Determinants of Health HIV/AIDS epidemic in Thailand

Title: Determinants of Health HIV/AIDS epidemic in Thailand

An essay/literature review of 2500 words +/-10%, excluding references and tables on the current situation of the HIV/AIDS epidemic in Thailand, in Vancouver style, including likely factors that may be contributing towards the current incidence rates of HIV. Critically appraise on what has been done to down scale HIV infection and the roll out of treatment of AIDS. Then, draft an advice to the Ministry of Health on the relative priority that should be given to treatment and prevention over the next five years. Argue why this priority should be given.

Current situation = You may discuss on magnitude/burden of disease, relative comparison regionally and globally, trend of the disease on increasing or decreasing, health policy with regards to the disease, available and existing health care delivery system, etc, etc. Where necessary you need to indicate how factors/determinants relate to each other. Include the impact of globalization on the health problem. The essay should contain a critical analysis of the health problem in the light of current theory and evidence. You are expected to do a search using the library and internet sources on the topic of your essay and describe how you did your search.(Methodology)

The essay should have:

-a head: a clear problem statement and an introduction to the problem, stating its significance and relevance,

-the search strategy and key-words you used to identify articles.

– the Dahlgren and Whitehead conceptual model from which the body will be structured

-a body: information you found on the different determinants that influence the problem, with a critical analysis on their importance and interactions. The different determinants should be clearly outlined as subheadings within the body.

Discussion /conclusions and recommendations (Indicate here how the Ministry of Health could contribute), relating to your most important findings.

Assessment criteria: -clearly presented / logical flow of argument /well structured (head, body, tail) /critical analysis of problem and its contributing factors / shows signs of original thinking /search strategy described / referencing in Vancouver style.

Important points

– The search engines and references should primarily be from Pub med, Scopus and published peer-reviewed articles in journals, in English. The search should focus on, but not be restricted to publications in the past five years;

– the Dahlgren and Whitehead- model should be used to describe and discuss the determinants of health for “HIV” in Thailand;

– as you know, the sex-workers in Thailand are the main HIV spreading problem in Thailand.

Important:I send you an example of assignment about dominican republic ,which is exactly the way I need to do this assignment please follow this example as dahlgrane and whitehead model, vancouver style referencing, figures should be add here,the search engine with pub med ,scholar and etc, this is not a normal assignment and to not to have problems we had last time, please pay attention to the example of the dominican republic and Dahlgrane and white head model step by step,following the titles one by one:

Table of Content

Abbreviations

Introduction

Methods

Results

– Age sex and constitutional factors

– Individual Lifestyle factors

– Social and community network

– Living and Working conditions

– Socioeconomically cultural and environmental factors

Conclusion and Discussion

Recommendations

References

Please let me know via mail if there are any question, to avoid the last assignment problems, thanks

p.s. The last assignment was not good ,so if you have a writer who is familiar with public health Dahlgrane and white head rainbow model essays(like example I send you) will be great.

Determinants of Health HIV/AIDS epidemic in Thailand

http://ww1.aegis.org/pubs/cdc_eid/2003/EID9701-Fig1lg.jpg

Word count: 2477

Table of content

Table of content……………………………………………………………………. 2

Abbreviations……………………………………………………………………….. 3      

Introduction………………………………………………………………………….. 4

Methods……………………………………………………………………………… 6

Results……………………………………………………………………………….. 7
             – Age sex and constitutional factors…………………………………………. 7
             – Individual Lifestyle factors………………………………………………… 7
             – Social and community network…………………………………………… 8
             – Living and Working conditions…………………………………………… 8
             – Socioeconomically cultural and environmental factors……………………. 10

