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Addressing HIV prevalence among gay men and drug users in Thailand Addressing HIV prevalence among gay men and drug users in Thailand
(3 months later)
In the early 1990's, Thailand's 100% condom use in brothels campaign was credited with bringing the country's HIV epidemic under control and was widely copied in neighbouring countries. Now HIV prevalence among female sex workers is largely stable and low: an estimated 1.8% in 2011 compared to 28% in 1996. Thailand is also proving successful in reaching HIV-positive pregnant women and is on the verge of virtually eliminating mother-to-child transmission.In the early 1990's, Thailand's 100% condom use in brothels campaign was credited with bringing the country's HIV epidemic under control and was widely copied in neighbouring countries. Now HIV prevalence among female sex workers is largely stable and low: an estimated 1.8% in 2011 compared to 28% in 1996. Thailand is also proving successful in reaching HIV-positive pregnant women and is on the verge of virtually eliminating mother-to-child transmission.
However, the picture is less rosy for other parts of the Thai population: an estimated 39% of people who inject drugs are HIV-positive, and a 2010 survey in Bangkok found that 31% of men who have sex with men (MSM) are infected with the virus.However, the picture is less rosy for other parts of the Thai population: an estimated 39% of people who inject drugs are HIV-positive, and a 2010 survey in Bangkok found that 31% of men who have sex with men (MSM) are infected with the virus.
"Since the mid-1990s the Thai government has really dropped the ball quite significantly in terms of legal and policy reform and also in terms of support for people living with HIV," said Scott Berry, executive director of the HIV Foundation Thailand. "According to Bangkok government figures 50% of newly diagnosed cases of HIV in Bangkok are gay men.""Since the mid-1990s the Thai government has really dropped the ball quite significantly in terms of legal and policy reform and also in terms of support for people living with HIV," said Scott Berry, executive director of the HIV Foundation Thailand. "According to Bangkok government figures 50% of newly diagnosed cases of HIV in Bangkok are gay men."
The two high-risk populations are being targeted with large-scale projects funded by the Global Fund to Fights AIDS, Tuberculosis and Malaria, and United States Agency for International Development (USAid) . As with the much-hailed condom campaign, it is hoped that lessons learned in Thailand trying out innovative approaches to reach MSM and drug users will help neighbouring countries to tackle their own HIV epidemics more effectively.The two high-risk populations are being targeted with large-scale projects funded by the Global Fund to Fights AIDS, Tuberculosis and Malaria, and United States Agency for International Development (USAid) . As with the much-hailed condom campaign, it is hoped that lessons learned in Thailand trying out innovative approaches to reach MSM and drug users will help neighbouring countries to tackle their own HIV epidemics more effectively.
The HIV Foundation Thailand is one of the beneficiaries of USAid funding with the recently launched the Good Life Project, which reaches out to gay men, encourages them to get tested and then shepherds those who test positive through the public health system, the only source of free HIV care in the country.The HIV Foundation Thailand is one of the beneficiaries of USAid funding with the recently launched the Good Life Project, which reaches out to gay men, encourages them to get tested and then shepherds those who test positive through the public health system, the only source of free HIV care in the country.
"What we've found when we talked to MSM is that they said they'd rather wait until they were really sick before getting tested because the health system is so poor. They are treated so badly that it's simply not worth engaging with," explained Berry. "We go out and talk to gay men at clinics and we guarantee support for the first three to six months."What we've found when we talked to MSM is that they said they'd rather wait until they were really sick before getting tested because the health system is so poor. They are treated so badly that it's simply not worth engaging with," explained Berry. "We go out and talk to gay men at clinics and we guarantee support for the first three to six months.
"The normal model is a big bubble of testing and prevention, and within that a smaller bubble of care and support. Our project flips that around so the big bubble is care and support and testing and prevention is the smaller.""The normal model is a big bubble of testing and prevention, and within that a smaller bubble of care and support. Our project flips that around so the big bubble is care and support and testing and prevention is the smaller."
Funding for the Good Life Project is provided through the USAid's US$36m CAP-3D project. The project also covers tuberculosis and malaria in Burma but $30m of the total is for HIV programmes in Burma, China, Laos and Thailand.Funding for the Good Life Project is provided through the USAid's US$36m CAP-3D project. The project also covers tuberculosis and malaria in Burma but $30m of the total is for HIV programmes in Burma, China, Laos and Thailand.
