What’s UP? Thailand News.

July 1, 2009

On 28–30 May 2009, the Thailand government held the XII National AIDS Seminar – Half of by 2011. Where are we? It was organized with the participation of Thai NGO Coalition on AIDS – TNCA, – that is composed of 17 networks and the Thai Network of People living with HIV/AIDS – TNP+. They created an official CS committee for organizing the National Seminar that had around twenty NGOs attending the meetings. Both TNCA and TNP+ used their communication channels to spread information among their members – around 850 groups of NGO and people living with HIV. Civil society also organized specific symposiums, skill-building workshops, community spaces and campaign activities during the seminar. It was informed by the media that around twenty-five hundred people attended the meeting, half of them organized civil society and PLHA groups and the other half government personnel.

Sign by the Youth Network of People Living with HIV

Sign by the Youth Network of People Living with HIV

The importance of strengthening communication channels with CS is a key part of the government’s response in Thailand. Although the country is recognized because succeeded in addressing AIDS in many ways , this success does not guarantee that the HIV epidemic will come to a halt. In particular, the roots of the problem still exist and have often been overlooked by many policies in place.

Although, the communication channels between CS and government are not always reflected in the level of support accessed by civil society, particularly when related to funds allocation. The XII National Seminar was estimated by the media to cost 12 million Bahts. However it did face a lack of funds for CS participation that drove sex-worker groups to creates strategies on how to raise funds in order to participate in Seminar. Initially they decided to work harder (as sex workers) to support their own participation, but soon they realized that they would not be able to cover all their colleagues’ costs for traveling and lodging. They calculated how many clients they should attend, the number of days working, and how many of them would be necessary to engage to cover all people who wanted to attend the seminar. It would come short anyway. The mobilization was large and the idea led to an urgent meeting between NGOs and government to see how the matter could be solved. The result was that CS got support to include more one hundred people in the official budget. This is a very good example of how civil society mobilization works in Thailand.

UNGASS-AIDS: Monitoring Tool

Sexual and reproductive health in discussion at the Thai XII National AIDS Seminar

Sexual and reproductive health in discussion at the XII National AIDS Seminar in Bankok, Thailand.

The National Seminar was also an important moment where the government expressed how helpful the UNGASS-AIDS Declaration of Commitment is to encourage both government and civil society to pay more attention to putting in place better M&E strategies for AIDS and health policies. Thailand is about to receive a new round of resources from the Global Fund – it will receive 100 million dollars for strengthening overall health system, and monitoring migrant, IDU, sex workers and MSM populations. The need to address these specific populations is evident. They estimate in three million the migrant population in the country, mainly coming from Laos, Cambodia and Myanmar. When they get infected with HIV or tuberculosis it is hard to access medicines, and without funds to pay for it, the situation has become a nightmare for them. The national health system is not prepared to absorb it and it is evident that there is no clear policy in place for addressing migrant women.

But even recognizing the need of the most affected populations, the problems in fact are much more complex and addressing all of them will require a more integrated, interdisciplinary, approach. Nowadays, for instance, one of the major challenge for the HIV/AIDS situation in Thailand is the increasing rate of HIV among youth – young sex workers, IDU, migrants, MSM, etc.

Government data showed that 1.127.168 cases of AIDS and symptomatic HIV infection were reported to the division of epidemiology. In total, 613.510 people died because of AIDS and, in 2008, eleven thousand new cases were registered. Only 19% of the general population has been tested. This percentage increases for sex workers (52.60%) and for MSM (34.90%,) however there is no data available for IDU. The government informed that 52.90% of the people who needs it are receiving ARV treatment, and PMTCT has been available 93.96% of the time.

It was also showed that AIDS is rapidly spreading among women. The 2008 UNGASS report showed that the ratio of HIV infection among women and men has significantly increased from 1:7 in the early days of the epidemic to 1:2.5 in 2005. From 2002, the morbidity of female youth (15–19 year-olds) has been higher than male youth at the same age (2:1). The youth groups at 15-24 years tend to have a high level of unsafe sex. According to the national behavioral surveillance survey (BSS) conducted by the Ministry of Public Health (MOPH), the percentage of youth that have ever had sex is increasing, and with low condom usage. This unsafe sex correlates with the increased incidence of HIV infection and unwanted pregnancy among youth.

