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W. P H O O L C H A R O E N

Evolution of Thailand's strategy to cope with the HIV/AIDS epidemic

HIV/AIDS is the highest-ranking cause of death among working-age adults in Thailand. The disease has led to incalculable human suffering and social disruption, as well as huge economic costs. Yet, through an innovative, compre­hensive strategy, Thailand has become the first country in the developing world where declines in HIV prevalence are seen nationally and the HIV epidemic has been successfully controlled through a prevention strategy (Phoolcharoen et al., 1998).

Thailand's strategy for HIV/AIDS prevention and care has evolved through a number of stages. This article explores the evolving policy and addresses its impact on the HIV/AIDS epidemic in Thailand.

Evolution of the HIV/AIDS policy

The evolution of Thailand's approach to HIV/AIDS may be categorized into three main phases – confrontation with the new epidemic; creation of unified alliances; and alleviation of the consequences of HIV/AIDS.

Confrontation with the epidemic (1984–90)

When Thailand witnessed an upsurge in the prevalence of HIV/AIDS in the 1980s, the government followed a standard public health approach, which emphasized case reporting of AIDS through the medical system. However, the system failed to detect the rapid spread of HIV infection, which can be asymptomatic for many years before the onset of AIDS disease. There was very limited information on risky behaviour that might spread HIV in the general population. The public perception was that AIDS affected only homosexual men, male sex workers and intravenous drug users, and the government focused preventive activities on these groups.

Prior to 1988, AIDS-related activities were funded by international and bilateral donors. The Royal Thai Government (RTG) began to allocate funds for the programme and slowly became more open to developing a policy to address HIV/AIDS, and prominent activists lent their credibility and prestige to the anti-AIDS campaign.

The Medium Term Programme for the Prevention and Control of AIDS (1989– 91) included measures for programme management, health education, coun­selling, training, surveillance, monitoring, medical and social care and laboratory and blood safety control. The strategy focused on individual risk and responsibility by providing information, raising awareness and sometimes delivering fear-inducing messages.

In 1990, a national study of behav­ioural risks for HIV infection among key population groups was sponsored by the World Health Organization and conducted by the Thai Red Cross and Chulalongkorn University. The survey findings transformed perceptions and raised awareness that the disease posed a threat to the whole population. The epidemiological surveillance results helped non-governmental organizations (NGOs) to accelerate their prevention and treatment activities and human rights advocacy and create a lobbying group for an effective AIDS policy (UNAIDS, 1998).

Human rights for people living with HIV/AIDS

IN THE EARLY 1990s, mandatory reporting of names and addresses of AIDS patients and regulations that sought to isolate and detain people with HIV/AIDS were rejected as measures to control the epidemic, and the principle of voluntary, anonymous, confidential counselling and testing for HIV/AIDS was established. The central policy in Thailand emphasized empowering people infected with HIV and AIDS. In contrast to the earlier phase of the response, people with HIV and AIDS were recognized as an essential resource for prevention and care rather than a potential reservoir of the epidemic.

 

National programme to promote condom use

THE "100% CONDOM PROGRAMME" was adopted nationwide in 1991–92 to promote universal use of condoms in commercial sex. While prostitution is illegal, authorities adopted a pragmatic approach of encouraging widespread condom use and seeking collaboration among public health officials, brothel owners, local police and sex workers. Thailand's extensive network of treatment clinics for sexually transmitted diseases (STDs) and the public health service's list of sex establishments made monitoring feasible. 

Social marketing of safe sex together with condom use has been conducted for young men and women. Condoms are available in drugstores, supermarkets, convenience stores and gas stations. Because condoms can be manufactured from Thai rubber products, they are quite affordable and accessible in markets throughout the country.

Creation of alliances and multisectoral public action (1991–97)

In 1990, then Prime Minister Anand Panyarachun announced that the official AIDS policy would be brought under the coordination of his office, and the National AIDS Prevention and Control Committee would be chaired by him (Viravaidya, 1995).

PUBLIC INFORMATION AND EDUCATION

Under the leadership of then cabinet member Mechai Viravaidya, an intensive public information campaign on HIV/ AIDS prevention was launched through the mass media, including mandatory one-minute AIDS education spots every hour on television and radio. These messages emphasized prevention through behaviour change, including condom use, and treated AIDS as not only a health problem, but also a social problem.

