Introduction

Over the past decade, The HIV/AIDS epidemic in Thailand has grown from a handful of infections to a major public health problem with tremendous medical, psychosocial and economic consequences for the country. The infection initially spread among homosexual men and injecting drug users before it gained a foothold among commercial sex workers. It then swiftly spread from commercial sex workers to their clients and subsequently to the clients’ spouses or partners and finally their children.

While intervention efforts may have slowed the spread of HIV in Thailand, this cannot alter the fact that a large number of people who have the virus do not have any symptoms for a long period of time and are therefore not aware of their infection status. Hence, a large reservoir of the virus remains in the community and the epidemic spread of HIV continues. It has been estimated that approximately 755,000 Thais (1.2 per cent of population) are infected with HIV nationwide. In some parts of the country, the infection rates are much higher. Since heterosexual transmission is the most frequent mode of transmission in Thailand, Thai women are obviously at risk for contracting this disease. Once the women are infected and become pregnant, they can transmit the virus to their unborn children.

A survey in 1998 by the Thai Ministry of Public Health found that approximately 1.5 per cent of pregnant women attending at antenatal care clinics were HIV-infected. Based on this finding, it is predicted that 15,000-20,000 HIV-infected women will give birth every year. Since the transmission rate of HIV from pregnant Thai women to their infants is between 19 to 25 per cent, about 3,000-5,000 HIV-infected Thai children would be born annually if no interventions were implemented.

HIV-infected children frequently experience many medical and psycho-developmental complications as the result of the infection. These lead in many cases to impaired development, multiple and prolonged hospitalizations and early death. The devastating impact is not limited only to the infected child. The family or the guardian will be greatly affected, both psychologically and socio-economically, by the child’s illness. The impact will eventually extend to the community in many ways. The community will be affected by the direct and indirect cost of the child’s medical care. Household members will not be able to participate in the workforce at the same level, as they are obliged to take care of the sick child. The problems of discrimination and the curtailment of educational opportunities will ultimately arise. Therefore, any interventions that can reduce the number of HIV-infected Thai children are certainly worthwhile and will benefit the society.

In 1994, the landmark Paediatric AIDS Clinical Trials Group (ACTG) 076 study in the United States and France demonstrated that zidovudine, a medication against HIV, can reduce the risk for mother-to-child transmission of HIV by almost 70 per cent. This intervention was quickly adopted as the standard of care in most developed countries and it has contributed to the significant reduction of paediatric HIV/AIDS cases in those countries. However, because of its high cost and complexity, it is impossible to implement this strategy in most of the developing world.

BRIEF DESCRIPTION OF THAI RED CROSS ZIDOVUDINE DONATION PROGRAMME

The Thai Red Cross zidovudine donation programme was contrived by the Thai Red Cross AIDS Research Centre of the Thai Red Cross Society. In brief, the programme procures zidovudine for HIV-infected pregnant women by means of public donation. The donation can be in the form of either the medication or financial support. By using the donated funds, the Thai Red Cross can purchase zidovudine in a large quantity at low cost. The medication is distributed throughout the country upon the request of pregnant women’s health care providers.

After a pregnant woman has been provided with voluntary counselling and testing, and has been tested positive for HIV, her health care provider can request zidovudine for her from the Thai Red Cross. Once the request is approved, the medication will be delivered to the health care provider periodically. The zidovudine supply will be sufficient for a pregnant woman and her infant according to the prophylactic regimen, which should be started any time between 14 and 34 weeks’ gestation and should be continued until delivery. The infant will receive zidovudine during the first 6 weeks of life.

The health care provider taking care of the infant is asked to submit infant’s dried blood spots on the provided filter paper to the Thai Red Cross. These blood samples are to determine whether the infant acquires HIV from the mother. The test result is made available to the health care provider, who will inform the parents of their child’s infection status. The medication, the medication shipment and the blood testings are all provided at no cost to the family or the health care provider.

OBJECTIVES OF THE PROGRAMME

The objective of this programme is to procure zidovudine with public donations and to provide it at no cost to HIV-infected pregnant women throughout Thailand who cannot afford this medication. The programme’s major goal is to reduce the number of Thai children being infected with HIV from their mothers. This objective genuinely follows the basic principle of the Red Cross as being a charitable, non-profit, humanitarian organization.