HIV/AIDS in Thailand

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Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. [1] In 2009 the adult prevalence of HIV was 1.3%. [2] As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations. [3] [4] : 91 

Contents

A 2011 report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified Thailand among the eleven countries in the Asia-Pacific with a majority of the world's HIV-infected people. [5]

HIV/AIDS history and prevalence

Estimated prevalence in % of HIV among young adults (15-49) per country as of 2011 AIDS and HIV prevalence 2008.svg
Estimated prevalence in % of HIV among young adults (15–49) per country as of 2011

After Thailand's first case of [imported] AIDS was reported in 1984—in a Thai student who returned from college in the United States [7] —and after the first laboratory detection of HIV in 1985, [8] starting in early 1988, HIV infection spread explosively in sequential waves in one risk group after another. [9]

Information on the prevalence of AIDS in Thailand was initially suppressed due to the concern of affecting the economy of the tourist industry. [10] In 1991, the government adopted a strategy to combat the disease, and in recent years, the number of new infections has declined. According to Avert, the second-highest prevalence of HIV in Asia existed in Thailand in 2002, with a rate of 1.8 percent. [11] HIV prevalence had remained the same from 2003 to 2005 (1.4 percent). By 2017 HIV prevalence had declined to 1.1 percent, with 75 percent having access to antiretroviral therapy (ART). [12]

Thailand's early cases of HIV/AIDS occurred primarily among gay men. The virus then spread rapidly to injecting drug users (IDUs), followed by prostitutes. Between 2003 and 2005, there were increases in HIV prevalence from 17 to 28 percent among men who have sex with men in Bangkok. In addition, prevalence among IDUs still ranges from 30 to 50 percent.

In 2005, more than 40 percent of new infections were among women, the majority of whom were infected through intercourse with long-term lovers. Money and a low level of condom use due to women's activity in the illegal sex trade are factors responsible for the spread of HIV among this group. Although the prevalence of HIV/AIDS in Thailand has declined, the epidemic has moved to the general population and there is a greater need to match prevention efforts with recent changes in the epidemic. [13]

As of 2011, IDUs in Thailand are among the most vulnerable to HIV/AIDS and number between 40,000 and 97,300. [14]

Dynamics

Several factors had put Thailand at risk of a resurgence of HIV/AIDS cases. Awareness of HIV status was low in 2006. For example, 80 percent of HIV-positive men who have sex with men (MSM) had never been tested or thought they were HIV-negative, according to a 2006 study cited by UNAIDS. By 2017, awareness of HIV status had risen to 98 percent. [12] A large portion of IDUs—35 percent according to one study—use non-sterile injecting equipment. [13]

Other research has noted an increased trend of erratic condom use by female prostitutes. In some cases, women selling sex reported using a condom in just over one half of commercial sex encounters. Finally, premarital sex, once taboo, is increasingly common among young Thais, only 20 to 30 percent of whom use condoms consistently, according to the United Nations Development Program. [13]

According to the World Health Organization, Thailand has a high tuberculosis (TB) burden, with 63 new cases per 100,000 people in 2005. Approximately 7.6 percent of TB patients are also infected with HIV; HIV-TB co-infections pose a challenge to treatment provision and care for both diseases. [13]

National response

Thailand's initial response to the epidemic was weak.[ citation needed ] However, since the National AIDS Control Program was moved from the Ministry of Public Health to the Office of the Prime Minister in 1991, the country's HIV/AIDS prevention efforts have been recognized[ by whom? ] as among the world's most successful. The Ninth National Economic and Social Development Plan (2002–2006) emphasized the adoption of a human-centered approach to bring about reform through the public health system, especially the health care system. Thailand's policy on AIDS has worked toward educating its citizens on HIV/AIDS and prevention measures; developing a system of medical, public health, social, and consultation services to improve the quality of life of persons living with HIV/AIDS (PLWHA); developing medical biotechnology, medicine, and AIDS vaccination research; and working with all parties involved, such as the government and private sector, to prevent and alleviate the HIV/AIDS situation. [13]

Thailand's HIV/AIDS activities include conducting a public education campaign targeting the general public and most-at-risk populations (MARPs), improving sexually transmitted infection (STI) treatment, discouraging men from visiting sex workers, promoting condom use, and requiring sex workers to receive monthly STI tests and carry records of the test results. [13] [15] The Thai sex industry has become the major focus of campaigns aimed at HIV prevention and treatment due to the perception that prostitution has been responsible for the spread of AIDS. [4]

In 2004, Thailand received a third-round grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria to prevent HIV/AIDS among IDUs and increase care and support for them. Objectives of the grant are to train peer leaders within IDU communities; create harm-reduction centers; educate health care providers, police, prison staff, and policymakers; and provide peer-based outreach, education, counseling, referral services, and HIV testing support. The US Government provides one-third of the Global Fund's contributions. [13]

