 8%of
women sai d t hey used a condom at l ast sex, even t hr ough 19% di dn t know
t he ser ost at us of t hei r par t ner . Pr event i on counsel i ng i s advant ageous i n
i ncr easi ng condom use, but not yet t o opt i mal l evel s.
2. Pr omot i on of compr ehensi ve sexual i t y educat i on ( CSE)
Ther e ar e a number of sex educat i on cur r i cul a i n Thai l and, i ncl udi ng t he
MOE, t he PPAT, t he Ban Peuan Jai Wai Teen, and t he CSE pi l ot pr ogr am of
PATH. The t hr ee NGO sex educat i on cur r i cul a show t he r el at i onshi p
bet ween sex behavi or and soci et y. Thi s i s i mpor t ant because i t i s ver y har d
t o change t een sex val ues once t hey set i n, especi al l y i n t he ar ea of unsaf e
sex behavi or . New sex educat i on appr oaches i n Thai l and have not yet
demonst r at ed l ong- t er m behavi or al i mpact . ( Hi gh school and vocat i onal
st udent condom use i s l ow but at di f f er ent l evel s: see t he Teenpat h
eval uat i on r epor t by Heal t h Count er par t s. ) Sex educat i on needs t o be
sust ai ned si nce adol escent s pr ocess i nf or mat i on di f f er ent l y as t hey age.
Ot her consi der at i ons concer n access t o di f f er ent medi a and conf l i ct i ng
messages i n soci et y whi ch want t o ent i ce or seduce yout h i nt o r i sk. Ther e
ar e al so t he soci al and peer pr essur es t hat af f ect r i sk behavi or . The 15
agenci es i nt er vi ewed i n t hi s st udy agr eed t hat sex educat i on shoul d gi ve
i mpor t ance t o gender and l i f e ski l l s f or yout h.
In addi t i on, condom use behavi or i n yout h and t he gener al popul at i on i s st i l l
l ow.
54
The r easons ar e di f f er ent i n i nt er est i ng ways bet ween yout h, t he
gener al popul at i on and PLHA as shown bel ow:
54
From the national survey of sex behavior, 2006, it was found that males use condoms 12% of the time with regular partners and
47% with casual acquaintances, and 94% with sex workers. A survey of 17-20 year old adolescents in Chiang Mai by Dr. Arunrat
Tangmankongworakul found that of the sample of 1,749 57.8% were in a love relationship, and 63.3 of these were sexually active,
with condom use at 18%.


213
Reason f or not usi ng condoms
Yout h Gener al Popul at i on PLHA
1. Tr ust t he par t ner
2. Tr i ed t hem but
di dn t l i ke
3. No suppl y, coul dn t
af f or d
4. Inconveni ent
5. Too embar r assed t o
buy or ask f or
6. Unpr epar ed;
emer gency sex
7. The at t i t ude of t he
condom
pr ovi der / di st r i but o
r i s aut hor i t ar i an,
or r ecei ver i s t oo
meek
Mal e:
Wi t h r egul ar par t ner : t r ust
her
Wi t h non-r egul ar par t ner :
t r ust her / di dn t
pr epar e/ coul dn t f i nd an
out l et / don t l i ke
Femal e
1. Not abl e t o negot i at e
condom use
2. Af r ai d of l ooki ng t oo
exper i enced or i nf ect ed
3. Condoms ar e associ at ed
wi t h commer ci al sex,
sex power
r el at i onshi ps, r ol es
of t he mal e and
women, economi c
vul ner abi l i t y