All ministries provided education for their constituent populations. The Ministry of Education launched peer education programmes among students and held an annual national competition for schoolchildren to write essays about HIV/AIDS, which greatly raised their level of awareness. Government efforts were complemented by private initiatives, such as the Thailand Business Coalition on AIDS, which promoted HIV/AIDS education and prevention in the work­place. A programme was launched to discourage young girls from entering into prostitution by providing scholarships for continuing their education and enhancing their employment opportunities (Wasi, 1997).

Timely information, education and communication interventions require the capacity to keep pace with social and behavioural transformations in a rapidly changing society. Better understanding of the cultural and social dimensions of behaviour was crucial to developing more sophisticated responses aimed at facilitating community support for changed behaviour. People living with HIV/AIDS have been valuable allies in formulating concepts and messages. Although HIV/AIDS information and education can be sensitive social and cultural topics, effective preventive campaigns were developed, and stig­matization of vulnerable target groups was avoided.

NATIONAL AIDS PLAN

During the period 1992–96, a compre­hensive action plan was formulated under the National Economic and Social Development Board (NESDB) to ensure cooperation among 14 government ministries, NGOs and the private sector. Government financial commitments to combating AIDS rose sharply from 1989 to 1996, and additional support was received from 19 international organiza­tions and foreign governments (see Table, page 18). The plan served as a vehicle for various Thai agencies and departments to participate in the work. Larger-scale participation resulted in increased AIDS awareness among the general public and higher-risk groups (Porapakkham et al., 1996).

During the period 1991–97, the main players were the Ministry of Public Health (MOPH) and the NGO community. While other ministries had funds, they lacked the expertise to conduct programmes, which in effect went beyond their mandates. In 1994, the MOPH was given authority for coordination of programmes; the Prime Minister continued to chair the national committee. NGOs participated formally in the policy-making process and lobbied strongly for wider dissemination of public information, protection of human rights and compassionate care for AIDS patients (UNAIDS/Phoolcharoen, 1998).

The NESDB planned the national AIDS strategy and five-year AIDS control programme, allocating resources to ministries and NGOs. The plan em- phasized the mobilization of society and communities to participate in prevention of HIV infection, to care for those who were sick and to reduce discrimination towards and stigmatization of people living with HIV/AIDS. This strategy of forming alliances and taking advantage of synergies continues at the present time.

ORCHESTRATING ALLIANCES

Government funds were allocated for:

Behavioural and social factors. Funds were directed to disseminate information and support education for the general public, as well as target groups. The programme aimed to prevent HIV infection among various groups by promoting proper values and motivation to ensure non-risky behaviour. It supported creating a mutual understanding among community members to accept the reality that AIDS threatened everyone in society. It required persuasion and support for communities to become reconciled to HIV/AIDS and for them to work with people with HIV/ AIDS.

Total funding for HIV/AIDS programmes, 1988-1998

YEAR

ROYAL THAI GOVERNMENT (million US$ )

INTERNATIONAL (million US$

TOTAL (million US$ )

PERCENT FROM RTG

1988

0.18

0.50

0.68

26.7

1989

0.44

3.87

4.31

10.2

1990

2.63

4.11

6.74

39.0

1991

7.22

2.81

10.03

72.0

1992

25.20

4.11

29.31

86.0

1993

44.33

8.39

52.72

84.0

1994

45.63

12.36

58.00

78.7

1995

62.09

11.87

73.95

84.0

1996

81.96

7.90

89.85

91.2

1997 *

44.15

6.32

50.47

87.5

1998 *

32.91

6.24

39.15

84.1

Source: Data from the AIDS Division, Communicable Disease Control, MOPH, Thailand.

* Currency value is different from that of former years (45 baht = US$1).

 

Children and HIV/AIDS

IN THAILAND CHILDREN are a high-risk group for HIV/AIDS infection because women are infected by their husbands, and the infection is transmitted to children during pregnancy or delivery. About 15 000 pregnant women are estimated to be infected with HIV each year. Approximately one-fifth of these cases lead to infection in the children. Because children can contract the HIV virus from their mothers, HIV has had an impact on infant and child mortality (Office of the Prime Minister, 1992).

A substantial number of children will experience the effects of AIDS through the death or disability of one or both of their parents: parents die before their children are capable of independent living. In 1998, His Majesty the King publicly expressed his concern about AIDS orphans and graciously advised support of AIDS orphans' education in order to assist them to live normal lives in their communities. This stimulated a national effort to alleviate the social impact of the epidemic. The Rachapracha Samasai Foundation set up a scholarship fund for AIDS orphans in four provinces, which was extended to include another five provinces before 1999. Later, the pilot project was extended and became government policy under the Ministry of Education (Rachapracha Samasai Foundation, 1998).