Since the change of government in 2006, Thailand has reinvigorated its HIV/AIDS prevention and control efforts. In 2007, Thailand adopted a three-year strategic plan that focuses on scaling up HIV prevention efforts, particularly for people most likely to be exposed to HIV and for difficult-to-reach populations. Thus, the government continues to strive for achieving universal access to treatment. As of the end of 2006, 88 percent of HIV-infected people were receiving ART, according to UNAIDS. [13]

Early in 2007, the government announced that it would, if necessary, break patents on drugs to treat HIV. Thailand's Government Pharmaceutical Organization will produce the antiretroviral drug efavirenz after receiving WHO approval in 2018. GPO's product costs 180 baht per bottle of thirty 600 mg tablets. The imported version retails for more than 1,000 baht per bottle. GPO will devote 2.5 percent of its manufacturing capacity to make 42 million efavirenz pills in 2018, allowing it to serve export markets as well as domestic. [16]

Despite the efforts put into anti-HIV strategies, it is estimated that condom use remains quite low: in 2010, the Department of Disease Control (DDC) estimated that 60 percent of sexually active teenagers, more than 50 percent of MSM and 40 percent of sex workers do not regularly use condoms.[ citation needed ]

Research

The American Centers for Disease Control and Prevention (CDC) conducted a study in partnership with the Thailand Ministry of Public Health to ascertain the effectiveness of providing people who inject drugs illicitly with daily doses of the anti-retroviral drug Tenofovir as a prevention measure. The results of the study were released in mid-June 2013 and revealed a 48.9% reduced incidence of the virus among the group of subjects who received the drug, in comparison to the control group who received a placebo. The Principal Investigator of the study stated in the Lancet medical journal: "We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use." [17]

A study done by AIDS Care investigated substance use of HIV risk behaviors among kathoey sex workers in Bangkok, Thailand. [18]

See also

Related Research Articles

<span class="mw-page-title-main">Epidemiology of HIV/AIDS</span> Epidemic of HIV/AIDS

The global epidemic of HIV/AIDS began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), by 2023, HIV/AIDS had killed approximately 40.4 million people, and approximately 39 million people were infected with HIV globally. Of these, 29.8 million people (75%) are receiving antiretroviral treatment. There were about 630,000 deaths from HIV/AIDS in 2022. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2020, there are approximately 1.5 million new infections of HIV per year globally.

The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.

Angola has a large HIV/AIDS infected population, however, it has one of the lowest prevalence rates in the Southern Africa zone. The status of the HIV/AIDS epidemic in Angola is expected to change within the near future due to several forms of behavioral, cultural, and economic characteristics within the country such as lack of knowledge and education, low levels of condom use, the frequency of sex and number of sex partners, economic disparities and migration. There is a significant amount of work being done in Angola to combat the epidemic, but most aid is coming from outside of the country.

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.

With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country in Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.

<span class="mw-page-title-main">HIV/AIDS in Nepal</span>

The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.

The Philippines has one of the lowest rates of infection of HIV/AIDS, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.

HIV/AIDS in Bolivia has a less than 1 percent prevalence of Bolivia's adult population estimated to be HIV-positive. Bolivia has one of the lowest HIV prevalence rates in the Latin America and Caribbean region.

Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic.

The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total, with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.

HIV/AIDS in Jamaica has a 1.5 percent prevalence of the adult population estimated to be HIV-positive. There has been no significant change over the last five years and therefore Jamaica appears to have stabilized its HIV/AIDS epidemic.

In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).

Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.

With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year. But, in 2012 and 2013 it increased to about 600 new cases and in 2014 it reached 880 new cases per year. According to UNAIDS 2016 statistics, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

With 1.28 percent of the adult population estimated by UNAIDS to be HIV-positive in 2006, Papua New Guinea has one of the most serious HIV/AIDS epidemics in the Asia-Pacific subregion. Although this new prevalence rate is significantly lower than the 2005 UNAIDS estimate of 1.8 percent, it is considered to reflect improvements in surveillance rather than a shrinking epidemic. Papua New Guinea accounts for 70 percent of the subregion's HIV cases and is the fourth country after Thailand, Cambodia, and Burma to be classified as having a generalized HIV epidemic.

Vietnam faces a concentrated HIV epidemic among high-risk groups, including sex workers, and intravenous drug users. There are cases of HIV/AIDS in all provinces of Vietnam, though low testing rates make it difficult to estimate how prevalent the disease is. The known rates among high-risk groups are high enough that there is a risk of HIV/AIDS rates increasing among the general population as well. People who are HIV+ face intense discrimination in Vietnam, which does not offer legal protections to those living with the condition. Stigma, along with limited funding and human research, make the epidemic difficult to control.

