HIV in Thailand

Thailand HIV/STD

HIV is thought to have originated in Kinshasa, Democratic Republic of the Congo, in the early 1920s (Rangsin et al., 2015). The exact number of people infected by the virus is unknown due to a lack of genuine data in various health institutions.The disease spread first in different countries around the globe and led to the loss of millions of lives. In Thailand, the first case of HIV was reported in 1984. The disease spread first among the adults, and in 2008, around 1.2 million adults had been diagnosed with it. Moreover, from the 1.2 million affected grown-ups, half a million had died from the disease since it was first reported in the country in 1984. This represents an average prevalence rate of 1.3 among the adults which makes Thailand the most infected country in Asia (Rangsin et al., 2015).

A report in 2011 from the joint United Nation program on the HIV/ AIDS described Thailand to be among the eleven countries in Asia Pacific region with the highest number of people affected by HIV (Rangsin et al., 2015). The origin of the disease in Thailand can also be traced to the famous sex trade that had flourished in Bangkok during the Vietnam War. During this time, the United States soldiers went to Bangkok for their desire for entertainment. So why is the disease spreading so fast in Thailand? What are the strategies set by the Thailand government that are not working? These are some of the questions often asked by different researchers in trying to evaluate the reason behind the high prevalence rate in the country. In the light of this, the study will illuminate on the problem of HIV/ STD spread in Thailand. This will incorporate the different reasons behind the proliferation of the virus in the country and the various strategies set by the Thai government in trying to find a solution to the menace. Moreover, the research will assess the strategies and try to suggest the adoption of long term plans that can help the government and other organizations in reducing the rate of infection in the country.

After the first case of the deadly disease had been reported in the country, the incidence of infection increased steadily. In 1991, the Thai government adopted a strategy that would help in combating the disease. The approach led to a decline in the total number of persons affected in a year. The HIV prevalence in the country however remained the same at 1.4 percent between 2003 and 2005 (Chandeying, 2016). Most of the people infected by the disease before or during 2003 have been put on medication by the government of the country with each of them receiving antiretroviral therapy (ART).

Thailand not only has two types of the virus, HIV1 and HIV2, but also has other two substrains A and B. Substrain A is the same as the other strains found in countries, such as the United States, while substrain B is mostly found in the African continent. In Thailand, substrain A is found primarily in Bangkok while substrain B is more prevalent in the northern part of the country (Chandeying, 2016). According to the AIDs education and research trust, the prevalence rates in Thailand have been continually increasing with the highest incidence being recorded in 2002 at 1.8 percent. Notably, the first incident in Thailand was reported among the gay men. The virus then spread rapidly among drug users who injected themselves followed by prostitutes.

The prevalence rate among the gay in the country rose from 17 percent to 28 percent between 2003 and 2005. Also, the prevalence rate among the injecting drug users increased from 330 to 50 percent. This indicated an overall increase in the number of new HIV-infected persons making it hard for the government to control or to employ strategies that would help in fighting the virus. In 2005, a high number of the infected persons were women. They represented an average of 40 percent of the total infections in the country with majority of them being infected through intercourse with their long-term lovers.

Factors Promoting the Spread

Among the most highlighted factors that have led to the spread of the disease in the country is the level of income in the country. Most of the Thai population is occupied in low income activities and can hardly support their lives and their families. This leads to the low level of education among the children who then grow up without knowing how to prevent themselves from contracting the disease. Young girls get into prostitution and early marriages that increasingly become a norm in the Thai society. Young men get into drug addiction and other criminal activities that lead to the increase of the disease through sharing the body piercing objects.

Youths between the ages of 15-24 years make a large fragment of the total population in Thailand. Although the Thai government encourages most of its population to adopt the use of condoms to avoid contracting of different sexually transmitted diseases, most of its citizens shun away from the same (Rangsin et al., 2015). The findings of the reports suggest that most of the youth who are not married shun away from using condoms in any sexual relation. Most of these youths prefer having temporary partners, therefore, increasing their chances of contracting HIV.