Mal e
1. Pr obl ems wi t h use
( char act er i st i cs and si ze)
2. Emot i on/ f eel i ng ( don t
l i ke; l ess sensat i on)
3. Haven t di scl osed
ser ost at us t o par t ner
4. Bel i eve i n saf et y of
wi t hdr awal
Femal e:
1. No power t o negot i at e
t er ms of sex ( di dn t dar e,
di f f i cul t y communi cat i ng
wi t h par t ner )
2. Haven t di scl osed
ser ost at us t o par t ner
Sour ces:
Mal e yout h: Ad hoc st udy and IDIs wi t h yout h sex educat or s ( 2009)
Gener al mal e popul at i on Fr om t he nat i onal sur vey of sex behavi or , 2006, Inst i t ut e f or
Popul at i on and Soci al Resear ch, Mahi dol
Gener al f emal e popul at i on Resear ch st udy on women, r i sk and vul ner abi l i t y f or HIV, and
HIV pr event i on, as par t of t he Pr oj ect of Of f i ce of t he St udy of Heal t h Pol i cy and Soci al
Wel f ar e, Mahi dol Uni ver si t y ( 2009)
PLHA Fr om t he r epor t of Voi ces and Choi ces Pr oj ect , Raks Thai Foundat i on ( 2009)
The r oot s of t he pr obl em ar e t he f ol l owi ng:
1) The concept ual model of sex st i l l l acks a gender per spect i ve and an
accept ance of t he changi ng r ol es of mal e and f emal e r el at i onshi ps. Thi s
l eads t o a cont i nued emphasi s on st ayi ng a vi r gi n unt i l mar r i age ( f or
women) . But t hi s appr oach does not gi ve t he yout h t he ski l l s t o i mpl ement
t hi s or ot her st r at egi es on sex communi cat i on. The cur r ent f or mal appr oach
t o sex educat i on doesn t bui l d sex negot i at i on ski l l s i n women f or saf e sex
or no sex.
2) Teacher s st i l l pi ck t he modul es f or sex educat i on t hat conf or m t o t hei r
bel i ef s and val ues. Thi s pr event s t he t eachi ng f r om bei ng r el evant t o t he
cur r ent si t uat i on i n soci et y.
3) Ther e i s st i l l no cl ear pol i cy on CSE at t he mi ni st er i al l evel , and t her e i s
no l eader shi p t o advocat e f or such a pol i cy t o see CSE as a f or m of
i mmuni zi ng yout h f r om t he r i sks t hey wi l l f ace, and bui l d t he necessar y l i f e
ski l l s t o pr event t he r i sks. The cur r ent appr oach doesn t t ake i nt o
consi der at i on r el i gi on, l anguage, di sabi l i t y, and sexual di ver si t y.
Consequences of t hese pr obl ems of l ack of r el evant sex educat i on f or yout h
i ncl ude t he f ol l owi ng:
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Unpl anned pr egnancy and decl i ni ng age at HIV i nf ect i on of new cases
Condoms ar e st i l l vi ewed sol el y as a di sease pr event i on t ool ; f al se
at t i t udes t owar d condoms ar e not addr essed and cor r ect ed; yout h
don t l ear n t he communi cat i on ski l l s t o per suade t hei r par t ner t o use
condoms. These f act or s r esul t i n l ess- t han- opt i mal r esul t s f r om
condom pr omot i on campai gns.
Cl i ent - f r i endl y ser vi ces ar e benef i ci al but st i l l l ack pr oper expansi on.
Ther e i s no i nt egr at i on i nt o t he syst em; yout h ar e st i l l not conf i dent
t o go f or counsel i ng or t r eat ment .
3. Vi ol ence agai nst women
Laws r el at ed t o vi ol ence agai nst women
Ther e ar e l aws r el at ed t o vi ol ence i n t he f ami l y i n t he 2007 l aw whi ch
became ef f ect i ve i n June, 2008. Thi s l aw pr ot ect s f ami l y member s,
chi l dr en, spouses, co- habi t i ng coupl es and ot her f ami l y member s wi t h t he
pr i nci pl es of pr omot i ng har mony i n t he f ami l y, wi t h l ess har sh penal t i es
t han i n t he Cr i mi nal Code r egar di ng assaul t . Thus, women who suf f er abuse
i n t he f ami l y may not r ecei ve a f ai r hear i ng, and may suf f er r epeat abuse i f
f or ced t o r emai n i n t he househol d.
Sexual vi ol ence i ncl udi ng r ape i s cover ed under t he Cr i mi nal Code and
di dn t i ncl ude mar i t al r ape ( Measur e 276) unt i l 2007, but i nt er pr et at i on i s
subj ect t o var i at i on ( Measur e 277) . A char ge i s di smi ssed i f a yout h age 13-
15 agr ees t o mar r i age i f t he sex par t ner i s under 18.
Abor t i on i s al l owed i n cases of r ape or i f t he f emal e i s age 13 t o 15 year s or
has a ment al heal t h pr obl em.
Act i vi t i es t o combat t he sexual expl oi t at i on of f emal e yout h and chi l dr en
Ther e i s no speci f i c l aw t o addr ess t hi s. Ther e i s st i l l conf usi on about what
const i t ut es t hi s and t he ext ent of t he pr obl em. Ther e ar e al so pr obl ems of
accessi ng t he vi ct i ms of sex expl oi t at i on.
Readi ness t o pr ovi de shel t er and suppor t f or f emal e vi ct i ms of vi ol ence or
sexual expl oi t at i on and vi ol ence. Pr ovi nci al hospi t al s have cr i si s cent er
ser vi ces t o pr ot ect women and gi r l s who ar e vi ct i ms of vi ol ence. The
Mi ni st r y of Soci al Wel f ar e has opened shel t er s at t he pr ovi nci al l evel f or
chi l dr en and f ami l i es t o pr ot ect women and t hei r chi l dr en who ar e vi ct i ms
of vi ol ence. However , si nce many cases of vi ol ence occur i n t he out er
di st r i ct s i t i s quest i onabl e how many r eal l y have access. Al so, t he pol i ce
don t al ways t ake t hi s i ssue ser i ousl y.
Ser vi ces f or pr event i on of STIs, cont r acept i on, and l egal abor t i on The
MOPH has i ssued gui del i nes f or cl i ni cal f aci l i t i es on pr event i on of HIV f r om
r ape and cont act wi t h bl ood or body f l ui ds f r om PLHA. In t he case of r ape,
t he gui del i nes cal l f or counsel i ng, emer gency cont r acept i on, and post -
exposur e pr ophyl axi s f or HIV.
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Publ i c dat a syst em f or i nf or mat i on compi l at i on and shar i ng wi t h t he publ i c
on vi ol ence agai nst women. The Of f i ce f or Women s Act i vi t i es and t he
Fami l y i s r esponsi bl e f or t hi s ar ea as st i pul at ed by l aw. Whi l e t her e i s dat a
on t he number of r apes, t her e i s no dat abase f or i nci dent s of spousal
vi ol ence or admi ssi ons t o t he pr ovi nci al cr i si s cent er s f or cases of vi ol ence
agai nst women. Thi s dat a syst em i s under devel opment .
Nat i onal campai gn on vi ol ence agai nst women and sexual expl oi t at i on of
adol escent s At pr esent ef f or t s t o combat vi ol ence agai nst women occur at
t he cent r al l evel but l ack cont i nui t y or an ef f ect i ve st r at egy f or of f er i ng
pr ot ect i ons. Women l ack i nf or mat i on on wher e t o go, or who t o seek t o get
out of an abusi ve si t uat i on. Campai gns ar e needed t o f i l l t hese gaps so mor e
women at t he communi t y l evel can access ser vi ces.
Laws agai nst f emal e t r af f i cki ng Thai l and has a l aw f or bi ddi ng human
t r af f i cki ng i ncl usi ve of women and men, and not j ust f or pr ost i t ut i on, but
al so ot her f or ms of f or ced or sl ave- l i ke l abor .
Suppor t f or f emal e vi ct i ms of t r af f i cki ng i n t he ar ea of r epr oduct i ve heal t h
and HIV counsel i ng. Thai women ar e t r i cked i nt o i nt er nat i onal pr ost i t ut i on
r i ngs but do not want t o r eveal t hei r si t uat i on t o seek hel p when r et ur ni ng
t o Thai l and. Aut hor i t i es who ar e i n cont act wi t h t hese women when t hey
r et ur n need t o be sensi t i ve t o t hese i ssues. Ther e ar e cur r ent l y no l aws t o
hel p compensat e vi ct i ms of i nt er nat i onal t r af f i cki ng or t o subsi di ze SRH
car e, heal t h suppor t and HIV VCT.
Ar ea of concer n Women r et ur ni ng f r om abr oad don t want t o r eveal t hei r
i dent i t y out of per sonal saf et y. Even t hough t hey ar e vi ct i ms of t r af f i cki ng,
t hey of t en ar e vi ewed as cr i mi nal s when t hey r et ur n. Ther e shoul d be SRH
ser vi ces and HIV VCT f or t hese women r egar dl ess of whet her t hey wer e
t r af f i cked or not t o pr ot ect t he anonymi t y of t hose t hat wer e.
Recor di ng of cases of vi ol ence agai nst women who suf f er abuse as a r esul t
of di scl osi ng t hei r ser ost at us. Thi s i s st i l l a gap t hat needs f i l l i ng. Thi s may
r esul t f r om l ack of conf i dent i al i t y of ser ost at us, or l ack of counsel i ng whi ch
consi der s t hi s di mensi on and t he pot ent i al f or vi ol ence. HIV+ women may
not be r eady t o di scl ose t hei r st at us because t hey ar e st i l l f i nanci al l y and/ or
emot i onal l y dependent on t hei r par t ner . Some of t hese women ar e
abandoned by t hei r husbands when he l ear ns of her ser ost at us, and t he
women t hus become househol d heads and have t o t ake car e of chi l dr en and
t hemsel ves by t hemsel ves. Some pr ovi der s vi ol at e t hese women s r i ght s by
di scl osi ng t hei r ser ost at us, or pr essur e t hem t o have st er i l i zat i on wi t hout
r eal i zi ng t hat t hese act i ons ar e a f or m of vi ol ence. Si mi l ar l y, t he women
t hemsel ves don t al ways r ecogni ze what happens t o t hem as vi ol ence, and
t hus do not seek hel p. Remedi al act i on i s needed f or bot h pr ovi der and t he
PLHA women.
Ot her f or ms of vi ol ence agai nst i nf ect ed women i ncl ude: ( 1) i nf ect ed
adol escent f emal es ar e f or bi dden t o have boyf r i ends; ( 2) gi r l s as young as
13 ar e sexual l y vi ol at ed, have abor t i ons and t hen post - abor t i on
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st er i l i zat i ons; ( 3) t hey ar e t he l ast t o r ecei ve physi cal exami nat i on even
t hough t hey ar r i ved ear l i er t han ot her s; t her e i s ext r a cost i n st er i l i zi ng
equi pment t hat i s exposed t o t hei r bodi l y f l ui ds; ( 4) ar en t encour aged t o
t hi nk expansi vel y or i ndependent l y about mar r i age and chi l d- bear i ng
deci si ons; ( 5) r ecei ve compul sor y bl ood scr eeni ng when appl yi ng f or wor k;
( 6) have t o r eveal t hei r ser ost at us when goi ng f or benef i t s such as t he
wel f ar e subsi dy of 500 baht .
St r at egi es f or suppor t i ng mal e and f emal e chi l dr en wi t h HIV t he NAP pl an
f or 2007- 11 cont ai ns a st r at egy f or pr event i on car e and t r eat ment f or
chi l dr en af f ect ed by AIDS as a key t ar get gr oup. Thi s emphasi zes: ( 1)
Devel opi ng t he ser vi ce syst em f or af f ect ed chi l dr en i ncl udi ng pr event i on,
car e and educat i on; devel opi ng ser vi ces f or ser ost at us r esul t s di scl osur e f or
chi l dr en and adol escent s, pr ot ect i ng t he r i ght s of chi l dr en and r educi ng
st i gma and segr egat i on of chi l dr en af f ect ed by AIDS, and devel opi ng t he
dat a syst em t o moni t or and eval uat e t he st at us of t he pr obl em; ( 2) Devel op
and suppor t t he capaci t y of t he chi l d, f ami l y, communi t y and soci et y t o
pr event and cont r ol pr obl ems of chi l dr en af f ect ed by AIDS. Pr ovi de car e
f or chi l dr en t o hel p t hem economi cal l y, gai n knowl edge, ski l l s, and
conf i dence as a f or m of soci al i mmuni zat i on f r om pr obl ems l at er on.
Campai gn and pr omot e under st andi ng i n t he soci et y, and wor k t oget her t o
sol ve pr obl ems of chi l dr en af f ect ed by AIDS.
A pr obl em i n pr act i ce i s f ol l owi ng up af f ect ed chi l dr en due t o l ost cont act
wi t h t he mot her i n t he post - par t um per i od. Ther e i s al so a l ack of SRH
ser vi ces f or adol escent PLHA, and f or AIDS or phans f or whom t her e i s no
pr obl em moni t or i ng syst em. In addi t i on, st af f of t he Mi ni st r y of Soci al
Wel f ar e and st af f of pr i vat e chi l d car e cent er s l ack t he under st andi ng and
sensi t i vi t y i n car e f or chi l dr en af f ect ed by AIDS. Ther e ar e st i l l sub- st andar d
ser vi ces i n wel f ar e and chi l d cent er s and cases of chi l d r i ght s vi ol at i ons.
4. Ar eas f or speci al consi der at i on
1) Li nks bet ween sex educat i on, sex and r epr oduct i ve heal t h
A) Condoms ar e st i l l a di sease pr event i on t ool , wi t h an i mage of
behavi or al cont r ol r at her t han coupl e car i ng, and t hi s i mpact on
use/ non- use such as at t i t udes, bel i ef s, negot i at i ng use, et c. These
f act or s ar e an expl anat i on f or t he l ess t han opt i mal condom use l evel s
among adol escent s and mar r i ed coupl es.
B) Teachi ng sex educat i on r equi r es adul t under st andi ng of chi l dr en. But
par ent s and t eacher s st i l l t hi nk about sex i n t r adi t i onal ways, and
can t see t he evol ut i on of pr act i ces t hat i s t aki ng pl ace i n soci et y.
Par ent s and t eacher s t hemsel ves have t r oubl e communi cat i ng about
sex and saf e sex and sexual happi ness. Thus, i t i s di f f i cul t f or t hem t o
communi cat e cl ear l y and honest l y t o t hei r chi l dr en and st udent s.
C) The concept ual t hi nki ng about sex ( gender , sexual i t y, and sexual
di ver si t y) i s mi ssi ng f r om t r adi t i onal appr oaches t o sex educat i on and
SRH ser vi ces, at t he l evel of pol i cy and seni or management . When
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t hi s i s combi ned wi t h t he di sease cont r ol appr oach of t he aut hor i t i es
i t becomes a puni t i ve appr oach r at her t han one of under st andi ng
( e. g. , by por t r ayi ng women as spr eader s of HIV, who shoul d not mar r y
or have chi l dr en, or shoul d get st er i l i zed, shoul d di scl ose t hei r
ser ost at us, et c. ) . Thi s r educes t he abi l i t y t o pr ovi de vi abl e opt i ons,
especi al l y f or women.
2) Di f f er ent per spect i ves on t he pr obl ems
A) Despi t e t her e bei ng a PMTCT pol i cy, t her e i s st i l l a const ant l evel of
i nf ect i on among pr egnant women. Aut hor i t i es don t under st and why t he
number of HIV+ pr egnant women doesn t decl i ne. The f ocus of t he DOH
pr ogr am i s not on t he r epr oduct i ve age coupl e, but f ocuses nar r owl y on
ver t i cal t r ansmi ssi on. Thi s gi ves r i se t o r epeat pr egnanci es and mor e
ver t i cal t r ansmi ssi on, r esul t i ng i n war ni ngs f r om heal t h st af f f or PLHA t o
not get pr egnant , t hat t hei r chi l d wi l l be or phaned, t hat t hey wi l l bot h be
st i gmat i zed, and t hat mor e soci al pr obl ems wi l l r esul t . In f act , t he PLHA
woman i s awar e of t hese consequences but st i l l may want t o have a chi l d.
In sum, HIV+ women who want t o get pr egnant ar e st i l l not wel l - accept ed
i n Thai soci et y, and counsel i ng ser vi ces ar e not wel l - pr epar ed f or t hi s.
B) Fr om a pol i cy st udy
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i t was f ound t hat t he pr obl em of pr egnancy
among HIV+ women i s seen as a pr obl em comi ng f r om i nadequat e or poor
qual i t y counsel i ng. The counsel or usual l y says: What ever I t el l her , she
wi l l become pr egnant agai n. Ther e i s pr essur e on bot h t he pr ovi der and
t he HIV+ woman. The subt ext i s You ar e HIV+, so how come you got
pr egnant ? What i s dr i vi ng t hi s at t i t ude i s t he t ar get r educt i on of ANC
HIV f r om 0. 88 i n 2006 t o 0. 85 i n 2007 and f r om 0. 05% each year
t her eaf t er . In addi t i on t her e i s t he t ar get t o r educe MTCT of HIV f r om 3%
i n 2006 t o under 3% i n each year t her eaf t er . Thus, i t can be seen t hat
t he emphasi s i s not cl i ent - cent er ed, but i s t ar get - cent er ed. Of t en st af f
ar e not sur e t hat what t hey ar e doi ng i s cor r ect pol i cy or not , and act i ons
out of i gnor ance may r esul t i n vi ol at i ons of SRH r i ght s such as pr essur i ng
PLHA t o have a st er i l i zat i on or not pr ot ect i ng t he conf i dent i al i t y of t he
woman s HIV st at us dur i ng coupl e counsel i ng.
C) In t he eval uat i on by t he gover nment
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t her e was a speci f i cat i on t hat
ar e gaps i n cover age such as PLHA women who ar e not yet el i gi bl e f or
t r eat ment but can t be l ocat ed, because t he women do not want t o
r eveal t hei r ser ost at us out of f ear of r eper cussi ons and st i gma. Chi l dr en
bor n of t hese HIV+ mot her s mi ss di agnost i c appoi nt ment s. The DOH does
not have dat a on t hese gaps and l acks a st r at egy f or f i l l i ng t hem. So t he
vi ew of ci vi l soci et y i s not al ways al i gned wi t h t hat of t he gover nment i n
t er ms of t he causes and bar r i er s t o gr eat er cover age of ser vi ces.
D) Counsel i ng t hat emphasi zes t he ser oposi t i ve l eads t o a l ost oppor t uni t y
t o counsel i ng HIV- negat i ve pr egnant women.
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St udy of r epr oduct i ve heal t h pol i cy Voi ces and Choi ces Pr oj ect by Sul ai por n Chol wi l ai 2010
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Pr ogr ess r epor t of Thai l and t o UNGASS of t he PMTCT wor ki ng gr oup, 2010
218
E) Even t hough coupl e counsel i ng has been benef i ci al f or women so t hat
t hey can l ear n of t hei r i nf ect i on dur i ng t he cur r ent pr egnancy, and
r ecei ve hel p f or f ur t her pr event i on, coupl e counsel i ng i s pr obl emat i c f or
women who ar e not yet r eady t o di scl ose t hei r ser ost at us t o t hei r
par t ner , or who have mar i t al pr obl ems, or who had an unpl anned
pr egnancy. These women mi ght be l ost t o t he syst em because of coupl e
counsel i ng. Thus t her e shoul d be mor e f l exi bi l i t y i n t he choi ce whet her
t o have coupl e counsel i ng or not r at her t han maki ng i t a condi t i on of
ANC.
4. Recommendat i ons
1) Ther e needs t o be a pol i cy f or posi t i ve sex educat i on t hat vi ews
di f f er ent sex l i f est yl es on an equal basi s, i n whi ch t her e i s no st i gma
or di scr i mi nat i on based on sex, and pr omot es r esponsi bl e sex
behavi or f or ever yone, ever y age, and sex. Sex educat i on needs t o
cover not onl y adol escent s i n school and out - of - school but al so
adul t s, because adul t s of t en por t r ay a negat i ve at t i t ude about sex
whi ch i ncr eases r i sk behavi or or r educes access t o saf e sex. These
at t i t udes exacer bat e sexual coer ci on and vi ol ence i n t he f ami l y and
sexual vi ol ence i n gener al . Ever y agency i n t he count r y at ever y
l evel , f r om t he cent r al t o t he per i pher al , needs t o under st and t he
moder n concept of sex educat i on as i nt egr at ed i nt o t he HIV
pr event i on pl an and gener al heal t h pl ans, and pl ans t o pr omot e
equal i t y bet ween mal e and f emal e, and pl ans f or women and chi l dr en
t hat al r eady exi st .
2) SRH ser vi ces ar e needed i ncl udi ng t hose f or vi ct i ms of f ami l y or
sexual vi ol ence, and PLHA women, t hat ar e user - f r i endl y f or bot h
sexes of al l ages, and pr ovi de access t o ser vi ces, i nf or mat i on,
counsel i ng, and whi ch el i mi nat e bar r i er s t o ser vi ce based on sex,
mobi l i t y, r el i gi on, di sabi l i t y, age, or heal t h st at us. Ther e i s a need t o
i ncr ease conveni ence of ser vi ce and access t o ser vi ces by pr omot i ng
one- st op ser vi ces t hr ough bet t er l i nki ng among uni t s wi t hi n a f aci l i t y
and good l i nks wi t h ext er nal agenci es and t he communi t y.
3) Ther e i s a need t o bui l d sust ai nabi l i t y i n t he syst em f or l ear ni ng sex
educat i on and SRH ser vi ces t hat ar e user - f r i endl y by i mpl ement i ng a
nat i onal pol i cy on sex educat i on wi t h a cl ear l y r esponsi bl e
gover nment coor di nat i on agency t o l i nk gover nment and ci vi l soci et y
gr oups br oadl y and use exi st i ng l aws and pol i cy so t hat t hey ar e
ef f ect i ve, such as l aws agai nst vi ol ence, pr ot ect i on of vi ct i ms of
t r af f i cki ng, et c.
4) Ther e i s a need t o bui l d communi t y par t i ci pat i on i n t he sex educat i on
ef f or t s and SRH ser vi ces t hat ar e user - f r i endl y t o i mpr ove access t o
yout h and ot her gr oups not yet cover ed.
5) Ther e shoul d be pr ovi si on of educat i on on sex, and SRH ser vi ces must
r ecogni ze t he i mpor t ance of coupl e power dynami cs r el at ed t o sex,
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and r ecogni ze t hat sex l i f est yl es af f ect at t i t udes and behavi or ,
i ncl udi ng access t o ser vi ces. The ser vi ce syst em shoul d conduct mor e
out r each t o gi ve ser vi ces and sex educat i on f or mal es t o r educe t hei r
under ut i l i zat i on of i nf or mat i on ser vi ces about posi t i ve sex, pr omot e
r esponsi bl e r el at i onshi ps, and f ami l y r el at i onshi ps ( e. g. ,
cont r acept i on, chi l d car e, condom use, AIDS pr event i on, r educt i on of
usi ng f or ce t o get one s way i n t he f ami l y, et c. ) . They need t o see
t hat sex educat i on and SRH ser vi ces ar e a way of expandi ng
under st andi ng about sex and soci et y whi ch has t o over come obst acl es
such as i ngr ai ned mal e at t i t udes about sex and t he r ol e of men i n t he
f ami l y, and under st and t he i nappr opr i at eness of mal e vi ol ence i n t he
f ami l y t hat has been a par t of Thai soci et y f or many gener at i ons.
6) Sex educat i on and SRH ser vi ces f or PLHA must r educe t he f ocus on
t he women as t he dr i ver of t he epi demi c, and i nst ead vi ew her as a
cl i ent wi t h human r i ght s and who i s ent i t l ed t o equal ser vi ces wi t h
i nf or med consent i n ever y ser vi ce out l et . St af f must see t hat
cont r ol l i ng t he deci si on- maki ng and opt i ons of women i s a f or m of
di scr i mi nat i on and r i ght s vi ol at i on.
7) Ther e shoul d be suppor t f or par t i ci pat or y st udi es and r esear ch, and
set t i ng up dat abases on SRH ( publ i c and NGO or ci vi l soci et y
net wor k) .
8) Ther e i s a need t o expand and suppor t col l abor at i on bet ween
r el evant agenci es i n t he gover nment and NGO sect or s on out r each f or
SRH, AIDS and r i ght s, and r educe gaps i n ser vi ce l i nkages wi t hi n and
among out l et s. Ther e needs t o be a dat abase t o expand r esul t s or
modi f y t he pr ocess of l ear ni ng by par t i ci pat or y dat a shar i ng bet ween
gover nment and NGOs wi t h bot h quant i t at i ve and qual i t at i ve dat a.
Rel evant agenci es shoul d see t he i mpor t ance of col l ect i ng dat a t hat
ar e sensi t i ve t o sexual i t y such as dat a on sex segr egat i on, dat a on
unpl anned pr egnancy of PLHA, dat a on f ami l y vi ol ence. Thi s wi l l hel p
i nf or m SRH pol i cy and ser vi ces at t he cent r al and per i pher al l evel .
9) Gender - based vi ol ence must be under st ood i n br oader t er ms t han
mer el y physi cal assaul t . It must be seen t o be a f unct i on of soci et al
const r uct s, i ncl usi ve of psycho- emot i onal vi ol ence. Gender - based
vi ol ence must be seen as an i nt egr al par t of t r adi t i onal cul t ur e and
whi ch i s l i nked t o r i ght s vi ol at i ons such as r ape i n t he f ami l y, vi ol ence
i n t he f ami l y, human t r af f i cki ng, especi al l y f or young gi r l s and
chi l dr en, whi ch l i mi t s sex educat i on oppor t uni t i es f or yout h,
st i gmat i zes and bl ames t een gi r l s f or get t i ng pr egnant whi l e i n
school , gi ves r i se t o pr ej udi ce agai nst women who have di ver se sex
l i f est yl es f r om t he mai nst r eam, vi ct i mi zes women as spr eader s of HIV
or as soci al l y i r r esponsi bl e when PLHA want t o r e-mar r y or have
anot her chi l d, pr omot es pr ej udi ce agai nst t hose who chose t o be gay,
kat oey, l esbi an, or t r ansgender .

