Punnee Pitisuttithum
MB, BS, DTM&H, FRCP(T)
Among the general population, the national trend for the prevalence of HIV infection has been one of continuous decline since 1996. Among pregnant women, the prevalence of HIV was < 1%, with < 0.5% among new military recruits. Among the higher risk groups, new infections among indirect and street sex workers nearly doubled by 2008, compared with data for 2005. HIV infections among men who have sex with men (MSM) remain higher, and show no sign of declining. Nevertheless, intensified prevention activities among this population over the past 2 years, especially in Bangkok, are starting to show results in terms of reducing the prevalence of HIV, from 30.7% in 2007, to 24.7% in 2009. Thailand aims to reduce the rate of new HIV/AIDS infections by two-thirds within the next 5 years. Of the 481,770 Thais living with HIV/AIDS, 283,612 have been listed for anti-retroviral therapy under 3 national health schemes, covering the civil service, company employees, and the universal healthcare scheme.
Preventing mother-to-child transmission (PMTCT) is being implemented efficiently in Thailand. Triple therapy is now being used. The percentages of adults and children with advanced HIV infection undergoing antiretroviral therapy has increased from 41% in 2004, to 77.76% in 2010. Sixty percent of infected pregnant women knew their serological status before becoming pregnant. The percentage of HIV-positive pregnant women who received antiretroviral therapy to reduce the risk of mother-to-child transmission has also increased, from 89.77% in 2005, to 94.71 in 2009.
Youths are an important target group under the National AIDS Plan for 2007-2011, which has a target of reducing new infections by half, by 2011. The challenge here is to find a way to institutionalize comprehensive sex education in the school system, through policy improvements at national and ministerial levels.
The best practice for the prevention and control of HIV/AIDS has included various projects with people living with AIDS, pregnant women with the cooperation of their partners, and comprehensive sex education for adolescents (Teampath Project).
HIV-vaccine research and development in Thailand continues, especially after the exciting efficacy results reported in 2009. Potential immune correlates to protection were discovered, and were presented at the Bangkok AIDS Vaccine Conference 2011. The first statistically significant correlate was IgG antibody that binds to the V1/V2 loops of HIV Env. The presence of these antibodies correlated with a 43% reduction in the HIV infection rate. The second immune response identified as a statistically significant correlate of risk was plasma IgA antibody, which binds HIV Env. These IgA antibody responses directly correlated with a 54% increase in the HIV infection rate among vaccinated volunteers.
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