Lao People's Democratic Republic

Only one third of gay men and other men who have sex with men know their HIV status in the Lao People’s Democratic Republic, partly because stigma and discrimination remains a barrier for accessing HIV testing in public hospitals and clinics. Complicated protocols, uneven and at times judgemental treatment by health providers and non-confidentiality of testing results further impact on HIV testing.

“Many of our friends are scared of getting an HIV test because they think the testing steps are challenging and often unfriendly,” said Phoulikhan Siphabouddy, a community-based supporter of LaoPHA, a Lao nongovernmental organization.

To address this, USAID supported the government and LaoPHA to pilot oral fluid screening in three provinces.

Most people assume that testing involves taking a blood sample. But oral fluid testing detects antibodies for HIV, not the virus itself. A test swab is gently wiped along a person’s upper and lower gums once, then the swab is placed inside a test tube containing a reagent. The result is known within 20 minutes.

Members of the community, so-called peer educators, train volunteers for the oral fluid screening. The screening is fast, easy and can be done anywhere.

Around 82% of people reached agreed to have an HIV test through oral fluid screening, compared to only 17% of referrals to clinics, according to the Ministry of Health.

“The new approach dramatically exceeded Laos’ HIV testing targets by more than 200%,” said Bounpheng Philavong, Director of the Lao Centre for HIV/AIDS and STI.

He, along with LaoPHA, are convinced that community-led services provide an enabling environment for key populations to access HIV services in a non-discriminatory manner. Linkages to care and support for people living with HIV has also improved for people who test positive, with the same community volunteers providing support for referral to trusted clinics.

The Bamrasnaradura Infectious Disease Institute in Nonthaburi is one of Thailand’s premier hospitals in AIDS treatment and care. Its waiting rooms welcome many patients. This month, people waiting for appointments will see on hospital screens stories about people living with HIV who overcame stigma thanks to support from their communities. Bamrasnaradura is one of around 1000 hospitals in Thailand that have joined the zero discrimination in health-care settings campaign.

The Ministry of Public Health of Thailand, the Thai Network of People Living with HIV/AIDS (TNP+) and UNAIDS launched the campaign on 2 March at Bamrasnaradura. 

“More than 30 years since HIV was detected in Thailand, stigma still remains a major challenge,” said Jessada Chokdamrongsuk, Director-General, Department of Disease Control, Ministry of Public Health. “Thailand is committed to ensuring health-care settings are safe and supportive environments.”

The campaign features a video with a short message from the popular Thai singer and UNAIDS National Goodwill Ambassador for Thailand, Chalatit Tantiwut, in which he encourages everyone to join the zero discrimination movement.

“Discriminating against anybody for any reason is always out of bounds,” said Mr Chalatit. “Making music is what I do best and I think it’s my duty to contribute to society and make some noise about zero discrimination.”

This initiative is part of an ongoing effort by the Ministry of Thailand to tackle stigmatizing behaviours and attitudes among staff towards people living with HIV. A survey of 1600 Thai health-care workers showed that more than 60% of workers feared an HIV infection while performing routine tasks and 90% admitted to at least one stigmatizing attitude.

The Ministry of Public Health, with support from civil society, UNAIDS and the United States Agency for International Development, has developed a comprehensive stigma reduction programme that is gradually being scaled-up to include all public hospitals.

“Thailand is showing how to tackle HIV-related stigma and discrimination in hospitals and clinics, “said Tatiana Shoumilina, UNAIDS Country Director for Thailand. “This problem is persistent and pervasive in many parts of the world. Only by overcoming this challenge will we Fast-Track the response to HIV and end the AIDS epidemic as a public health threat.”

“Zero Discrimination Day on 1 of March is now a well-recognized event both in Thailand and globally,” said Apiwat Kwangkaew of TNP+. “However, I would like to urge people to practice zero discrimination every day. Fear of HIV transmission and prejudice against people living with HIV are holding back access to treatment and care, employment and education.”

Thailand’s HIV-related stigma reduction programme for health-care workers is one of the world’s most ambitious initiatives and it has been such a success that it is being adapted and implemented in other South-East Asian countries.

After a survey in 2014 of people living with HIV found that stigma and discrimination in health-care settings was a significant issue in Viet Nam, health officials started exploring best practices and the Thai model seemed a good example.

In Ho Chi Minh City, the Viet Nam Administration for AIDS Control, with support from UNAIDS, has started pilot-testing the programme. The initiative began with a survey of three hospitals in the city, which led to a programme for health workers tailored to the Vietnamese context. A training in how to capacitate health-care workers to reduce stigmatizing attitudes and behaviours is under way in the city from the 28 February to 3 March.

“We will conduct an assessment at the end of this pilot project. I hope the lessons learned from this pilot will help further improve the methodology of measuring HIV-related discrimination in health-care settings and programme approaches, so we can expand the practice nationwide,” said Hoang Dinh Canh, Vice-Director, Viet Nam Administration for AIDS Control.

The Lao People’s Democratic Republic is also adapting Thailand’s initiative and Myanmar has expressed an interest in a similar approach. Discrimination is a barrier to accessing health services for people living with HIV globally, which is why UNAIDS dedicated this year’s Zero Discrimination Day on 1 March to elimination discrimination in health-care settings.

A version of this story first appeared on unicef.org

During a recent visit to a youth centre in the capital, Vientiane, Mr Ban met representatives of people living with HIV (PLHIV) including Mr Kinoy, from the Lao Network of People Living with HIV (LNP+).
Photo credit: UNICEF
Lao PDR/2009/Holmes.

