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HIV and AIDS in Thailand

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HIV and AIDS in Thailand HIV and AIDS in Thailand KEY POINTS Thailand has one of the highest HIV prevalences in Asia and the Pacific, accounting for 9% of the region’s total population of people living with HIV. Although the epidemic is in decline, prevalence remains high among key affected groups, with young people from key populations particularly at risk. Thailand is the first country to effectively eliminate mother-to-child transmissions, with a transmission rate of less than 2%. In 2018, Thailand began to scale up PrEP in order to make it nationally available to people at high risk of HIV, making it a leader in the region. Thailand hopes to be one of the first countries to end AIDS by 2030. However to achieve this, significantly more young people and key affected populations need to be reached. Explore this page to read more about populations most affected by HIV, HIV testing and counselling programmes, HIV prevention programmes, antiretroviral treatment availability, civil society’s role, HIV and tuberculosis (TB), barriers to prevention, funding for HIV and the way forward for Thailand. Of Thailand’s population of nearly 70 million, an estimated 470,000 people were living with HIV and 14,000 people died of AIDS-related illnesses in 2019.1 After East and Southern Africa, Asia and the Pacific is the region with the largest number of people living with HIV, with Thailand home to a large proportion of the region’s HIV positive people.2 Although official testing, treatment and viral suppression target data for UNAIDS’ 90-90-90 targets is incomplete, current estimates suggest around 80% of all people living with HIV in Thailand were on treatment as of 2019. Of those on treatment, >95% are virally suppressed. 3 Thailand’s HIV epidemic is concentrated among certain key populations. Those most affected are men who have sex with men (sometimes referred to as MSM), who account for around 40% of new infections each year, sex workers and their clients, around 10% of new infections, transgender people and people who inject drugs (sometimes referred to as PWID), around 10% of new infections each. Migrants and prisoners are also more vulnerable to HIV than others in the country.4 5 Young people from key populations are particularly at risk of acquiring HIV. In 2018, around half of new HIV infections in Thailand occurred among people aged 15-24.6 HIV prevalence is declining in Thailand due to successful HIV prevention programmes. A study has shown that nearly 10 million people avoided HIV transmission because of early intervention programmes with key affected populations between 1990 and 2010.7 Between 2010 and 2018, AIDS- related deaths declined by a third (32%) and new infections fell by 59%.8 In 2019, 5,400 people in Thailand became HIV positive.9 Unprotected sex is estimated to account for 90% of all new HIV infections. Unsafe injecting drug use is the second biggest transmission route.10 Although increased access to prevention services has resulted in new infections decreasing overall, they are rising among certain groups. For example, while the rate of new infections through injecting drug use steadily decreased between 1995 and 2015, the rate of new infections through male-to-male sex dramatically increased over the same period.11 Key affected populations in Thailand Men who have sex with men (MSM) In Thailand between 12% and 15% of men who have sex with men were estimated to be living with HIV in 2018, although prevalence varies greatly depending on location.1213For example, in 2015 around 29% of men who have sex with men in Bangkok were thought to be living with HIV.14 Around 40% of new HIV infections among adults in the country each year occur among men who have sex with men, with young men from this population group particularly vulnerable to infection.15 Condom use among men who have sex with men is high, with around 80% reporting consistent condom use in 2018, a rate that has remained steady for the past five years.16 However although the availability of prevention services has improved, new infections have not declined as much as intended.17 A 2015 study estimated that there were 185,000 men who have sex with men living in metropolitan Bangkok, 60,000 of whom were at high risk of HIV infection. It found that, while there are enough clinics and health personnel in Bangkok to support testing and treatment for all men who have sex with men at risk of HIV, there was limited take up of these services. Of those 60,000 considered high- risk, only 14,000 tested for HIV in the course of a year, of whom 4,000 were diagnosed as HIV- positive. Yet fewer than 1,000 of these men started taking antiretroviral treatment despite it being available for free.18 Prevention programmes haven’t reached enough young men who have sex with men, meaning they are less likely to know where to get an HIV a test, or understand their risk.19 This, alongside a perception of low risk and multi-partner