|Children and AIDS in Thailand: one country's response (UNAIDS, 1996, 17 p.)|
Current situation and trends In less than a decade, the HIV/AIDS epidemic in Thailand has grown from a handful of infections to become a major national problem with wide ranging medical, social and economic consequences for the country. In the beginning, HIV gained a foothold in the drug injecting community and among commercial sex workers, but spread with frightening speed to the population at large. Currently, twice as many men as women are HIV-positive, but this imbalance is projected to level out as transmission occurs from clients of commercial sex workers, who may not be aware of their seropositivity, to their wives or girlfriends and children.
Thai HIV prevention efforts have made substantial progress in reducing new infections each year, with the result that the number of new infection has dropped almost four-fold since 1990. To date, more than 800,000 Thai people have been infected. With this large scale of the epidemic among the general population, it is inevitable that HIV/AIDS will have a serious impact on many children both directly and indirectly. Some of them have been infected with HIV and died of AIDS, while many others have witnessed the illness and death of their parents and relatives and face discrimination and stigmatisation as a result.
A national assessment of the HIV/AIDS impact on children was carried out in 1995-96 with the support of Save the Children Fund (U.K.). This assessment was initiated by the national government in collaboration with major non-governmental agencies which had become concerned that children, who represented the country's future, were increasingly at risk of HIV/AIDS. It was found that as a consequence of HIV transmission from husband to wife, the rate of HIV infection among women attending antenetal clinics has climbed steadily from 0.2% in 1990 to 2% in 1994 on the national level, with some regions showing seropositivity rates of up to 10%.
A national assessment of the HIV/AIDS impact on children was carried out in 1995-96 with the support of Save the Children Fund (U.K.). This assessment was initiated by the national government in collaboration with major non-governmental agencies which had become concerned that children, who represented the country's future, were increasingly at risk of HIV/AIDS. It was found that as a consequence of HIV transmission from husband to wife, the rate of HIV infection among women attending antenetal clinics has climbed steadily from 0.2% in 1990 to 2% in 1994 on the national level, with some regions showing seropositivity rates of up to 10%. Currently, the HIV infection rate is highest at the 25-29 age group for men and women aged 20-24, the group most likely to be starting families. In addition, men who have become infected since marriage will transmit HIV to their spouses since condom use between married partners is uncommon in Thailand. HIV may pass from the infected mother to child before or during birth, although infection after birth through breast-feeding is also possible. A multisite study conducted by the Thai Red Cross Society showed that transmission rates from mother to child ranged from 25 to 42 percent. A national assessment of the HIV/AIDS impact on children was carried out in 1995-96 with the support of Save the Children Fund (U.K.).
More than 5,000 children are born each year with HIV. About half will develop AIDS rapidly and die within two years; the others will not develop full-blown AIDS for years. About 63,000 children under the age of 15 will be infected with HIV and 47,000 will die of AIDS by the year 2000 New annual pediatric AIDS cases will rise from 3,100 in 1993 to 7,000 in 2000.
As parents die, the number of AIDS orphans will increase. Projections indicate that, by the year 2000, more than 100,000 under-15s will have lost their mothers to the disease, about a third of them under the age of five.
1. Preventing parental infections through prevention efforts for women and men
The national AIDS programme has been successful in reducing the risk of infection in adults through interventions such as public education campaigns aimed at changing sexual risk behaviour; condom promotion; and improvement of STD treatment services. The programme has had particular success in reducing infection rates among men. The number of men visiting sex workers has halved over four years, and due to the 100% condom use campaign, condoms are widely used in commercial sex work and STD rates have dropped dramatically.
Single women have not been given a high priority in HIV/AIDS prevention campaigns, because of the presumption that there is little sexual activity in this group. However, in fact this is not always the case: surveys among single female factory workers in Bangkok have found that perhaps 20% have had at least one sexual experience. Although there is evidence that married women are becoming infected from their husbands, HIV prevention strategies among married women have not been systematically implemented on a large scale.
