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global health presentation
Transcript of global health presentation
Homero Silva Preventing HIV/AIDS and Sexually Transmitted
Infections in Thailand Background about HIV/AIDS Human Immunodeficiency Virus (HIV) Retrovirus
Slow progressive disease
Common way of spreading:
By transmission from infected mothers to their newborns during pregnancy
Labor (delivery process) and breastfeeding Acquired Immunodeficiency Syndrome (AIDS) AIDS is caused by HIV
Body becomes vulnerable to:
Cancers Assumption: Almost all cases of HIV/AIDS can be found in sub-Saharan Africa.
Reality: The epidemic is becoming increasingly serious in Asian countries. AIDS and its affect on Thailand What made it work? What the program
did NOT achieve No Condom, No Sex: The 100 Percent Condom Program Dr. Wiwat Rojanapithayakorn, while serving as Director, Office of Communicable Disease Control Region 4 in Thailand, initiated the “100% Condom Use Programme” which has been recognized worldwide as one the most successful HIV/AIDS prevention tools. 1989: 1991: Currently 100% Condom Program Expansion
Dr. Wiwat actively advocated this program in the international arena.
Programs have been implemented in Cambodia, Vietnam, Philippines, China, Myanmar, Mongolia and Laos PDR.
World Health Organization, World Bank, UNAIDS, USAIDS, recognize this 100% Condom Use program as one of the most successful HIV prevention tools.
It is also seen as a successful example of behavioral change and social empowering in the public. Changes in Behavior
and Health Outcome Condom Use STI Results Increased from 14% in 1989 to 90% in 1992 Surveyed sex workers and young men STI include gonorrhea,syphilis, and other infections Reporting to STI clinics fell drastically from 1989
to 2001, from 200,000 cases in 1989 to 27,597 in 1994. Cohort Study Rate of HIV infection fell by fivefold between 1991 and 1995, while the rate of new STIs fell tenfold.
Prevalence of HIV halved between the mid-1990s and 2002 Failed to target condom use in casual but noncommercial sex
Lack of interventions targeted towards injecting drug users Sex industry – relatively structured
Good network of STI services
Adequate number of trained health workers
Collaboration of different sectors
Health authorities, governors and police
Strong leadership Most of the cost consisted of human resources
Condoms: $1.2 million per year
Private sector spending: $48 million
Education and information campaigns
65% of the money spent on treatment and care Challenges Discussion Question: Currents of Thailand: COST ANALYSIS: DISCUSSION QUESTION Are there any HIV/AIDS Campaign or Program established in your country? DISCUSSION QUESTION What does it mean by "direct" and "indirect" sex workers? COST: Between 1997-2004, budget declined by 2/3
Limited access to health care and information
No blue print for other countries Institute for Population and Social Research at Mahidol Univ. in Thailand
Backed by UNAIDS and Thai Ministry of Public Health
Concluded the program significantly reduced HIV transmission based on large scale reduction of HIV transmission
World Bank suggested the program prevented ~200,000 HIV infections during the '90s Evaluating the Program Reported rates
97% of sex workers reported condom use with one-time clients; 93% reported condom use with regular clients
92% of sex workers refused sex without condom after higher pay rate was offered
Massage parlors reported 98% condom use
Lowest rate: hotels, reported 85% condom use
Difficult to reach "indirect" sex workers working in restaurants and bars
Biased results if this group is underrepresented
Reported that 90% of these workers used condoms 3 Key Points of this Program
Empowerment of vulnerable populations (sex workers)
Collaboration (health officials, sex establishment operators, and law enforcement)
Support through logistics (condom distribution), monitoring, and evaluation Cabbages and Condoms Condom King Q AND A Mechai Viravaidya: Thailand's “Condom King” Chairman of Thailand's National HIV/AIDS Education Commission
Initiatives focused on the younger generations
Safe sex education programs
Safe sex slogans aimed at the next generation
Stop global warming use a condom
A condom a day keeps the doctor away Discussion Question Do you agree with Thailand's program to provide condoms to the sex workers? What would you have done differently? Current Status in Thailand Condom Use in Cambodia Prevalence of HIV/AIDS cases in Thailand is 1.3% (2009) Discussion Question What key aspects of the AIDS prevention and reduction programs in your country helped to make them successful or unsuccessful? Led by Thailand's prime minister and implemented the "100 percent condom program" nationwide
Health officials provided boxes of condoms free of charge
Law enforcement attempted to cooperate with operators and workers of sex establishments.STI infected men were asked which sex establishment they frequented, so that individual establishments could be targeted for safe sex education. National AIDS Committee of Thailand Evaluating the Program Difficult to accurately grasp effectiveness of program
STI incidence decreased during the '90s before all provinces had implemented the program
Proportion of men visiting commercial sex establishments halved between '90-'93
Believed mass advertising (information campaigns) played important role
Complementary component with promotion of 100 percent condom use program Real-life setting vs. artificially controlled conditions Skeptics doubted program's effectiveness Sex Workers: 99% (2010) Homosexual males: 86.5% (2010) Prevalence of HIV/AIDs cases in Cambodia is 0.5% (2009) What were the challenges faced by your low-income countries in reducing the prevalence of HIV? AIDS in Thailand National Advisory Committee on AIDS
Established in 1988
Surveillance of sentinel groups
Dr. Wiwat Rojanapithayakorn
Safe sex for sex workers