The risk perception on the use of condom has also affected married couples who avoid the use of the materials as a sign of trust and a taboo in the Thai tradition. Other facilitating factors that have led to non-adoption of the use of condoms among the Thailand citizens include the level of poverty, living in semi-urban areas and lack of access to different mass media for educative programs set by the government. The odds ratio also showed that condom user who had indulged in beer and drinking of liquor were less likely to contract the disease or other STI diseases. It is not clear how the youth relate the risk involved in using condoms and the risk of contracting the sexually transmitted diseases (Chandeying, 2016). The perceived danger of getting the diseases may have various important implications on the health of the youth and they must, therefore, be educated on the importance of using them to safe guard the health of the future generations.

Notably, lack of enough educative program or workshops organized by the government and other non-governmental organizations has led to lack of enough knowledge among the Thai citizens. These workshops have very educative insights that can help the citizens know the various aspect of the disease such as the way of transmission, the different phases of the disease, and how to get treatment in case one contract the disease (Murray et al., 2016). Consequently, the conferences and other educative programs help the infected people to get cure through the anti-retroviral drugs and any medical prescription from the qualified medical personnel such as clinical officers and doctors. Such prescriptions may include proper diet and exercise as well as guiding and counseling sessions. Lack of enough knowledge on the disease has led to the citizen engaging in practices that propel the spread of the disease.

Culture sensitivity has also been identified as one of the key areas that have propelled the spread of various sexually transmitted diseases in Thailand. The cultural component has different aspects that are greatly valued by the Thai people (Anand et al., 2015). Recognizing the cultural norms of the Thai people will enable the government to formulate strategies that would help them to reduce the rate of infection. For example, that high culture values sexual behavior as important aspects that bring compactness in a family as well as the community. In the light of it, the citizens start engaging different sexual activities from a tender age. Consequently, the Thai government has an illegal but tolerated sex industry (Chandeying, 2016). The industry is controlled by different persons in the government, and it serves the different tourists that visit the country as well as other Asian countries that border Thailand. These cultural practices have social dynamics effect to the people including the increase in the spread of HIV/STDs.

Concerns

In the report released by the UNICEF, 70 percent of all the sexually transmitted diseases and HIV infections in Thailand were registered among citizens between the ages of 15 and 24. Further, the report suggested that there has been a gradual drop in the number of people suffering from the disease over the last decade, but the number of new infections has exponentially increased too. The report also suggests that the new cases reported mainly come from young individuals involved in unprotected sex, sex trade, and drug injections.

Notably, health activists in Thailand have also observed that the current challenges faced in HIV prevention are the same as the number of people engaging in high-risk behaviors in the country. Besides, 10 to 15 years ago it was easy to conduct awareness campaigns in Thailand than it is now (Murray et al., 2016). Most of the discussions were carried out in bars and schools to enable sex workers and the youth to know the importance of using condoms and how to protect oneself from contracting the virus. Undoubtedly, women working in bars, brothels, and massage parlors are widely exposed to contracting the virus due to the environment they work in (Anand et al., 2015).

However, the research has noted that non-Thai female sex workers in Thailand in most cases lack access to the free medical attention given to their Thai counterparts, therefore, leaving numerous gaps on fighting the spread of the disease. The number of people living with sexually transmitted infections in Thailand is approximated to be 500,000 over the last decade. Four percent of the total number of deaths recorded annually is as a result of these diseases. Moreover, the number of new infections filed per year has increased to 100,000 in the same period arising from the different sex encounters in the country (Laskar et al., 2015). The reason for researching on the spread of HIV/STD in Thailand is to assess the different gaps that the Thailand government has left in the fighting the diseases. Besides, the spread of HIV in Thailand is always increasing, therefore, reducing the effort applied by different international organizations.

Cultural Factors Affecting the Problem

Sexuality in Thailand is used to describe the interesting co-existence of the Thai people and their culture. The different values and practices among the people were a result of the mixing of various cultures over the centuries (Laskar et al., 2015). In the last decade, these sexual attitudes among the people have undergone numerous changes based on the urbanization, economic growth, and exposure to western culture. The country has laid a fertile growth for sex industry commercials to flourish despite the different criticisms that come from various quotas in the world.

