Thailand
COUNTRY SITUATION ANALYSIS
The Royal Thai Government used the opportunity of the United Nations (UN) High Level Meeting on HIV held in New York, United States of America, in June 2006 to announce its renewed commitment to universal access to HIV prevention, treatment, care and support. This announcement included the ambitious goal of decreasing by 50% the annual number of new HIV infections in Thailand by 2010.
Laudable success continues to be achieved by Thailand in scaling up prevention of mother-to-child transmission ‘plus’ programmes (i.e. including treatment for women) and antiretroviral therapy services to those in need. This has been brought about through the integration of antiretroviral therapy into the National Health Security Scheme. As of the end of 2006, more than 100 000 people are estimated to have been provided with antiretroviral drugs (Department of Disease Control, Ministry of Public Health, Royal Thai Government, 2007). Thailand has issued two compulsory licenses for antiretroviral drugs, in the hope of bringing under control the steeply increasing costs of the provision of and access to antiretroviral drugs.
A new National Strategic Plan on AIDS 2007 – 2011 has been developed and costed through a broadly consultative and inclusive national process. The National Strategic Plan focuses on scaling up HIV prevention efforts, particularly for people most likely to be exposed to HIV and difficult to reach populations. It is accompanied by a detailed implementation plan that reflects the Thai road map to universal access, as well as an additional civil society plan that highlights the detailed action civil society partners in Thailand have selected as priority needs.
Despite all the achievements, however, complacency by national and local political leaders still risks overshadowing the activism of the National AIDS Programme and civil society partners in responding to AIDS in the country.
The national response remains primarily health-sector focused, with slight evidence of substantive movement in other critical sectors (most particularly education and the security services).
Antiretroviral therapy services, while expanding, still only reach approximately two thirds of those estimated to be in need of treatment. As many as three quarters of the 500 000+ people estimated to be living with HIV in Thailand are thought to be unaware of their HIV status.
The vast majority of investments on HIV-related activities are for treatment, care and support, with approximately 10% being invested in prevention programming.
According to the Asian Epidemic Model, the estimated rate of HIV infection in Thailand continues to decrease. However, serosurveillance reports of HIV infection rates indicate increasing levels of infection in groups presumed not to have significant risk behaviour (such as female spouses) as well as in those more likely to be exposed to HIV (e.g. men who have sex with men; sex workers; and military recruits). Experiences of stigmatization and discrimination continue to be reported by up to 40% of people living with HIV, and economic livelihoods for people living with HIV are still severely restricted due to social stigma and ostracism.
Challenges and emerging issues for 2007
With the stated commitment of the Royal Thai Government to reduce by half the number of new HIV infections by 2010, a substantial new investment of time, resources and energy needs to be channelled into the overall national and local response to AIDS, if Thailand is to ensure that universal access to HIV prevention, treatment, care and support can actually be achieved.
In particular, prevention programming must not only be scaled up, but must focus priority efforts on people most likely to be exposed to HIV in Thailand, including injecting drug users; men who have sex with men; sex workers; young people; HIV-discordant couples (one partner being HIV positive and the other HIV negative); and cross-border as well as internal migrants. Additional efforts will concentrate on:
•promotion of a more effective and decentralized national and local response to AIDS in Thailand, including a particular focus on HIV prevention programming in marginalized people. As Thailand pushes administrative decentralization, skills and capacities at the local level must be built to ensure effective public–private partnerships, as well as the capacities to respond effectively to the challenges;
•assessment of gender inequalities in Thailand, including gender-based violence, and their impact on HIV infection;
•establishment of an effective evidence base, upon which more focused advocacy programming and initiatives can be developed.
UNAIDS SUPPORT TO THE NATIONAL RESPONSE
Activities in 2006
The UN partners in Thailand supported critical joint initiatives during 2006, including:
•providing technical and financial support for the government and civil society review and planning of the new five-year National Strategic Plan. This planning process included the development of a comprehensive universal access road map for the scaling up of HIV prevention, treatment, care and support in Thailand by 2010;
•developing a comprehensive evidence base on the AIDS epidemic in Thailand, including the translation of best practice documentation into Thai and the design and support of new research initiatives into general Thai sexual behaviour as well as specific risk behaviour of those most likely to be exposed to HIV in Thailand.
Plans for 2007
The UN partners in Thailand will focus efforts in 2007 on a number of key initiatives, including:
•promotion of a more effective and decentralized response to AIDS in Thailand, including a particular focus on prevention programming for marginalized people;
•assessment of gender inequalities in Thailand and their impact on HIV infection;
•establishment of an effective evidence base, upon which more focused advocacy programming and initiatives can be developed;
•stimulation and support of Joint UN Country Team programming initiatives under the United Nations Partnership Framework for Thailand, focusing in particular on: holistic HIV prevention, treatment, care and support programming for young people and adolescents; capacity-building for a decentralized local response; more complete and effective programming for condom promotion and distribution.
Estimated Population (thousands) / 64 233
Population Growth Rate / 0.9%
Life expectancy at birth / Men / Women
67 / 73
Human Poverty Index / Rank / Value
28 / 12.8
Human Development Index / 73
Percentage of people living with less than US$2 a day / 32.5%
Per Capita Gross National Income, ppp, Intl dollar rate / US $ 8020
Per Capita Government Expenditure on health at Intl dollar rate / 160
II. HIV AND AIDS ESTIMATES
Number of people living with HIV / 580 000 [330 000 – 920 000]
Adults aged 15 to 49 HIV prevalence rate / 1.4 [0.7 – 2.1]%
Adults aged 15 and up living with HIV / 560 000 [320 000 – 900 000]
Women aged 15 and up living with HIV / 220 000 [100 000 – 370 000]
Deaths due to AIDS / 21 000 [14 000 – 42 000]
GENERALIZED EPIDEMICS
Children aged 0 to 14 living with HIV / 16 000 [5400 – 38 000]
Orphans aged 0 to 17 due to AIDS / –
III. COUNTRY PROGRESS INDICATORS
GENERALIZED EPIDEMICS
Expenditures
National funds spent by governments from domestic sources / US $ 92 821 968
National Programmes
Percentage of pregnant women receiving treatment to reduce mother-to-child transmission / 30.6%
Percentage of HIV-infected women and men receiving antiretroviral therapy / 60.0%
School attendance among orphans / N/A / non-orphans / N/A
Knowledge and Behaviour
Percentage of young people aged 15 to 24 who correctly identify ways to prevent HIV / Men / Women
N/A / N/A
Percentage of young people aged 15 to 24 who had sex with a casual partner in the past 12 months / Men / Women
N/A / N/A
Percentage of young people aged 15 to 24 who had sex before 15 / Men / Women
10.9% / 6.6%
Percentage of young people aged 15 to 24 who used a condom last time they had sex with a casual partner / Men / Women
N/A / N/A
CONCENTRATED/LOW PREVALENCE EPIDEMICS
Expenditures
National funds spent by governments from domestic sources
Policy Development and Implementation Status
Policy on information, education, communication and prevention for most-at-risk populations
Policy to expand access to essential preventive commodities among most-at-risk populations
National Programmes
Percentage of HIV-infected women and men receiving antiretroviral therapy
Percentage of most-at-risk populations reached by prevention programmes
Injecting drug users / Men who have sex with men / Sex workers
N/A / N/A / N/A