Many of Thailand’s more than five million migrants find themselves in situations that heighten their risk of HIV and have difficulty accessing key services such as antiretroviral therapy.
Credit: UNDP
Migration plays an integral role in Thailand’s economic development and the country hosts more than five million migrants from Cambodia, Lao People’s Democratic Republic (PDR) and Myanmar.
Many migrants however find themselves in situations that heighten their risk of HIV and have difficulty accessing key services such as antiretroviral therapy (ART). A recent regional conference, organised by the UN Development Programme (UNDP) and the Joint Initiative on Mobility and HIV/AIDS (JUNIMA) from 24-25 April explored ways of ensuring better provision of ART to this potentially vulnerable group.
Although migration is not in itself a risk factor for HIV, it can increase vulnerability, such as exploitative working conditions, which may include sexual violence; and separation from spouses/partners, families and established social and cultural norms and values.
A new study in the six provinces most affected by HIV in Thailand has shown that Cambodian migrants bear the highest burden with an HIV prevalence of 2.5%. The estimated adult prevalence in the country as a whole is 1.3%.
The Government of Thailand has taken steps to ensure that migrants have access to ART. Speaking at the conference, Dr Petchsri Sirinirund, Director of the National AIDS Management Centre at the Ministry of Health’s Department of Disease control said, “In the new national strategy for 2012-2016, we aim to provide access to quality HIV treatment and care for any person living with HIV in Thailand, regardless of their nationality.”
There is provision of antiretrovirals (ARVs) for certain categories of low skilled migrants but there are more people in need. Those who are officially registered can pay a fee for universal health coverage which includes HIV treatment and a limited number of people with temporary papers, some 2 300, receive ART through Thailand’s Global Fund project.
While we need to focus our discussion on availability of ARVs as a commodity, what also needs to be in place is a comprehensive system of medical and social care that is backed up by national and regional policy.
Promboon Panitchpakdi, Executive Director of Raks Thai Foundation, development NGO
Political commitment to providing high quality care, including antiretrovirals, is also evidenced by the establishment of a Memorandum of Understanding on Joint Action to Reduce HIV Vulnerability Associated with Population Movement. This was signed in December 2011 by the six members of the Greater Mekong Sub-region (Cambodia, Lao PDR, Myanmar, Thailand, Vietnam and the Yunnan Province of China). A Joint Plan of Action for the memorandum is being formulated.
In addition, Thai and Cambodian authorities have collaborated on a scheme which allowed Cambodian migrants to return to their home country to obtain a three month supply of ARVs.
However, many migrants are not in a position to access antiretrovirals. Each health scheme has a cost to individuals ranging from the equivalent of around 45 US dollars to 90 US dollars and there is also a long waiting list for treatment. A number of those who are unregistered never come to the attention of authorities and therefore receive no help.
The challenges of cross border navigation of different regulations, health systems, and languages, as well as the often temporary nature of migration, make it particularly challenging for migrants living with HIV to access ART along the migration continuum and to adhere to drug regimens.
Furthermore, being given ART does not only involve obtaining the drugs themselves but also ensuring access to wider HIV services like voluntary and confidential counseling and testing as an entry point to treatment.
According to Promboon Panitchpakdi, Executive Director of the Raks Thai Foundation, a development NGO, “While we need to focus our discussion on availability of ARVs as a commodity, what also needs to be in place is a comprehensive system of medical and social care that is backed up by national and regional policy.”
A number of recommendations emerged from the UNDP/JUNIMA conference. These included: examining ways to use TRIPS intellectual property and free trade agreement flexibilities to lower the cost of treatment services and increase coverage for migrants; harmonize treatment and referral protocols across countries; and ensure that in addition to treatment, migrants have better HIV services available.
Rathin Roy, Manager of UNDP Asia Pacific Regional Centre, is confident that migrants will be increasingly better served. “Thailand is a pioneer in implementing the human principle that migrants can access the same quality of HIV services and commodities that are available to citizens, and UNDP, through JUNIMA, is pleased to work in partnership with government and civil society across borders to address the challenges that will allow all migrants in need to access vital HIV treatment.”
