| 1. Capitalising on the success: Thailand has been extraordinarily
successful in reversing the spread of HIV/AIDS. Yearly new
infections have fallen from over 143,000 in 1991 at the peak
of the epidemic, to about 20,000 last year. No country in
the world can rival these results. This success can be attributed
to early top-level leadership that created a supportive political
environment for strong action, broad-based mobilisation of
partners well beyond the public health sector, and openness
about AIDS, safe sex, and condoms so essential for an effective
response. This past experience must inform today’s policy-making
in Thailand, as well as be disseminated effectively to other
countries grappling with the complexity of the challenges
posed by HIV/AIDS.
2. Revitalizing a multi-sectoral response: Thailand has in
the last few years reverted to a narrow public health sector
response to HIV/AIDS. The chairmanship of the National AIDS
Committee has been delegated to the Minister of Health, non-health
ministries are not adequately involved, and spending on AIDS
has fallen by half. Non-health ministries must urgently formulate
their own operational HIV/AIDS plans and allocate resources
for their implementation. In addition, HIV/AIDS prevention
and care, as well as management of the social and economic
impact on households and communities, need to be better integrated
into provincial- and Tambon-level strategic development planning
and programmes, especially in hardest hit areas.
3. Shifting the focus of prevention: While still keeping
the pressure on brothel-based HIV transmission, attention
must now shift towards young people in general who are highly
vulnerable to infection. Evidence shows that young people
are having more sex, starting at an earlier age, while only
20 to 30 percent are using condoms. Less than 5% of young
people are now being reached by adequate prevention services,
while public awareness campaigns have all but disappeared.
Simultaneously, prevention efforts must also shift focus to
effectively target specific vulnerable groups such as mobile
populations, MSM, and IDUs. Evidence shows that HIV prevalence
has reached 17% among young gay men (up from 4% in 1991),
50% among IDUs (up from 35% in 1996), and 6% among mobile
labourers in some industrial locations.
4. Mobilising the school system: A major soft-spot for Thailand’s
current response to HIV/AIDS is the fact that the school system
is not adequately mobilised. On an urgent basis, the Ministry
of Education needs to include non-judgemental AIDS and sex
education in school curriculum, going well beyond the current
old fashioned biology lessons. Life skills programmes, open
debate about sexual health, condom promotion, and peer education
need be introduced in a systematic manner in all schools and
universities across the country as part of Thailand’s
national education straPHP has encountered an Access Violation at 01800AFDtegy.
5. Achieving universal access to ARV treatment: It is estimated
that around 20,000 people have access to ARVs out of a bare
minimum of 100,000 who urgently need such treatment today.
As a country with a well organized health system and the capacity
of producing generic ARVs at less than USD 300 per patient
per year, Thailand should aim at becoming a leader in the
global campaign for access to ARVs by going well beyond the
WHO target of 50% coverage set for less developed countries.
But for this to happen, Thailand needs to allocate more resources
to treatment (but not at the expense of prevention), incorporate
ARVs into its universal health coverage, and at the same time
seek out alternative and multi-sourced financing to ensure
sustainability.
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