220
10) Ther e i s a need t o bui l d st r engt h of t he syst em of counsel i ng i n
gover nment , NGO and communi t y gr oups by emphasi zi ng pr e- and
post - t est counsel i ng, peer - t o- peer counsel i ng, and empower ment and
opt i on counsel i ng. Ther e needs t o be an emphasi s on hel p f or
vul ner abl e popul at i ons, or t hose wi t hout power t o negot i at e t he
t er ms of sex, such as women, chi l dr en or i nf ect ed adol escent s.

11) Ther e i s a need t o est abl i sh a pol i cy and pl an t hat i s cl ear f or t he
i mpl ement at i on of at t i t ude devel opment about sex, AIDS and r i ght s
among t he gover nment , pol i cy maker s and ser vi ce pr ovi der s,
pr ovi nci al admi ni st r at or s and t he gener al publ i c.
12) Ther e i s a need t o est abl i sh a pol i cy, pl an, pr ogr am of act i on and
budget f or suppor t i ng NGOs or CBOs wor ki ng on AIDS, sex and SRH f or
gr oups t hat ar e har d t o r each such as chi l dr en and yout h af f ect ed by
AIDS, sex wor ker s, f or ei gn mi gr ant l abor er s and et hni c mi nor i t i es.
221
Annex 6
N Na at t i i o on na al l E Ex xp pe en nd di i t t u ur r e e o on n H HI IV V/ / A AI ID DS S2 20 00 08 8- -2 20 00 09 9
Thai Wor ki ng Gr oup on Nat i onal AIDS Spendi ng
Assessment Repor t i ng dat e Mar ch 10, 2010
Background
As r equi r ed by UNGASS count r y r epor t 2010, t he Thai wor ki ng gr oup on
Nat i onal AIDS Spendi ng Assessment ( NASA) convened sever al r ounds of wor k
sessi on among par t ner s i n and out si de Mi ni st r y of Publ i c Heal t h, who ar e
most knowl edgeabl e on spendi ng on HIV/ AIDS. These wor k sessi ons wer e
t asked t o est i mat e t he t ot al spendi ng on HIV/ AIDS f or 2008 and 2009.
Thi s r epor t cont i nues t he l ast r epor t of 2007 spendi ng, t abl e 1 pr ovi des
backgr ound spendi ng on HIV/ AIDS i n 2007
Tabl e 1 Tot al AIDS expendi t ur e, 2007, cur r ent year pr i ce
2007
Tot al AIDS expendi t ur e, mi l l i on Baht 6, 728
For ecast Tot al Heal t h Expendi t ur e, mi l l i on Baht 248, 852. 4

