Migration and HIV/AIDS in Thailand: Triangulation of biological, behavioural and programmatic response data in selected provinces Migration and HIV/AIDS in Thailand: Triangulation of biological, behavioural and programmatic response data in selected provinces 1 Migration and HIV/AIDS in Thailand: Triangulation of biological, behavioural and programmatic response data in selected provinces This report is written by Nigoon Jitthai, Siriporn Yongpanichkul and Mandhana Bijaisoradat. The opinions expressed in the report are those of the authors and do not necessarily reflect the views of the International Organization for Migration (IOM), Ministry of Public Health, Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Canada South East Asia Regional HIV/AIDS Project (CSEARHAP). Publisher: International Organization for Migration, Thailand 18th Floor, Rajanakarn Building 183 South Sathorn Road Sathorn, Bangkok 10120, Thailand Tel: +66-2-343-9300 Fax: +66-2-343-9399 ISBN 978-974-401-983-7 © 2010 International Organization for Migration, Bangkok, Thailand _____________________________________________________________________ All rights reserved. No part of this publication may be reproduced, stored in retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording; or otherwise without the prior written permission of the publisher. IOM is committed to the principle that humane and orderly migration benefits migrants and society. As the leading intergovernmental organisation for migration, IOM acts with its partners in the international community to assist in meeting the growing operational challenges of migration management; advance understanding of migration issues; encourage social and economic development through migration; and uphold the human dignity and well-being of migrants. 2 ACKNOWLEDGEMENT This analysis was made possible due to numerous individuals, IOM and funding from the Joint United Nations Programme on HIV/AIDS (UNAIDS) Thailand Country Office and the Canada South East Asia Regional HIV/ AIDS Project (CSEARHAP). The authors would like to express sincere gratitude to Sushera Bunluesin for coordinatiing with Technical Support Team, Ministry of Public Health (MOPH), UNAIDS, CSEARHAP, and local counterparts which required extensive time and efforts; as well as to Chiaki Ito for his assistance in coordinating with consultants for data verification and with the printing company for art works; and to Bernice Sarpong and Lissa Giurissevich for final English copy-editing. A special thank goes to the Provincial Data Collection Team who provided valuable information and insights including HIV/AIDS and migrant health focal persons at Chiang Rai, Mukdahan, Nong Khai, Phang Nga, Prachuap Kiri Khan, Ranong, Sa Kaeo, Samut Sakhon, Tak, and Trat Provincial Health Offices. Without their generous supports, this study could not have been possible. As important, we would also like to thak several other individuals who provide technical and managemene supports to this study that we could not name all of them here but we especially would like to thank Dr. Petchsri Sirinirund from the National AIDS Management Center (NAMC); Mr. Surasak Thanaisawanyangkoon from Bureau of AIDS, Tuberculosis, and Sexually Transmitted Infections (BATS), Ministry of Public Health; and Ms. Vipa Danthamrongkul and Dr. Penpaktr Utis from Chulalongkorn University. ACKNOWLEDGEMENT Migration and HIV/AIDS in Thailand: Triangulation of biological, behavioural and programmatic response data in selected provinces Migration and HIV/AIDS in Thailand: Triangulation of biological, behavioural and programmatic response data in selected provinces ACRONYMS AIDS Acquired immunodeficiency syndrome ART Antiretroviral therapy ARV Antiretroviral BATS Bureau of AIDS, Tuberculosis, and Sexually Transmitted Infections, Ministry of Public Health BCC Behaviour change communication BSS Behavioural surveillance survey CBO Community-based Organization CMHI Compulsory Migrant Health Insurance CSEARHAP Canada South East Asia Regional HIV/AIDS Project ECAT Enhancing HIV-Related Care and Treatment for HIV-Infected Mothers, their Partners and Children GPP Gross provincial product GFATM Global Funds to Fight AIDS, Tuberculosis and Malaria HIV Human immunodeficiency virus ID Identification IPSR Institute of Population and Social Research IOM International Organization for Migration KAP Knowledge, attitude and practice MOI Ministry of Interior MOL Ministry of Labour and Social Welfare MOPH Ministry of Public Health MOU Memorandum of Understanding MSF Médecins Sans Frontières NAPHA National Access for Antiretroviral Program for People Living with HIV/AIDS NGO Non-governmental organization OI Opportunistic infection OOP Out-of-pocket payment OTDSAR Office of Technical