Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Bangkok Post - January 26, 1999
Aphaluck Bhatiasevi; Chiang Mai
"Had the medicine been available during the days of my pregnancy, my daughter would probably not have contracted Aids ... and she would not have died so early," said Mrs Lamai.
Mrs Lamai, whose nickname is Eid, lost her six-year-old daughter to the killer disease about two years ago.
Anti-retroviral drugs like Zidovudine (ZDV) or AZT were available in the country in 1990, when Mrs Lamai was pregnant. But circumstances did not permit her and many other HIV-positive pregnant women to have access to ZDV at that time. This was due to the drug's price, lack of information on its use and uncertain policies over the matter.
Mrs Lamai, who contracted HIV from her late husband, was speaking at a seminar on "Experiences on Reduction of Mother-to-Child HIV Transmission in Upper Northern Thailand" attended by over 450 health representatives from Chiang Mai, Chiang Rai, Lampang, Lamphun, Phayao and Mae Hong Son.
The seminar also announced results on the use of ZDV on HIV-positive women in the upper North. It found mother-to-child HIV transmission was reduced to 6.32 percent, much less than found in studies elsewhere.
Dr Vallop Thainuca, region 10 public health inspector-general covering the upper North, said since the project started in July 1997, ZDV had been provided free to HIV-positive pregnant women at district and provincial hospitals.
Up to September 1998, 436 HIV-infected pregnant women received ZDV and 417 had given birth
Of 95 babies whose HIV status is known, only six were reported infected with HIV, thus showing the infection rate to be 6.32 percent, said Dr Vallop.
In the upper north, the mother-to-child HIV transmission rate without ZDV is 25 percent. If the babies are breast-fed, the infection rate is as high as 35 percent, said Dr Chavalit Nakprathan, director of the Communicable Diseases Control Centre for the upper North.
He said northern hospitals should have begun the programme of free provision of ZDV to HIV-positive pregnant women much earlier, but had been unable to do so due to unclear policies.
"The drug was there and the health staff were trained. We would have managed the programme because our antenatal care is well administered, but we couldn't start our project because we didn't have clear leadership," said Dr Chavalit.
In 1994, the Aids Clinical Trial Group 076 of the United States Communicable Diseases Control revealed that provision of ZDV during early stages of pregnancy could reduce mother-to-child HIV transmission from 25 percent to eight percent.
In early 1997, the US-Thai Communicable Diseases Control Collaboration announced that short course use of ZDV given during the late stages of pregnancy reduced mother-to-child HIV transmission by half - from 18 percent to nine percent.
Dr Chavalit said, however, he wanted to be cautious with the latest findings for the upper North, where mother-to-child HIV transmission reduced from 25 percent to 6.32 percent, because the figures were based on information from the actual provision of ZDV and not on a study with a comparable group.
Under the programme, HIV-positive pregnant women received ZDV during the last four weeks of pregnancies and during labour. The new-born child also received ZDV for a week to increase the chances of reducing HIV infection, said Dr Chavalit.
To avoid the problem of a shortage of infant formulas which have to replace breast milk for babies born to HIV mothers, Dr Chavalit said mothers have also been encouraged to feed babies with early weaning food.
Deputy Health Minister Khamron na Lamphun said the ministry is thinking about applying this policy to all hospitals under the ministry's control.
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