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Bangkok Post
Battling deadly diseases: More foreign money is pouring into the country to control HIV/AIDS, malaria and tuberculosis

<p>Krissana Parnsoonthorn</p>

August 25, 2012

Through the efforts of many dedicated people, Thailand enjoys a reputation for fighting the spread of three of the deadliest diseases - HIV/Aids, tuberculosis and malaria. But the gains could be nullified if more is not done, according to an international financing institution.

Intense projects have been undertaken for decades to eradicate the diseases with foreign financing. One group with a strong presence in Thailand is the Global Fund to fight Aids, Tuberculosis and Malaria.

It finances programmes to fight the diseases initiated and designed by the individual grant-recipient countries.

The Global Fund says its model is based on the concepts of country ownership and performance-based funding. It offers financing on the condition that verifiable results are achieved.

In Thailand, the Fund has pledged to provide more than US$500 million (1.55 billion baht) worth of grants over the next five years, focusing on vulnerable population groups.

Christoph Benn, the Global Fund's director for resource mobilisation and donor relations division, said the vulnerable population targets are migrant workers who are in the country illegally, particularly in the fishing industry, gay men and injecting drug users.

Around $500 million in grants has sustained several health programmes in Thailand in the past nine years.

"Thailand did very well to fight the three diseases and more work is still needed to help some risk groups in the near future," he said.

The additional grants will be extended to support both new and existing health projects by the Public Health Ministry, civil society, the private sector and affected communities.

Some that will benefit from Global Fund-sponsored health projects are the campaign for condom use to prevent HIV infection, directly observed treatment shots for TB control and partnerships to reduce malaria in areas affected by conflicts or with a high concentration of migrant workers.

The Global Fund raised its concern over risk population groups in discussions with the Public Health Ministry's representatives at a forum on Investing in Asia Pacific: Public-Private Partnerships in Health held in Bangkok last month.

"In the case of malaria, we should be serious about countering fake drugs in border towns.

"Some malaria-affected people buy drugs from the black market and these drugs may lead to the higher risk of artemisinin-resistant malaria. It's dangerous and could spread to other areas," Dr Benn said.

During the first five months of this year, 4,381 new cases of malaria were reported in Thailand, according to the Public Health Ministry.

With a $29 million grant, the Public Health Ministry last year began a programme focusing on containing artemisinin resistance in populations affected by the disease and eliminating the malaria-causing plasmodium falciparum parasite in border areas.

The programme is operating actively in regions bordering Myanmar and Cambodia, and in areas close to Laos, benefiting Thai people and migrants living in the malaria-infested areas.

Currently, the risk of artemisinin-resistant malaria spreading to other countries is very high.

The programme involves close monitoring of treatment outcomes, intensive vector-control, indoor residual spraying and distribution of long-lasting insecticide-treated bed nets. To date, 680,000 bed nets have been distributed to malaria-eradication target areas in Thailand.

For tuberculosis, the problem is particularly prevalent among migrants, especially in the towns bordering Myanmar.

World Vision implements the tuberculosis reduction programme near the Thai-Myanmar border, targeting non-Thai migrants vulnerable to the disease.

The programme reaches more than 235,000 people in six border and adjacent provinces including Tak, the frontline zone with a large concentration of Myanmar workers.

The success rate in curing patients enrolled for treatment was 89% in 2011.

However, there is a danger the infected migrant workers relocating to the cities including Bangkok could contribute to the spread of tuberculosis, according to Global Fund.

Altogether 216 community health posts are up and running under the programme which are accessible to migrant workers. This is where they can be tested for tuberculosis infection and receive health information.

Besides tuberculosis eradication, Global Fund's funding also provides education to children living with or affected by HIV/Aids, livelihood support to affected families, and HIV/Aids treatment.

The Rak Thai Foundation is a non-government organisation which carries out the HIV/Aids projects through the Global Fund grants. The foundation aims to strengthen communities and aid marginalised people.

The projects work to reduce HIV infection among the most at risk populations (Marp).

The Bangkok forum last month was told the programmes were established to reduce new HIV infections among needle injecting drug users in Bangkok and major provinces of Surat Thani and Nakhon Sri Thammarat and to prevent HIV infections among teenagers in 12 northeastern provinces and build a strong preventive mechanism for remote communities.

Dr Benn said many campaigns fighting HIV/Aids have met their targets.

However, the campaigns should refocus on the high-risk population of gay men as they might be less concerned about disease prevention.

The Public Health Ministry's report said the number of accumulated HIV patients was about 1.15 million in Thailand with about 10,000 new cases reported in 2011.

Dr Benn said the government should not be left alone to combat HIV/Aids, malaria and tuberculosis. The private sector must help.

"The private sector can bring much needed skills, capabilities, expertise resources and networks that are critical in the fight against Aids, tuberculosis and malaria," he said.

"The continued and expanded engagement of private contributors will ensure long-term success in fighting the three epidemics," he added.

Anthony Pramualratana, executive director of the Thailand Business Coalition on Aids, said despite the resources and energy expended in trying to tackle the diseases, the general public is largely unaware of how they, as a collective force in society, can turn the situation around.