Opinion: a model for HIV management

The key to ending Aids is to end inequality, and countries most affected by the disease must lead the effort against the disease by closing the economic gap.

Inequality, compounded by stigmatisation, if not, criminalisation, is making it impossible for many people at risk of contracting HIV, as well as those living with the disease, to receive the quality care they need.

In theory, people living with HIV have the right to health care, employment and housing without discrimination. Migrant workers too have the right to seek HIV prevention and treatment programmes, just as those who are living on the margins of society, such as LGBTQI individuals, drug users and sex workers, have the right to seek health services from the state.

But in too many countries and regions, these are simply not happening.

The current paradigm in which Global North leads the world's Aids response taking charge of the decision-making, agenda-setting and public education needs to change. The developing world has just as many inspiring figures and innovations which the rest of the world could learn a lesson or two from in making HIV-related services more accessible to all. There are models from the Global South too, which can show the world how to address the structural, social and legal factors that are slowing the progress towards ending this epidemic.

Thailand is among these trailblazers. It has converted political commitment into political will, and political will into action. The results prove it. Thailand was first in the Asia Pacific region to eliminate mother- to-child transmission of HIV. Nine out of every ten people diagnosed with HIV here are receiving HIV treatment and an impressive 97% of these people are virally suppressed!

Just recently the country launched its "Undetectable = Untransmittable" or U=U initiative. This strategy is based on empirical testing which shows that people living with HIV who are on treatment and have an undetectable viral load cannot pass the virus on to their sexual partners or to their children.

Thailand has demonstrated the value of linking high-level buy-in for the vision of ending Aids with multi-sectoral collaboration. The country has taken a long-term view for planning and coordination through the 2017– 2030 National Strategy to End Aids. HIV response best practices are not cherry picked. Thailand has moved decisively to leverage innovations like same-day treatment for people who are newly diagnosed with HIV, HIV self-testing, and pre-exposure prophylaxis.

We are grateful that during Dec 13-16 last year, the government of Thailand was able to host the Joint United Nations Programme on HIV and Aids (UNAids) board meeting in Chiang Mai. This meeting brought civil society organisations, including associations of people living with HIV, to the discussion table with member states and United Nations agencies. Together these constituencies provide oversight and strategic direction for UNAids, which guides and supports the global HIV response.

For Thailand, the long-term plan is to reduce new infections, ensure everyone in need has access to HIV treatment, end stigma in healthcare, workplace, education, community, shift public perceptions about HIV and work through the justice system to protect and promote human rights for all. Not only has Thailand joined the Global Partnership to Eliminate all Forms of HIV-related Stigma and Discrimination, but it has developed a plan to end HIV-related prejudice.

This robust planning and implementation do not happen just everywhere. It is an example to the world.

Perhaps the greatest lesson Thailand can share is the importance of prioritising and supporting community-led work around HIV prevention, testing, treatment and care. By integrating HIV services into the Universal Health Coverage scheme and increasing investments in people most affected by HIV and community-led health services, the government is working towards a best practice for a long term, financially sustainable and high impact HIV response.

More than that, by leaning into the strength of community-led organisations, Thailand is giving itself the best chance of reaching people who are hardest to reach. These are the people who are diagnosed late, who are fearful to access HIV services and/or those who experience discrimination due to their HIV status and other intersecting vulnerabilities.

We were thrilled to offer UNAIDS board members the opportunity to see the power of a people-centred approach through community leadership as well as the power of partnerships between the community and public sector and integration of HIV in UHC in action.

The government, community organisations and UNAids will continue the work needed to ensure global HIV response is informed by the wealth of experiences from the entire world, particularly from countries most affected by HIV. And, as we have from the start, together we will prioritise community and civil society activism and leadership as a connection to the lived experience of people living with and affected by HIV. This inclusive approach is the only way to end Aids.

Written by: Tares Krassanairawiwong, Director-General of Department of Disease Control; Apiwat Kwangkaew, Chairman of the Thailand Network of People Living with HIV (TNP+); and Patchara Benjarattanaporn, UNAIDS Country Director, Thailand.

This piece was originally published on the Bangkok Post.