Welcome to Chiang Mai, Thailand
:
How much we succeed !
HIV / AIDS Situation in Thailand
Suwat Chariyalertsak, MD., Dr.PH
Research Institute for Health Sciences, CMU
Present to EAA Member Meeting in Chiang Mai, 21 Mar 2011
Chiang Mai University
3
Research Institute for Health Sciences (RIHES)
Chiang Mai University, Thailand
Hey Guy !
Do you know
where did HIV
come from ?
Shuu ! Be
quiet, I did
it by myself
N u m b e r o f P e o p le L iv in g w ith H IV /A ID S (in m illio n s )
20 years of H IV /A ID S
30+
The first efficacy trial of a potentia l HIV vaccine
in a developing country starts in Thaila nd
The World Health O rganization (W HO )
launches the S pecial Prog ramm e on AIDS
The first cases of unusual
imm une deficiency are
identified amo ng
gay men in the US A
In Africa, a
heterosexual
A IDS
epidem ic is
revealed
In the USA , th e
first HIV antibody
test is approved by
the Food and Drug
A dministration and
HIV screening of
blood donations
starts
The Hum an Imm unodeficiency Viru s (HIV) is
identified as the cause of
A IDS
A t le ast one ca se of
HIV/AIDS has be en
repo rted from each region
of the world
A cquired Imm unodeficiency S ynd rom e
(A ID S) is defined for the
first time
Highly A ctive A ntiretroviral
Therapy (HAA RT) is
discussed for th e first time
The first therapy
for AIDS
- azidoth ym id ine
(A ZT) - is
approved fo r
use in the US A
In 199 1-1993, H IV
prevalence in young
preg nant wom en in
Ugan da be gin s to
decrease , the first m ajor
down turn in a
developing country
S cientists develop
the first treatm ent
regim en to redu ce
mother-to-child
transm issio n
The International C ouncil of A IDS Service O rganiza tions (ICA SO ) and
the G lobal Network of P eople Living with HIV/AIDS are founded
June 2001
The UN Security Co uncil
discusses HIV /AIDS fo r
the first time
UNA ID S
is cre ated
A n HIV outbreak
in Eastern E urope
is detected
(am ong injecting
drug users)
Rock Hudso n becom es
the first p ublic figure to
disclose he has AIDS
UN Se cretary-G enera l
K ofi An nan m aps a plan of action,
and calls for the cre ation of a
global fund on A IDS and h ealth
B razil b ecom es th e first
developing country to
provide a ntiretroviral therap y
through its
public health system
Estimated HIV burden in SouthEast Asia Region, 2007
* Without Pacific Region
Source: Reports of HIV estimates, National AIDS programs cited in HIV/AIDS in South-East Asia_WHO, 2009
HIV prevalence (%) in adults (15–49) in Asia
Source: UNAIDS_epidemiological data, 2008
Reported HIV/AIDS cases by mode of
transmissions in selected countries, 2008
* Unsafe sex includes MSM
transmission
Source: HIV/AIDS case reports by National AIDS programs cited in HIV/AIDS in South-East Asia_WHO, 2009
Prevalence distribution among
MARPs in Asia
New infections in year
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
1990 1995 2000 2005 2007 2009 2010 2015 2020
Client
FSW
IDU
MSM
Lo-risk males
Lo-risk females
Source: UNAIDS_Estimates and projections_P.Rao presentation in ICAPP, Bali, August 2009
Children
Thailand
Health
Statistics
Population
64,233,000
Population (15-49 y)
35,595 thousand
# Physicians per 10,000 population
2.8
# Nurses per 10,000 population
13.7
Infant mortality rate (per 1000 live births)
16.3
Under 5 year mortality (per 1,000 live births) 20.4
Maternal mortality (per 100,000 live births)
Leading causes of deaths,
(2002, all age)
WHO Report on Health Statistics, 2006
44
1. AIDS
2. Ischemic Heart Disease
3. Cerebrovascular Disease
First AIDS Case Report in Thailand
28 yeas old Thai male, studied in U.S.
with history of homosexual exposure
 In 1983, he was admitted at a hospital
in USA with Pneumocystis
Carinii pneumonia


