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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
8
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.