“Thailand is progressing in the right direction to end AIDS,
but needs sustained political and policy commitment with a sense of urgency for
‘the last miles’,” Dr Praphan Phanuphak of the Thai Red Cross AIDS Research
Center told the Conference on Retroviruses and Opportunistic Infections (CROI)
in Seattle last week.
The country has numerous achievements in HIV prevention,
treatment and research that are admired internationally, but Dr Praphan noted
that these individual successes were often pilot or demonstration projects, usually
originating in the non-governmental sector. “Scaling up and sustaining progress
is the government’s responsibility, but has been extremely slow,” he said. This
may be due to complacency, a lack of commitment, or a lack of capacity among
policy makers, he suggested.
Antiretroviral medications have been locally produced in
1997, antiretroviral therapy (ART) has been included in universal health coverage
since 2006 and Thai guidelines have recommended a ‘treat all’ approach since
2014 (one year before the World Health Organization). Nonetheless only 70% of
people diagnosed with HIV receive sustained ART and 83% of those receiving ART
have viral suppression.
The Thai Red Cross began offering triple therapy for the
prevention of mother-to-child transmission in 2004, six years before the WHO
and Thai national guidelines. Dr Praphan said that a key lesson from the Thai
experience was to innovate and dare to start things. “Don’t wait until
everything is ready or in a guideline,” he said. In 2016, Thailand eliminated
mother-to-child transmission of HIV.
More recently, services led and staffed by men who have sex
with men and transgender women have been crucial to the scale of HIV testing
and prevention. Over a third of new diagnoses in these groups in Thailand are
made at so-called key population led services in just seven community health
centres. Equally, over half of all PrEP
users are engaged at these services.
This points to a lack of scale-up in the wider health sector.
Whereas the estimated need is for 250,000 people to be on PrEP in Thailand, by
the end of 2018, only 5613 people were doing so. A recent decision to include
PrEP in the universal health coverage programme may boost its uptake.
Dr Dr Praphan said that HIV activism is diminishing, but is
vital. “We are here today because we had activists push us in the past,” he
said. “We need new generations of activists to finish the job on time.”
Equally he urged global agencies to push Thailand to do
more. When appropriate, they should advise or condemn, rather than just
offering “diplomatic sweet words”.