HIV/AIDS in Thailand

By: Chloe Withers and Lacy Carter

AIDS or Acquired Immune Deficiency Syndrome is one of the worst pandemics the world has ever known. AIDS is caused by the human immunodeficiency virus or HIV. AIDS broke out in the early 1980’s and in just over 30 years it has become one of the leading causes of death worldwide. AIDS has resulted in the deaths of over 28 million people that we know of, resulting in a significant global impact (Bosner, 2001). As awareness rises and research progressed the outcome of people living with HIV/AIDS continues to improve around the world.

The first case of HIV in Thailand was reported in 1984 (Avert, 2012). Since then almost 1,115,500 adults had been infected as of 2008, with 585,830 having died (Bosner, 2001). In Thailand there are an estimated 490,00 people living with HIV/AIDS (Avert, 2012). Thailand is an example of a developing country where public policy has been effective in preventing the transmission of HIV on a national scale. In the 1990s, a massive program that began to control HIV reduced visits to commercial sex workers by half, raised condom usage, achieved substantial reductions in new HIV infections, and decreased the prevalence of STDs dramatically.  There were 143,000 new HIV infections in 1991 by 2011 they were down to 9,700 (Avert, 2012). Although the program has been successful in preventing the spread of HIV, Thailand still has the highest prevalence of HIV in Asia with 1.1% of the population living with the virus (Avert, 2012). Obviously there is still work to be done.

In 2012, Thailand launched its AIDS Zero campaign. The AIDS Zero campaign has two main goals in mind: boost HIV prevention initiatives especially among the at-risk age group as well as maintain the initiatives, which are already in place. This campaign aims to have zero new cases of HIV, zero fatalities related to HIV and zero stigma surrounding HIV and those seeking treatment by 2016 (Avert, 2012). The campaign will also focus on educating the at-risk groups who practice unprotected sex which are young people with risky sexual behaviors, men that sleep with men, female sex workers and their clients and injection drug users. By educating these at risk groups they aim to improve condom use and reduce unprotected sex.

Young people age 15 to 24 are considered an at-risk age group because they were not exposed to the past AIDS campaigns like the older generations were (Unicef, 2010). Before 2012 there were reports of a decrease in knowledge of HIV/AIDS, more people with multiple sex partners and fewer people using condoms. Men that sleep with men  (MSM) have been an at-risk group for HIV and Aids since the outbreak in the early 1980’s. Of all HIV infections 41% are transmitted via MSM (Avert, 2012). HIV prevalence among transgender people in Thailand is much lower at 10% (Avert, 2012). Female sex workers (FSW) and their clients are at a high risk for HIV because of the risky and unprotected sexual behaviors they participate in on a daily basis. Sex work is illegal in Thailand, but there are still thousands of commercial sex establishments (CSEs) throughout the country. It is estimated that 1.8% of venue based FSW’s are living with HIV (Avert, 2012). HIV among non-venue based FSW’s is very difficult to monitor. HIV prevalence among injection drug users is estimated at 22% with prevalence among opium and heroin users as high as 50% (Avert, 2012). Since a strong government crackdown on drug trafficking in 2003, drug use has been driven underground and users branded as ‘criminals’, making it more difficult for prevention campaigns to target this group (Avert, 2012). Peer educators are being used to help address this issue.

As of 2012, 82% of the budget from domestic sources was spent on treatment rather than prevention. Thailand follows the World Health Organization (WHO) guidelines of initiating antiretroviral drugs (ARVs) at CD4 levels of <350 cells/mm3, rather than the previous 200 cells/mm3, and the phasing out of stavudine (d4T). They are doing a vaccine trial in Thailand called RV144 that was first announced by the  U.S. Military HIV Research Program (MHRP) in 2009. This tested the combination of two vaccines: ALVAC HIV vaccine (the prime) and AIDSVAX B/E (the boost).  The vaccine combination was based on the strains of HIV that common circulate Thailand.  This trial demonstrated that the vaccine was safe and modestly effective in preventing the HIV infection.  The results also showed that the prime-boost combination lowered the rate of HIV infection by 31.2% (MHRP, 2014).  They had a placebo group in this study and that is how they determined that it helps in lowering the rate of infection.  One finding was that the immunoglobulin G antibodies that bind to the V1/V2 region of the HIV’s Envelope protein correlated with lower infection rates among those who were vaccinated (MHRP, 2014).  Scientists then examined whether the vaccine-induced antibodies that blocked certain HIV strains.  RV144 is generating a wealth of scientific data through secondary studies with collaborators around the globe (MHRP, 2014).

Along with countries such as Brazil and Haiti, Thailand has shown the world that it is possible for a developing country to form an effective response to HIV and AIDS (Bosner, 2001). The country is also an active participant in World’s AIDS Day where they aim to raise awareness by wearing red, pass out condoms and hold parades (amfAR, 2013). Although there are still certain regions and groups heavily affected by the epidemic Thailand is making progress in the right direction participating in new experimental drug trials and implementing new educational campaigns which shows the countries commitment to increasing prevention efforts.

References

amfAR. (2013, December 02). World aids day 2013 in thailand . Retrieved from http://www.amfar.org/articles/around-the-world/treatasia/2013/world-aids-day-2013-in-thailand/

Avert. (2012). Hiv & aids in thailand. Retrieved from http://www.avert.org/hiv-aids-thailand.htm

Bosner, K. (2001, July 24). How aids works. Retrieved from http://science.howstuffworks.com/life/aids.htm

Military HIV Research Program. (2014). Research: RV144 Trial. U.S Military HIV Research Program. Retrieved from http://www.hivresearch.org/research.php?ServiceID=13

Unicef. (2010). Young people. Thailand. Retrieved , from    http://www.unicef.org/thailand/hiv_aids_317.html