Ending Aids

Thailand has taken great strides in dealing with the virus. But there's still a long way to go

The world sees two million new cases of HIV/Aids infection every year. The annual death rate is only half that. But in Thailand, it's a completely different story. Here, the death rate is triple the number of newly-infected patients.

"Thailand has 6,000 to 7,000 new cases of HIV/Aids infection each year. But the death rate is around 20,000. The question is, why?" asked Professor Emeritus Dr Praphan Phanuphak, director of the Thai Red Cross Aids Research Centre, ahead of the recent 21st Bangkok International Symposium on HIV Medicine. The event was aimed at providing doctors, nurses, pharmacists, medical technicians and healthcare providers with better knowledge and understanding about HIV/Aids and its prevention, including updates on antiretroviral (ARV) drugs and their side effects.

According to Dr Praphan, these statistics reflect a situation in Thailand where certain problems and failings persist, such as the newly-infected not getting treated early enough or patients only getting access to treatment when the disease is at an advanced stage.

Interestingly, there has been significant change in the HIV/Aids landscape with regards to who is being infected. In the past, the majority of infected cases were heterosexual males and females. Now, according to Dr Praphan, it's primarily men who have sex with men.

"In the past, a lot of HIV cases were the result of transmission between sex workers and heterosexual males and then from those men to their wives. That's not the case now. Of around 6,000 new cases in Thailand, approximately 55% are men who have sex with other men," said Dr Praphan, also director of the HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT). The age profile has also changed. Currently, around 40-50% of the newly infected are under 24.

Although a vaccine against HIV is in the pipeline, it remains some way away. "There is hope. But it's not close," Dr Praphan said. Given that no vaccine has yet been developed against the virus, condoms have for years been seen as one of the best protections against exposure. But getting people to use condoms every time they have sex is easier said than done.

"We all know one of the best ways to prevent HIV is for drug users not to share needles and for people to use condoms when they sleep with someone who is not their partner. But less than 60% of people actually use condoms," Dr Praphan explained. The challenge is to find a preventative method that is neither vaccine nor condom -- pre-exposure prophylaxis or PrEP.

PrEP is a way for people who are not infected with HIV but who are at substantial risk of contracting it to prevent infection by taking a pill every day. Thailand is at the forefront when it comes to PrEP in Southeast Asia. The country has implemented PrEP for five years, while the Philippines and Myanmar, for instance, are only getting started.

But PrEP is not without controversy. "There are some who say PrEP encourages people not to wear condoms," the doctor admitted. "But the fact is that, if people do not want to use condoms, there is no way we can make them do so. What we can do is to give them the drug."

Dr Praphan cited a study of 100 men who engage in homosexual intercourse who were screened for HIV. The first test showed negative results. After 12 months, six out of the 100 were found to have been infected. If the six patients had been given PrEP, not only would the pill have prevented them from contracting the virus, but also any people they subsequently passed the virus on to over the ensuing 12 months.

"PrEP is an issue that the public should be aware of, instead of just waiting for the state to provide it for free. In particular, people whose sexual behaviour puts them at risk should take the medication, because it is affordable," he said, adding that the National Health Security Office is now at work to get PrEP covered as social welfare first for high-risk groups, including sex workers and gay men.

As for those who are diagnosed with HIV/Aids, taking antiretroviral (ARV) medication remains paramount: "ARV allows HIV/Aids patients to live and work like normal people. It helps prevent and alleviate symptoms and the patients won't die from HIV/Aids if they take ARV regularly. Today, the virus is still taking lives across the world. But if patients are treated, they can live for as long as the non-infected.

"More importantly, ARV reduces the viral load to the point that patients [on the medication] will not transmit the virus to others," Dr Praphan added, citing a global study on 3,000 HIV/Aids-infected people and their non-infected partners, both homosexual and heterosexual. The infected were given ARV and all 3,000 couples were monitored for three years. Not a single person got infected, even though they engaged in sexual intercourse on almost 100,000 occasions without using condoms. This means that taking ARV can completely prevent HIV transmission.

The global target in the fight against HIV is that by 2020, the number of new infections be reduced by 90% compared to 2010. By 2030, that figure should be 95%. To achieve such a goal, it's crucial to strictly follow the "test and treat plus PrEP" protocol.

"HIV screening is one of the key things," said Dr Praphan. "Because ideally, people should get ARV before symptoms develop, before immunity gets very low. I want for people to get screened for HIV like they do their annual blood sugar.

"Also to end Aids, policy and political commitment is required. We have the know-how but the execution needs support through policy and budgeting. Investing now will be worth it because the sooner we can end it, the better for the whole country."


Back to top