"Key populations at risk of HIV are not necessarily reached by the public health system and you need community-based groups to reach them," said Aye Aye Thwin, director of the Office of Pubic Health at USAid's regional development mission to Asia in Bangkok. Population Services International (PSI) manages the CAP-3D project, which runs from 2011 to 2016. "Through groups like PSI we are involved with building the capacity of lots of local groups," said Thwin."Key populations at risk of HIV are not necessarily reached by the public health system and you need community-based groups to reach them," said Aye Aye Thwin, director of the Office of Pubic Health at USAid's regional development mission to Asia in Bangkok. Population Services International (PSI) manages the CAP-3D project, which runs from 2011 to 2016. "Through groups like PSI we are involved with building the capacity of lots of local groups," said Thwin.
"We're finding creative and cost-effective ways to get MSM and transgenders into testing, treatment and care," explained Andrew Boner, PSI Thailand country representative and CAP-3D chief of party. Apart from projects like Good Life, PSI is also working with other members of the CAP-3D consortium, such as Save the Children on using online social networks to reach high-risk members of key populations that are not easily reached through peer-based outreach in venue settings."We're finding creative and cost-effective ways to get MSM and transgenders into testing, treatment and care," explained Andrew Boner, PSI Thailand country representative and CAP-3D chief of party. Apart from projects like Good Life, PSI is also working with other members of the CAP-3D consortium, such as Save the Children on using online social networks to reach high-risk members of key populations that are not easily reached through peer-based outreach in venue settings.
"The highest HIV prevalence is among the general MSM population in Bangkok, and it's not necessarily transactional sex that is feeding the epidemic," said Boner. "We need to find out where the high-risk behaviour is happening and encourage people to get tested. If you can catch people early and get them onto treatment then the treatment as prevention benefits kick in.""The highest HIV prevalence is among the general MSM population in Bangkok, and it's not necessarily transactional sex that is feeding the epidemic," said Boner. "We need to find out where the high-risk behaviour is happening and encourage people to get tested. If you can catch people early and get them onto treatment then the treatment as prevention benefits kick in."
PSI is also managing a $16.5 million Global Fund grant for HIV prevention among injecting drug users. The Champion-IDU programme, now in its fourth year, operates peer-led harm reduction services out of drop-in centres and offices in 19 provinces. Promoting the concept of harm reduction to law enforcement agencies is an uphill battle. The project is operating in a hostile legal environment that puts its outreach workers at the same risks as its client group, said Pascal Tanguay PSI's programme director for harm reduction.PSI is also managing a $16.5 million Global Fund grant for HIV prevention among injecting drug users. The Champion-IDU programme, now in its fourth year, operates peer-led harm reduction services out of drop-in centres and offices in 19 provinces. Promoting the concept of harm reduction to law enforcement agencies is an uphill battle. The project is operating in a hostile legal environment that puts its outreach workers at the same risks as its client group, said Pascal Tanguay PSI's programme director for harm reduction.
"Law enforcement agencies will use needles as evidence of drug use. Anyone found with a needle can be forced to undergo a urine test. Ifit's positive, they can be forced into a compulsory drug treatment centre. If they have drugs on them, then it's straight to prison," he said."Law enforcement agencies will use needles as evidence of drug use. Anyone found with a needle can be forced to undergo a urine test. Ifit's positive, they can be forced into a compulsory drug treatment centre. If they have drugs on them, then it's straight to prison," he said.
Despite these obstacles, the project has succeeded in distributing safe injecting kits directly, with outreach workers trained in how to respond when confronted by beat police officers. Kits are also distributed via commercial pharmacies participating in the Champion-IDU project using a voucher system and training for pharmacists to ensure they do not discriminate against drug users.Despite these obstacles, the project has succeeded in distributing safe injecting kits directly, with outreach workers trained in how to respond when confronted by beat police officers. Kits are also distributed via commercial pharmacies participating in the Champion-IDU project using a voucher system and training for pharmacists to ensure they do not discriminate against drug users.
The Champion-IDU projects holds valuable lessons for other engaged in harm reduction in a hostile environment, said Tanguay. "Getting the donor to understand the situation we're working in has been critical to the project's success. The Global Fund has provided tremendous flexibility and has been very supportive, of the measures we have taken to protect our staff."The Champion-IDU projects holds valuable lessons for other engaged in harm reduction in a hostile environment, said Tanguay. "Getting the donor to understand the situation we're working in has been critical to the project's success. The Global Fund has provided tremendous flexibility and has been very supportive, of the measures we have taken to protect our staff."
The drop-in centres have also added other health services beyond those supported by the Global Fund, such as an overdose prevention to increase the attractiveness of their services to clients.The drop-in centres have also added other health services beyond those supported by the Global Fund, such as an overdose prevention to increase the attractiveness of their services to clients.
He added:"Clients are often more afraid of the police than they are of getting HIV. We've been able to understand that dynamic and use it to our advantage and focus on the law enforcement challenge."He added:"Clients are often more afraid of the police than they are of getting HIV. We've been able to understand that dynamic and use it to our advantage and focus on the law enforcement challenge."
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