Morocco has been identified as one of the best countries within the MENA region in dealing with the HIV epidemic based on their research capacities, surveillance systems, and evidence-informed and comprehensive responses. While the general public has a fairly low HIV prevalence, the majority of HIV/AIDS cases can be found in three high-risk groups, which is important when deciding how to approach intervention and prevention.

References

  1. ↑ Pongphon Sarnsamak (25 November 2008). "More teenaged girls getting HIV infection". The Nation. Archived from the original on 26 November 2014. Retrieved 17 June 2013.
  2. ↑ "Thailand". HIV InSite. UCSF Center for HIV Information. July 2009. Retrieved 17 June 2013.[ not specific enough to verify ]
  3. ↑ "COUNTRY COMPARISON; HIV/AIDS – ADULT PREVALENCE RATE". Central Intelligence Agency. Archived from the original on 13 June 2007. Retrieved 1 December 2018.
  4. 1 2 Lines, Lisa (July 2015). "Prostitution in Thailand: Representations in fiction and narrative non-fiction" (PDF). Journal of International Women's Studies. 16 (3): 86–100. Retrieved 21 March 2018.
  5. ↑ "HIV/AIDS: Pakistan has one of Asia's highest HIV prevalence rates". The Express Tribune. 27 August 2011. Retrieved 17 June 2013.
  6. ↑ "AIDSinfo". UNAIDS. Retrieved 4 March 2013.
  7. ↑ "Weniger BG. History of the Early HIV/AIDS Epidemic in Thailand and Highlights of the Country's Key Contributions to Global Prevention". The Siam Society, Bangkok, Thailand (Lecture 2019-05-02 @Youtube). Archived from the original on 21 December 2021.
  8. ↑ "Wangroongsarb Y, Weniger BG, Wasi C, Traisupa A, Kunasol P, Rojanapithayakorn W, Fucharoen S. Prevalence of antibody to HTLV-III/LAV in selected populations in Thailand" (PDF). Southeast Asian Journal of Tropical Medicine and Public Health 1985;16(4):517-20. Archived from the original (PDF) on 20 January 2016.
  9. ↑ "Weniger BG, Limpakarnjanarat K, Ungchusak K, Thanprasertsuk S, Choopanya K, Vanichseni S, Uneklabh T, Thongcharoen P, Wasi C. The epidemiology of HIV infection and AIDS in Thailand" (PDF). AIDS 1991;5(suppl2):S71-S85. Archived from the original (PDF) on 31 January 2016.
  10. ↑ Jackson, Peter A. Male homosexuality in Thailand: an interpretation of contemporary Thai sources. Elmhurst, NY: Global Academic Publishers, 1989. Print.
  11. ↑ "Timeline of AIDS in Asia". Avert. 2013. Retrieved 17 June 2013.
  12. 1 2 Saengpassa, Chularat (1 December 2018). "Sharpened focus in Aids battle". The Nation. Archived from the original on 4 April 2019. Retrieved 1 December 2018.
  13. 1 2 3 4 5 6 7 8 "Thailand Country Profile" (PDF). 30 October 2017. Archived from the original on 16 August 2008. Retrieved 19 August 2021. "Thailand HIV/AIDS Health Profile" (PDF). USAID. March 2008. Archived from the original (PDF) on 14 November 2008. Retrieved 19 August 2021.
  14. ↑ "Slideshow: The Need for Clean Needles in Thailand". World Bank Thailand. Archived from the original on 18 June 2012. Retrieved 29 August 2012.
  15. ↑ Celetano, David D.; Kenrad Nelson; Cynthia Lyles; Chris Beyner; Sakol Eiumtrakal; Vivian Go; Surinda Kuntolbutra; Chirasak Khamboonruang (1998). "Decreasing Incidence of HIV and Sexually Transmitted Disease in Young Thai Men: Evidence for Success of HIV/AIDS Control and Prevention Program". AIDS. 12 (29): 29–36. doi: 10.1097/00002030-199805000-00004 . PMID   9543437. S2CID   39577722.
  16. ↑ Wipatayotin, Apinya (3 November 2018). "Thailand gets nod to make HIV/Aids drug". Bangkok Post. Retrieved 3 November 2018.
  17. ↑ Emma Bourke (14 June 2013). "Preventive drug could reduce HIV transmission among injecting drug users". The Conversation Australia. The Conversation Media Group. Retrieved 17 June 2013.
  18. ↑ Nemoto, Tooru, Mariko Iwamoto, Usaneya Perngparn, Chitlada Areesantichai, Emiko Kamitani, and Maria Sakata. "HIV-related Risk Behaviors among Kathoey (male-to-female Transgender) Sex Workers in Bangkok, Thailand." AIDS Care (2011): 1-10. Web.
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