Free, anonymous HIV testing 'will save thousands of needless deaths'

There is an HIV epidemic among men who have sex with men (MSM) in Bangkok, according to a new study “Scaling up HIV Treatment for MSM in Bangkok: What Does it Take?”

“Advancing efforts to end the global Aids epidemic by 2030 requires a combination approach to HIV prevention that includes biomedical, behaviour change and structural approaches,” said David Wilson, director of the World Bank’s Global HIV/Aids Programme. “With its quality medical infrastructure, Bangkok now has the opportunity to prevent more than 5,000 needless deaths, to halve new infections by 2022, and to serve as a model for other cities.”

HIV intervention programmes in Thailand have effectively targeted female sex workers and their clients. However, the national response to HIV among MSM has been largely limited. As a consequence, the share of HIV-positive men in the MSM community has remained high and has been increasing. In metropolitan Bangkok, it is estimated to have increased from 21 per cent in 2000 to 28 per cent in 2012 among the 120,000 - 250,000 MSM in the city.

The new study recommends affordable public health strategies to halve HIV-related deaths and the rate of new infections by 2022. The study – produced by the World Bank in close cooperation with the Thai Red Cross, Ministry of Public Health, the Bangkok Metropolitan Administration (BMA) and UNAIDS – urges greater use of the free and anonymous testing and treatment services currently available at public health clinics. 

”HIV/Aids testing and treatment can save lives, maintaining people’s health and preventing new infections,” said Ulrich Zachau, World Bank country director for Southeast Asia. “With testing and treatment available for free at many public and community-based clinics, Thailand can slow, even stop, Bangkok’s HIV epidemic, among men who have sex with men and other groups. The time to act is now.”

The report finds that while there is limited use of HIV testing services among MSM in Bangkok, there are enough clinics and health personnel available to support testing and treatment for all MSM who need it. Only one-fifth of treatment-eligible MSM are receiving anti-retroviral treatment (ART) medicines, despite their availability free of charge.

It suggests that by utilising this spare capacity at existing facilities, about 43,000 more MSM could be tested for HIV and 5,100 could then receive ART services by 2022. 

This would increase the percentage of MSM in Bangkok receiving ART from 20 per cent to 44 per cent by 2022, without increasing the current level of investment in HIV services. With additional investment of $55.3 million over the next decade, Bangkok could achieve universal treatment coverage within the same period by reaching additional 12,600 MSM with ART services.

The report cites examples of initiatives that have been used to successfully increase testing at public facilities, including creating a patient-friendly environment to encourage testing and follow-up; BMA’s Gay BKK website promoting safe sex and HIV testing among MSM and its weekly night mobile clinics at Bangkok venues frequented by MSM; and convenient drop-in testing centres in major MSM hotspots in Bangkok.

The study was authored by researchers from the Kirby Institute of the University of New South Wales, the Thai Red Cross and the World Bank.