Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
Bangkok Post - September 17, 2000
Aphaluck Bhatiasevi
The report, to be officially released next month, states that despite an overall decline in new HIV cases in a number of sectors like commercial sex workers and intravenous drug users, an increase in infection is observed in various localities.
"These national averages hide very large regional differences," the report says, adding that sex workers of all groups-brothel-based, indirect and males-are on a continuous rise in a number of areas, particularly in Bangkok.
Despite international recognition for performing well in handling HIV/Aids problems, the report states that Thailand has not been able to effectively control the spread of the epidemic which is hitting back hard, particularly among commercial sex workers, intravenous drug users, military conscripts, pregnant women and children.
According to the report, despite the best efforts of policy makers and dramatic changes in behaviour and social norms, Thailand faces the enormous challenge of a severe Aids epidemic with nearly a million cumulative infections and about 700,000 people living with HIV/Aids.
"With Thailand's level of income and its strong health infrastructure, it can again show access to treatment of opportunistic infections for people living with HIV/Aids, both rich and poor," the report says.
It suggests authorities concerned provide critical information about the costs and benefits of alternative treatment to the patients.
At the same time, the government should improve access to, and facilitate reduced prices for, combination anti-retroviral treatment for patients who can afford it and implement adequate safeguards to minimise inappropriate use of anti-retroviral drugs.
"There is limited but disturbing evidence that many, if not the majority of people with HIV/Aids in Thailand, are not currently reached by existing cost-effective prophylaxis, treatment and care programmes for opportunistic infections," the World Bank report says.
Regarding voluntary counselling and testing, the report points out that despite being widely available, the service is under-utilised and is beneficial only to those who seek it.
In addition, combined anti-retroviral therapies remain expensive and out of reach of most patients, states the report, adding that about 2,100 Aids patients in Thaialnd are enrolled in various clinical trials of anti-retroviral drugs, 2,000 patients for two-drug therapy and 100 patients for triple-drug therapy. The majority of people with HIV/Aids end their lives at home cared for by family members, the report says, pointing out that there is no systematic assessment of the type of services, coverage and geographical gaps in terminal home-based care support provided on a national level.
The increase in the number of HIV patients with illness symptoms poses an increased burden for hospitals and the impact of Aids is already evident in the changing national pattern of adult mortality, which is dramatically increasing the number of Thai children who have lost one or both parents.
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