The United Nations Secretary-General, Mr Ban Ki-moon, praised the efforts of the UN Country Team and its partners to support prevention, treatment, care and support activities for people living with HIV, and to raise knowledge and understanding of the issue in Lao PDR.

During a recent visit to a youth centre in the capital, Vientiane, Mr Ban met representatives of people living with HIV (PLHIV) including Mr Kinoy, from the Lao Network of People Living with HIV (LNP+).

Mr Kinoy thanked the Secretary-General for all the UN’s support to PLHIV in the Lao PDR. He said it was vital to ensure continued free access to treatment, care and support services for all in need, to address stigma and discrimination at all levels, and to strengthen the participation of PLHIV in the national response to AIDS.

The Joint UN Team on AIDS in Lao PDR is supporting PLHIV and a greater involvement of people living with HIV in many parts of the country, through capacity building, direct support for activities, and resource mobilization efforts. UNAIDS advocates for meaningful involvement of people living with HIV as one of the key elements of a continuously successful response to AIDS in the country.

UNAIDS, together with a support consortium consisting of several partners, works closely with LNP+ in developing the network as “the voice” of PLHIV. Support is also provided to local level PLHIV support groups to strengthen their self management and representation.

Mr Ban told the young reporters about his recent meeting with UN+ (the UN system HIV positive staff group) and his personal commitment to address stigma and discrimination.
Photo credit: UNICEF
Lao PDR/2009/Holmes.

“I am very much impressed by all that you are doing to help young people of Laos, to teach them awareness and the importance of prevention of HIV/AIDS,” the Secretary General told reporters from a UNICEF-supported youth radio programme.

He told the young reporters about his recent meeting with UN+ (the UN system HIV positive staff group) and his personal commitment to address stigma and discrimination.

Although rates of HIV infection are low in Laos compared to other parts of South East Asia, there are signs that it is gaining hold among some adolescent groups.

During his visit to the Vientiane Youth Centre, Mr Ban applauded the work being done by young counselors and volunteers – including a group of Buddhist monks – for helping people living with HIV to overcome stigma and integrate into society.

Pointing out that the global response to AIDS was a priority for the UN, Mr Ban added: “This is very important for the community, the government, and citizens of Laos to work together, to provide good counseling, provide good care and support and good source of encouragement to people living with HIV”.

During his visit to the Vientiane Youth Centre, Mr Ban applauded the work being done by young counselors and volunteers – including a group of Buddhist monks – for helping people living with HIV to overcome stigma and integrate into society.
Photo credit: UNICEF
Lao PDR/2009/Holmes.

Established in 2001 under the Lao Women’s Union, the Vientiane Youth Centre is a pioneering initiative designed to promote youth capacity development and empowerment. With assistance from the UN Population Fund, the UN Office on Drugs and Crime and UNICEF, the Centre supports a telephone hotline offering advice on AIDS issues, a clinic providing reproductive health services and peer-to-peer education.

Earlier during his visit to Laos (the first by any Secretary-General in nearly a quarter of a century), Mr Ban held talks with His Excellency, Choummaly Sayasone, President of the Lao PDR, and other government leaders. In an address at the inauguration ceremony for a new UN headquarters, the Secretary General said he was optimistic that Lao PDR would achieve the Millennium Development Goals and graduate from Least Developed Country (LDC) status by the target date it has set itself of 2020.

The Secretary-General described a newly-released Millennium Development Goals report as a valuable tool for the Government and its development partners. To achieve the improvements still required in several areas, he called for “greater investments in human development, the social sector and environmental sustainability.”

In an address to more than 200 UN staff members working here, Mr. Ban said fostering a collaborative spirit among the various UN agencies was the most effective means of promoting development.

Every morning Buddhist Monk Maytryjit gets up at 3:45 am to meditate for one hour. Afterwards, he walks through the streets of Vientiane in the Lao Peoples Democratic Republic to collect his food alms.

However, this October he took time out of his usual routine to catch a flight to Pakse to attend a workshop convened by UNAIDS Cosponsor the United Nations Development Programme (UNDP) entitled Leadership for Results, which brought together more than 100 representatives from several provinces including Buddhist monks, government ministries and people living with HIV.

UNDP’s Leadership for Results training workshops aim to develop the capacity of local leaders to transform the response to AIDS by promoting leadership at all levels. A series of workshops were held, the final one in Pakse where the leaders attending formed seven “break through” groups in charge of developing proposals for a transformed response to AIDS in the country. The “break through” initiatives focused on increasing HIV prevention among women living in rural settings, improving access to condoms within the Army and increasing access to information on HIV through radio.

Ms. Setsuko Yamazaki, UNDP Resident Representative, a.i. said, “The rationale behind the Leadership for Results programme is to encourage the formation of strong leadership on AIDS related issues within all sectors, beyond those traditionally involved in the epidemic’s response.”

“This involves stimulating a deep-rooted shift within individuals, organizations and communities, to enable them to see AIDS from a new perspective, identify new possibilities and take action,” she added.

As a follow up to the workshop, the group committed to carrying out ten HIV prevention pilot projects at bus stations, markets and villages, with the aim of reaching out to thousands of people. Using radio programmes and loudspeakers, Monk Maytryjit and his group will also begin disseminating AIDS information during religious ceremonies, including one of Laos’ most significant religious festivals, the Pha That Luang (The Great Stupa or Sacred Reliquary) that is held in November.

“According to Buddhist philosophy one needs to follow the right path and an important part of our life-skills is to treat every person equally. It is important therefore to reduce stigma against people living with HIV in Laos and to help their families,” said Monk Mayrtyjit.

All photo credit : Yasmin Padamsee/UNDP