UNGASS-AIDS Forum in the National AIDS Seminar

Discussions about the UNGASS-AIDS Declaration of Commitment were made in many sessions. Civil Society expressed that, according to the CS report for UNGASS 2008, the vast majority of HIV positive women face more difficulty in life, many carrying more burden after their husband dies. Moreover, stigmatization from their own communities prevents them from participating in everyday activities that are part of normal life. In addition, the inadequate information hinders accessibility to treatment, ARV, or appropriate counseling and other support activities in relation to the HIV/AIDS epidemic mitigation.

Thai UNGASS-AIDS Forum group in the XII National AIDS Seminar

Thai UNGASS-AIDS Forum group in the XII National AIDS Seminar

One of the sessions in the National Seminar presented the study performed in 2008 by the UNGASS-AIDS Forum that collected data for monitoring the implementation of the national sexual and reproductive health policy in response to HIV/AIDS in Thailand. The area covered the implementation process of PMTCT strategies in nine provinces of five parts across the country.  It was done from November 2007 to January 2008 with a total samples of 195 key informants, among them 108 HIV infected pregnant women.

The study, coordinated by the RaksThai Foundation analyzes information according to the process of PMTCT implementation in state hospitals, both at the community and provincial levels, in the nine provinces. [Access it on the link Reports]

And the good news is that government decided to implement a national research on PMTCT based on the research findings that highlights what the gaps still are on this program. An example of civil society proactively contributing to better implementation of public health services.

Synthesis of the UNGASS-AIDS Forum in Thailand:

Held the 1st Forum in September 2007 with the participation of seventeen NGOs, networks, and Dr. Petchsri Sirinirun, Director of Epidemiology of the Ministry of Public Health.

Concluded the research and, in January 2008, held the 2nd Forum to validate the collected data together with a national consultation with the Thai government. Over three hundred representatives of NGOs, networks, Government and UNAIDS took part in the event.

The SRH and AIDS report produced by civil society focused on PMTCT was included as an annex in the National Report sent to UNAIDS in 2008, and Ms. Sunee Talawat, representative of the UNGASS-AIDS Forum Thailand was included in the national delegation for the HLM in the UN.


HIV and Maternity in Pernambuco

May 11, 2009

The housewifre P.J.S, thirty-five years old, born in Recife, northeastern state of Pernambuco, could not imagine that the happiness attached to having a baby could become a judicial nightmare.

When fnding out she was pregnant of her second child, in 2003, she took all medical pre-natal care. She did all blood tests, including the HIV reagent. The doctor at Maternity Barros Lima, northern area of the city, assured her she had nothing to worry about.

The child had a normal birth delivery. Two months later, to a complete surprise, the tests came back with the news that both her and the baby were HIV positive.

Ms Kariana Guerios, attorney of Gestos, who is following the case, says this is one of four similar cases in the Juridical Counseling department of the institution. She points to the fact that prevention of mother to child transmission is still failing in the health system and that this is somewhat frequent. “For the lack of appropriate assistance, my client was told to breast feed, what is completely inappropriate for HIV positive mothers for raising the risk of the baby getting infected. But fortunately such cases are becoming more rare,” explains Ms Guerios.

The attorney filed a case of moral damage and negligence against the County in the Civil Court, asking for a pension for the child because the mother has no financial condition for the treatment and care. “They are poor. It is necessary to try and repair a damage the municipal competence because this child, that could have been born healthy, was infected with HIV because of a sloppy pre-natal.”

Data from the report of monitoring the goals of the United Nations General Assembly Special Session on AIDS – UNGASS-AIDS – in sexual and reproductive health, prepared by the UNGASS-AIDS Forum Brasil, in 2008, shows that, despite the government’s efforts, reducing “vertical transmission” or PMTCT has a wide regional fluctuation in both care and eduction.

Based on the Plan for Preventing Mother to Child Transmission of HIV and Sifilis of the Ministry of Health, 2007, there is a 0,41% prevalence of HIV infections in mothers. There is an estimate of 12,456 newborns are exposed to HIV yearly. The transmission rate of HIV from mother to child, when the treatment intervention with prophylaxis is not done, reaches about 25% of newborns of HIV+ mothers, but it can lower to one or two percent with the application of the necessary measures during pre-natal care, delivery and post-delivery procedures. Such interventions are: the use of anti-retroviral medicines starting at the fourteenth week of gestation; use of injected AZT during labor; perform cesarian section when advisable; give oral AZT to the newborn exposed to HIV from birth to forty-two days and do not breast feed, use mild substitute instead.