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Bangkok Post
Getting the word out: While Thailand has a good track record on treating HIV-positive people, it should be working all out to prevent new infections
<p><span style="font-size: xx-small;">Napamon Roongwitoo</span></p>
November 29, 2011

It's been over two decades since World Aids Day was first marked on December 1, 1988. In the intervening years we have seen great strides made in terms of treatment and prevention, in public attitudes and levels of awareness, but the battle against this scourge is far from over yet.

Dr Michael Hahn is country coordinator here for UNAids, an organisation which was established primarily to coordinate the response of various UN agencies to the threat posed by HIV. He compares Thailand's struggle to check the spread of the virus to someone climbing a high mountain: The ascent has been difficult and has taken a great deal of exertion, but we have almost made it to the top.

"Thailand is in a very good position. It produces its own drugs, which are effective, and it has very well-trained people," Dr Hahn said, going on to remark that, as with scaling a peak, the higher one climbs, the harder it gets. The number of new HIV infections has dropped significantly since the 1990s, but the virus is still very much around. Total prevention is the final step this country needs to take, he said, and it will perhaps be the most difficult one.

"In Thailand, about 25 people are infected with HIV every day. That means that while, on one hand, Thailand has managed a very good response since the '90s, we still have over 9,000 new infections every year - and this has been constant over the past four to five years. The number [of new cases] has more or less stayed the same."

Dr Hahn revealed that 94% of these new infections occur in three groups: sex workers; men who have sex with men; and injecting drug users.

The rate of new infections has not decreased over the past few years because preventative measures are not effective enough, he said, whereas the treatment now being offered here to HIV-positive people is some of the best in the world.

"What it means is that Thailand has to do more about prevention. Thailand is good in other areas, especially treatment. Nearly 75% of the people who need treatment get access to it," he said, adding that in many countries only 40% of those living with HIV have access to proper care.

One of the most impressive signs of progress here vis a vis HIV prevention is that transmission of the virus from mothers to newborns has, according to Dr Hahn, been practically eliminated: the rate has been slashed by 98%.

Another groundbreaking advance is the discovery that starting infected people on anti-retroviral medication at an earlier stage can radically halt the passing on of the virus to others.

"There are studies which give us, for the first time, a game change. It was found that if you start treatment early you can actually prevent someone infecting anyone else. People who start treatment after their immune system drops below a certain threshold, can still infect others. But if you start immediately, while your immune system is still in pretty good shape, the virus disappears, more or less, from your blood [while HIV is still present, one's so-called viral load drops to below detectable levels] and you don't infect others. This finding is very exciting."

Dr Hahn is anxious to explode one myth about the virus that is all too widespread. He said that the general public needs to realise that people living with HIV are just like everyone else and that they shouldn't be discriminated against.

"It's absolutely normal now for those who live with HIV to fall in love, get married and have children without any risk for the partner or the children. People used to believe that an HIV-positive person and an HIV-negative person needed to have protected sex or else the HIV-negative partner would get infected, but recent findings have proven that to be invalid. If you have access to treatment, then that allows you to have unprotected sex without infecting your partner, it normalises the issue. It's wonderful, isn't it?"

HIV-positive people can lead relatively normal lives, he went on, and have children if they so wish and not have to worry that these kids will be orphaned within the space of five years, as was once the case.

"They can live for another 30 or 40 years. Most people still see HIV as a death sentence, but that's only true if you don't have access to treatment. It's just like people with diabetes or hypertension: If they have no access to treatment, they might very well die. It's not a death sentence any more; not at all. There are therapies that can prolong people's lives, for maybe 30 to 40 years. They can have a normal, proactive life."

He said the goal he would like to see achieved is what he calls the "three zeroes": zero new HIV infection; zero stigma; and zero HIV-related death.

The first zero is of great importance, he said, as it would alleviate the current financial burden on the state and allow the money now used for treatment to be put to other uses.

"If you are adding 25 new people every day, that is just increasing the expense. Thailand is paying mostly out of its own pocket. Only a small fraction of the cost is being covered by foreign assistance."

At present, Thailand has about half a million people living with HIV. Sixty percent of them are receiving treatment, which is mostly financed by the government. "More new cases means less money left over for prevention and that leads to more and more people needing treatment. This is a vicious cycle."

Dr Hahn went on to cite a report from four years back which found that each US dollar spent on prevention could save eight dollars on treatment. "It saves lives, too, of course, but it also has a financial effect if you take into account the 25 new infections a day - it adds up to a lot of money."

So what does Dr Hahn's work at UNAids involve?

"We coordinate the support the UN can provide - financial, technical or moral support - and try to align this to the country's priorities. By 'country', I don't mean the government alone. It also includes the civil society and NGOs. The country has to look at the situation to see what the challenges are; that's what we are helping with."

First and foremost, he said, people who heretofore have had no chance to express themselves must be given a voice.

"Sex workers, young children, homosexual men and other marginalised groups - they were hiding and afraid to come out, and what we do is to give them a voice. All these numbers are people, with faces, with lives. We are not talking about potatoes! We have to bring both sides - these groups and the government - closer together so that they listen to each other. If that happens, the likelihood that the support meets the need is much higher."

When teenagers are asked to list the things that they most fear about having sex, HIV doesn't even make it into the top three, Dr Hahn noted. "The biggest fear for them is unwanted pregnancies, followed by STDs [sexually transmitted diseases] and being caught by their parents."

The best preventative approach starts in the home, he declared, stating that parents have to accept changes in cultural mores and realise the importance of sex education.

"Parents talk to their kids about traffic safety and they have no problem making their points. It should be the same with sex, but the embarrassment makes it difficult. More importantly, if parents teach their children about the need for safe sex, they shouldn't get angry if they find them carrying condoms. Accept that your children live in a different culture from that in which you yourself lived as a child. Blocking them from porn sites and pretending that sex doesn't exist won't get you anywhere."

Youngsters, as well as adults, also need to be made aware that discrimination against people with HIV is usually caused by ignorance and irrational fears, he concluded.

"Many governments try to frighten their citizens, proclaiming that contracting HIV is a death sentence. This makes some people so afraid that they don't dare to touch those who are HIV-positive, or even use the same toilet. I really hope that this game change I mentioned earlier will normalise the lives of those living with HIV.

"Hopefully, as the years pass, we'll be able to get the message out that HIV is like other chronic diseases ... like diabetes; that it's not a death sentence and that people infected with the virus can still lead normal lives."