Development to Support HIV/AIDS Response, Department of Disease Control, Ministry of Public Health PATH Program for Appropriate Technology in Health PHAMIT Prevention of HIV/AIDS among Migrant Workers in Thailand PHIM Prenatal HIV intervention monitoring system PHO Provincial Health Office PLHA People living with HIV and AIDS PMTCT Prevention of mother-to-child transmission RTF Raks Thai Foundation STI Sexually transmitted infection TBBC Thai-Burma Border Consortium VCT Voluntary counseling and testing for HIV VMHI Voluntary migrant health insurance WVFT World Vision Foundation of Thailand UNAIDS Joint United Nations Programme on HIV/AIDS UNHCR United Nations High Commissioner for Refugees ACRONYMS TaBLE OF CONTENTS Tables and Figures 1 Exective Summary 6 Chapter I. Introduction 11 1. Background 11 2. Study Sites 11 3. Methodologies 12 4. Definition of Mobile and Migrant Populations in this Study 13 5. Limitations of the Study 13 Chapter II. Overview of Migrant Policy and Data System in Thailand 15 1. The Government Policy on Migrant Worker Registration 15 2. Migrant Health and STIs/HIV/AIDS Surveillance Systems 18 3. Migrant Healthcare Financing Systems 19 4. Limitation of Available Migrant Data Systems 21 Chapter III. Migrants and STIs/HIV/AIDS in the 10 Studied Provinces 23 1. Characteristic of Studied Provinces 23 2. Migrant Profile 25 3. STIs/HIV/AIDS Situation 28 Chapter IV. Data Triangulation and Analysis of Six Studied Provinces 49 1. Samut Sakhon Province 49 2. Trat Province 60 3. Prachuap Khiri Khan Province 71 4. Phang Nga Province 80 5. Ranong Province 90 6. Tak Province 98 Chapter V. Strengthening the Responses to STIs/HIV/AIDS Situation in Migrant 107 Population: Implication from the overview of migrant policy and information systems in Thailand 1. Data Collection, Management and Use 107 2. STIs/HIV/AIDS Situation and Programmatic Responses 112 3. Conclusion 118 References 121 Appendix 127 A1. Summary of Geographic and Economic Characteristics of the 10 Studied Provinces A2. Number of Migrant Workers with Work Permits in Chiang Rai Province, 2004-2007 A3. Number of Registered Migrant Workers in Nong Khai Province, 2004-2006 A4. Number of Registered Migrant Workers in Mukdahan Province, 2003-2007 ONTENTS A5. Number of Registered Migrant Workers in Phang Nga Province, 2002-2006 C A6. Number of Registered Migrant Workers in Prachuap Khiri Khan Province, 2004-2006 A7. Number of Registered Migrant Workers in Ranong Province, 2004-2007 A8. Number of Registered Migrant Workers in Samut Sakhon Province, 2004-2006 A9. Number of Registered Migrant Workers in Tak Province, 2003-2006 A10. Number of Registered Migrant Workers in Trat Province, 2003-2006 BLE OF A11. Summary of Key Data on STIs/HIV in Migrant Populations in the 10 Studied Provinces, Ta 2002-2006 Migration and HIV/AIDS in Thailand: Triangulation of biological, behavioural and programmatic response data in selected provinces 1 Migration and HIV/AIDS in Thailand: Triangulation of biological, behavioural and programmatic response data in selected provinces TaBLES AND FIGURES Table 2.1 Number of Migrant Workers Granted Work Permit According to the Cabinet Resolution, 1996-2006 16 Table 2.2 Category of Migrant Medical Examination 20 Table 3.1 Number of Migrant Population Reported in the 10 Studied Provinces, 2006 26 Table 3.2 HIV Sero-prevalence among Thai and Migrant Populations in Studied Provinces, 2004-2006 28 Table 3.3 Comparison of HIV Prevalence in Thai and Migrant Pregnant Women in Studied Provinces, 2004-2006 29 Table 3.4 HIV/AIDS Programme Implementation Sites and Targeted Migrant Groups in the Studied Provinces, 2007 44 Table 3.5 HIV/AIDS Programme Reach to Migrant Population in Selected Migrant Populated Districts of Four Selected Studies Provinces (Only Phang Nga, Ranong, Tak and Trat), 2006 45 Table 4.1 Distribution of Migrant Workers by Occupation and Country of Origin in Samut Sakhon Province, 2006 50 Table 4.2 HIV Sero-prevalence in Thai and Migrant Populations in Samut Sakhon Province, 2002-2007 51 Table 4.3 STIs in General Thai Population and Sex Workers in Samut Sakhon Province, 2003-2007 54 Table 4.4 HIV/AIDS Programme Implementation for Migrant Population in Samut Sakhon Province, 2006 56 Table 4.5 Distribution of Registered Migrant Workers in Trat Province by Occupation and Country of Origin, 2004-2006 62 Table 4.6 Reported HIV Symptomatic and AIDS Cases in Thai and Migrant Populations in Trat Province by Sex, 2002-2006 64 Table 4.7 HIV/AIDS Programme Reach for Migrant Population in Trat Province, 2006 (Only Muang and Klong Yai Districts) 67 Table 4.8 Distribution of Registered Migrant Workers by District and Country of Origin in Prachuap Khiri Khan Province, 2005 72 Table 4.9 Proportion of Migrant