HIV/AIDS IN THAILANDAND ITS PREVENTION

Presented by

Mr. Md. Matiar Rahman

Ethics group

Course: Bioengineering and Environmental Health

INTRODUCTION

Definition:

HIV - continuum progressive damage to the immune system

and manifestation of severe immunological damage - AIDS

Background information:

Initial identification of AIDS in 1981

AIDS a killer disease in the world

33 million of patients in the world in 1998

40 million of patients likely to be in the world by 2000

16,000 new patients daily

8.2 million children has mother or parents - 1998

13 million children likely to be has no mother or parents by 2000

OVERVIEW OF HIV/AIDS IN THAILAND

Position in the world - 3rd

Starts on September 1984

Total population 62 million

Total HIV patients 1 million up to 1998

Total AIDS patients 142,027 up to April 2000

Total number of AIDS patients died 39,193 up to April 2000

Approximate number of HIV patients 1028,000 by 2000

Approximate number of AIDS patients 562,000 by 2000

‘AIDS IS A REGIONAL EPIDEMIC’ IN THAILAND

AS IN REST OF THE ASIA

Long latency period of the disease

Asian economic crisis - 50% of the young population are infected among the new patients

Geographically more in the northern part of country since 1989

Government, political, community and religious leader overlooked the significance of AIDS

Public health problem increases due to high infection rates

AIDS distribution in Thailand

43665

24201 26164 25691 20416

1890

142027

39193

0

20000

40000

60000

80000

100000

120000

140000

160000

1984

-95

1996

1997

1998

1999

April

,200

0

Tota

l AID

S

Death

Year

AID

S c

as

es

Age and sexwise distribution of patients in the year 1998

55 60

4185

1553

63 91 23

5403

318333 182365

1203

1973

27768

0

1000

2000

3000

4000

5000

6000

0-4 yr 5-9 yr 10-19 yr 20-29 yr 30-39 yr 40-49 yr 50-59 yr Above60yrAge group

Sexwise - male:female = 1:1Age below 20yr 1:1, above 20 yrs 4:1

Nu

mb

er

of

pati

en

ts Male

Female

CAUSATIVE AGENT

HIV virus (Human Immunodefficiency Virus)

Incubation period

Less than 1 year to 20 years

AIDS survival time

Onset of disease to death

MODE OF TRANSMISSION

Heterosexual - 82.6%

Drug users - 5.3%

Mother to child - 5.03%

Blood transfusion - 0.05%

Unknown - 7.02%

COMMERCIAL SEX WORKER

AND THEIR STATUS

Prostitution is illegal but continuing

87% of all women and children in prostitution are HIV positive

Among sexual infected HIV patients 97-98% are from C.S.W.

Young adolescent girls prostitutes are at greater biological risk of

HIV infection

Selection of CSW from village, hilly and border areas, who are not

able to understand the Thai Language

COFACTORS FOR

DISEASE PROGRESSION

Genetic factor Discrimination

Age Sexual inequality

Sex Inadequate health and

Route of HIV infection social services

Other infections Rapid urbanization

Poverty and nutrition Inappropriate development

Smoking Increased labour migration

HIV PREVENTION MEASURES

HIV prevention programme is a multidisciplinary approachcombining behavioural science, social science and biological methodsto fight against the spread of HIV.

Aims of HIV prevention - to benefit people with affected by or atrisk of HIV/AIDS, so that they received better care, greater respectand more integration in the society.

GENERAL MEASURES

Health policy relating to HIV/AIDS

Education- medical education including responsibility and ethical advice for health professional.

Promotion of education to the policy makers about ethical, social policy and human rights of HIV/AIDS

Health education regarding safe sex, HIV prevention and sexual health promotion to the public

GENERAL MEASURES

Health development had to be adopted to economic, political and social change

Health legislation reflects the principles of social, medical ethics and human rights

Broad social policy

GENERAL MEASURES (Continued)

‘Integrated approach for HIV prevention with care’

Integration of all services in the health sector and other sectors as

well as business, tourism, the armed forces, education, religious

organization, development agencies and mass media - to create a

more favourable environment for peoples’ risk reduction strategies

and vulnerability to HIV through measures to bring about social,

cultural and economic change.

GENERAL MEASURES (Continued)

‘Integrated approach for HIV prevention with care’

Active community participation of different organizations and social movements can change the attitudes and practices of the people regarding risky sexual behaviour and injectable drug use.

High level political commitment for prevention of HIV is of value

In Thailand a policy aimed at 100% condom use in brothels was initiated in 1989 by the Ministry of Public Health and lead to a dramatic increase in condom use and causes a sharp decrease in STD including HIV.

PREVENTION OF SEXUAL TRANSMISSION

Promotion of safer sex

100% use of condom of good quality

Encouraging patient to seek care for disease

Changing peoples behaviour related to sex by comprehensive and early sex education and training in prevention skill, safer sex etc.

Providing confidential voluntary counseling and testing of HIV

PREVENTION OF SEXUAL TRANSMISSION

Illegal CSW industry should be stopped and rehabilitation of CSW is needed

Providing incentive to girls to complete secondary education

Provision of comprehensive service delivery and medical care for HIV patients by medical and paramedical professionals and community workers.

Prevention of IDU:

Needle exchange programme have cut HIV

transmission among IV drug users

Prevention of HIV through bloodtransfusion:

Blood screening technology has reducedtransmission of HIV through infected blood by99%.

Prevention of transmission from mother tochild:

Before pregnancy both mother and father should be checked whether they have HIV infection or not.

Use of anti retroviral regimen has cut perinatal transmission of HIV

GLOBAL HIV/AIDS EPIDEMIC REPORT-JUNE 2000

People newly infected with HIV in 1999Total - 5.4 millionsAdult - 4.7 millionsWomen - 2.3 millionsChildren (<15 years) - 620,000

Number of people living with HIV/AIDSTotal - 34.3 millionsAdult - 33.0 millionsWomen - 15.7 millionsChildren (<15 years) - 1.3 millions

GLOBAL HIV/AIDS EPIDEMIC REPORT-JUNE 2000(cont’d)

AIDS death in 1999Total - 2.8 millionsAdult - 2.3 millionsWomen - 1.2 millionsChildren (<15 years) - 500,000

Total number of AIDS death since beginning ofthe epidemicTotal - 18.8 millionsAdult - 15.0 millionsWomen - 7.7 millionsChildren (<15 years) - 3.8 millions

Total AIDS orphans since beginning- 13.2 million

GLOBAL HIV/AIDS EPIDEMIC REPORT-JUNE 2000THAILAND

Adult and Children - 755,000

Adult 15-49 years - 740,000

Women 15-49 years - 305,000

Children (<15 years)- 13,900

AIDS orphans - 75,000

AIDS death - 66,000

CONCLUSION

Prevention is better than cure

The drugs used in the treatment of AIDS has no curative value rather than suppression and not able to prevent the transmission of virus

Preventive methods coupled with unsqueamish public awareness campaigns to make those methods widely known and adopted can turn the tide and check the spread of this insidious disease.