Conclusion and Discussion…………………………………………………………. 11

Recommendations…………………………………………………………………… 12

References…………………………………………………………………………… 14

Abbreviations

AIDS                    Acquired Immune Deficiency Syndrome

ART                     Antiretroviral Treatment

CSW                    Commercial Sex Workers

HIV                      Human Immune deficit Virus

IDU’s                    Injection Drug Users

MOH                     Ministry of Health

MOT                     Modes of transmission

MSM                     Men who have Sex with Men

NGO                      Non-governmental Organization

PLWHA                 People Living With HIV/AIDS

PMTCT                  Prevent Mother to Child Transmission

VCT                        Voluntary Counseling and Testing

Introduction

Thailand was the first Asian country to report cases of HIV. [1] Unfortunately it was the first country to report the highest rate of spread of HIV/AIDS in the early 1990s across the world. [1]The main mode of transmission of HIV/AIDS in Thailand is through unsafe sex especially among high risk groups such as Commercial Sex Workers (CSW) and their clients, men who have sex with men (MSM) and Injecting Drug Users (IDUs). [11]The numbers were high due to the rise of the prostitution industry by the Commercial Sex Workers (CSW) and gender disparity that has existed between men and women. There has been a substantial improvement in the fight against HIV/AIDS in Thailand due to the raising awareness among the locals. [2] Then, the number of commercial sex workers who using any form of protection was almost nil but as a result of the awareness created among the commercial sex workers the percentage of them using condoms as risen to almost 95% . This led to a 90% drop transmission of HIV through sexual means. Today the numbers stand at approximately 500000 people between the age of 15 and 49 currently living with HIV in Thailand.[4][5]figure 1 shows this. Unfortunately, as of 2009, Thailand was the country in south East Asia with the highest HIV prevalence rate standing at 1.2% as shown in figure 2 below. [3] [14]The country has been able to reduce the number of new infections to 9700 in 2011 from 143000 in 1991. [10] [13]There is need to maintain the past efforts made in dealing with the spread of HIV/AIDS since Thailand is in the danger of experiencing a resurgence in the epidemic. There is new to address new sources of infected or rather MOT. There has been an increase in the number of youth engaging in sexual behaviors. There is also an irregular pattern in the use of condoms in the country. Due to these factors and other arising factors there is need for the government to ensure that it sustains these new sources of infection.

In this paper we will discuss determinants that influence the high prevalence of HIV in Thailand and identify successful steps taken to stop further spreading of the disease among locals. We will make an attempt to explain the difference in HIV distribution among groups and try to connect the determinants to the mode of transmission within Thailand. Furthermore, we will note our recommendations to the ministry of health and health care providers in order to help them provide a better public HIV prevention and treatment policies and achieve a more effective

HIV/AIDS related health care interventions.

Figure 1: estimates of people living with HIV/AIDS in Thailand

Figure 2: Estimated HIV burden in South East Asia

Methods and materials

In order to make an evaluation on determinants of health influencing HIV/AIDS prevalence in Thailand a literature review was performed on search engines; Google Scholar and PubMed and in journals; JAIDS and Sage Journal, using the following keywords separate or in combination: HIV/AIDS, Thailand, South East Asia, determinants of health, Dahlgren and whitehead, prevalence, distribution, prevention, risk, factors, group, policy, ART, tourism, gender, economy, healthcare, working conditions, labor, migration, culture, education, MSM, sex-workers, alcohol, drugs, transmission, programmes, age, environment, lifestyle. Websites used: WHO, UNAIDS. The inclusion criteria where: not older than 10 years and English language.

In order to discuss all factors contributing to HIV prevalence we will use the Dahlgren and Whitehead conceptual model on determinants of health, shown in Figure 1. [7] The model was used by reviewing the factors that contribute to the risk of HIV transmission on different levels. All relevant determinants named in the model were individually reviewed and translated into the local situation. Relevant factors will be evaluated and the summary will be given ondeterminants that are of a major importance to HIV prevalence in Thailand. The determinant ‘water and sanitation’ is not relevant for the Thailand and is not included in this paper.

FIGURE 2: Dahlgren and Whitehead model

Results

Age, sex and constitution factors

As stated before there are more than 500000 people living with HIV/AIDS in Thailand and unfortunately this rate is rising among children. [4] Many young people are becoming more sexually active at a young age and unfortunately they are not using protection. About 14000 children in Thailand are unfortunate enough to be living with HIV. [4]There is also an increase in the number of young people engaging in sex with multiple partners. Most teenagers might not be aware of the campaigns carried out in the 1990s thus there is a decrease in HIV/AIDS among the young generation. This number might be higher because 14000 are the ones under medication or treatment.  80% of the causes of HIV is as a result of heterosexual relationship. This is quite evident because the large number of commercial sex workers (CSW) in the country. As of 2004 the percentage of men having sex with men (MSM) was 28.5%. [3] As of 2012 according to UNAIDS the percentage of CSW who had knowledge in HIV, used condoms, tested and knew their results and their HIV prevalence stood at 41%, 95.7%, 50.4%, 1.8% respective as compared to those of MSM which were 26%, 84.5%, 29.5%, 20% respectively. [5] There is a more worrying trend on the part of MSM whose reasons will be discussed later on.

Individual lifestyle factors

It has been found out that, through various researches that alcohol and other drugs impair judgment. Alcohol is easily accessible to the locals of Thailand. This leads to actions like unprotected sexual behaviors among the locals. There are also Injecting Drug Users (IDUs).[20] Their HIV prevalence as of 2010 was ranging from 11% to 24%. [6] It was estimated that the prevalence of HIV among IDUs in southern Thailand could be double this number.