The traditional Thai culture gave room for a polygamous society where a man could have as many wives as he wished. Moreover, a nervous tension exists between the different genders in the country; it is evident that the Thai women and men view each other differently, especially in areas of intimacy; sexuality and trust manliness have become increasingly associated with various practices such as searching for gratification (Anand et al., 2015). Despite the high attention given to the Thai sex industry, the Thai people can be very conservative when it comes to anything associated with sex. Talking openly about sex in the Thai community is regarded as a taboo. The Thai concept of sanuk is portrayed as one of the sex attitudes that have propelled sex among men. Men who use prostitutes after or before marriage are always tolerated since it is regarded as an act of purification (Liamputtong et al., 2015).

The recent studies show that 80 percent of the males in Thailand and 72 percent of females are said to engage in oral sex while 87 percent of the men and 14 percent of the of the females are said to be the ones initiating the act of sex. Moreover, 45 percent of men and 43 percent of the female stated that they have more than one sexual partner (Ford et al., 2014). These statistics represent a culture that has developed among the Thai community. Thai people advocate for the use of any sexual behavior for the fulfillment of their entertainment desires. These practices have led to the increase in the rate of HIV/STD infections in the country making it hard for the country's government to fight the disease.

Solutions

Different organizations around the globe have in many years strategized on the best method to reduce the effect of the disease on the Thai people. Most of these organizations are international non-governmental organizations with skilled personnel who can offer services like teaching the citizens on different aspect of the disease and how it can be controlled (Holtz et al., 2015). Besides, most of them conduct guidance and counseling services as well as free testing of the HIV virus (Chandeying, 2016). Finding the solutions to the spread of the sexually transmitted diseases rest on the change of the behavior and empowering of the different classes of people in the society.

The different behaviors in the Thai community including homosexuality and prostitution should be reduced to reduce the number of the newly reported infections in the country (Anand et al., 2015). Additionally, some cultural practices that promote the spread of the disease such as allowing polygamy among men should be changed. The act of polygamy makes it possible for the disease to spread among couples and eventually to the newborn babies (Laskar et al., 2015). Moreover, the community inn general should be empowered to ensure that young children are taught the importance of education as well as the significance maintaining good morals inn the society.

The government of Thailand in recent years has formulated different strategies that would help in the fight of the spread of HIV and other sexually transmitted diseases. The disease is ranked among the diseases causing the highest number of deaths in Thailand (Ishikawa et al., 2016). This has deprived the government a large number of skilled and productive citizens, therefore, leading to the decline of the rate of productivity. Some of the strategies adopted by the Thailand government include policy evaluation, political and health reforms, and social reconstruction.

Policy evaluation involves the setting of different policies as well as regulations that are aimed at making sure that the spread and treatment of the disease are under control. Thailand's strategy on prevention and cure of HIV has been evolving through some years. The evaluation process can be categorized into three main stages. These include the confrontation of the epidemic, creating different unified alliances, and elevation of the consequences of the epidemic.

Confrontation of the Epidemic

When the first case of the disease was reported in Thailand, the Thai government followed a unique and standardized health approach which put more emphasis on reporting of the STD and HIV cases through the set medical system (Ford et al., 2014). This was to ensure that the government keeps the record of the new cases and the areas that are mostly affected by the disease. However, the set process failed to work as the medical system failed to detect the rapid spread of the disease. Liamputtong et al. (2015) noted that the government received little information and the risky behavior that led to the rapid spread of the disease. During this time, the public believed that the sexually transmitted diseases could only affect homosexuals, drug users, and male sex workers, therefore, most of the government efforts were directed to the specific groups (Holtz et al., 2015).

Also, most of the AIDS-related activities during this stage were funded bilateral and international donors including the Royal Thai Government (RTG). The organization begun to fund the program and later developed a policy of addressing HIV and other sexually transmitted infections (Chandeying, 2016). The medium-term program for the control and prevention of the epidemic included measures such as health education, concealing surveillance and training monitoring medical and social care as well as blood safety control.

