Thailand

UNAIDS has appointed the singer and television personality Chalatit Tantiwut as a UNAIDS National Goodwill Ambassador for Thailand.

The announcement was made on 1 July during a special National HIV Testing Day event hosted by the Bangkok Metropolitan Administration (BMA). The Deputy Governor of Bangkok, Pusadee Tamthai, was among the first to congratulate him. 

Mr Chalatit will help raise awareness and promote greater use of HIV prevention, treatment, care and support services, particularly among gay men and other men who have sex with men.

Thailand has made immense progress in its AIDS response, with new HIV infections dropping by 56% since 2005. At the same time, there is a continuing epidemic among gay men and other men who have sex with men, especially in large urban areas. BMA’s Department of Health reports that in 2014 HIV prevalence among gay men and other men who have sex with men was 28.6% in Bangkok, which was much higher than among the general population.

Mr Chalatit’s powerful voice has entranced Thailand’s music scene for more than a decade. He has recorded numerous hits and has also acted in movies and television series.

The Tangerine Community Health Centre is Asia’s first clinic to provide a full range of health-care and counselling services specifically for transgender people. Transgender people need access to a range of health, social protection and other support services that are tailored to them.

“At the Thai Red Cross Tangerine Community Health Centre we are committed to providing the highest attainable standard of health in an affordable and accessible manner for all transgender people,” said Praphan Phanuphak, Director of the Thai Red Cross AIDS Research Centre, in which the clinic is located.

UNAIDS Deputy Executive Director Luiz Loures visited the clinic with Mr Praphan, its founder, on 21 June. The clinic provides hormone counselling and therapy, sexual and reproductive health services, psychosocial counselling and HIV testing. Trained transgender personnel and gender-sensitive medical professionals manage and provide the services. While the clinic offers a full range of services, it encourages all clients to have an HIV test.

“We like to encourage everyone to have an HIV test and learn more about HIV prevention and treatment as part of a holistic approach to health care for transgender people,” said Krittima Samitpol, Supervisor of the Tangerine Community Health Centre.  

According to Thailand’s Bureau of Epidemiology, epidemiological surveys of transgender women at five sites report high HIV prevalence, ranging from around 9% to 17% in 2014. Despite the risk of HIV infection, many transgender people do not get tested for the virus and studies find only about a third know their HIV status.

Most transgender people in Thailand self-administer hormones they commonly purchase on the Internet or in local pharmacies. Without professional medical care, incorrect use of hormones can lead to liver, kidney and cardiovascular problems. At the Tangerine Community Health Centre, medical professionals oversee testosterone injections for transgender men and transdermal hormone creams and oral hormone therapy for transgender women.

The Political Declaration on Ending AIDS adopted in early June by United Nations Member States noted with alarm the slow progress made in reducing new HIV infections among specific populations.

“To end AIDS, the health and rights of key populations need to be at the centre,” said Mr Loures. “The Tangerine Community Health Centre is transforming the health choices for transgender people.”

The clinic opened in November 2015 and in its first five months received visits from nearly 250 transgender people. Around 80% of the visitors were tested for HIV and the 10% who tested positive were linked to treatment at either the Thai Red Cross AIDS Research Centre or public hospitals.

During his visit to the clinic, Mr Loures spoke with representatives of three community groups: the Thai Transgender Alliance, Service Workers In Group and Rainbow Sky.

The Prime Minister of Thailand, Prayut Chan-o-cha, received a certificate from the World Health Organization (WHO) on 20 June confirming the elimination of mother-to-child transmission of HIV and syphilis in the country. Thailand is the first country in Asia to reach the milestone, which was officially announced earlier this month at the United Nations General Assembly High-Level Meeting on Ending AIDS.

UNAIDS Deputy Executive Director Luiz Loures, WHO Regional Director for South-East Asia Poonam Khetrapal Singh, the Minister of Public Health of Thailand, Piyasakol Sakolsatayadorn, and representatives of other organizations and partners participated in the event, which took place in Bangkok, Thailand.