Social and community networks stigma

Homophobia is prevalent in Thailand. In fact the act of MSM is illegal. Therefore man MSMs are afraid to come out because they fear the society around them will not accept them. The government has not put up any law that protects the MSMs. [4]There aren’t any programmes to protect their right or protect them against stigma and discrimination. This leads to hindrance in any effort made in dealing with HIV since most of the MSMs with HIV/AIDS don’t come out. [4] Therefore the prevalence among them becomes higher due to failure of awareness. The Rainbow Sky Association of Thailand is the first organization trying to create awareness about same sex. [15]

Living and working conditions.

Work environment, food production and housing.

Thailand receives immigrants from Cambodia and Myanmar and other neighboring countries who come to look for work. Many immigrant workers had not even heard of HIV/AIDS before coming to Thailand, due to poor awareness campaigns made. While immigrant workers in Thailand are fairly knowledgeable about the risk factors for HIV transmission, important gaps remain. Women, because they are the most affected, persons with poor education, seafarers, those who deal in farming, those who do not know anyone affected by HIV/AIDS. Those who have not yet received instruction in HIV/AIDS are the ones most likely to have gaps in their knowledge of HIV/AIDS risk factors. [8]

Health Services and Education Programs.

Poor health services and a lack of proper education leads to a higher prevalence of HIV/AIDS.

It has been found out that more people with a poor education background lack the necessary awareness to protect themselves against the MOT of HIV/AIDS pandemic. Health care in Thailand I somehow a positive affair. 71% of the people requiring the treatment have access to

It. [10]97% 0f these are adults and the other 3% are children. [11] The government is really putting an effort to help its people. 97% of the ARTs accessible to PLWHA is being paid for by the government. [11] Thailand is trying to follow the World Health Organization (WHO) of initiating the antiretroviral drugs (ARVs) at CD4 levels of <350 cells/mm3. Its previous levels were at 200 cells/mm3. It’s also trying to phase out stavudine (d4T). The government of Thailand is producing cheap generic drugs within its borders. In conjunction with NGOs the government is now able to offer the ARVs at half the price. [12] The Thai government faces some challenges in reaching the universal access target of 80 percent of all people eligible for treatment receiving it. At the moment, 60% of people who have tested positive for HIV already have CD4 levels as low as 100 cells/mm3. [11] The government has therefore put in measures of improving the promotion and quality of VCT, and administering of ARVs immediately upon detection. [11] Allocating extra time and money for the provision of ARVs for migrant workers in the coming years will be another challenge.  In the last six years the administration of Antiretroviral treatment (ART) among pregnant women has consistently been above 90% which has seen the reduction of HIV/AIDS through Mother to Child (MTC). [11]

Social economic, cultural and environmental

Financial and economic choices and position of country.

Efforts have been made to improve the social environment of people living with HIV/AIDS (PLWHA) in Thailand but have not been assessed in terms of their quality of life (QOL). People with a better financial state tend to have a better QOL. It has been determined that the individuals with a low QOL have a higher prevalence of HIV/AIDS.  Those who perceive themselves as well accepted by the community, perceive health services accessible or someone’s help available, tend to have better QOL in terms of mental health. Community acceptance is most significantly related to QOL. Hence the people with a low QOL face more discrimination than those with a higher QOL. It has been determined that community acceptance for PLWHA is important for their mental health which reduces the stigma that they face. [9]

Individuals who are finically sable have access to better health care and services. This leads to a lower HIV/AIDS prevalence among them.

Internal migration

Migration of individuals in a country contributes to the spreads of the HIV/AIDS virus. There is a movement of people in towards the urban areas.[8] Once they get in contact with PLWHA in the urban areas there is a high chance that they will spread the HIV/AIDS once they get back to their homes or even in those urban areas where there is a higher prevalence of HIV/AIDS.

External migration

There are approximately 2.5 million immigrants leaving in Thailand mainly from Cambodia and Myanmar. 75% of these immigrants are in the country illegally hence have no health records. The 25% may have the necessary health documents and services, there still some hindrances due to factors like stigma, cultural differences, language barrier, exploitative working conditions and discrimination. This hinders the fight against HIV/AIDS prevention among immigrant workers [8] [16] Migrants are also more likely to pay for sex and this leads to multiple non-regular partners. The chances of them being infected significantly increases and thus the spread of HIV/AIDS also become more significant.[15]

Cultural environment and gender

It has been mentioned earlier that gender difference contributes to the spread of HIV/AIDS. The matter is worse when there is a higher prevalence as a result of heterosexuality as in the in the case in Thailand. Women are being discriminated by the men leading to stigma among the women. In other cases the man has the say whether to use condoms during sex. If a woman can’t have a say during sex they become more vulnerable to contracting HIV/AIDS. There is GBV which includes rape which again makes the women more vulnerable to HIV/AIDS.                                                

Discussion and conclusion

There is no denying that Thailand has made great efforts to eradicate the epidemic that is HIV/AIDS. Thailand has seen a drop in the numbers of those infected with HIV/AIDS since it was detected in the country. This can be attributed to the large awareness that is being made among CSW. In fact there have been campaigns like “no condom, no sex” among the CSW. This, as mentioned earlier, has seen the increase of condom use from almost nil in the 1990s to currently more than 95% leading to a drop in HIV/AIDS transmitted sexually. However, more can be done to create more awareness in MSM. The continued discrimination of MSM is not helping in the fight against HIV/AIDS since it’s driving them away and a result not much can be done to help the individuals. In fact it leads to a wider spread of HIV/AIDS among the MSM.