Tot al AIDS expendi t ur e 2007
x per capi t a popul at i on, Baht 105
x per capi t a PLWHA, Baht 11, 600
x %GDP 0. 08%
x %THE 2. 7%
Sour ce UNGASS count r y pr ogr ess r epor t f or Januar y 2006- December 2007
2. Obj ect i ves
1. To est i mat e t he magni t ude, sour ces and pr of i l e of expendi t ur e on
HIV/ AIDS f or 2008 and 2009
2. To pr oduce key i ndi cat or s on t ot al expendi t ur e on HIV/ AIDS i n t er ms
of
a. Baht per capi t a Thai popul at i on
b. Baht per capi t a PLWHA,
c. Per cent of GDP
d. Per cent of Tot al Heal t h Expendi t ur e ( THE)
3. Met hodol ogy
3. 1 Met hods
1. Wi t h t he appl i cat i on of Nat i onal Heal t h Account [ OECD Syst em of
Heal t h Account , ver si on 1. 0: 2000] , a t wo di mensi onal mat r i x of
f i nanci ng sour ces by heal t hcar e f unct i on was pr oduced. We
222
del i ber at el y do not pr oduce t he t hi r d di mensi on on AIDS expendi t ur e
by publ i c and pr i vat e heal t hcar e pr ovi der s, as t her e i s l i mi t ed pol i cy
ut i l i t i es and huge t i me consumi ng t o pr oduce such dat a.
2. Compi l e secondar y dat a on act ual expendi t ur e on HIV/ AIDS wher e
avai l abl e f r om r el evant f i nanci ng agent s.
3. Wher e t her e i s no r eady r ef er ence secondar y dat a on spendi ng on
HIV/ AIDS, t he Wor ki ng Gr oup appl i ed di f f er ent i mput e met hods,
based on PQ appr oaches ( P r ef er s t o pr i ce or uni t cost , Q r ef er s t o
quant i t y or ser vi ces r ender ed, most l y r el i ed on epi demi ol ogi cal dat a) .
For exampl e, expendi t ur e on ART, oppor t uni st i c i nf ect i ons and
l abor at or i es f r om heal t h i nsur ance schemes. Ther e ar e t hr ee publ i c
heal t h i nsur ance schemes oper at i ng i n Thai l and i n 2008 and 2009, t he
Ci vi l Ser vant Medi cal Benef i t Scheme, t he Soci al Heal t h Insur ance and
t he Uni ver sal Cover age Scheme. Pr i vat e i nsur ance was del i ber at el y
excl uded as i t appl i es pr e- appl i cat i on scr eeni ng and excl uded PLWHA
t o j oi n i n member of pr i vat e i nsur ances.
3. 2 Dat a sources
1. Act ual spendi ng on HIV/ AIDS was r et r i eved f r om most l y gover nment
spendi ng r ecor ds i n var i ous Depar t ment s acr oss di f f er ent Mi ni st r i es,
as wel l as donor sour ces, such as Mi ni st r y of Publ i c Heal t h, Nat i onal
Heal t h Secur i t y Of f i ce who i s r esponsi bl e f or uni ver sal access t o ART
pr ogr am and OI f or HIV pat i ent s under t he Uni ver sal Heal t h Car e
Scheme ( UC) , t he Compt r ol l er Gener al s Depar t ment of t he Mi ni st r y
of Fi nance on expendi t ur e on HIV/ AIDS f or t he Ci vi l Ser vant Medi cal
Benef i t Scheme, Soci al Secur i t y Of f i ce who spent f or t hei r soci al
heal t h i nsur ance member s and t he Gl obal Fund and ot her donor s f r om
out si de count r y.
2. The most updat e GDP f or 2008 and 2009 wer e r et r i eved f r om t he
websi t e of t he Nat i onal Account Of f i ce of t he Nat i onal Economi c and
Soci al Devel opment Boar d
[
57
]
3. Tot al Heal t h Expendi t ur e f or 2008 was r et r i eved f r om t he Nat i onal
Heal t h Account 1994- 2008 of Thai l and, however ; t he t ot al heal t h
expendi t ur e f or 2009 was est i mat ed based on hi st or i cal gr owt h of THE
[
58
]
.
4. Number of peopl e l i vi ng wi t h HIV/ AIDS i n 2008 and 2009 based on
est i mat i on f r om t he r egi st r at i on syst em of t he Nat i onal Heal t h
Secur i t y Of f i ce.
3. 3 Scope
1. We use act ual spendi ng on HIV/ AIDS, not budget i ng f i gur es.
57
Nat i onal Account Of f i ce, t he Nat i onal Economi c and Soci al Devel opment Boar d
ht t p: / / www. nesdb. go. t h/ econSoci al / macr o/ NAD/ 1_qgdp/ st at i st i c/ menu. ht ml [ access 23
Febr uar y 2010] .
58
Thai wor ki ng gr oup on Nat i onal Heal t h Account . Nat i onal Heal t h Account 1994- 2008
ht t p: / / www. i hppt hai gov. net / nha/ t hai _nha_1994-2008. xl s [ access 10 Mar ch 2010]
223
2. Thi s st udy cover s onl y spendi ng by gover nment and donor r esour ces.
We del i ber at el y excl ude househol d spendi ng on HIV/ AIDS, as t her e i s
no any nat i onal dat aset capt ur i ng househol d spendi ng speci f i cal l y on
HIV/ AIDS. In t he cont ext of uni ver sal cover age, househol d spendi ng
on HIV/ AIDS i s l i kel y t o be ext r emel y l ow; al l OI ser vi ces wer e f ul l y
cover ed by each of t he t hr ee i nsur ance schemes and al so ART i s
uni ver sal l y cover ed by al l t hr ee schemes, f r ee at poi nt of ser vi ces.
Ther e i s no co- payment . However , t her e may be cer t ai n pr opor t i on
of pat i ent s seek ART ser vi ces f r om pr i vat e hospi t al s, f or whi ch
househol ds bear t he f ul l cost of t hese t r eat ment . However , i t i s
unknown on t he magni t ude of t hese pat i ent s, vol unt ar i l y opt ed out
f r om i nsur ance scheme.
3. Due t o gr oss l ack of dat a, we di d not cover expendi t ur e by l ocal
gover nment
4. Fi scal year ( Oct ober t o Sept ember ) f or gover nment expendi t ur e and
cal endar year ( Januar y t o December ) f or i nt er nat i onal expendi t ur e
ar e t r eat ed equi val ent .
5. Heal t hcar e f unct i on appl i es t he 8 i t ems of expendi t ur e pr oposed by
UNGASS t empl at e.
4. Resul t s
4.1 Fi nanci ng cont ex t i n Thai l and
Tabl e 2 backgr ound dat a on heal t hcar e f i nanci ng 2008- 09, cur r ent year
pr i ce
2008 2009
Popul at i on 63, 121, 000 63, 396, 000
Tot al Heal t h Expendi t ur e ( THE) per capi t a, Baht 5, 739 6, 183
THE per capi t a, US$ 171 178
Exchange r at e, Baht per US$* 33. 13 34. 72
Sour ce: Tot al Heal t h Expendi t ur e f or 2008 r ef er s t o Thai NHA 1994- 2008
[
2
]
.
The t ot al heal t h expendi t ur e f or 2009 was est i mat ed based on hi st or i cal
t r end of 1994- 2008 by The Wor ki ng Gr oup ( Aver age geomet r i cal gr owt h r at e
was 5. 3%) .
Not e: Exchange r at e quot e f r om Bank of Thai l and
Backgr ound dat a on heal t hcar e f i nanci ng i ndi cat ed t hat i n 2008, Thai l and
spent 5, 739 Baht per capi t a f or heal t h of t he Thai popul at i on, or US$ 173
per capi t a ( exchange r at e 33. 13 Baht per US$) , see Tabl e 2. Per capi t a
t ot al heal t h expendi t ur e sl i ght l y i ncr eased t o US$ 178 i n 2009.
224
Tabl e 3 Tot al heal t h expendi t ur e and sel ect ed NHA i ndi cat or s, sel ect ed
year 1994 t o 2008, cur r ent year pr i ces
NHA i ndi cat ors 1994 1997 2001 2002 2005 2006 2007 2008
THE, Tot al Heal t h
Expendi t ur e,
mi l l i on Baht
127, 6
55
189, 1
43
170, 2
03
201, 6
67
251, 6
65
290, 5
73
314, 7
12
363, 7
71
THE as %of GDP 3. 5% 4. 0% 3. 3% 3. 7% 3. 6% 3. 7% 3. 7% 4. 0%
Publ i c Fi nanci ng
Agenci es ( %)
45% 54% 56% 63% 64% 68% 73% 75%
Pr i vat e Fi nanci ng
Agenci es ( %)
55% 46% 44% 37% 36% 32% 27% 25%
THE, Baht per
capi t a
2, 160 3, 110 2, 732 3, 211 4, 032 4, 625 4, 992 5, 739
THE, USD per
capi t a
86 99 61 74 100 122 144 171
Sour ce: Thai Wor ki ng Gr oup on NHA, 1994- 2008
Tabl e 3 pr ovi des a t i me ser i es bet ween 1994 and 2008, f or some sel ect ed
year s; THE as per cent of GDP had never r eached beyond 4. 0%. The publ i c
f i nanci ng agenci es pl ay i ncr easi ng r ol e i n f i nanci ng heal t h i n Thai l and, f r om
45% i n 1994 t o 75% i n 2008; whi l e a decr easi ng t r end of t he pr opor t i on of
pr i vat e sour ce of f i nance was obser ved; down f r om 55% i n 1994 t o 25% i n
2008.
Fi gure 1 Long t er m THE pr oj ect i on 2006 t o 2026 based on 1994- 2005 NHA
Expendit ure Share in GDP of Financing Agencies - Long-t erm Trends
0.0
1.0
2.0
3.0
4.0
5.0
6.0
1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026
P
e
r

c
e
n
t
MoPH Ot hMin LocGovt St at eEnt erprise CSMBS SocSec UC WCF PrivI ns TrafficI ns ERBenefit s PrivHH NonProfit RoW
Based on 1994- 2005 NHA, a l ong t er m pr oj ect i on of t ot al heal t h expendi t ur e
bet ween 2006 and 2026 was conduct ed j oi nt l y by ILO and a number of Thai
r esear cher s
[
59
]
. In f i gur e 1, by 2026, t ot al heal t h expendi t ur e woul d be
59
Schol z W, Sakul pani ch T, Long t er m pr oj ect i on of t ot al heal t h expendi t ur e i n Thai l and, 2006- 2026.
Nont habur i , Heal t h Syst ems Resear ch Inst i t ut e. 2009
225
wi t hi n t he capaci t y of t he gover nment t o af f or d, l ess t han 6% of GDP,
wher eby t he gener al t ax f unded uni ver sal cover age woul d have t he hi ghest
shar e of f i nanci ng sour ces; t hi s was f ol l owed by Ci vi l Ser vant Medi cal
Benef i t Scheme expendi t ur e. Pr i vat e househol d spendi ng woul d be
equi val ent t o t hat of by Soci al Heal t h Insur ance Scheme. Hi st or i cal l y,
donor s r esour ces pl ay i nsi gni f i cant r ol e i n f i nanci ng heal t h i n Thai l and, l ess
t han 0. 05%of t ot al heal t h spendi ng.
4. 2 How much Thailand spent on HIV/ AIDS?
Tabl e 4 Tot al AIDS expendi t ur e, 2008- 09, cur r ent year pr i ce
2008 2009
Tot al AIDS expendi t ur e, mi l l i on Baht 6, 928 7, 208
Tot al Heal t h Expendi t ur e, mi l l i on Baht 363, 771 383, 051*