According to Thailand’s Ministry of Public Health, 98% of all pregnant women living with HIV have access to antiretroviral therapy and the rate of mother-to-child transmission of HIV has been reduced to 1.91%. WHO’s global guidelines consider mother-to-child transmission of HIV to be effectively eliminated when the rate of transmission falls below 2%.

In 2000, an estimated 1000 children became infected with HIV through mother-to-child transmission. By 2015, that number had dropped to 85. This is a significant achievement in a country where an estimated 440 000 people were living with HIV in 2015.

NEW DELHI/BANGKOK, 7 June 2016— Thailand today received validation from WHO for having eliminated mother-to-child transmission of HIV and syphilis, becoming the first country in Asia and the Pacific region and also the first with a large HIV epidemic to ensure an AIDS-free generation.  The Minister of Health of Thailand was presented with the certificate of validation during a ceremony which took place in New York on the eve of the United Nations General-Assembly High-Level Meeting on Ending AIDS.

 “This is a remarkable achievement for a country where thousands of people live with HIV. Thailand’s unwavering commitment to core public health principles has made elimination of mother-to-child transmission of HIV and syphilis a reality, a critical step for rolling back the HIV epidemic. Thailand has demonstrated to the world that HIV can be defeated,” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region, said presenting the certificate of validation to Thailand in New York.

"Thailand has turned around its epidemic and transformed the lives of thousands of women and children affected by HIV," said UNAIDS Executive Director, Michel Sidibé. "Thailand's progress shows how much can be achieved when science and medicine are underpinned by sustained political commitment."

"By investing in strong maternal and child health care and national AIDS prevention measures, Thailand has demonstrated there are ways to protect children from the global AIDS pandemic response,” said Karin Hulshof, Regional Director, UNICEF East Asia-Pacific Region. “Thailand’s achievement inspires its neighbours to greater action. There are still 21,000 infants who are born with HIV each year in the Asia-Pacific region, and more than 200,000 children who are growing up with HIV.”

Untreated, women living with HIV have a 15-45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. However, that risk drops to just over 1% if antiretroviral medicines are given to both mothers and children throughout the stages when infection can occur.

According to Thailand’s Ministry of Public Health 98% of all pregnant women living with HIV have access to antiretroviral therapy and the rate of mother-to-child transmission of HIV has been reduced to less than 2%. In 2000, an estimated 1000 children became infected with HIV. In 2015, the number of children who became infected with HIV through mother to child transmission was reduced to 85, a decline of more than 90%, a significant achievement in a country where an estimated 450 000 people were living with HIV in 2014.

At the same time, sustained efforts and success in preventing new HIV infections have helped reduce HIV among women of childbearing age. According to Thailand’s health authorities, between 2000 and 2014, the annual number of women newly infected with HIV fell from 15 000 to 1 900 – a 87% reduction. Thailand’s Universal Health Coverage framework ensured essential health services were available to both rich and poor. The country’s commitment to equitable access has ensured that both Thai citizens and migrants are covered for HIV treatment.

Thailand’s commitment to the UNAIDS-led ‘Global Plan towards the elimination of new HIV Infections among children by 2015 and keeping their mothers alive’, combined with the Government’s decision to provide all pregnant women – including documented and undocumented migrant workers – free antenatal care, delivery and services for HIV and syphilis pushed treatment coverage rates up, culminating in validation of elimination of mother-to-child transmission.

Thailand’s pioneering success and leadership demonstrates how countries can make real change when good policy is followed up with high-level commitment. WHO, UNAIDS and UNICEF will continue to work with other countries in the region, along with partners to replicate Thailand’s success.

WHO validation process

In 2014, WHO and key partners published the guidance on global processes and criteria for the validation of the elimination of mother-to-child transmission of HIV and syphilis, which outlines the validation process and the different indicators countries need to meet.

As treatment for prevention of mother-to-child-transmission is not 100% effective, elimination of transmission is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.