 

Health promotion, medical services and counselling. To support health care and community care for people with HIV and AIDS, guidelines and regimens were devel­oped to improve the standard treatment for AIDS patients. A small-scale clinical trial was conducted to improve hospital practices, and clinical settings were better outfitted to protect clients and personnel (National AIDS Committee, 1994).

Provision of counselling. Separate funds were provided so that people with HIV and AIDS, their families, service providers and other concerned people would have access to anonymous counselling. Counselling training and refresher courses were supported to extend service, as well as to maintain its quality. Testing for HIV was provided under the condition of pre- and post-counselling, as well as with prerequisite informed consent.

Living with AIDS and legal measures. The programme wished to create a positive attitude among the general public towards people with HIV and AIDS. It supported development of guidelines for the government attorney, NGOs and the community to protect human rights related to AIDS matters. Funds were allocated to support social welfare and assistance for people with HIV and AIDS and their families.

AIDS management capacity building. The structure of the national committee was expanded through every sector and province. Efforts to mobilize and empower a broad set of stakeholders to coordinate AIDS activities in each sector and area were supported. Because government officers could not reach certain populations at the margins, NGOs received an increasing amount of funds during the period 1992–96 to provide the assistance required to groups who were difficult to reach (Office of the Prime Minister, 1992).

AIDS research and evaluation. The budget was directed to promote research that leads to policy formulation and the practical application of research results, as well as to assess AIDS prevention and control efforts in Thailand. It provided financial grants through a network of researchers from universities and NGOs with the intention of expanding knowledge for the AIDS programme.

Alleviation of the consequences of AIDS (1998–present)

By 1996, the epidemic had spread more broadly through the population, reaching families and groups originally considered to be at low risk, particularly housewives, women of reproductive age in general and their infants.

A TURNING POINT: THE PLAN OF 1997–2001

The National Plan for the Prevention and Alleviation of HIV/AIDS for 1997–2001 (Office of the Prime Minister, 1997) was formulated to modify existing policy and strategy to meet new challenges. The plan of 1997–2001 was a turning point for coping with HIV/AIDS in Thailand. It recognized the strong interrelationships among national development goals in social and economic improvement, health including HIV/AIDS, children and youth development, labour and social welfare, cultural development and other areas. Community strengthening was acknowledged as the foundation for economic, cultural and social self-reliance. HIV/AIDS was no longer to be seen as a separate problem, but as an integral part of a complex social problem.

The plan of 1997–2001 emphasized efforts to mobilize communities and civil society to initiate their own activities. The plan included eight main programmes, among which were:

Empowerment of community and family. Community structures to support HIV/ AIDS alleviation were given financial assistance to sustain activities. Village programmes received matching funds, particularly in the north, where most of the people with HIV/AIDS resided. In other parts of the country, community empowerment was encouraged through collaboration of the Ministry of Interior, local government and grassroots civil society. The aim was to enable communities to manage both prevention of HIV/AIDS and alleviation of the impact of AIDS through their own resources. Education through community schools was used to strengthen the programme.

HIV/AIDS psycho-social care development. Social welfare services to cope with the special needs of people living with HIV/ AIDS and children orphaned by HIV/ AIDS became a priority. The policy aimed to enable communities and families to be self-reliant. However, knowledge was required for developing, managing and promoting programmes so that communities could apply for services and people with HIV/AIDS could live a healthier life. To nurture AIDS orphans in the community required consideration of the diverse cultures in each community. Attention to human rights protection was fundamental to sustaining the livelihood of people with HIV/AIDS.

Health and medical care for HIV/AIDS. Life can be prolonged for people with HIV/AIDS, and HIV transmission from mother to child can be prevented with health and medical care. Therefore, the health care infrastructure in the country was reoriented to be able to provide HIV/ AIDS care. The capability of health services was strengthened so that clients would be able to access appropriate services. Home-based care was made available to support the continuation of care for people with HIV/AIDS.

Cost of the national programme:1999

IN 1999, THE RTG spent 1.4 billion baht (US$37.9 million), or about 24 baht (US$0.63) per capita, from its national AIDS programme budget to prevent transmission of HIV, to care for and treat AIDS patients, to mitigate the impact of AIDS and to support AIDS research.

