THAILAND 

Ending AIDS 
THAILAND AIDS RESPONSE PROGRESS REPORT 
2015 
คณะกรรมการแหง่ ชาติ วา่ ดว้ ยการป้องกั นและแกไ้ ขปัญหาเอดส ์ NATIONAL AIDS COMMITTEE 
 
2015 
T 
HAILAND 
AIDS R 
ESPONSE 
R 
EPORT 
Reporting Period: Fiscal Year of 2014 
P 
ROGRESS 
 
Introduction 
Thailand  has  joined  the  commitment  to  the  2011  UN  General  Assembly  Special  Session  on  HIV  to 
prevent  and  control  the  AIDS  epidemic  and  pursue  the  strategy of 3 Zeroes: (1) Zero HIV new infection; 
(2)  Zero  AIDS death; and (3) Zero AIDS stigma and discrimination. The Thailand National Strategic Plan 
of  HIV  (2014-16)  has  set  the  2016  targets  to  reduce  new  HIV  infection  by  two-third,  peri-natal 
transmission  rate  less  than  2%,  AIDS  related  deaths  reduced  by  half,  and  discrimination  to  key 
populations  and  people  living  with  HIV  reduced  by  half.  The  National  AIDS  Committee  (NAC)  further 
approved  the  policy  of  ending  AIDS  epidemic  in  Thailand  by  2030 as the national priority on November 
28,  2014,  and  directed  all  related  agencies  at  the  national  and  sub-  national  level  to  mobilize  efforts  to 
achieving  the  objectives.  In  addition,  Thailand  has  developed  key  measures  and  the  operational  plan  for 
2015-19  to  support  the  ending  AIDS  policy.  The  measures  have  applied  strategies  of  test  and  treat 
regardless of CD4 level with the focus to most affected areas and populations 
This  report  is  the  product  of  active  and  participatory  collaboration  of  government  and  non-  government 
agencies,  civil  society  organizations,  academia,  international  agencies,  and  representatives  of  key 
populations  and  the  Thailand  Network  of  Positive  People  (TNP+)  during  fiscal  year  of  2014. 
Representatives  from  these  agencies  and  individuals  reviewed,  analyzed  and  discussed  the  latest  data  on 
indicator  targets  as  a  basis  for  the  findings  reported  herein.  This  progress  report  has  been  acknowledged 
by the NAC Sub-committee on Strategic Information. 
I 
 
Contents 
Introduction I 
Contents II 
Table and Figure III 
Acronyms IV 
Summary 2015 Thailand Global AIDS Response Progress Report 6 
1. Overview of the AIDS Epidemic 7 
2. Thailand National AIDS Strategy and Responses during 2014 9 
3. Country Progress 
Target 1: Reduce sexual transmission of HIV 11 
Target 2: Reduce transmission of HIV among people who inject drugs 21 
Target 3: Eliminate mother-to-child transmission of HIV 25 
Target 4: Reach universal access to quality antiretroviral therapy 28 
Target 5: Reduce tuberculosis-related deaths for PLHIV 31 
Target 6: Close the resource gaps 33 
Target 7: Eliminate gender inequalities and gender-based abuse and violence and 
increase capacity of women and girls to protect themselves from HIV 
36 
Target 8: Eliminate stigma and discrimination against PLHIV and the affected 40 
Target 9: Eliminate travel restriction 42 
Target10: Strengthen HIV integration 43 
4. Summary Tables of GARP Indicators for all targets between 2009 and 2014 45 
II 
 
Table and Figure 
Table 1 Key figures of HIV estimation in Thailand 7 
Figure 1 Estimated new HIV infections in adult population based on the current 
response 
8 
Figure 2 Estimated AIDS-related deaths based on the current response 8 
Figure 3 Framework of the National AIDS Strategic Plan (2014-16) and Operational 
Plan to End AIDS (2015-19) 10 
Figure 4 Percentage (%) of people who inject drugs who reported using sterile 
injecting equipment the last time they injected 10 
Figure 5 Percentage (%) of people who inject drugs that have received an HIV test 
in the past 12 months and know their results 22 
Figure 6 Percentage of adults and children with HIV currently receiving 
antiretroviral therapy 
29 
III 
 
Acronyms 
AEM: AIDS epidemic model AIDS: Acquired immunodeficiency syndrome ANC: Antenatal care ART: 
Antiretroviral therapy ARV: Antiretroviral drugs ASO: AIDS-response Standard Organization BATS: 
Bureau of AIDS, TB and STIs BOE: Bureau of Epidemiology BSS: Behavioral surveillance survey DDC: 
Department of Disease Control DIC: Drop-in center DOC: Department of Corrections DOH: Department 
of Health EWI: Early warning indicators FSW: Female sex workers Global Fund: Global Fund to Fight 
AIDS, Tuberculosis and Malaria HIV: Human immunodeficiency virus HLM: High level meeting HSS: 
HIV sentinel sero-surveillance HTC: HIV testing and counseling IBBS: Integrated biological and 
behavioral surveillance IPSR: Institute of Population and Social Research KAP: Key affected population 
KPI: Key performance indicator LAO: Local administrative organization M&E: Monitoring and 
evaluation MHW: Migrant health worker MW: Migrant worker MICS: Multiple indicator cluster survey 
MMT: Methadone maintenance therapy MOL: Ministry of Labour MOPH: Ministry of Public Health 
MSDHS: Ministry of Social Development and Human Security MSM: Men who have sex with men 
MSW: Male sex workers NAC: National AIDS Committee NAMC: National AIDS Management Center 
NAP: National AIDS Program: Database program for antiretroviral treatment of NHSO NAPHA: 
National access to antiretroviral drug for people living with HIV and AIDS NAS: National AIDS strategy 
NASP: National AIDS strategic plan NCPI: National commitment and policy instrument NGO: 
Non-governmental organization NHSO: National Health Security Office 
IV 
 