An international expert mission convened by WHO visited Thailand in April 2016 to validate the progress toward the elimination of mother-to-child transmission of HIV and syphilis. The members visited health centres, laboratories, and government offices, and interviewed health officials and other key actors. The mission included experts from Australia, Cambodia, China, Philippines, India, Indonesia, Nepal, Thailand, United States and representatives from WHO, UNICEF and UNAIDS.

Video on Thailand's success:  https://www.youtube.com/watch?v=eVIh3pnnOh4&feature=youtu.be

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

UNAIDS and the Global Health Workforce Alliance are launching an Agenda for Zero Discrimination in Health Care. The agenda supports a vision for a world where everyone, everywhere, enjoys health services without discrimination and where the health workforce is empowered to provide discrimination-free services to all.

Many people around the world face barriers to accessing quality health-care services and realizing the highest attainable standard of health. The multiple reasons for this vary across countries and communities. Even where health-care services are available and of good quality, people often experience or fear stigma and discrimination, which prevent them from accessing the health services they need and are entitled to receive.

A new report by Asia Catalyst produced in collaboration with eight community-based organizations in Cambodia, China, Myanmar and Viet Nam has documented discriminatory practices in health-care settings specifically against people living with HIV. Findings include experiences of involuntary HIV testing, involuntary disclosure of status, segregation, arbitrary additional expenses imposed due to HIV status and medical advice against pregnancy and for sterilization on the sole basis of HIV status.

The agenda offers a space for collaboration between countries, the World Health Organization, UNAIDS, other United Nations and intergovernmental organizations, professional health-care associations, civil society, academics and others to take coordinated action for achieving zero discrimination in health care.

The agenda will prioritize coherent joint actions in three critical areas:

• Political support: by increasing political commitment through mobilization of all key constituencies, to secure prioritization of this agenda at all levels.
• Implementation: by fostering scale-up of implementation of effective actions to achieve discrimination-free health care.
• Accountability: by promoting monitoring and evaluation frameworks and mechanisms to build evidence, monitor progress and ensure accountability.

The action plan outlines seven priorities; these include: building and sharing evidence and best practices; standard-setting; ensuring meaningful engagement of the people most affected by discrimination in the development, implementation and monitoring of policies and programmes; and strengthening the leadership of professional health-care associations.

A virtual community of practice has been created to mobilize more partners around the shared vision and action plan, to join contact ghwa@who.int. 

In the late 1990s, the Thai Government started offering free antiretroviral medicines to several thousand people. Apiwat Kwangkaew, currently Vice-Chair of the Thai Network for People Living with HIV, was one of the lucky ones.

“Twenty years ago I got really sick because of AIDS. I didn’t think I was going to make it,” said Mr Apiwat. Within a few months of starting treatment, he was healthy again.

“What was really tragic was that antiretroviral medicines existed, but my friends and other people living with HIV were not accessing them,” he said.

Because of that experience, ensuring access to HIV treatment has been his life’s passion. He is now one of Thailand’s better known advocates for people living with HIV.

Since the 1990s, the situation has vastly improved. In 2002, Thailand became one of the first members of the Association of Southeast Asian Nations (ASEAN) to integrate HIV services into its universal health coverage scheme. Between 2010 and 2014, coverage of people living with HIV receiving antiretroviral medicines increased from 42% to 61%.

Suchada Chaivooth, Director of the HIV and Tuberculosis programme at the National Health Security Office, said that Thailand had found many benefits from this integration. “The government can negotiate a good price for antiretroviral medicines because it’s supplying a large number of people living with HIV,” she said.

Panya Shoosiri, a gardener from Amphur Thamai village in Chantaburi Province, central Thailand, is one of the many people accessing free antiretroviral medicines. He has been living with HIV for more than 15 years. His monthly income is about US$ 100. “All HIV services are covered by the national plan. It’s a big relief for me,” said Mr Panya.

In 2014, Thailand reached a new milestone, becoming the first country in ASEAN to offer free HIV treatment to people living with HIV regardless of their CD4 count, the measurement used to indicate how significantly the immune system has been affected by HIV. Previously, people who tested positive could only access antiretroviral medicines after their CD4 count had decreased to 350 cells/mm³.

