Thailand

Alliance linking organisation: AIDS Network Development Foundation (AIDSNet) and partner: Thai Network for Positive People Upper North (TNP+UN)

Peer educators at their office in Chiang Khong district, Chang Mai

The first case of HIV was identified in Thailand in 1984 and over the subsequent two decades the epidemic has evolved from one that primarily affected certain ‘high risk’ groups to one where the primary route of transmission is heterosexual transmission.

Thailand is one of a handful of countries to have reversed a serious HIV epidemic. There has been a steady decrease in prevalence rates down to 1.4% by 2006, and a cumulative number of 50,572 people receiving antiretroviral (ARV) treatment by 2005. However, HIV and AIDS are still stark realities in Thailand. Since records began, 21,000 people have died of AIDS and today nearly 600,000 people are living with the virus. The epidemic is also evolving: young people are again increasingly at risk of HIV, and Thailand is now in real danger of a resurgence of HIV infections.

In the Upper North Region, where the Alliance is working, recent data shows that a cumulative total of 96,727 people are either living with HIV, or have died from AIDS since records began. Of these, approximately 15,323 have received or are on ARV treatment (NAPHA, January 2006), although it is reported that drug resistance to first line regimen is beginning to rise.

What we do

The Alliance’s partnerships in Thailand are in the Upper Northern provinces. Here, HIV spread rapidly in the late 1980s and early 1990s. By 2002, more than half of Thais living with HIV were in the Upper North, even though the region represented only 8% of the national population.

Because of efforts to organise themselves and respond to their situation, the Upper North of Thailand is also home to one of the most highly mobilised populations of people living with HIV anywhere. For a history of this phenomenon, see Positive People’s Groups.

The Alliance is a partner the AIDS Network Development Foundation (AIDSNet). Together, the Alliance and AIDSNet provide support to the Thai Network of People living with HIV/AIDS, or TNP+ Upper North. Together, our three organisations have developed and tested an innovative model of prevention for people living with HIV, integrated into the system of ARV provision.

Our efforts are complementary to the success of other organisations that have put in place comprehensive care centres in district hospitals, the Access Network (formed of TNP+, another Thai NGO called AIDS Access, and Médecins Sans Frontières).

What we’ve achieved

AIDSNet’s and TNP+’s efforts supporting prevention for people living with HIV is currently in its second year. In 2005, we developed and rolled out a model of prevention integrated into ARV treatment provision. This involved 13 people living with HIV organisations being attached to district hospitals and providing peer and psychosocial support to their organisations’ members. The intention was to develop a model of quality prevention programming at scale. This was deemed successful and reached approximately 2,500 people living with HIV with a combination of the following: primary prevention options, information on curable STIs, disclosure of HIV status, and community rejection and self-acceptance.

The methodology guidance and tools are expected to be available in 2007 for wider dissemination. They will be available in English and Thai and, depending on resources, in other languages used in the Mekong sub-region.

In 2006, AIDSNet and TNP+ are attempting to support the sustainability of this approach, providing training (but not onward grants) to another 50 organisations of people living with HIV that are expected to integrate prevention for people living with HIV in their funded projects. This would extend prevention for people living with HIV from three provinces to all eight provinces in the Upper North.

In June, the Alliance co-published with AIDSNet and TNP+ Positive People’s Groups, a history of organisations of people living with HIV in the Upper North of Thailand. It was disseminated at a regional consultation meeting, co-organised with the regional network APN+.

Future plans

We are currently working with AIDSNet to include a fifth subject within their prevention programmes: reproductive health choices for couples with at least one partner who is living with HIV. A field assessment is currently underway, and some of the technical support will be provided by the Alliance in India.

For late 2006 and 2007, we are also planning to work with AIDSNet to develop programming for men who have sex with men and who are living with HIV, a significant but under-served population.