This strategy helped the Thai government to focus on individual risks and taking the responsibility of providing the relevant information to the public, raising awareness on any measures to be considered and in other instances, delivering of fear inducing messages. Later in 1990, the world health organization (WHO) initiated the national study on behavioral risks among individuals in Thailand, and the study was managed by the Thai Red Cross Society and the Chlalongkorn University (Murray et al., 2016). The initiative has a significant impact on the control of the disease as it had helped to transform the perception of the public about the diseases as well as raising awareness of the methods of transmitting the viruses (Anand et al., 2015). The findings by these organizations helped other non-governmental organizations to increase their intensity of their prevention and treatment activities and advocating for human rights plus creating of lobbying groups for effective HIV policy.

Creation of Multi-sectoral Public Action and Alliances

Different government officials come forward to help in the management of the epidemic in Thailand in the 1990s. For example, the Prime Minister of the country in 1990 Mr. Anand Panyarachun made it clear that he would coordinate any activities that were aimed at reducing the effect of the virus to the Thai people (Laskar et al., 2015). This would include chairing the National AIDS Prevention Committee which was an essential part in the fight against the diseases. Under his leadership, extensive public educative programs were initiated and were mainly carried out through the mass media such the television and local radio stations. Most of these messages emphasized on prevention of the diseases through behavioral change and adoption of new culture.

Some of the behavioral strategies emphasized on included increased use of condoms and the understanding that the disease is not only considered as a health problem but the major social problem in the country (Ford et al., 2014). The different ministries in the country were required to provide educative programs across their areas of operation. The ministry of education in Thailand, for example, was required to launch programs among the students that would increase their awareness on the epidemic (Chandeying, 2016). Specifically, the ministry organized different competitions to the students including essay writing competitions to evaluate their knowledge on HIV/ STDs. It is through these programs that the government of Thailand finally managed to increase the awareness of the public across the country.

The timely education, information, and communicative interventions required the ability of the government to keep pace with the behavioral and rapid transformation that was taking place in the country. To make the implementation process a success, different financial resources had to be employed by both the Thai government and the non-governmental organizations. These resources would be used in ensuring that the relevant and qualified personnel are employed, the educative programs reach the required audience, and different materials needed to make the programs a success are bought.

Financial Strategy

The adaptation of the different strategies by the various organizations in the country required a comprehensive action plan that was initiated by the national economic and social development board (NESDB). To ensure that the various cooperation's in the ministries, NGOs and the private sector worked effectively additional support was required from the other international organizations and foreign governments. Sources of finance in the different programs included the Royal Thai government and international organizations, such as Red Cross and World Health Organization (Anand et al., 2015). Since the beginning of the problem in Thailand, budget allocations have remained steady with the AIDS division being allocated over 87.5 million Baht per year. The World Bank, on the other hand, allocated 2.6 million dollars to the government of Thailand to help them finance some of the HIV/STD oriented projects.

Evaluation

Different plans and strategies that had been set by the government and various organizations were a turning point to fighting of the epidemic. The long term of the deadly pandemic lies in adaptation of different culture and the empowerment of the younger generation in Thailand. The Thailand government developed different plans that were aimed at increasing the level of employment among the youth (Murray et al., 2016). These strategies include the funding of various youth groups who have business proposal to enable them to generate income. Girl child education has also been emphasized by different non-governmental organizations as well as the government of the country. By improving the level of education among girls, the Thai government aims at reducing the level of school dropout and to reduce the number of girls recruited into sex business.

Another long term strategy that can lead to the eradication of the disease in Thailand is ensuring political and health reform. Under the Thailand 1997 constitution, health was regarded as a human right rather than a basic necessity that is to be provided by the government to its people. The National Health Insurance Act that was formulated in 2002 proposed the adaptation of the policy of universal healthcare coverage (Logie et al., 2016). This led to the equal entitlement of the elderly, disabled, abandoned children, and people living with the HIV/ STDs to free access to different health care programs that were being offered by the government. Additionally, to prevent the spread of the disease, the development of the socio-economic environment was proposed to enable it to cope up with the increasing number of drug users. The government adopted a program that would reduce the number of newborn babies being infected by their mothers. This strategy has led to the raising of an aware and HIV-free generation in Thailand.