The largest share of the AIDS budget (63 percent) financed treatment and care, including anti-retroviral and opportunistic infection drugs for clinical trials, HIV testing and counselling, blood screening and universal precautions to prevent HIV infection in medical settings. Sixteen percent of the budget was spent on services to mitigate the impact of AIDS, including programmes to prevent transmission of HIV from mother to child, care of orphans, subsidized living arrangements for people living with HIV/AIDS who were out of work, skills training and legal counsel for people living with HIV/AIDS.

Programmes to prevent the spread of the epidemic in the population accounted for only 8 percent of the budget, covering public information, purchase of condoms for free distribution, condom promotion and other community prevention activities. An additional 6 percent of the AIDS budget was distributed as grants to NGOs for community-level AIDS prevention and care activities. The remaining 7.2 percent of the AIDS budget was allocated to management and research (World Bank, 2000).

HIV/AIDS research. Research focused on developing guidelines for the appropriate application of AIDS therapy in clinical practice and collaboration with interna­tional studies on HIV vaccine develop­ment. A need for social and behavioural research to strengthen the prevention programme was identified. However, investment in this area of research was lower than in the other two areas.

POLITICAL AND HEALTH REFORM AND THE NATIONAL PLAN FOR THE PREVENTION AND ALLEVIATION OF HIV/AIDS 2002–2006

Under Thailand's new constitution, health is protected by the state as a human right. The National Health Insurance Act, promulgated in 2002, supports the policy of universal health care coverage. Equal entitlement to health has been introduced for vulnerable populations, such as the elderly, the disabled and abandoned children, as well as people with HIV/ AIDS.

The National Plan for the Prevention and Alleviation of HIV/AIDS 2002–2006 (Office of the Prime Minister, 2002) is endeavouring to accommodate AIDS policy to fit this restructuring. The plan includes:

Contribution NGOs

NGOS HAVE PLAYED an important role in the response to AIDS in Thailand. Their critical role in facilitating care for AIDS patients has been well cited. Budget allocations to NGOs have remained steady since the beginning of the crisis, although the mix of services provided, programme coverage and likely impact have not been studied.

In 1999, the AIDS Division allocated 87.5 million baht to 465 projects of 373 organizations, for an average outlay of 188 200 baht (US$4 704) per project. In 2000 and 2001, the allocations for NGOs declined, but this difference was in part offset by the US$2.6 million AIDS component of the World Bank-financed Social Investment Project (SIP). In 2000, the AIDS budget allocated 60 million baht to nearly 300 NGOs for prevention and care, and the SIP an additional 27 million baht to six major NGOs, which allocated funds to smaller NGO collaborators (Ministry of Public Health, 2000).

Little information is available about the precise activities of the NGOs, the effectiveness of their activities and their potential to complement other public and private programmes. In particular, information is not readily available on the extent to which NGOs are involved in prevention activities, as opposed to patient care, and whether the prevention activities are focused on those at greatest risk of transmitting AIDS to others, or on the general population.

While financing of NGO activities represents a small share of overall expenditures (6.1 percent in 1999, or about 1 baht of the 24 baht per capita) – the NGO share is only slightly less than the share spent on prevention (7.6 percent) (World Bank, 2000). The extent to which these activities complement both the prevention and treatment components of the budget, as well as the activities' coverage and effectiveness, deserves review.

HIV/AIDS prevention. As a preventive measure, development of a socio­economic environment to reduce risky behaviour among individuals, families and communities is supported. Support for treatment programmes to cope with the increasing number of drug users is envisioned. Small-scale community work by NGOs will be initiated and eventually scaled up. Preventing transmission of HIV from mother to child has been emphasized for nationwide coverage.

HIV/AIDS alleviation. Clinical and community services will be strengthened to accommodate HIV/AIDS care into the evolving primary medical service. The Global Fund1 will subsidize this extension of HIV/AIDS care. The Government Phar­maceutical Organization will produce and maintain some essential drugs and diag­nostic devices to guarantee the availability of effective therapeutic measures.

In addition, capacity building of communities will be supported and encouraged through networking of NGOs. In 2002, 32.6 percent of the annual AIDS budget was devoted to health coverage, with the National Health Insurance Authority being accountable for further support of medical care for Thailand's people with HIV/AIDS (Ministry of Public Health, 2002).

HIV/AIDS research. Research will be co­ordinated to meet needs as circumstances evolve. The universities' consortium will manage research related to therapeutic treatment, socio-behavioural prevention measures and socio-economic impact so that the research results will lead to pragmatic planning and empower those coping with HIV/AIDS.