Tot al AIDS expendi t ur e 2007, as
x per capi t a popul at i on, Baht 110 114
x per capi t a PLWHA, Baht 14, 275 14, 417
x per capi t a popul at i on, US$ 3. 3 3. 3
x per capi t a PLWHA, US$ 430. 9 415. 2
x %GDP 0. 08 0. 08
x %THE 1. 9 1. 9
* Tot al Heal t h Expendi t ur e f or 2009 was est i mat ed based on hi st or i cal t r end
of 1994- 2008 by The Wor ki ng Gr oup
In 2008, t he t ot al expendi t ur e on HIV/ AIDS was 6. 928 bi l l i on Thai Baht . Thi s
i s equi val ent t o 110 Baht per capi t a Thai popul at i on, or 14, 275 Thai Baht
per capi t a PLWHA, gi ven t he t ot al number of 485, 325 PLWHA. The t ot al
expendi t ur e on HIV/ AIDS account s f or 0. 08%of GDP i n 2008, or equi val ent t o
1. 9%of Tot al Heal t h Expendi t ur e, See t abl e 4.
In 2009, t her e was a sl i ght i ncr ease of Tot al AIDS expendi t ur e, 114 Baht per
capi t a popul at i on or 14, 417 Baht per PLWHA. Ther e was a ver y mar gi nal
i ncr ease of AIDS spendi ng. Ther ef or e t he r at i o bet ween AIDS spendi ng and
GDP or THE was unchanged i n t wo year s; r emai ned at 0. 08%of GDP and 1. 9%
of THE r espect i vel y f or bot h year s.
4. 3 What are HIV/ AIDS expendit ure used f or?
226
Tabl e 5 Tot al AIDS expendi t ur e by f unct i ons, 2008- 09, cur r ent year pr i ce
2008 2009
Thai
Baht ,
mi l l i on
Per cent Thai
Baht ,
mi l l i on
Per cent
1. Pr event i on 1, 500 21. 7% 987 13. 7%
2. Car e and Tr eat ment 4, 560 65. 8% 5, 483 76. 1%
3. Or phans and Vul ner abl e Chi l dr en
( OVC)
50 0. 7% 52 0. 7%
4. Pr ogr am Management
Admi ni st r at i on St r engt heni ng
397 5. 7% 250 3. 5%
5. Incent i ve Human Resour ces 44 0. 6% 208 2. 9%
6. Soci al pr ot ect i on and soci al
ser vi ces excl udi ng Or phans and
vul ner abl e Chi l dr en
219 3. 2% 171 2. 4%
7. Enabl i ng Envi r onment and
communi t y Devel opment
2 0. 0% 8 0. 1%
8. Resear ch excl udi ng oper at i onal
r esear ch
156 2. 3% 49 0. 7%
Tot al 6, 928 100. 0% 7, 208 100. 0%
In t he l i ght of t he uni ver sal ART adopt ed by t he Royal Gover nment of
Thai l and si nce 2003, a maj or i t y shar e of t ot al AIDS spendi ng was used f or
car e and t r eat ment , up t o 65. 8%i n 2008 and i ncr eased t o 76. 1%i n 2009. At
t he same t i me, expendi t ur e on pr event i on r educed f r om 21. 7% i n 2008 and
t o 13. 7% i n 2009. Si x ot her spendi ng i t ems wer e smal l ; see Tabl e 5. In
2009, OVC and r esear ch got l ess t han 1% shar e, pr ogr am management and
admi ni st r at i on st r engt heni ng got 3. 5% shar e, i ncent i ve f or human r esour ces
2. 9%and soci al pr ot ect i on and ot her soci al ser vi ces, 2. 4%.
Not e t hat Annex 1 pr ovi des f ul l account of det ai l expendi t ur e on HIV/ AIDS
227
4. 4 What are sources of f inancing HIV/ AIDS?
Tabl e 6a Tot al AIDS expendi t ur e by sour ces and f unct i ons 2008, cur r ent year
pr i ce
Tot al Domest i c
sources
Int ernat i onal
1. Pr event i on 22% 20% 30%
2. Car e and Tr eat ment 66% 71% 34%
3. Or phans and Vul ner abl e Chi l dr en 1% 1% 0%
4. Pr ogr am Management
Admi ni st r at i on St r engt heni ng
6% 3% 22%
5. Incent i ve Human Resour ces 1% 1% 1%
6. Soci al pr ot ect i on and soci al ser vi ces
excl udi ng Or phans and vul ner abl e
Chi l dr en
3% 4% 0%
7. Enabl i ng Envi r onment and
communi t y Devel opment
0% 0% 0%
8. Resear ch excl udi ng oper at i onal
r esear ch
2% 0% 13%
Tot al 100% 100% 100%
Tot al , mi l l i on Thai Baht 6, 928 5, 917 1, 011
Col umn per cent 100% 85% 15%
Tabl e 6b Tot al AIDS expendi t ur e by sour ces and f unct i ons 2009, cur r ent
year pr i ce
Tot al Domest i c
sources
Int ernat i onal
1. Pr event i on 14% 13% 29%
2. Car e and Tr eat ment 76% 80% 15%
3. Or phans and Vul ner abl e Chi l dr en 1% 1% 0%
4. Pr ogr am Management
Admi ni st r at i on St r engt heni ng
3% 2% 17%
5. Incent i ve Human Resour ces 3% 1% 33%
6. Soci al pr ot ect i on and soci al ser vi ces
excl udi ng Or phans and vul ner abl e
Chi l dr en
2% 3% 0%
7. Enabl i ng Envi r onment and
communi t y Devel opment
0% 0% 1%
8. Resear ch excl udi ng oper at i onal
r esear ch
1% 0% 4%
Tot al 100% 100% 100%
Tot al , mi l l i on Thai Baht 7, 208 6, 726 482
Col umn per cent 100% 93% 7%
228
Fi nanci ng HIV/ AIDS pr ogr am r el i ed most l y on domest i c r esour ce, 85% of
t ot al spendi ng i n 2008 and 93%i n 2009. Thi s r ef l ect ed gover nment f i nanci al
commi t ment and we f or esee good f i nanci al sust ai nabi l i t y, as i t r el i es l ess on
donor r esour ces.
Expendi t ur e pr of i l e of donor r esour ces si gni f i cant l y di f f er ed f r om t hat of
domest i c r esour ces. Domest i c r esour ces concent r at e most on car e and
t r eat ment ( 71%and 80%i n 2008 and 2009 r espect i vel y) . The Thai HIV/ AIDS
pr ogr am pur chased gener i c medi ci ne f r om l ocal l y pr oduced ARV and
i mpor t ed gener i c ARV whi l e donor r esour ces had l i mi t at i on t o pur chase
gener i c, onl y WHO Pr e- qual i f i ed most l y br and pr oduct s wer e al l owed t o
pur chase usi ng r esour ces f r om t he Gl obal Fund.
Al so donor r esour ces spr ead t hr oughout t he ei ght maj or spendi ng i t ems, i n
par t i cul ar 33%on i ncent i ve f or human r esour ces, 29%on pr event i on, 17%on
pr ogr am management and admi ni st r at i on st r engt heni ng, 15% on car e and
t r eat ment . See Tabl e 6a and 6b
4. 5 How much dif f erent domest ic source cont ribut es t o f inancing
HIV/ AIDS?
Fr om t he syst ems anal ysi s, we cat egor i ze f i ve gr oups of domest i c f i nanci ng
sour ces f or HIV/ AIDS, ( 1) t he Mi ni st r y of Publ i c Heal t h ( al l r el evant
depar t ment s) i s t he mai n st akehol der f or HIV/ AIDS pr event i on and cont r ol ,
( 2) ot her mi ni st r i es such as Mi ni st r y of Educat i on, Mi ni st r y of Def ense, bl ood
saf et y pr ogr am spear headed by t he Thai Red Cr oss, ( 3) t he Nat i onal Heal t h
Secur i t y Of f i ce i s r esponsi bl e f or t he pr ovi si on of OI ser vi ces and ART f or
member s of t he UC scheme, ( 4) t he Ci vi l Ser vant Medi cal Benef i t Scheme
cover s t he f or mal sect or publ i c empl oyees f or t r eat ment of OI and pr ovi si on
of ART, ( 5) The Soci al Heal t h Insur ance cover s t he pr i vat e sect or empl oyee,
i s r esponsi bl e f or pr ovi si on of ART and OI ser vi ces f or i t s member s.
Tabl e 7a Tot al AIDS expendi t ur e by sour ces and f unct i ons 2008, cur r ent year
pr i ce
Domest i c resources
Expendi t ur e pr of i l es Tot al
MOPH Ot hers NHSO CSMBS SHI
Int ernat i onal
1. Pr event i on 22% 37% 43% 24% 4% 4% 30%
2. Car e and
Tr eat ment
66% 4% 8% 73% 96% 96% 34%
3. Or phans and
Vul ner abl e Chi l dr en
1% 20% 0% 0% 0% 0% 0%
4. Pr ogr am
Management
Admi ni st r at i on
St r engt heni ng
6% 30% 7% 2% 0% 0% 22%
5. Incent i ve Human
Resour ces
1% 2% 1% 1% 0% 0% 1%
6. Soci al pr ot ect i on 3% 0% 39% 0% 0% 0% 0%
229
and soci al ser vi ces
excl udi ng Or phans
and vul ner abl e
Chi l dr en
7. Enabl i ng
Envi r onment and
communi t y
Devel opment
0% 0% 0% 0% 0% 0% 0%
8. Resear ch
excl udi ng
oper at i onal r esear ch
2% 6% 2% 0% 0% 0% 13%
Tot al 100% 100% 100% 100% 100% 100% 100%
Tot al , mi l l i on Baht 6, 928 245 556 3, 349 831 936 1, 011
100% 4% 8% 48% 12% 14% 15%
Tabl e 7b Tot al AIDS expendi t ur e by sour ces and f unct i ons 2009, cur r ent
year pr i ce
Domest i c resources
Expendi t ur e pr of i l es Tot al
MOPH Ot hers NHSO CSMBS SHI
Int ernat i onal

1. Pr event i on 14% 43% 47% 11% 3% 3% 29%
2. Car e and
Tr eat ment
76% 0% 1% 88% 97% 97% 15%
3. Or phans and
Vul ner abl e Chi l dr en
1% 16% 0% 0% 0% 0% 0%
4. Pr ogr am
Management
Admi ni st r at i on
St r engt heni ng
3% 36% 8% 0% 0% 0% 17%
5. Incent i ve Human
Resour ces
3% 1% 1% 1% 0% 0% 33%
6. Soci al pr ot ect i on
and soci al ser vi ces
excl udi ng Or phans
and vul ner abl e
Chi l dr en
2% 0% 37% 0% 0% 0% 0%
7. Enabl i ng
Envi r onment and
communi t y
Devel opment
0% 0% 0% 0% 0% 0% 1%
8. Resear ch
excl udi ng
oper at i onal r esear ch
1% 4% 4% 0% 0% 0% 4%
Tot al 100% 100% 100% 100% 100% 100% 100%
Tot al , mi l l i on Baht 7, 208 324 461 3, 939 937 1, 064 482
100% 4% 6% 55% 13% 15% 7%
Among t he domest i c sour ces of f i nance, Nat i onal Heal t h Secur i t y Of f i ce- -
r esponsi bl e f or t he UC Scheme has t he maj or shar e of spendi ng, 48%i n 2008
230
and 55% i n 2009 r espect i vel y, as t he NHSO i s r esponsi bl e f or UC scheme
whi ch cover s 75%of t ot al Thai popul at i on, see Tabl e 7a and 7b.
Ci vi l Ser vant Medi cal Benef i t Scheme and Soci al Heal t h Insur ance has a
si mi l ar shar e, 12% and 14% i n 2008, and 13% and 15% i n 2009 r espect i vel y;
Tabl e 7a and 7b. Di f f er ent sour ce of f i nance has di f f er ent spendi ng
pr of i l es. Whi l e al l t hr ee publ i c i nsur ance schemes concent r at e mor e on
car e and t r eat ment , MOPH and ot her mi ni st r i es concent r at e t hei r spendi ng
on pr event i on, 43%and 47%r espect i vel y and al so on ot her i t ems.
Ref erences
Nat i onal Account Of f i ce, t he Nat i onal Economi c and Soci al Devel opment Boar d
ht t p: / / www. nesdb. go. t h/ econSoci al / macr o/ NAD/ 1_qgdp/ st at i st i c/ menu. ht ml [ access 23
Febr uar y 2010] .
Thai wor ki ng gr oup on Nat i onal Heal t h Account . Nat i onal Heal t h Account 1994- 2008
ht t p: / / www. i hppt hai gov. net / nha/ t hai _nha_1994-2008. xl s [ access 10 Mar ch 2010]
Schol z W, Sakul pani ch T, Long t er m pr oj ect i on of t ot al heal t h expendi t ur e i n Thai l and,
2006-2026. Nont habur i , Heal t h Syst ems Resear ch Inst i t ut e. 2009
231
Annex 7
Nat i onal Moni t ori ng and Eval uat i on Commi t t ee
1. Nat i onal Moni t ori ng and Eval uat i on Commi t t ee f or Prevent i on and Management on AIDS
Probl ems
1. Dr . Somsak Akksi l p
Depar t ment of Di sease Cont r ol , MoPH
2. Dr . Supachai Rer k- ngar m
Depar t ment of Di sease Cont r ol , MoPH
3. Dr . Anupong Chi t war akor n
Depar t ment of Di sease Cont r ol , MoPH
4. Dr . Kamnuan Ungchoosak
Depar t ment of Di sease Cont r ol , MoPH
5. Dr . Pasakor n Akar asewi
Bur eau of Epi demi ol ogy, Depar t ment of
Di sease Cont r ol
6. Dr . Pat char a Si r i wongr angsan Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
7. Dr . Yut t i chai Kaset j ar oen
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
8. Dr . Supaki t Si r i l ak
Bur eau of Pol i cy and St r at egy, Of f i ce
of Per manent Secr et ar y
9. Dr . Somsak Pat t ar akul wani ch Bur eau of Heal t h Pr omot i on,
Depar t ment of Heal t h
10. Dr . Ki t t i pong Saej eng
Bur eau of Repr oduct i ve Heal t h,
Depar t ment of Heal t h
11. Dr . Chanvi t Thar at hep Bur eau of Heal t h Ser vi ce Syst em Devel opment ,
Depar t ment Of Heal t h Ser vi ce Suppor t
12. Dr . Vi r oj Ver achai
Thanyar ak Inst i t ut e on Dr ug Abuse,
Depar t ment of Medi cal Ser vi ce
13. Dr . Ampor n Benj aponpi t hak
Bur eau Of Ment al Heal t h Techni cal
Devel opment , Depar t ment of Ment al Heal t h
14. Dr . Sor aki j Bhakeecheep
Nat i onal Heal t h Secur i t y Of f i ce
15. Ms. Par anee Wat t ana
Of f i ce of t he Nat i onal Economi cs and Soci al
Devel opment Boar d
16. Ms. At char a NgamSomj i t
Of f i ce of Per manent Secr et ar y Mi ni st r y of Labour
17. Ms. Puangpet Nakchar t
Of f i ce of Per manent Secr et ar y Mi ni st r y of Int er i or
18. Mr . Saj at hor n Wat t anamongkol
Of f i ce of Per manent Secr et ar y Mi ni st r y of Educat i on
19. Mr . Thana Yant r akowi t
The Depar t ment of Local Admi ni st r at i on
20. Ms. Supat r a Nakapew
Thai NGO Coal i t i on on AIDS ( TNCA)
21. Mr . Bor i pat Donmon
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
22. Ms. Sunee Tal awat
Raks Thai Foundat i on
23. Ms. Ji t t i ya Waj ee
Thai Yout h Net wor k on HIV/ AIDS
24. Dr . Ant hony Pr amual r at ana, Ph. D
Thai l and Busi ness Coal i t i on on AIDS
25. Ms. Pawana Wi enr awee PATH
26 Dr . Chur nr ur t ai Kanchanachi t r a, Ph. D
Inst i t ut e f or Popul at i on and Soci al r esear ch,
Mahi dol Uni ver si t y
27. Dr . Bhassor n Li manonda, Ph. D
Col l ege of Popul at i on St udi es,
Chul al ongkor n Uni ver si t y
28. Dr . Sukhont ha Kongsi n, Ph. D
Facul t y of Publ i c Heal t h, Mahi dol Uni ver si t y
232
29. Dr . Ki at Ruxr ungt ham
The Thai Red Cr oss AIDS Resear ch Cent r e,
The Thai Red Cr oss Soci et i es
30. Dr . Weer asi t Si t t i t r ai , Ph. D
Of f i ce of Pol i cy and Pl anni ng,
The Thai Red Cr oss Soci et i es
31. Dr . Wi wat Peer apat anapoki n
The Pol i cy Resear ch and Devel opment
Inst i t ut e Foundat i on ( PRI)
32. Dr . Mi chael Hahn UNAIDS, Thai l and
33. Dr . Sombat t hapr aser t suk
Wor l d Heal t h Or gani zat i on
34. Dr . Taweesap Si r apr apasi r i Uni t ed Nat i ons Popul at i on Fund
35. Ms. Nongl ak Boonyabuddhi
Uni t ed Nat i ons Chi l dr en's Fund
36. Mr . Gar y Lewi s
Uni t ed Nat i ons Of f i ce on Dr ugs and Cr i me ( UNODC)
37. Dr . Achar a Teer ar at kul
Thai l and MOPH - U. S. CDC Col l abor at i on
38. Dr . Pet chsr i Si r i ni r und Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
39. Dr . Pat char a Benj ar at t anapor n, Ph. D UNAIDS, Thai l and
40. Ms. Por nt i p Khemnger n Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
2. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or Prevent i on and
Management on AIDS Probl ems
1. Dr . Pet chsr i Si r i ni r und
Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
2. Dr . Sanchai chasombat Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
3. Dr . Cheewanan Ler t pi r i yasuwat Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
4. Dr . Sor aki j Pakeecheep Nat i onal Heal t h Secur i t y Of f i ce
5. Ms. Pi yat i da Samut pr aput
Heat h Depar t ment , Bangkok Met r opol i t an
Admi ni st r at i on
6. Ms. Supat r a Nakapew
Thai NGO Coal i t i on on AIDS ( TNCA)
7. Mr . Bor i pat Donmon
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
8. Mr . Sur i ya Wi ngwon Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
9. Ms. Sunee Tal awat
Raks Thai Foundat i on
10. Mr . Ni wat Suwanphat t hana
Nor t h - Thai NGO Coal i t i on on AIDS ( Nor t h - TNCA)
11. Dr . Ki at Ruxr ungt ham
The Thai Red Cr oss AIDS Resear ch Cent r e,
The Thai Red Cr oss Soci et i es
12. Dr . Weer asi t Si t t i t r ai , Ph. D
Of f i ce of Pol i cy and Pl anni ng, The Thai Red Cr oss Soci et i es
13 Dr . Wi wat Peer apat anapoki n The Pol i cy Resear ch and Devel opment Inst i t ut e
Foundat i on (PRI)
14. Ms. War anya Teokul
Independent schol ar s
15. Dr . Sombat t hapr aser t su
Wor l d Heal t h Or gani zat i on
16. Dr . Taweesap Si r apr apasi r i Uni t ed Nat i ons Popul at i on Fund
17. Ms. Nongl ak Boonyabuddhi
Uni t ed Nat i ons Chi l dr en's Fund
18. Dr . Achar a Teer ar at kul
Thai l and MOPH - U. S. CDC Col l abor at i on
19. Dr . Pat char a Benj ar at t anapor n, Ph. D
UNAIDS, Thai l and
29. Ms. Por nt i p Khemnger n
Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
21. Ms. Suwanee Mai suwan
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
22. Ms. Ni r amon Rat t anasupor n
Bur eau of Epi demi ol ogy, Depar t ment of
Di sease Cont r ol
23. Ms. Busaba War akami n
Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
3. Nat i onal Techni cal Worki ng Group on Inf ormat i on Technol ogy f or Moni t ori ng and
Eval uat i on on HIV/ AIDS
233
1. Dr . Nar ong Kasi t i pr adi t
Heal t h Techni cal Of f i ce, Of f i ce of
Per manent Secr et ar y Mi ni st r y of Publ i c Heal t h
2. Mr . Yonsi l p Suchonwani ch Nat i onal Heal t h Secur i t y Of f i ce
3. Dr . Sanchai chasombat
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol

4. Ms. Pannapa Pungpadong Bur eau of Pol i cy and St r at egy, Of f i ce of
Per manent Secr et ar y
5. Ms. Ladar at Phat i navi n Bur eau of Epi demi ol ogy, Depar t ment
of Di sease Cont r ol
6. Ms. Benj awan Rar uek
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
7. Ms. Thongkor n Yunnar ungsr i
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
8. Ms. Wi l awan Somsong
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
9. Ms. Nar eel uck Kul l er k
Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
10. Ms. Amor nr at Ngowabunpat
Pr i nci pal Reci pi ent Admi ni st r at i ve Of f i ce,
Depar t ment of Di sease Cont r ol
11. Mr . Tant Tant i nor oj
Pr i nci pal Reci pi ent Admi ni st r at i ve Of f i ce,
Depar t ment of Di sease Cont r ol
12. Ms. Rungnapa Pr asant hong Nat i onal Heal t h Secur i t y Of f i ce
13. Ms. Puenghat hai Ingun
Nat i onal Heal t h Secur i t y Of f i ce
14. Ms. Por npi mol Si r i mai
Nat i onal Heal t h Secur i t y Of f i ce
15. Ms. Si r i pen Teppi t ug
Soci al Secur i t y Of f i ce
16. Mr . Pi nai Luanl er t
Heat h Depar t ment , Bangkok Met r opol i t an
Admi ni st r at i on
17. Ms. Pannee Chai phosr i
Heat h Depar t ment , Bangkok Met r opol i t an
Admi ni st r at i on
18. Mr . Chuchai Ni t i r at
PATH
19. Mr . Vor avud Tomon
The Pl anned Par ent hood Associ at i on of
Thai l and ( PPAT)
20. Ms. Nar t l ada Chant har oj wong
Thai l and MOPH - U. S. CDC Col l abor at i on
21. Dr . Achar a Teer ar at kul
Thai l and MOPH - U. S. CDC Col l abor at i on
22. Ms. Par i t a Kuai ki et kul
Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
23. Ms. Toenj ai Radomt hong
Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
24. Ms. Wi pavee Ki at at chasai
Thai l and MOPH - U. S. CDC Col l abor at i on
25. Ms. Chat t ong Sawat phi phat phong Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
4. Nat i onal Techni cal Worki ng Group on HIV Si t uat i on Anal ysi s and Pat t ern of HIV
Epi demi c
1. Mr . Sur i ya Wongkongkat hep Of f i ce of Inspect or - Gener al of Mi ni st r y of Publ i c Heal t h
2. Dr . Kamnuan Ungchoosak Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
3. Dr . Pasakor n Akar asewi
Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
4. Dr . Thanar ak Phl i phat Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
5. Mr . Sahaphap Poonkesor n
Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
6. Dr . Pat char a Si r i wongr angsan Bur eau of AIDS, TB and STIs, Depar t ment of Di sease Cont r ol
7. Dr . Cheewanan Ler t pi r i yasuwat Bur eau of AIDS, TB and STIs, Depar t ment of Di sease Cont r ol
8. Ms. Benj awan Rar uek
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease Cont r ol
9. Dr . Sr i pr apa Nat eni yom Bur eau of Tuber cul osi s, Depar t ment of Di sease Cont r ol
10. Dr . Sor aki j Pakeecheep
Nat i onal Heal t h Secur i t y Of f i ce
11. Ms. Nar eel uck Kul l er k Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
234
12. Li eut enant Col onel Ram Rangsi n
Phr amongkut kl ao Hospi t al , Royal Thai Ar my Medi cal
Depar t ment
13. Ms. Por nt i p Khemnger n Nat i onal AIDS Management Cent er , Depar t ment of
Di sease Cont r ol
14. Ms. Sunee Tal awat
Raks Thai Foundat i on
15.Ms. Chant awi pa Api suk
Empower
16. Ms. Pawana Wi enr awee PATH
17. Ms. Or apan Sangwanl oi Independent schol ar s
18. Dr . Weer asi t Si t t i t r ai , Ph. D
Bur eau of Pol i cy and St r at egy, The Thai Red Cr oss Soci et i es
19. Ms. Vi pa Dant hamr ongkul
Col l ege of Publ i c Heal t h Sci ences, Chul al ongkor n Uni ver si t y
20. Dr . Pi ni j Far amnuayphol Heal t h Inf or mat i on Syst em Devel opment Of f i ce
21. Dr . Wi wat Peer apat anapoki n
The Pol i cy Resear ch and Devel opment Inst i t ut e
Foundat i on ( PRI)
22. Dr . Achar a Teer ar at kul
Thai l and MOPH - U. S. CDC Col l abor at i on
23. Dr . Taweesap Si r apr apasi r i
Uni t ed Nat i ons Popul at i on Fund
24. Dr . Pat char a Benj ar at t anapor n, Ph. D
UNAIDS, Thai l and
25. Ms. Ni r amon Rat t anasupor n
Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
26. Ms. Sar i nya Pongpan Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
27. Ms. Ki r a- t i kan Kl at sawat
Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
28. Ms. Wi phawee Ki at at chasai
Thai l and MOPH - U. S. CDC Col l abor at i on
5. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or Nat i onal HIV/ AIDS
Spendi ng Assessment
1. Dr . Vi r oj Tangchar oensat hi en
Int er nat i onal Heal t h Pol i cy Pr ogr am Thai l and
2. Ms. War anya Teokul
Independent schol ar s
3. Ms. Sukhont ha Kongsi n
Facul t y of Publ i c Heal t h, Mahi dol Uni ver si t y
4. Mr . Thana Yant r akovi da
The Depar t ment of Local Admi ni st r at i on
5. Ms. Taweesr i Gr eet eng
Nat i onal Heal t h Secur i t y Of f i ce
6. Dr . Peer amon Ni ngsanond
Nat i onal Heal t h Secur i t y Of f i ce
7. Ms. Si r i pen Teppi t ug
Soci al Secur i t y Of f i ce
8. Chi ef War r ant Of f i cer
Wi chai Tr eechar t
Gener al Admi ni st r at i on Budget Pr epar at i on Of f i ce,
The Bur eau of Budget
9. Mr . Somki d Chai kasaewee Eval uat i on Of f i ce, The Bur eau of Budget
10. Ms. Kul sek Li mpi yakor n
The of f i ce of publ i c account i ng st andar ds,
The Compt r ol l er Gener al s Depar t ment
11. Ms. Pi nt usor n Hempi sut
Bur eau of Pol i cy and St r at egy, Of f i ce of
Per manent Secr et ar y
12. Ms. Suwanee Mai suwan
Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
13. Ms. Duangkamon Hat awee
Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
14. Dr . Sut ayut Osor npr asop, Ph. D
The Wor l d Bank - Bangkok Of f i ce
15. Ms. Bussaba Tant i sak Pr i nci pal Reci pi ent Admi ni st r at i ve Of f i ce,
Depar t ment of Di sease Cont r ol
16. Ms. Busaba War akami n
Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
17. Ms. Ji t pr anee Vasavi t Int er nat i onal Heal t h Pol i cy Pr ogr am, Thai l and (IHPP)
18. Ms. Manor os Haohan Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
19. Ms. Sut hasi nee Chunt har at hi r at i kul Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
5. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or Pol i cy and Ri ght on
HIV/ AIDS
235
1. Mr . Ni r an Pi t ak- wat char
Of f i ce of The Nat i onal Human Ri ght s
Commi ssi on of Thai l and
2. Dr . Pat char a Si r i wongr angsan
Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
3. Ms. Nongpor n Rungpet wong
Ri ght s and Li ber t y Pr ot ect i on Di vi si on,
Ri ght s and Li ber t i es Pr ot ect i on Depar t ment
4. Mr . Somki at Li amsomboon
Of f i ce of t he At t or ney Gener al i n Thai l and
5. Ms. Par anee Wat t ana
Of f i ce of t he Nat i onal Economi cs and Soci al
Devel opment Boar d
6. Dr . Sor aki j Pakeecheep
Nat i onal Heal t h Secur i t y Of f i ce
7. Dr . Somyot Ki t t i mankong
Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
8. Ms. Napa Wongsi l p
Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
9. Ms. Por nt i p Yukt anon Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
10. Ms. Mal ee Sabyeyi ng
Nat i onal AIDS Pr event i on and Al l evi at i on Task For ce
11. Mr . Anan Muangmoonchai
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
12. Mr . Sompong Char eonsuk
UNAIDS, Thai l and
13. Ms. Tongt a Khi ewpai sar n
Uni t ed Nat i ons Devel opment Pr ogr am ( UNDP)
14. Ms. Supat r a Nakapew
Thai NGO Coal i t i on on AIDS ( TNCA)
15. Ms. Sut hi da Wor achot t hanan
Bur eau of AIDS, TB and STIs,
Depar t ment of Di sease cont r ol
16. Ms. Por nt i p Khemnger n
Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
6. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or Bl ood Saf et y and
Heal t h Servi ce Support
1. Ms. Nar umol Sawanpanyal er t
Depar t ment of Medi cal Ser vi ces
2. Dr . Por npet Panj api yakul
Bur eau of Heal t h Ser vi ce Syst em Devel opment ,
Depar t ment Of Heal t h Ser vi ce Suppor t
3. Ms. Napa Jeer akul
Bamr asnar adur e Inst i t ut e, Depar t ment of
Di sease Cont r ol
4. Ms. Chur eer at Bovor nwat t anuwong
Chonbur i Hospi t al
5. Mr . Chat chai Sawat di chai
Phr apokkl ao Hospi t al Medi cal Educat i onCent er ,
Chant abur i pr ovi nce
6. Ms. Wi l ai Chal er mchan Depar t ment of Medi cal Sci ences ( DMSC)
7. Ms. Wi l ai Saer eesi t i pi t ak
Gal yar aj anagar i ndr a Inst i t ut e
8. Capt . Thapanapor n Si nghakowi n
WRTA
Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
9. Ms. Nannaphat Pr asar nt hong Depar t ment of Ment al Heal t h
10. Ms. Wal ai por n Teopi pi t hapor n
Bur eau of Heal t h Ser vi ce Syst em Devel opment ,
Depar t ment Of Heal t h Ser vi ce Suppor t
11. Ms. Rat t ana Pr eechapunyakul
Depar t ment of Medi cal Ser vi ces
12. Ms. Kr i angsak Chai wong
Nat i onal Bl ood Cent r e, Thai Red Cr oss Soci et y
13. Ms. Li sa Kunt amal a
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
14. Ms. Por nt i p Yukt anon
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
15. Ms. Napar at Pat t r apr ayoon Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol

16. Ms. Lumduan Mahavan Nor t h - AIDS Net wor k Devel opment Foundat i on
( Nor t h-AIDSNet )
17. Mr . Sur i ya Wi ngwon Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
18. Ms. Suchada Mukt i er Thai l and MOPH - U. S. CDC Col l abor at i on
236
19. Mr . Somboon Nookai
Thai l and MOPH - U. S. CDC Col l abor at i on
20. Dr . Sombat t hapr aser t suk
Wor l d Heal t h Or gani zat i on
20. Ms. Chi t l ada Ut ai pi bool Thai l and MOPH - U. S. CDC Col l abor at i on
21. Ms. Pat r apor n Jongpi pat wani ch
Bur eau of Heal t h Ser vi ce Syst em Devel opment ,
Depar t ment Of Heal t h Ser vi ce Suppor t
22. Ms. Si neenar t Ut a
Nat i onal Bl ood Cent r e, Thai Red Cr oss Soci et y
23. Ms. Chat keaw Kasemsumr an
Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
7. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or HIV/ AIDS Care
1. Dr . Pet chsr i Si r i ni r und
Depar t ment of Di sease Cont r ol
2. Dr . Sor aki j Pakeecheep
Nat i onal Heal t h Secur i t y Of f i ce
3. Dr . Ki at Ruxr ungt ham
Facul t y of Medi ci ne, Chul al ongkor n Uni ver si t y
4. Ms. Chur eer at Bovor nwat t anuwong
Chonbur i Hospi t al
5. Dr . Sr i pr apa Nat eni yom
Bur eau of Tuber cul osi s, Depar t ment of Di sease
Cont r ol
6. Dr . Sanchai chasombat Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
7. Ms. Benj awan Rar uek
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
8. Dr . Jur ai Wongsawat
Bamr asnar adur e Inst i t ut e, Depar t ment of Di sease
Cont r ol
9. Dr . Peer amon Ni ngsanond
Nat i onal Heal t h Secur i t y Of f i ce
10. Ms. Si r i pen Teppi t ug Soci al Secur i t y Of f i ce
11. Mr . Kul sek Li mpi yakor n
The of f i ce of publ i c account i ng st andar ds,
The Compt r ol l er Gener al s Depar t ment
12. Mr . Kr i t sana Pai r oj bor i boon Inf or mat i on Technol ogy Di vi si on, Gover nment
Phar maceut i cal Or gani zat i on
13. Mr . Ni mi t Ti enudom
AIDS Access Foundat i on
14. Ms. Supat r a Nakapew
Foundat i on f or AIDS Ri ght s Thai l and
15. Mr . Rungr ueng Kanwong
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
16. Ms. Lumduan Mahavan Nor t h - AIDS Net wor k Devel opment Foundat i on
( Nor t h-AIDSNet )
17. Dr . Pat t ar a Sanchai sur i ya, PhD
Facul t y of Publ i c Heal t h, Khonkaen Uni ver si t y
18. Ms. Vi pa Dant hamr ongkul
Col l ege of Publ i c Heal t h Sci ences,
Chul al ongkor n Uni ver si t y
19. Mr . Ni wat Suwanphat t hana
Independent schol ar s
20. Dr . Sombat t hapr aser t suk
Wor l d Heal t h Or gani zat i on
21. Dr . Achar a Teer ar at kul Thai l and MOPH - U. S. CDC Col l abor at i on
22. Ms. Chi t l ada Ut ai pi bool
Thai l and MOPH - U. S. CDC Col l abor at i on
23. Dr . Rangsi ma Lol ekha Thai l and MOPH - U. S. CDC Col l abor at i on
24. Ms. Por nt i p Khemnger n
Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
25. Ms. Napar at Pat t r apr ayoon
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
26. Ms. Nar i sa Mant angkun
Nat i onal Heal t h Secur i t y Of f i ce
8. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or t he HIV Af f ect ed
Peopl e
1. Ms. Si r i r at Ayuwat Mi ni st r y of Soci al Devel opment and Human Secur i t y
of Thai l and
2. Ms. Por nt hi p Suksamr an Mi ni st r y of Soci al Devel opment and Human Secur i t y
of Thai l and
237
3. Ms. Raj ana Nedsaengt i p
The Nat i onal St at i st i cal Of f i ce
4. Ms. Tani ma Char eonsuk
Of f i ce of The Basi c Educat i on Commi ssi on, Depar t ment
Oper at i on Cent er , Mi ni st r y of Educat i on
5. Ms. Por nsi nee Amor nwi chet
Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
6. Ms. Si r i kul i sar anur ak, MD
Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
7. Ms. Nar eel uck Kul l er k
Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
8. Ms. Pi chai Ji nt anapakdee
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease Cont r ol
9. Mr . Kongsak Khamon
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
10. Mr . Api chai Mai akr ee
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
11. Ms. Chut i ma Sai sangchan We Under st and Gr oup
12. Ms. Or r at ai Rhuchar oenponpani ch Independent schol ar s
13. Ms. Thananda Nai wat t anakul
Thai l and MOPH - U. S. CDC Col l abor at i on
14. Ms. Nongl ak Boonyabuddhi
Uni t ed Nat i ons Chi l dr en's Fund
15. Ms. Si r i por nThavar or i t Mi ni st r y of Soci al Devel opment and Human
Secur i t y of Thai l and
16. Ms. Yenj i t Sompoa
Thai Nat i onal AIDS Foundat i on ( TNAF)
17. Ms. Toenj ai Radomt hong
Nat i onal AIDS Management Cent er , Depar t ment of
Di sease Cont r ol
10. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or PMTCT
1. Dr . Somsak Pat t ar akul wani ch
Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
2. Dr . Ni punpor n Vor amongkol Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
3. Ms. Chai l ai Ler t vanangkul
Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
4. Ms. Li sa Kunt amal a Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
5. Ms. Ni r amon Rat t anasupor n
Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
6. Mr . Suchon Wongsher ee Depar t ment of Medi cal Sci ences ( DMSC)
7. Ms. Ji t t r apor n Raksawong
Heal t h Depar t ment , Bangkok Met r opol i t an Admi ni st r at i on
8. Ms. Rekawan Rekakanakul
Nat i onal Heal t h Secur i t y Of f i ce
9. Ms. Yenj i t Sompoa
Thai Nat i onal AIDS Foundat i on ( TNAF)
10. Ms. War anya Pi t akt epsombat The Pl anned Par ent hood Associ at i on of Thai l and ( PPAT)
11. Mr . Somwang Deebucha
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
12. Ms. Nongl ak Boonyabuddhi
Uni t ed Nat i ons Chi l dr en's Fund
13. Dr . Sombat t hapr aser t suk Wor l d Heal t h Or gani zat i on
14. Ms. Nar eel uck Kul l er k Bur eau of Heal t h Pr omot i on, Depar t ment of Heal t h
15. Ms. Thananda Nai yawat kul
Thai l and MOPH - U. S. CDC Col l abor at i on
16. Ms. Sunee Tanwat Rakst hai Foundat i on
17. Ms. Por nt i p Khemnger n
Nat i onal AIDS Management Cent er , Depar t ment of
Di sease Cont r ol
11. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or HIV Prevent i on
among Yout hs
1. Dr . Ki t t i pong Saej eng
Bur eau of Repr oduct i ve Heal t h, Depar t ment of Heal t h
2. Ms. Tani ma Char eonsuk
Of f i ce of The Basi c Educat i on Commi ssi on, Depar t ment
Oper at i on Cent er , Mi ni st r y of Educat i on
3. Mr . Chai char n Chouypokl ang
Of f i ce of Per manent Secr et ar y Mi ni st r y of Educat i on
238
4. Ms. Suj i t r a Pr ongsang
Vocat i onal Educat i on Commi ssi on, Mi ni st r y of Educat i on
5. Ms. Api chaya Ki t j ao
The Hi gher Educat i on Commi ssi on, Mi ni st r y of Educat i on
6. Ms. Kanokpor n Pet chsuwan
Of f i ce of t he Non- For mal and Inf or mal Educat i on,
Mi ni st r y of Educat i on
7. Ms. Chaweewan Thammat hanon
Depar t ment of Educat i on, Bangkok Met r opol i t an
Admi ni st r at i on
8. Ms. Pensi nee Pr apr uet chuwong
Of f i ce of Wel f ar e Pr omot i on, Pr ot ect i on and
Empower ment of Vul ner abl e Gr oups, Mi ni st r y o
f Soci al Devel opment and Human Secur i t y of Thai l and
9. Ms. Ki r a- t i kan Kl at sawat
Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
10. Ms. Pat char abhor n Pawaput anon
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease Cont r ol
11. Ms. Wor al uck Pai mueng
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease Cont r ol
12. Ms. Por nt i p Khemnger n
Nat i onal AIDS Management Cent er , Depar t ment of Di sease
Cont r ol
13. Ms. Ur ai r at Nayai
Thai Yout h Net wor k on HIV/ AIDS
14. Ms. Wor anuch Chi nvor asopak
PATH
15.Ms. Puangt ong Wongwai
Phayao Devel opment Foundat i on ( PDF)
16. Dr . Aphi chat Chamr at r i t hi r ong, Ph D
Inst i t ut e f or Popul at i on and Soci al r esear ch,
Mahi dol Uni ver si t y
17. Ms. Nongl ak Boonyabuddhi
Uni t ed Nat i ons Chi l dr en's Fund
18. Dr . Taweesap Si r apr apasi r i
Uni t ed Nat i ons Popul at i on Fund
19. Ms. Yupa Poonkham Bur eau of Repr oduct i ve Heal t h, Depar t ment of Heal t h
20. Ms. Nuchanar t Kaewdamker ng
Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
21. Ms. Ji t t i ya Waj ee Thai Yout h Net wor k on HIV/ AIDS
22. Ms. Chat keaw Kasemsumr an
Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
12. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or HIV Prevent i on
among Reproduct i ve Age Popul at i on and Fami l y
1. Dr . Cheewanan Ler t pi r i yasuwat
Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
2. Pol Maj Gen Jant ana Wi t t awasi r i
Pol i ce Gener al Hospi t al
3. Lt Col Papr akor n Benj akun
Royal Thai Ar my Medi cal Depar t ment
4. L Cdr Ngem Puongnak
Royal Thai Naval Medi cal Depar t ment
5. Wg Cdr Jumr un Chal adki d
Di r ect or at e of Medi cal Ser vi ces, Royal Thai Ai r For ce
6. Ms. Suchada Wongwanl i yanon Mi ni st r y of Soci al Devel opment and Human Secur i t y
of Thai l and
7. Mr . Nawi n Tar aseang