sex alongside use of performance enhancing drugs, can result in low condom use.20 A 2013 study of men who have sex with men in Bangkok found HIV incidence to be much higher in younger men (8.8 per 100 person-years among those aged 18 to 21, compared to 3.7 per 100 person- years among men over 30).21 Sex workers In Thailand, HIV prevalence is higher among male sex workers than female. In 2018, of the estimated 145,000 sex workers in the country, HIV prevalence was approximately 4% among male sex workers and 1.7% among female sex workers.22 23However, urban settings have shown to yield exceptionally high HIV prevalences among female sex workers, as high as 20% in Bangkok, for example.24 Data from 2013 suggests female sex workers account for 10% of all new HIV infections in Thailand.25. This may be the result of a lack of information about HIV or a lack of access to services. For example, a 2015 UNICEF study of young key populations in Thailand found only 31% of young female sex workers in Bangkok and 50% in Chiang Mai had received any HIV-related information or services in the past 12 months, compared to 80% of the other key populations surveyed.26 Globally, transgender people are the most at-risk group of sex workers, with HIV prevalence estimated to be on average nine times higher than for female sex workers and three times higher than for male sex workers.27 Transgender people There are an estimated 62,800 transgender people living in Thailand.28 HIV prevalence among this group was estimated at 11% in 2018, making transgender people a particularly at-risk population.29A 2015 UNICEF study found 39% of young transgender people had sold sex, making them particularly vulnerable to HIV.30 Data reported by UNAIDS in 2019 suggests around three quarters (77%) of transgender women in Thailand use condoms regularly and around half have access to HIV prevention programmes. Around 40% of HIV positive transgender women are estimated to be aware of their status.31 Discriminatory heath systems, transphobia, family rejection and a lack of access to education and employment all discourage transgender people from seeking HIV services, leaving them behind in prevention and treatment work.32 A study conducted in 2015 and 2016 found younger transgender women were also more likely to be HIV positive than older transgender women. Having an STI, having a low education level and using amphetamine-type stimulants were found to be more common among HIV positive transgender women, suggesting these factors further heighten transgender women’s risk of acquiring HIV.33 People who inject drugs (PWID) Within the first few years of Thailand’s epidemic, HIV prevalence among people who inject drugs (sometimes referred to as PWID) rose from 0 to 40%. By 2011, prevalence had halved to 22%.34 Prevalence has remained at a similar level since then, standing at 20.5% in 2014, the most recent data available.35 Although the need for harm reduction is increasingly accepted in Thailand, a largely punitive policy and legal environment focused on drug control continues to undermine access to essential health services. There is intense social stigmatisation of people who inject drugs, and the country still operates compulsory detention centres for people who use drugs, both of which deter many from seeking healthcare, including harm reduction services.36 There are some signs of progress in this area as Thailand has begun to revise its drug laws, suggesting the government may be moving towards a more health-based approach to drug use. In 2017, the government reduced the penalties for drug possession, trafficking and production, and abolished the death penalty for selling drugs. This goes against an overall shift in the region towards more hostile approaches to drug use, as countries such as the Philippines and Indonesia implement more punitive policies.37 In 2014, the last data available, it was estimated that around half of people who inject drugs used condoms.38 However, Thailand’s National AIDS Committee (NAC) reported an increase in the proportion of people testing for HIV, from 40% in 2009 to 61% in 2016, but warns that its data is limited as it is based on research from a small number of areas.39 Migrants Migration can put people in situations that heighten their vulnerability to HIV, due to factors such as social exclusion and a lack of access to healthcare services or social protection. In South-East Asia, HIV prevalence among migrants to Thailand from neighbouring countries is up to four times higher than among the general population.40 The highest prevalence among migrants in Thailand was found in the fishing industry, with rates of 2% among fishermen and 2.3% among fishery workers, compared to HIV prevalence of 1.1% and 0.74% among factory workers and farm workers respectively.41 In a behavioural survey conducted in 24 provinces among migrant workers aged 15-49, 21.6% of male workers had sex with more than one partner in the previous year compared with 4.6% of female workers.
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