“I campaigned hard for this development because I am sure it will save many lives,” said Mr Apiwat. “People living with HIV often only came back to the hospital when they were really sick and by then the antiretroviral medicines didn’t work so well and they were more likely to die,” he added.

Since the new guidelines went into effect, Thailand has seen enrolment on its HIV treatment programme increase by more than 30%.

During a visit to Bangkok, UNAIDS Executive Director Michel Sidibé said, “The AIDS response in Thailand and around the globe has a lot to offer the universal health-care movement.”

Mr Sidibé pointed out that the AIDS response has achieved one of the most remarkable expansions in modern history. In 2000, fewer than 1% of people living with HIV in low- and middle-income countries had access to treatment. The annual cost per person was sky high. As of June 2015, the global number reached 15.8 million people or 40% of the total number of people living with HIV around the world.

He emphasized so much has been achieved in such little time because the AIDS movement has prioritized people. From the early days of the epidemic civil society has played a key role in expanding access to HIV services.

In Thailand, the government earmarks funds for health-care facilities to team up with community groups. “Our HIV programme is one where hospitals work in partnership with community groups to provide prevention services, reaching key populations at higher risk of HIV and providing them with HIV testing and care,” said Ms Suchada. 

Public health leaders and key stakeholders from around the world have come together at the Prince Mahidol Award Conference  to discuss how limited health resources can be used in the most cost-effective way to provide high-quality health care.

Her Royal Highness Princess Maha Chakri Sirindhorn opened the conference by saying it came at a key moment since it followed the adoption of the Sustainable Development Goals by countries late last year. The UNAIDS Executive Director Michel Sidibé delivered a keynote address speaking about the need for a paradigm shift, moving from a disease response to a people-centred approach.

The conference, which is taking place in Bangkok, Thailand from 26 to 31 January, is being held under the theme Priority Setting for Universal Health Coverage. It is welcoming more than 900 government officials, representatives of intergovernmental organizations, international development partners and researchers from around 50 countries.

Thailand is one of the countries that have succeeded in putting people at the centre of their universal health coverage plan. Thailand champions the scale-up of community-led services. The Bangkok Metropolitan Administration, for example, works closely with civil society and communities.

During his visit to Thailand, Mr Sidibé visited two community-led programmes with Ms. Pusadee Tamthai, the Deputy Governor of Bangkok. One was the Service Workers in Group Foundation, better known as SWING, which supports sex workers by providing screening for sexually-transmitted infections, HIV counselling, testing, treatment, care and support services.

Mr Sidibé also visited the Tangerine clinic, housed at the Thai Red Cross AIDS Research Center, which is the first clinic to offer comprehensive sexual health services to transgender people in Thailand. Mr Praphan Phanuphak, Director of the Research Center, is a pioneer in the AIDS movement and demonstrates how science, integrated into community work, brings health care to even the most marginalized people.

“When I was 30 years-old, I was surprised to learn that I was pregnant,” said Prem Paika, who lives in Chiang Mai, Thailand. “My partner, who I had been with for the past eight years, thought he was infertile, so we did not use any birth control.”

Ms Paika was also concerned because she and her partner had been diagnosed with HIV five years earlier. She had been taking antiretroviral medicine for the past few years and went to consult with the doctor overseeing her HIV treatment at a public hospital. 

“I was very worried my baby would have HIV, but my doctor reassured me that the antiretroviral medicine would protect my baby,” said Ms Paika.

Untreated, women living with HIV have a 15–45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. However, that risk drops to under 5% if antiretroviral medicines are given to both mother and child through the stages when infection can occur.

Thailand has made the elimination of new HIV infections among children a priority and has consistently adapted its prevention of mother-to-child transmission programme in accordance with the latest research findings. The country is currently following the World Health Organization’s guidelines to provide lifelong antiretroviral medicine to all pregnant women living with HIV. The Ministry of Public Health has implemented measures in its hospitals to ensure that mothers living with HIV receive key services.