Bur eau of pol i cy and st r at egy, Of f i ce of Per manent
Secr et ar y Mi ni st r y of Labour
8. Ms. Rat j ana Neat seangt i p
The Nat i onal St at i st i cal Of f i ce
9. Ms. Par adee Chansamon
Bur eau of Repr oduct i ve Heal t h, Depar t ment of Heal t h
010. Ms. Ki r a- t i kan Kl at sawat
Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
11. Ms. Ni t t aya Phr omponcheanbon
Duang Pr at eep Foundat i on ( DPF)
212. Ms. Supar at Suksakul wat
Thai l and Busi ness Coal i t i on on AIDS
13. Mr . Bor i pat Donmon Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
414. Ms. Sukanya Thongt amr ong
Uni t ed Nat i ons Popul at i on Funds
515. Mr . Sompong Char eonsuk
UNAIDS, Thai l and
616.Ms. Kr uat i p Jant har at haneewat
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
717.Ms. Wi l ai wan Koi kal epkr i ng
Depar t ment of Labour pr ot ect i on and wel f ar e,
Mi ni st r y of Labour and Soci al Wel f ar e
239
818. Ms. Li sa Kant amal a
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
919. Ms. Manor os Haohan
Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
13. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or HIV Prevent i on
among Sex Workers

1. Dr . Angkana Char oenwat anachokchai
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
2. Ms. Ji r apor n boonkan
Heat h Depar t ment , Bangkok Met r opol i t an Admi ni st r at i on
3. Ms. Sar i nya Pongpan
Bur eau of Epi demi ol ogy, Depar t ment of Di sease Cont r ol
4. Ms. Sombat sr i vaj ana
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
5. Mr . Somchai Fonghi r undr at Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
6. Ms. Sar i nya pongpan Bur eau of Epi demi ol ogy
7. Mr . Pr aween phayapwi papong Popul at i on And Communi t y Devel opment
Associ at i on ( PDA)
8. Ms. Jant awi pa Api suk
Empower Foundat i on
9. Ms. Supat r a Nakapew
10. Mr . Thawat ankko
Foundat i on f or AIDS Ri ght s Thai l and
The Pl anned Par ent hood Associ at i on of Thai l and ( PPAT)
11. Mr . Jumr ong peangnongyang SWING Foundat i on
12. Ms. Ar ee pr ommo
Inst i t ut e f or Popul at i on and Soci al r esear ch,
Mahi dol Uni ver si t y
13. Dr . Taweesap Si r apr apasi r i
Uni t ed Nat i ons Popul at i on Fund
14. Ms. Chi t l ada Ut ai pi bool
Thai l and MOPH - U. S. CDC Col l abor at i on
15. Ms. Wi pada Mahar at anavi r oj
Bur eau of AIDS, TB and STIs, Depar t ment of
Di sease Cont r ol
16. Ms. Chol l ada nandavi sai
Thai l and MOPH - U. S. CDC Col l abor at i on
17. Mr . Tai t at Pai pi l ai
Nat i onal AIDS Management Cent er ,
Depar t ment of Di sease Cont r ol
14. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or HIV Prevent i on
among MSMs

1. Dr . Weer asi t Si t t i t r ai , Ph. D
Of f i ce of Pol i cy and Pl anni ng, The Thai Red Cr oss
Soci et i es
2. Dr . Angkana Char oenwat anachokchai Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
3. Ms. Pannee Chai phosr i Heat h Depar t ment , Bangkok Met r opol i t an Admi ni st r at i on
4. Ms. Ni pa Ngamt r ai r ai
Medi cal Ser vi ces Di vi si on of f i ce, Depar t ment of
Cor r ect i on
5. Ms. Rat r ee Si r i sr eet r eel uck Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
6. Ms. Nar uemon Yenyar san
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol

7. Ms. Ki r a- t i kan Kl at sawat
Bur eau of Epi demi ol ogy, Depar t ment of Di sease
Cont r ol
8. Ms. Supat r a Nakapew
Foundat i on f or AIDS Ri ght s Thai l and
9. Mr . Kamol set Kenggar nr ua Ki ng Chul al ongkor n Memor i al Hospi t al , The Thai
Red Cr oss Soci et i es
10. Ms. Sur ang Janyam SWING Foundat i on
11. Mr . Api wat Kwangkaw
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
12. Ms. Pi mpawun Boonmongkon
Cent er f or Heal t h Pol i cy St udi es, Mahi dol Uni ver si t y
240
13. Ms. Chomnad Manopai boon
Thai l and MOPH - U. S. CDC Col l abor at i on
14. Ms. Ji t t i nee Khi envi chi t , Ph D
Fami l y Heal t h Int er nat i onal
15. Mr . Panus Rat t aki t vi j un Na Nakor n
USAID

16. Mr . Rapeepun Jommar oeng
The Uni t ed Nat i ons Educat i onal , Sci ent i f i c and Cul t ur al
Or gani zat i on ( UNESCO)
17. Ms. Chat wut Wangwon
Thai l and MOPH - U. S. CDC Col l abor at i on
18. Ms. Chi t l ada Ut ai pi bool Thai l and MOPH - U. S. CDC Col l abor at i on
19. Mr . Danai Li nj ongr at
Rai nbow Sky Associ at i on of Thai l and
20. Ms. Yupi n Chi nsanguanki at
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
21. Ms. Wassana Ni mvor apun
Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
15. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or HIV Prevent i on
among IDUs
1. Dr . Pet chsr i Si r i ni r und Nat i onal AIDS Management Cent er , Depar t ment of
Di sease Cont r ol
2. Dr . Vi r oj Veer achai
Thanyar ak Inst i t ut e on dr ug abuse, Depar t ment
of Medi cal Ser vi ce
3. Ms. Panr udee Manopai boon Dr ug Abuse and Dr ug Pr event i on Of f i ce, Heal t h
Depar t ment , Bangkok Met r opol i t an Admi ni st r at i on
4. Mr . Manop Sr i suphant havor n Depar t ment of Cor r ect i on
5. Ms. Ni pa Ngamt r ai r ai Medi cal Ser vi ces Di vi si on of f i ce, Depar t ment of Cor r ect i on
6. Ms. Yaowar et Nakayot hi nsakul Thanyar ak Inst i t ut e on dr ug abuse, Depar t ment
of Medi cal Ser vi ce
7. Ms. Chuanpi t Choomwat t ana
t he Of f i ce of t he Nar cot i cs Cont r ol Boar d ( ONCB)
8. Ms. Supoj anee Chut i damr ong t he Of f i ce of t he Nar cot i cs Cont r ol Boar d ( ONCB)
9. Mr . Jar uwat Budsar akamr uha
Bur eau of Heal t h Ser vi ce Syst em Devel opment ,
Depar t ment Of Heal t h Ser vi ce Suppor t
10. Ms. Ni r amon Rat t anasupor n Bur eau of Epi demi ol ogy, Depar t ment of Di sease
Cont r ol
11. Ms. Wassana Ni mvor apun
Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
12. Ms. Chi t r a Onnom Bur eau of AIDS, TB and STIs, Depar t ment
of Di sease Cont r ol
13. Ms. Supat r a Nakapew Thai NGO Coal i t i on on AIDS ( TNCA)
14. Mr . Sakda Puakchai
Thai Dr ug User Net wor k ( TDN)
15. Ms. Lawan Sar owat
PSI Thai l and Foundat i on
16. Mr . Pi yabut r Nakapew
PSI Thai l and Foundat i on
17. Ms. Kar yn Kapl an
Thai Ai ds Tr eat ment Act i on Gr oup ( TTAG)
18. Ms. Ar om Konchom
Raks Thai Foundat i on
19. Mr . Sopon Sunhok
Thai Net wor k f or Peopl e Li vi ng wi t h HIV/ AIDS
20. Ms. Bar al ee Meesuk
Asi an Har m Reduct i on Net wor k (AHRN)
21. Ms. Si val ee Kasemsi l p
Thai Har m Reduct i on Net wor k ( THRN)
22. Dr . Api nun Ar amr at t ana Chi angmai Uni ver si t y
23. Ms. Usaneya Per ngpar n
Col l ege of Publ i c Heal t h Sci ences,
Chul al ongkor n Uni ver si t y
24. Mr . Sompong Char eonsuk UNAIDS, Thai l and
25. Mr . Gr ay Sat t l er Uni t ed Nat i ons Of f i ce on Dr ugs and Cr i me ( UNODC)
26. Mr . Pr i n Vi savakum
Thai l and MOPH - U. S. CDC Col l abor at i on
27. Ms. Chaweewan Panj abut r
Thanyar ak Inst i t ut e on dr ug abuse, Depar t ment
of Medi cal Ser vi ce
28. Ms. Vi pa Pawanapor n
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
29. Ms. Yaowal ak Ji t t akoat PSI Thai l and Foundat i on
241
30. Ms. Busaba War akami n Nat i onal AIDS Management Cent er , Depar t ment
of Di sease Cont r ol
16. Nat i onal Techni cal Worki ng Group on Moni t ori ng and Evaluat i on f or HIV Prevent i on
among Mobi le Popul at i on
1. Dr . Chanvi t Thar at hep
Bur eau of Heal t h Ser vi ce Syst em Devel opment ,
Depar t ment Of Heal t h Ser vi ce Suppor t
2. Mr . Pr omboon Pani t chpakdi
Raks Thai Foundat i on
3. Dr . Sanchai chasombat
Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
4. Mr . Bhat t r awut Per sel a
Of f i ce of For ei gn Wor ker s Admi ni st r at i on,
Depar t ment of Empl oyment , Mi ni st r y of Labour
5. Ms. Wi l ai wan Goykaewpr i ng
Depar t ment of Labour pr ot ect i on and wel f ar e,
Mi ni st r y of Labour
6. Ms. Jat upor n Wongkaew
Thai l and Over seas Empl oyment Admi ni st r at i ve,
Mi ni st r y of Labour
7. Ms. Phannapa Pungphadung
Bur eau of pol i cy and st r at egy, Of f i ce of Per manent
Secr et ar y Mi ni st r y of Publ i c Heal t h
8. Mr . Sahaphap Poonkesor n Bur eau of Epi demi ol ogy, Depar t ment of Di sease
Cont r ol , MoPH
9. Ms. Tat sanai Kant ayapor n
PATH
10. Ms. Jar unee Sr i r i pan
PATH
11. Dr . Jar uwar ee Sni dwongse, Ph D
Wor l d Vi si on Foundat i on of Thai l and
12. Ms. Thongphi t Pi nyosi nwat Raks Thai Foundat i on
13. Mr . Br ahm Pr ess
Raks Thai Foundat i on
14. Mr . Sat ean Tanpr om
Foundat i on f or AIDS Ri ght s Thai l and
15. Dr . Bhassor n Li manonda, Ph. D
Col l ege of Popul at i on St udi es, Chul al ongkor n Uni ver si t y
16. Ms. Penpak Ut i t
Facul t y of Nur si ng, Chul al ongkor n Uni ver si t y
17. Ms. Ni goon Ji t t hai Int er nat i onal Or gani zat i on f or Mi gr at i on
18. Ms. Ar ee Mungchar uensuk
Wor l d Heal t h Or gani zat i on
19. Dr . Taweesap Si r apr apasi r i Uni t ed Nat i ons Popul at i on Funds
20. Ms. Dungt a Phal akor nkul Bur eau of Heal t h Ser vi ce Syst em Devel opment ,
Depar t ment Of Heal t h Ser vi ce Suppor t
21. Mr . Sur asak t hanai wanyangkul Bur eau of AIDS, TB and STIs, Depar t ment of Di sease
Cont r ol
22. Ms. Tassanee Sur awanna Raks Thai Foundat i on
23. Mr . Tai t at Pai pi l ai Nat i onal AIDS Management Cent er , Depar t ment of Di sease
Cont r ol

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