Recent developments have addressed these concerns. A programme initiated by TRC, one of the largest NGOs in Thailand, funded by UNICEF and the Australian government, has reached young women and young men in factories in more than 30 provinces. Moreover, a national communication plan on HIV/AIDS targeted at reducing risk for women has been initiated as a collaborative effort among non-government agencies, private business and the government.
2. Prevention of marital HIV transmission
The vast majority of HIV infections among adults and children are potentially preventable if couple know the HIV status of each other and are able to jointly make informed decisions about condom use and having children. Thailand has started a large scale programme, including both services and an information campaign, to promote voluntary premarital HIV counselling and testing and voluntary HIV testing and counselling in integrated reproductive health services.
3. Preventing mother to child transmission
Couples in Thailand living with HIV have a few options for reducing mother-child transmission.
· They may decide to use contraception and not to have any more children. Thailand is now expanding its programmes for voluntary HIV testing, and for contraceptive services and counselling for HIV-positive women and their husbands.
· The government and NGOs have initiated a programme to buy the drug AZT to treat pregnant mothers and their new-borns. Because AZT has been shown to reduce mother-child transmission of HIV, the new programme is designed to address problems with the cost, supply and distribution of the drug as it currently too expensive for many families. In this programme, funds are being raised from the general public and businesses to buy the drug, while the necessary care is provided by participating hospitals.
4. Caring for children with HIV
Many hospitals in Thailand have long experience in providing medical care for pediatric HIV/AIDS and the government has prepared guidelines for the clinical management of children. The country also plans to strengthen the capacity of most hospitals to provide medical care to children and to deal with variations in opportunistic infections. This includes making antiretrovirals and prophylaxis available for opportunistic infections in children. At the local level, there is a strong proposal to improve follow-up and psychosocial support to HIV-infected children and mothers as an integral part of routine antenatal, perinatal and postnatal care. In addition, the government is putting more emphasis on elimating discrimination in medical settings.
5. Reducing the impact on children orphaned by AIDS
Thailand has introduced various small-scale projects to care for and support children orphaned by AIDS within the comunity and family networks. Larger-scale projects are now beginning. It is not the policy to isolate the children in institutions, but rather to help them remain with the extended family. An effort is made to counsel relatives, reduce misunderstandings in the community and provide necessary financial subsidies. In addition, traditional networks such as the temple boys system are being revived to allow the fostering of orphans. Thai teachers have also begun playing a key role by ensuring orphans are not discriminated against or stigmatised at school.
6. Preventing the spread and reducing the impact of HIV among children in difficult circumstances
Government and non-governmental agencies have integrated HIV/AIDS education into their outreach programmes for street children. This began in cities such as Bangkok and Chiang Mai, and is expected to expand to other cities.
The government recognises that HIV/AIDS is a major concern which adds to the seriousness of the problem of commercial sexual exploitation of children. The issue of child prostitution has been a high priority in Thailand in the last four years. The past two governments have taken legal measures to address the problem, and police action against procurers and brothels offering children for sex has been stepped up. In addition, income-generating projects have been targeted at parents of children with few economic opportunities. The Prime Minister has initiated a programme at the provincial level, and established a joint government/NGO monitoring agency. Provinces which meet targets are given national recognition and media coverage. An increasing number of provinces have reported success in stopping child prostitution.
Thailand's strong commitment to addressing the issue of HIV/AIDS in children is illustrated by a high-level meeting in November 1995, chaired by the deputy Minister of Health. Government ministries, non-governmental agencies, businesses and the media discussed the national assessment of problem and furthur action to be taken. International agencies including UNAIDS and its co-sponsors will continue to play a crucial role in supporting these efforts and disseminating lessons learned to other countries.
For more information, please contact Anne Winter UNAIDS,
Geneva, (+41 22)