HIV/AIDS vaccine research and development. The programme aims to catalyse collaboration among research­ers, pharmaceutical companies and communities to join in the quest for a vaccine capable of controlling the HIV epidemic. A network for HIV laboratories, clinical trials and data management and a repository for vaccine research will be supported. The vaccine research and development plan aims to transfer novel technology into the country so that technical self-reliance will guarantee the national AIDS programme's feasibility.

LOOKING FORWARD

At present, these programmes under the National AIDS Alleviation Plan of 2002– 2006 have all been implemented with strong government support. However, it is too early to assess the outcomes of the programmes.

Since 1998, anti-retroviral therapeutic care and mechanisms for prevention of mother-to-child transmission have become increasingly effective, putting pressure on policy-makers to increase support for these aspects of the pro­gramme. Government funds have been allocated increasingly to medical services for AIDS patients and prevention of mother-to-child transmission of HIV in the past six years. Currently, the government has committed to allocating funds for anti-retroviral drugs and therapy of opportunistic infections to cover about 50 000 AIDS cases. With partial support from the Global Fund in 2003–2004, the government plans to extend its service to cover holistic care for all the people with HIV and AIDS in the next decade (Ministry of Public Health, 2002).

The key strategy is to repackage and manufacture anti-retroviral generic drugs and essential diagnostic tools locally. With this capability, it will be possible for all infected people to have access to medical care. In addition, NGO coalitions have joined their efforts to bolster community and family care so that continuous care will be sustained.

Behaviour change in Thailand has prevented an estimated 200 000 HIV infections that would have otherwise occurred between 1993 and 2000

The policy's impact on the epidemic

Since initiation of the national pro­gramme, behaviour and lifestyles have been profoundly affected. The demand for commercial sex has declined, condom use in commercial sex has risen and the prevalence of HIV among army conscripts has dropped by more than half. Condom use in brothels rose from about 14 percent to more than 90 percent between 1988 and 1992. A 1997 survey of nearly 2 000 sex workers in 24 provinces found that condom use was over 90 percent (Phoolcharoen et al., 1998).

The number of male STD patients reporting to public clinics fell precipitously from about 220 000 per year in 1988 to about 20 000 in 1995. The number of new cases of STDs declined from 6.5/1 000 in 1989 to 3.2/1 000 in 1991 and 1.6/1 000 in 1993. At the same time, two-thirds of the drugstores surveyed in 24 provinces reported a decline in the sale of antibiotics for STD treatment and a sustained increase in the sale of condoms, confirming that patients were not simply diverted to private treatment sources (Porapakkham et al., 1996).

Between 1990 and 1993,the proportion of men reporting any premarital or extramarital sex dropped from 28 to 15 percent, the proportion visiting sex workers dropped from 22 to 10 percent and the proportion consistently using condoms in commercial sex rose from 36 to 71 percent. HIV prevalence among 21-year-old army conscripts, which had risen to 4 percent in 1993, began a steady decline to 1.56 percent in 1999. There was a very strong association among increased condom use, reduction in visits to sex workers and reduced incidence of STDs and HIV over a relatively short period of time.

The prevalence of HIV among young women (< 25) giving birth to their first child at Chiang Rai Hospital, which is located in an area of high HIV/AIDS prevalence in the north, rose from 1.3 percent in 1990 to 6.4 percent in 1994, then declined to 4.6 percent and 2.1 percent in 1997 and 2002, respectively.

Behaviour change in Thailand has prevented an estimated 200 000 HIV infec­tions that would have otherwise occurred between 1993 and 2000. Recent estimates indicate that incidence of infection in Thailand was 29 percent lower in 2000 than what in 1994 was projected would have been the case. The number of new HIV infections in Thailand dropped from about 137 000 per year in 1990 to 29 000 per year in 2000 (Kaldor et al., 1998).

Accessibility to essential health care is still inadequate for people living with HIV/AIDS. It was expected that, given the government's policy on universal health care coverage, the pressure of civil society movements and the price adjustment of anti-retroviral drugs globally, the opportunity to gain access to appropriate care would have been improved. Although comprehensive care to encompass service and home care has been supported under the national AIDS programme, there has not been a scientific evaluation of the policy.