In 1984, he was referred to Thailand
for continuing treatment
What NEXT !
The HIV Epidemic Pregnant Women
Transition
Male with
Multiple Partners
in Thailand
Commercial
Sex Workers
Intravenous
Drug Users
Family
Children
Homosexual
Teenage
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996 -2004
Thailand HIV/AIDS Epidemic
First report  Explosive Epidemic
AIDS in 2 men Rapid spreading
(homosexual
among IDUs
contacts)
“0%”  “30%”
1984
1987
1988
Report in
blood
transfusion
1989
Interventions
Massive
campaign with
100% condom
1991
Rapid spreading
among FSW (44%)
Generalized Epidemic:
Children born to HIV+
women
 Care and ART
 Focus on
prevention
2000
2007
Concentrated epidemic
(MSM, SW and IDUs)
2007 AEM Estimation:
• 14,000 new infections
• 1,100,000 cumulative HIV+
• 550,000 Living with HIV
THE SUCCESS OF THE 100% CONDOM
PROGRAMME IN THAILAND
“Thailand’s “100% Condom
Program” has been one of the world’s
most successful condom promotion
campaigns”
(Lamb D. Despite economic crisis,
Thailand continue bold fight against AIDS.
Los Angeles Times, November 16, 1998)
HIV Prevalance among pregnant women
by age groups, 1995-2007
3
2.5
2
< 20 ปี
20-24 ปี
25-29 ปี
> 30 ปี
1.5
1
0.5
0
year
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Source: Sentinel Sero-surveillance, Bureau of Epidemiology, Ministry of Public Health
Reported AIDS Cases by age, gender,
Thailand 1984-2007
Number of cases
35,000
Female
30,000
Male
25,000
20,000
15,000
10,000
5,000
Source: Bureau of Epidemiology,MOPH,Thailand
data as of September 30, 2007
60
+
9
55
-5
4
50
-5
9
45
-4
4
40
-4
9
35
-3
4
30
-3
9
25
-2
4
20
-2
9
15
-1
4
.1
01
.5
-9
04
0
Reports of ever-had-sex
among high school students, 1996-2006
%
25
20
15
Male
10
Female
5
0
1996
1997
1998
1999
2000
SAQ
2001
2002
2003
2004
2005
2006
PASI
Source: Bureau of Epidemiology, Department of Disease Control, MOPH
Note SAQ = Self administered questionnaire
PASI = Personal digital assisted self interviewing
Fig. 5 Proportion of male conscripts, male factory workers and
male students who used condoms consistently with commercial
sex workers from 1995 – 2005
100
90
80
70
male conscripts
male factory workers
male students
60
50
40
30
20
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Current Situation
By the end of 2007:
Estimated number of people living with HIV
610,000
• Adults (15+)
600,000
• Women (15+)
250,000
• Children (0-15)
14,000
Estimated adult HIV prevalence
1.4%
Estimated number of AIDS deaths in 2007
31,000
2007 Estimation, 2008 Report on the global AIDS epidemic
110,824
65,046
Total 357,407 cases
Dead 90,054 cases
99,871
43,521
38,01
6
1,67
1,69
9
0
22,7
38
5,36
8
10,3
67
23,8
56
12,7
29
3,27
3
3,46
6
National HIV/AIDS ART Treatment Program
National Access to ARV
Treatment for PLHA (NAPHA)
National
Health
Security
Program
Global Fund
PMTCT national program
Social
Security
Civil servant
fund
ARV mono and dual therapy under
research settings
1997-1998
2000
2001
2002
2003
2004
2005
2006
2007
Number of Currently Received ARV, Thailand
160,000
142,390
140,000
120,000
120,000
100,000
88,261
80,000
58,133
60,000
40,000
19,551
20,000
0
0
1,710
3,640
1999
2000
2001
2002
0
2003
2004
2005
2006
2007
Up to 130,000 PLHA accumulatively received treatment
in 2007 by different schemes of health care services


CHIANGMAI AIDS Situation
1988 – 30 September 2009

New challenging
HIV epidemic in
Thailand
T&C and prevention and the window period
How many people
who are HIV+ but
don’t know their
HIV status ?
Anyone is
susceptible
to HIV
regardless of
race,
gender or
sexual
orientation!!
More emphasize on risk groups
•
•
•
•
•
•
Youth
MSM
Drug users group (Inject and others)
Sex workers (Female, Male)
Migrants/Mobile people
Etc ???
HIV Prevalence among MSM
IBBS using Time-Location Sampling, 2003-2007
%
Sentinel provinces
Thailand MOPH-U.S. CDC Collaboration
Success is the entry
point of failure !
Can I get HIV by means?
How do you fight ! It’s matter
Who is the
most at risk?
What we should do in the future
but need to start now
Scale up ART
Scale up
Prevention
Organize a workshop with monks in PA-THAI com.
PA-THAI Concert in community
PA-THAI Concert in community
Summary :- What need to be done
 Strong
political commitment and
leadership at the highest levels
through community levels
 Education and information initiative
 Successful
prevention, care,
support and treatment strategies ;
continuum care
Summary :- What need to be done
 Effective
use of available resources
and alternative medicines;
traditional , etc.
 Working
as partnerships ; GO,
NGO, PWLA, and community
 Active
promotion and protection of
human rights
Summary :- What need to be done
 Recognizing
the importance
of sharing and building
network on our collective and
diverse experiences, through
regional and international
cooperation
WE ALL ARE
A PART OF
SOLUTION....
Be
Cheerful!