Preface
There are very few developing countries in the world where public policy has been effective in preventing the spread of HIV/AIDS on a national scale. Thailand—where a massive program to control HIV has reduced visits to commercial sex workers by half, raised condom usage, curtailed STDs dramatically, and achieved substantial reductions in new HIV infections—is an exception. This issue of the Social Monitor considers two important questions arising from Thailand's
remarkable achievements in controlling HIV/AIDS. First, what are the lessons of this experience for countries in East Asia and the rest of the world? Half of the population of developing countries lives in areas where HIV is not yet widespread. Does Thailand offer lessons that can help these countries avoid catastrophe? The second question looks to the future: what are the new strategic priorities to control the spread of HIV/AIDS in Thailand's changing social and epidemiological environment? Thailand’s signal achievement of reducing the number of new HIV infections over the past
decade must be seen in the context of the still enormous impact of this epidemic. Nearly 1
million Thais have been infected with HIV since the beginning of the epidemic, and 289,000 have already died of AIDS. Nearly 700,000 are currently living with HIV/AIDS out of a total
population of 61 million, due to the past high infection rates and the long incubation period of HIV. As the epidemic matures, an increasing share of those who are HIV-positive will require medical care, and some households will be pushed into poverty. Thus, as we learn about Thailand’s past success, we must also consider priorities for the future, given the large number of people infected and the continued spread of HIV. This report was commissioned by the World Bank Office in Bangkok as an outgrowth of our
participation in the United Nations Thematic Working Group on HIV/AIDS in Thailand. The
report is the work of a team of analysts which visited Thailand in June 2000 to consult with
government officials, international agencies, non-governmental organizations, and research
institutes about their perspectives on the Thai HIV/AIDS control program. The report team
consisted of Martha Ainsworth, Ph.D., Senior Economist in the Policy Research Department of the World Bank; Chris Beyrer, M.D., MPH, School of Public Health at Johns Hopkins
University; and Agnes Soucat, M.D., Ph.D., Senior Economist for the Africa Region of the World Bank. This report summarizes the results of the consultations and the recommendations of the mission team. The report concludes that Thailand’s efforts to slow the AIDS epidemic have shown the potential impact such programs could have worldwide. However, unless past efforts are sustained and new sources of infection are addressed, the striking achievements made in controlling this epidemic could be put at risk. The report identifies several cost-effective investments that would have a large impact on the future course of the epidemic. The report also recommends that the growing demand for treatment and care be addressed urgently with cost-effective, equitable, and affordable solutions. It is also essential that the Government maintain and expand its focus on prevention if future generations are to be spared the threat of HIV/AIDS. In preparing this report, the team has had access to a vast body of empirical evidence on the
AIDS epidemic in Thailand and has heard from many dedicated Thai and international
professionals on how this public health menace can best be controlled. With the stakes so high, and with the suffering of people with AIDS so tragic and compelling, there is no shortage of passionate argument on the complex issues surrounding the control of HIV/AIDS. We have done our best to reflect these diverse perspectives and to cite the many contributions to our understanding of the HIV/AIDS epidemic in Thailand. Given the extensive work already available on HIV/AIDS in Thailand, the approach of this report is strategic and focuses on the big picture. The report seeks to identify the areas in which the Thai Government, building on past efforts and using its limited public resources, can have the largest impact in reducing the epidemic and in helping those living with HIV/AIDS. The report is not a comprehensive roadmap for the control of HIV/AIDS in Thailand, nor is it a detailed operational plan for new interventions. Those tasks are the responsibility of the Royal Thai Government, working in partnership with civil society organizations, the private sector, and international agencies. We hope this report provides useful guidance on priorities, knowing that the operational policies and decisions will come from the hard work and detailed knowledge of those battling this epidemic in Thailand day to day. On behalf of the team, I would like to thank the many people in and out of government who
offered their views and insights as well as valuable data to document the issues. In particular, we would like to thank Dr. Anupong Chitwarakorn and Mr. Chawalit Tantinimitkul (AIDS Division, Ministry of Public Health), Ms. Waranya Teokul (NESDB), and Dr. Ying-Ru Lo (WHO) for their extensive assistance with epidemiological and budget data. The staff of UNAIDS, both locally and in Geneva, and the members of the UN Thematic Working Group on HIV/AIDS here in Bangkok have provided invaluable advice and support. J. Shivakumar
Country Director
World Bank Office Bangkok
and Chairperson, UN Thematic Working Group on HIV/AIDS in Thailand |
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