Future Actions

Since 1998, the use of the antiretroviral drugs and other mechanism has been on the increase in Thailand. The prevention of mother to child transmission has also become effective, therefore, putting more pressure on policymakers to elevate the support they have for these programs (Ishikawa et al., 2016). In future, therefore, the government of Thailand will have to increase the number of finances allocated to these programs. This will, in turn, mean that the number of qualified personnel that will be employed by the government will increase.

With the potential support that is expected to be received from the global fund, the Thai government plans to extend the services of providing antiretroviral drugs to cover all the people that are affected by the HIV or other sexually transmitted diseases. Additionally, the government also plans to repackage and manufacture the antiretroviral drugs and other essential diagnostic tools locally. This strategy will ensure increased capability of the government to produce more of these drugs to take care of the infected population (Anand et al., 2015). Also, the number of NGO in Thailand have also been increasing over the years with their primary objective being boosting the community and family care so as to ensure continuous care is sustained.

In summation, the fighting off the HIV/STDs in Thailand has been a process that has incorporated the employment of numerous resources by the government of the country and other, non-governmental organizations and international bodies. The major contributor to the improvement made by Thailand is the positive feedback received from the general public as well as the willingness of more people to change their behavior. Also, the knowledge of the risk of some cultural practices has made people change various aspects of their lives. The experience has also led to the exposure of the different roles played by different sectors of the society.

References

Anand, T., Nitpolprasert, C., Ananworanich, J., Pakam, C., Nonenoy, S., Jantarapakde, J., & Phanuphak, N. (2015). Innovative strategies using communications technologies to engage gay men and other men who have sex with men into early HIV testing and treatment in Thailand. Journal of Virus Eradication, 1(2), 111.

Chandeying, V. (2016). Past, present of the HIV prevention in Thailand. สงขลา นครินทร์ เวช สาร (Songklanagarind Medical Journal), 34(5), 223-225.

Ford, K., Chamratrithirong, A., Apipornchaisakul, K., Panichapak, P., & Pinyosinwat, T. (2014). Social integration, AIDS knowledge and factors related to HIV prevention among migrant workers in Thailand. AIDS and behavior, 18(2), 390-397.

Holtz, T. H., Pattanasin, S., Chonwattana, W., Tongtoyai, J., Chaikummao, S., Varangrat, A., & Mock, P. A. (2015). Longitudinal analysis of key HIV-risk behavior patterns and predictors in men who have sex with men, Bangkok, Thailand. Archives of Sexual Behavior, 44(2), 341-348.

Ishikawa, N., Newman, L., Taylor, M., Essajee, S., Pendsee, R., & Ghidinellif, M. (2016). Elimination of mother-to-child transmission of HIV and syphilis in Cuba and Thailand. Bulletin of the World Health Organization, 94(11), 787.

Laskar, M. S., Gazi, E. A., Basu, B. K., Farhana, A., & Shakil, M. (2015). AIDS awareness and associated factors among men in Bangladesh: Evidence from Bangladesh Demographic and Health Survey 2007. Mediscope, 1(1), 1-13.

Liamputtong, P., Haritavorn, N., & Kiatying-Angsulee, N. (2015). Participating in HIV clinical trials: reasons and experiences among women living with HIV in Thailand. Journal of HIV/AIDS & Social Services, 14(2), 239-256.

Logie, C. H., Newman, P. A., Weaver, J., Roungkraphon, S., & Tepjan, S. (2016). HIV-related stigma and HIV prevention uptake among young men who have sex with men and transgender women in Thailand. AIDS patient care and STDs, 30(2), 92-100.

Murray, J. K., DiStefano, A. S., Yang, J. S., & Wood, M. M. (2016). Displacement and HIV: Factors Influencing Antiretroviral Therapy Use by Ethnic Shan Migrants in Northern Thailand. Journal of the Association of Nurses in AIDS Care, 27(5), 709-721.

Rangsin, R., Kana, K., Chuenchitra, T., Sunantarod, A., Mungthin, M., Meesiri, S., & Nelson, K. E. (2015). Risk factors for HIV infection among young Thai men during 2005-2009. Plos One, 10(8), e0136555.