|Connecting Lower HIV Infection Rates with Changes in Sexual Behaviour in Thailand - Data collection and comparison (UNAIDS, 1998, 18 p.)|
The methods and results of individual studies may be disputed. However, taken together, and particularly when data from different sources are compared, the implications of Thailand's exceptional efforts to track the epidemic and the behaviours that lead to it are clear:
· high levels of unprotected sex with sex workers were followed by a boom in HIV infection;
· a national effort to promote safe behaviour was followed by a drop in visits to sex workers and an increase in condom use;
· those changes in behaviour have been rewarded by a decrease in STDs and new HIV infections.
The body of evidence gathered by Thailand's epidemiological and behavioural information systems and widely publicized in the country and abroad has been a vital tool in reducing the further spread of HIV. It has allowed for the design of appropriate programmes to slow the spread of the disease. It has generated political and public support for funding of those programmes. It has created awareness among those whose behaviour put them and their partners at risk. Most importantly, it has enabled Thailand to demonstrate convincingly to its own people and the world that adopting safe behaviours can change the course of the epidemic on both a personal and a national scale.
This case study is a UNAIDS Best Practice because it demonstrates an approach to the collection and use of epidemiological and behavioural data that has been fruitful in making a persuasive case for the connection between decreased HIV infection rates and the adoption of safer behaviour on the part of individuals. It meets four of the Best Practice criteria: effectiveness, ethical soundness, relevance and sustainability.
· Effectiveness: The primary objective of the case study was to demonstrate a definite link between the epidemiological data showing declining HIV infection rates and behavioural data showing widespread adoption of safer behaviour with regard to commercial sex and use of condoms. This study provided strong evidence to demonstrate that link.
· Ethical soundness: All the studies reported here received the ethical approval of the Ministry of Health, the Ministry of Defence (i.e., for military conscripts) and ethical review committees in several universities. The ethical requirements of the WHO guidelines on anonymous unlinked sentinel surveillance of HIV infection were strictly applied in Thailand. In carrying out surveys on sexual behaviour and HIV and STD prevalence, special attention was given to issues of informed consent and confidentiality. Questionnaire forms, laboratory forms and database entries only contained identity numbers and not names.
· Relevance: The comparative epidemiological and behavioural analysis undertaken supports the main goals of UNAIDS: it makes a clear contribution to the prevention, control and reduction of impact of HIV/AIDS. By helping to demonstrate the positive effect of behavioural change on the course of the epidemic, it provides a useful communications tool for future public awareness campaigns everywhere. It also gives support to public health officials hoping to undertake activities similar to the 100% Condom Use campaign and other prevention programmes in their countries.
· Sustainability: The costs of maintaining HIV surveillance and long-term studies on sexual behaviour are reasonable, once the basic mechanisms are in place. Thailand's HIV surveillance system has been in operation for more than 10 years, and two national surveys on sexual behaviour have been done. There is thus a good deal of high quality local expertise in these two areas. So it is feasible, in addition to being desirable, to continue to track the relationship between behaviour and epidemiological trends. There is also a clear commitment on the part of the Thai government to continuing this work: the government, along with numerous international and bilateral agencies, have pledged their ongoing support.