Conclusion

A major contributor to the Thai programme's positive impact has been the willingness to alter policies and programmes as knowledge of the extent of risk behaviour has grown and the social, economic and cultural roots of the epidemic have been exposed. This knowledge has shown clearly the role that each sector of society has had to play in the response to the epidemic. Recruitment of various sectors to participate in the programme has allowed the country to move quickly to a broad-based holistic response. True multisectoral involvement has been emphasized, and environments that foster risk reduction and care have been sought. Another factor contributing to successes in the Thai effort has been the use of multiple simultaneous approaches for HIV prevention.

The HIV/AIDS strategy has evolved to become an integral part of broader polit­ical reform in terms of decentralization, universal health care coverage and public sector reform. Evaluations should be conducted to assess the capabilities of local authorities and communities to manage the extensive endeavours of the HIV/AIDS programme. As financial support from central authorities declines, the firmness of the foundation of Thai society with respect to its ability to cope with the AIDS threat will be tested.

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summary résumé resumen

W . P H O O L C H A R O E N

Evolution of Thailand's strategy to cope with the HIV/AIDS epidemic

HIV/AIDS has led to incalculable human suffering and social disruption, as well as huge economic costs. By acknowledging the problem early and creating a comprehensive strategy, Thailand has become the first country in the developing world where declines in HIV prevalence are seen nationally and the HIV epidemic has been successfully controlled through a prevention strategy. The multifaceted approach to prevent the spread of HIV and care for those who are affected is the focus of this article. Government commitment at the highest levels and willingness to alter policies and programmes are highlighted as major contributors to the positive experience in Thailand. The evolution of the policy is described in three phases: confrontation with the new epidemic; creation of unified alliances; and alleviation of the consequences of HIV/AIDS. As understanding of the social, economic and cultural roots of the epidemic grew, each sector of society came to play a role in the response to the epidemic. Public information campaigns, mobilization of resources and support for HIV-affected people are discussed.

L'évolution de la stratégie de la Thaïlande face à l'épidémie du VIH/SIDA

Le VIH/SIDA entraîne des souffrances humaines incalculables et un dérèglement social considérable, et comporte des coûts économiques faramineux. En reconnaissant rapidement le problème et en élaborant une stratégie globale, la Thaïlande est devenue le premier pays du monde en développement où une diminution de la prévalence du VIH est enregistrée au niveau national et où l'épidémie a pu être maîtrisée grâce à une stratégie de prévention. L'approche polyvalente de la prévention de la diffusion du VIH et des soins à ceux qui en sont atteints, est le thème central de l'article. L'engagement des pouvoirs publics aux plus hauts niveaux et la volonté de modifier les politiques et les programmes, sont indiqués comme étant les principaux moteurs de l'expérience positive de la Thaïlande. L'évolution des politiques s'est déroulée en trois temps: confrontation à la nouvelle épidémie; création d'alliances unifiées; et allégement des conséquences du VIH/SIDA. Grâce à une meilleure compréhension progressive des racines sociales, économiques et culturelles de l'épidémie, chaque secteur de la société a été appelé à jouer un rôle face à l'épidémie. L'article traite notamment des campagnes d'information du public, de la mobilisation de ressources et du soutien apporté aux personnes atteintes du VIH/SIDA.

Evolución de la estrategia de Tailandia para hacer frente a la epidemia de VIH/SIDA

El VIH/SIDA ocasiona incalculables sufrimientos humanos y un considerable trastorno social, a la vez que enormes costos económicos. Al reconocer muy pronto el problema y elaborar una estrategia global, Tailandia ha pasado a ser el primer país del mundo en desarrollo donde se observa un descenso de la prevalencia del VIH a escala nacional y donde la epidemia ha podido ser controlada gracias a una estrategia de prevención. El presente artículo se centra en el método polivalente utilizado para prevenir la propagación del VIH y atender a las personas afectadas. El compromiso del Gobierno al más alto nivel y la voluntad de modificar las políticas y los programas son señalados como los principales factores que han contribuido a la experiencia positiva de Tailandia. Se describe la estrategia, que se desarrolla en tres frases: enfrentamiento a la nueva epidemia; creación de alianzas unificadas; y mitigación de las consecuencias del VIH/SIDA. A medida que se comprenden mejor las causas sociales, económicas y culturales de la epidemia, cada sector de la sociedad pasa a desempeñar una función en la lucha contra la epidemia. En el artículo se examinan las campañas de información pública, la movilización de recursos y el apoyo a las personas afectadas por el VIH.


1 Editor's note: The Global Fund to Fight AIDS, Tuberculosis and Malaria is a partnership among governments, civil society, the private sector and affected communities that assists with international health financing. For more information, see: http://www.theglobalfund.org/en/.


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