By Rifat Rahman
Special to The Nation
Today marks World Aids Day, an occasion to remember the 35 million who have lost their lives to the disease. It is also a time for optimism among the more than 36 million people currently living with HIV, as governments, business and civil society continue making progress together towards an Aids-free generation.
The theme of this year’s World Aids Day is “Leadership. Commitment. Impact.” Thailand has long been a global leader in the fight against HIV.
First to end mother-child transmission
This year, the World Health Organisation declared that Thailand was the first country in Asia to eliminate mother-to-child transmission of HIV.
“The success against mother-to-child transmission is both humbling and encouraging, but we cannot stop there,” said Sunee Talawat, director of the Raks Thai Local Capacity Initiative, which combats the spread of HIV with funding from the US Agency for International Development (USAID).
“Thailand must continue to set an example for countries in the region on the importance of applying evidence-based strategies, grounded in human rights, to halt the epidemic.”
Despite recent progress, there is a real risk that communities may be left behind. Key populations – including men who have sex with men, transgender people, sex workers, and people who inject drugs – face disproportionately high risks of contracting HIV. Yet these same groups face barriers to accessing HIV-related services that range from stigma and discrimination to concerns over confidentiality.
“No one would love me [if I was HIV-positive],” is a typical explanation given by those who fear getting tested.
Community leadership is fundamental to ending the Aids epidemic in Thailand. Experience has shown that it has been crucial for reaching these vulnerable people and ensuring their access to the health and other services they need. Among them, testing is critically important as it allows people to learn their HIV status, linking them to immediate treatment which is essential for long-term health impacts, and helping prevent further transmission.
‘For the community, by the community’
In Thailand, USAID and the Thai Red Cross Aids Research Centre have joined hands to pilot community-led HIV services (CLHS).
Under the CLHS model, community health workers, often members of key populations, perform HIV testing, provide counselling, and connect clients to appropriate prevention and treatment services. “For the community, by the community,” is how Noppanai Rittiwong, a community health worker at the Rainbow Sky Association of Thailand (RSAT) in Songkhla province, describes it.
This community-led approach is already showing promise.
In the words of Thitiyanun Nakpor, director of the SISTERS Foundation, CLHS is like a “second home”.
“We understand their problems and their hearts,” explains Supian Jealomeasea, a counsellor at RSAT in Hat Yai.
“We are well placed to see what their next options are. Some people are afraid. Some have families who reject them.”
CLHS combines health service delivery with peer psychosocial support, creating an environment that promotes safe-sex practices and the recognition of human rights norms and gender diversity.
It is already becoming clear that CLHS clients keep coming back for services, which is very important for the continuation of health seeking behaviours. Many point to the warmth of the staff.
“It was as if we had known each other for a long time in the past and had just met again,” comments a client at RSAT Ramkhamhaeng.
“This helped to relieve my anxiety. I began to feel that this disease is not as scary as I once thought.”
By offering regular, accessible HIV services at the community level, “CLHS can reach the highest risk groups for HIV, most of whom are unlikely to visit government outlets,” says Dr Nittaya Phanuphak, who heads the Prevention Department at the Thai Red Cross Aids Research Centre.
“In the hospital, most of our patients are already very sick with HIV and have complications,” says Kannikar Tridet, a nurse at Nakhon Ping Hospital. “When they [CLHS] find an HIV-positive case, they immediately refer the case for treatment at the hospital. This means that the hospital is seeing more HIV-positive people who are still in good health. This helps to significantly reduce the cost of hospital-based care and treatment.”
Despite the successes of CLHS, many key population communities in Thailand still do not have access to essential HIV services.
“The heart of CLHS is an attempt to augment the national program by reaching the unreached people and bridging gaps between the target populations and the government services, especially the marginalised communities who are most vulnerable,” says Dr Taweesap Siraprapasiri, director of National Aids Management Centre.
“The challenge is how to better and adequately reach and recruit them into the formal health service system. If these groups are empowered to serve their own members, this would be the best outcome for all. This requires a collaboration and trust between the government and community organisations and is a promising strategy for ending Aids in Thailand.”
Ending Aids is possible, but it will not happen without stronger and sustained collaboration between government and civil society.
Community-led HIV services are winning the battle. Now the model needs support through stronger partnerships between community organisations and professional associations, government health service providers, and policymakers. There is an urgent need for policy that accredits community organisations to safely practice CLHS while assuring the highest quality standards in service delivery, as well as to institutionalise domestic funding channels to sustain the work of community organisations in the national fight against HIV.