There are findings which show that policy makers are giving more priority to preventing HIV/AIDS interventions by targeting high risk populations. This is according to the Thai national policy on priority setting of HIV interventions, which identifies the individuals who are more liking to be affected by the HIV/AIDS pandemic and gives them a higher priority. The MOH puts policy puts higher priority on HIV prevention programs, it’s apparent that therapy can also be put into consideration. [17] [18] [19] It has been found out that it has been a bit difficult to formulate ways of dealing in the smaller MOT like IDUs and MSM.

Recommendations

  1. The government should at least create awareness among MSM something that the NGOs have been doing.
  2. The government ought to put laws that protect MSM. This will reduce the stigma involved thus more people will be willing to come out and get tested thus reducing the HIV/AIDS spread among PLWHA.
  3. Continuation of the current programs which evidently have worked in cutting the HIV/AIDS pandemic since it was first discovered in the country.
  4. Strict immigration laws ought to be put in places in order to reduce the number of people leaving in the country who don’t have the proper medication documents.
  5. There is need for accurate data collection and reporting on prevalence of HIV among children in order to anticipate on future needs.
  6. Proper education among the illiterate should be put in place to create awareness among them.
  7. Trying to balance the gender imbalance which will reduce the stigma among women.
  8. Allocating extra time and money for the provision of ARVs for migrant workers.
  1. Testing and transmission prevention by condom use should be further promoted, especially among  the  high  risk  groups  (CSW,  MSM,  IDU’s,  women).
  2. Social and community networks should focus on preventing stigmatization and encourage testing. 
  3. Improving quality of health that enhances the PMTCT.
  4. Continuing the administering of ARVs to everyone irrespective of nationality.

References

  1. Nyamathi A, Cavington C, Mutere M. Vulnarable populations in Thailand: Giving voice to women living with HIV/AIDS.
  2. Punpanich W, Ungchusak K, Detels R. Thailand’s response to the HIV epidemic: Yesterday. Today and Tomorrow, 2004.
  3. Social determinants of HIV/AIDS in South-East Asia, 2009.
  4. Unicef. Thailand HIV/AIDS, 2010.
  5. UNAIDS. Thailand, 2011.
  6. ATLAS of Substance Use Disorders country profile: Thailand, 2011.
  7. Dahlgren G, Whitehead M. Policies and Strategies to promote social equity in Health.

            Stockholm: Institute of Futures Studies, 1991.

  • Theodore D, Aphichat C. Knowledge of HIV Risk Factors Among Immigrants in Thailand, 2009.
  • Ichikawa M, Natpratan C, Percieved Social environment and Quality of life among people living with HIV/AIDS in Nothern Thailand, 2006.
  • UNAIDS, Global Report 2012: AIDSInfo, 2012.
  • UNGASS, Thailand: Global AIDS Response Country Progress Report, 2012.
  • Reuters, Activists hail Tai Move to make Generic AIDS Drugs, 2006.
  • UNDP, Thailand Response to HIV/AIDS, 2004.
  • UNAIDS, Global Report: UNAIDS Report on the Global AIDS epidemic, 2012.
  • National AIDS Prevention and Alleviation Committee ,UNGASS Country Progress Report Thailand, 2012
  • UNAIDS, Thailand and neighbouring countries get together to help provide HIV treatment for thousands of migrants in need, 2012.
  • UNAIDS/WHO working group on global HIV/AIDS and STI: Epidemiological fact sheet on HIV and AIDS: Core data on epidemiology and response. Geneva: World Health Organization; 2008.
  • Tantivess S, Walt G: Using cost-effectiveness analyses to inform policy: the case of antiretroviral therapy in Thailand. Cost Effectiveness and Resource Allocation,2006.
  • Masaki E, Green R, Greig F, Walsh J, Potts M: Cost-effectiveness of HIV interventions for resource scarce countries: setting priorities for HIV/AIDS. Berkeley: University of California; 2003.
  • WHO, UNAIDS, Unicef, GLOBAL HIV/AIDS RESPONSE, Epidemic update and health sector progress towards Universal Access, Progress Report, 2011.
  • National Drug Threat Assessment, National Drug Intelligence Center, 2008
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