“We have developed a system in hospitals where the mother’s confidentiality is guaranteed. Health sector staff have been trained to communicate well with their patients,” said Danai Teewanda, Director from the Bureau of Health Promotion at the Ministry of Public Health in Thailand.

Ms Paika found her regular doctor supportive and she was happy because the hospital provided psychological counselling for her through her pregnancy and until her child was one year old. She could also access her HIV treatment and receive her antenatal check-ups in the same hospital and so did not have to travel from one part of town to another, visiting different specialists.

However, despite efforts by Thailand’s health authorities to create a supportive environment, stigma remains a problem among staff working in other health areas. Ms Paika found that the hospital’s gynaecologist treated her badly and was often misinformed.

“From my first antenatal examination, the gynaecologist encouraged me to have an abortion. He wouldn’t let me see the sonogram as he said in any case there was no point. He told me my baby only had a 2% chance of being born free of HIV.”

Ms Paika turned to her HIV treatment doctor for comfort and her partner complained to the hospital’s director. After this, she found that the gynaecologist treated her better. Finally, the big day arrived: she gave birth to a baby girl.

“They provided her with an antiretroviral prophylaxis and she was tested at one month and then every six months. She was HIV-negative each time. I am so happy she is free of HIV,” said Ms Paika.

Through its efforts, Thailand has achieved remarkable progress in eliminating new HIV infections among children. In 2014, country programme data showed that almost 95% of HIV-positive pregnant women received antiretroviral medicines to reduce the risk of HIV transmission and almost 98% of their babies were born free of HIV.

The country is hoping to further reduce new HIV infections among children. “We have a few weak spots, such as early detection. We are encouraging women to seek antenatal care within the first 12 weeks of their pregnancy,” said Mr Danai.

Since 2013, Thailand has provided free antenatal services to pregnant women at all health centre facilities, promoted HIV counselling and testing for couples and provided antiretroviral medicines to infants as soon as possible after birth. The country hopes by 2016 to have virtually eliminated new HIV infections among children.

Senior government health authorities from Thailand were among representatives from 20 countries who attended the 10th Asia–Pacific United Nations Elimination of Parent-to-Child Transmission of HIV and Syphilis Task Force meeting in Beijing, China, from 15 to 17 September. The meeting examined regional successes, but also roadblocks to stopping new HIV infections among children.

While major advances have been made in responding to HIV and ensuring access to lifesaving treatment, progress for adolescents urgently needs to be scaled up. Young people, especially young women and young key populations, continue to be disproportionately affected by HIV—In 2014, there were 3.9 million young people aged between 15 and 24 years living with HIV and 620 000 young people became newly infected with the virus. AIDS is now the leading cause of death among young people in Africa and the second leading cause of death among young people world-wide.  

Young people are continuing to face immense challenges in accessing timely and appropriate health education—including comprehensive sexuality education, social services—including access to youth friendly services, and decent housing and job opportunities. However, the opportunities for youth to engage in decision-making processes to ensure access to these essential services remain limited.

To celebrate International Youth Day and young people’s empowerment, UNAIDS and The PACT, a global coalition of youth-led and youth-serving organizations, met in Bangkok to discuss ways of ensuring the active participation of youth in efforts to end the AIDS epidemic as a public health threat by 2030.

The three-day meeting, held from 10-12 August, focused on shaping The PACT’s strategy to mobilize the global youth movement and build the capacity of youth organizations to engage in the AIDS response. They addressed issues such as policy and legal barriers for young people’s access to HIV services, scale-up of evidence-based HIV prevention and treatment programmes and increasing resources for youth organizations.

The PACT committed to continue to shape a strategy to ensure that young people are meaningfully engaged in All In—an initiative led by UNAIDS, Unicef and partners to end HIV among young people. Participants also agreed on a strategy to mobilize youth organizations to hold governments’ accountable for ensuring access to comprehensive sexuality education and youth friendly services.