1. Guideline on a method to approach and deliver an HIV prevention package in MSM and TG: Why and How ?
Petchsri Sirinirund
Advisor to HIV/AIDS Policy and Programme
Department of Disease Control, Thailand
ICAAP 11, 19 Nov 2013, Bangkok
THAILAND

2. Country context Population: 68 million Middle Income Country
GDP per capita: 7,995 US$
Universal Health Coverage
Robust Health Infrastructure
87% of AIDS spending is from domestic resources (US$ 267 M)
THAILAND

3. Epidemic Mature epidemic with naturally declining incidence
Peak in the mid-90’s with around 160,000 new HIV infections per year
2012: less than 10,000 new HIV infection per year
Estimated 500,000 PLHIV
Mother-to-child transmission: 2.7%
THAILAND

5. Whom and where most new infections occur...
Projection using AEM Model
Geographic Focus:
Population Groups: (Mode of Transmission) 6%
32%
41%
65% of new HIV infections happen in 31 provinces
10%
11%
MSM
41%
27% of new infections occur in BKK
43,040 new infections
THAILAND

6. National AIDS Strategy, 2012-2016: Vision and Goals
Vision: To get to Zero New HIV Infections
Goal for 2016:
New HIV infections reduced by two-thirds
Rate of vertical transmission of HIV less than 2%
Vision: To get to Zero AIDS-related Deaths
Goal for 2016:
Equal access to quality treatment, care, support and social protection for all people affected by HIV
AIDS related deaths reduced by half
TB deaths among people living with HIV reduced by half
Vision: To get to Zero Stigma and Discrimination
Goal for 2016:
All laws and policies which obstruct equal access to prevention, treatment and care services are revised
Human Rights and gender specific needs are addressed in all HIV responses
Stigma and discrimination of PLHIV and key affected populations reduced by half
THAILAND

7. National AIDS Strategy 2012-2016
Relating key points
At scale - coverage
More accessible
Ensure quality
Strategic information
Sustainability (Local administrative organization)
THAILAND

8. Public Health Questions for the program
Are we doing the right things?
What are contributing factors?
What interventions can work?
What interventions and resources are needed?
Are we doing them right?
Are we doing them on a large enough scale? “
Source: “A Public Health Questions Approach to HIV/AIDS Monitoring and Evaluation” UNAIDS

9. Process to develop national guideline for HIV prevention among MSM
Evidence
Assessment of practices
Synthesis of the findings from various sources
Study visit to Avahan project in India
Workshop training for the multi-sectoral team on SOP (Standard Operating Procedure)
THAILAND

10. Synthesis of findings… as formative assessment
Sources of Information
Assessment of practices
Lessons learned from CHAMPION project
Consultation for development of national guideline
Study on MSM network
(Draft) National AIDS Strategy
THAILAND

11. Main issues Management Innovation Target population
Subgroups
Core package of services
Outreach / Facility based services
BCC, VCT, STI
Condoms and lubricant
Enabling environment
Continuum of services
Understanding and positive attitudes (Policy, implementation, community, public)
Management
Strategic information
Routine HIV Integrated HIV Information System (RIHIS)
Micro-planning
Innovation
PrEP
ART for prevention
THAILAND

12. Target population By people By place By context
Age group (young MSM:<15, 15-19, yrs)
Sexual identity (Gay, TG)
Multiple risk (sex work, drug use)
Potential barriers (Muslim, migrant)
HIV status
Multiple risk (drug use)
Formal education
Entertainment
Public place
Internet
Closed setting
By context
City
Rural
THAILAND

13. National Guideline Development
Characteristics
Process
Technically sound
Feasibility
Acceptability
Participatory
Advocacy
SOGI understanding
Participants
Policy / Implementation
GO / CSO / Academia
THAILAND

14. Technical support and administration
Working structure
Advisory committee
Technical task force
Technical support and administration
Experts
Members:
Gov, NGO, Community, Academia (national and international)
THAILAND

15. Participatory – Technically and Feasibility sound
National consultation at the first step
Technical task force with experts
First draft of national guideline
Working with selected provinces to review feasibility
Final draft of national guideline
Oversight by advisory committee
THAILAND

16. More Focus
Area-based planning
THAILAND

17. Three levels of program intensity
Most intensive implementation - BKK
Intensive implementation
Minimum implementation
Criteria
HIV prevalence
Number of KAPs
Social context
Intensivity
Spectrum of interventions
Resources
Monitoring and evaluation
THAILAND

18. Acknowledgement UNDP World Bank Thailand MOPH – US CDC Collaboration
UNAIDS
Stakeholders (Gov and NGO and CSO)
Avahan
THAILAND