NSO: National Statistical Office PCM: Provincial coordinating mechanism PCR: Polymerase chain 
reaction PHAMIT: The project entitled: Prevention of HIV and AIDS among Migrant Workers PHIMS: 
Peri-natal HIV information monitoring system PICT: Provider initiated counseling and testing PLHIV: 
People living with HIV and AIDS PMTCT: Prevention of mother-to-child HIV transmission PWID: 
People who inject drugs RDS: Respondent driven sampling RIHIS: Routine integrated HIV information 
system STI: Sexually transmitted infection TB: Tuberculosis TBCA: Thailand Business Coalition on 
AIDS TG: Transgender people TNP+: Thai Network of People Living with HIV/AIDS TUC: Thailand 
MOPH-US CDC Collaboration UNAIDS: Joint United Nations Programme on HIV/AIDS UNGASS: 
United Nations General Assembly Special Session on HIV/AIDS UNHCR United Nations High 
Commissions for Refugees UNICEF: United Nations Children’s Fund UN Woman United Nations Entity 
for Gender Equality and the Empowerment of Women USAID: United States Agency for International 
Development VCT: Voluntary counseling and testing WHO: World Health Organization 
V 
 
Summary: 2015 Thailand Global AIDS Response Progress Report 
Target 1: Progress has been made but the scale and coverage are not enough to reach targets and have the desired impacts 
particularly in MSM and TG. More effort and resources are needed to rapidly expand the re-designed services and approaches to 
reach 90-90-90 targets in key population. Adjustment of HIV interventions to address specific needs and/or context is needed for 
non-Thais, young key population, and non-venue based key populations. 
Target 2: There has been progress on policy with better political support for harm reduction programs. While the drug use 
situation is fast evolving and diverse, harm reduction services, including opioid substitution therapy, and needle/syringe programs 
have to be rapidly implemented and addressed the needs of the local context. 
Target 3: Thailand can be among the one of the first countries in the world to eliminate mother-to- child transmission of HIV. 
The MTCT rate was 2.1% in 2014, thus achieving the target ahead of the national target date. Validation towards elimination of 
MTCT is underway. 
Target 4 Thailand was one of the first countries in the Asia and Pacific region adopting ambitious targets and providing 
anti-retroviral treatment to people with HIV irrespective of CD4 count. There is a need to focus on early detection and treatment 
for key populations as well as improving access to services for non-Thais. 
Target 5 Thailand has made considerable progress in alignment of HIV and TB programmes. The focus needs to be on improving 
ART in co-infected patients, monitoring and improving clinical practice to ensure early detection of HIV and/or TB, and 
prevention of leakage in treatment cascade. 
Target 6 Thailand has mobilized more domestic resources to support the Ending AIDS policy. Continuous effort is needed to 
prepare for the transition to self–reliance and ensure sustainability of the HIV response with continued engagement of CSOs and 
communities in delivering appropriate HIV prevention for key populations. 
Target 7 Progress has been made on advocacy and mobilization of organizations, communities and networks on gender issues 
related to transgender populations, MSM and women living with HIV. Thailand needs to ensure the provision of gender-sensitive 
services especially for HTC, prevention, treatment and care through appropriate policies and quality- controlled implementation 
with meaningfully engagement of CSO and local communities. Target 8 Legal and policy barriers have been reduced including 
parental consent for HIV in young people, harm reduction, and migrants. Development and scaling up of stigma and 
discrimination reduction interventions in the health care setting is underway. Thailand is planning to normalize HIV as a key 
measure for enabling environment of sigma reduction 
Target 9 Thailand has no travel restriction in place. 
Target 10 The re-designed HIV/AIDS-related services can be an example for Global Health Integration through task-shifting and 
task-sharing in new partnerships between the public sector, civil society, and the private sector. 

6 
 
2015 Thailand Global AIDS Response Progress Reporting 
1. Overview of the AIDS Epidemic 
HIV burden Using the AIDS epidemic model (AEM) for adults (aged 15+ year) and Spectrum for 
children (aged less than 15 year), there were estimated 7,816 new HIV infections, 20,492 AIDS related 
deaths, and 445,504persons living with HIV (PLHIV) at the end of 2014 in Thailand. Females account for 
39% of total adult PLHIV and 47% of children living with HIV. 
Table 1: Key figures of HIV estimation, Thailand 
Estimated Number 2000 2005 2010 2012 2014 
Total annual new infections 
• New infections in all adults* 
29,619 28,241 
16,014 15,266 
10,215 
8,877 10,011 
8,719 
7,816 7,695 New infections in women adults * 
• New infections in all children 
New infections in girl children 
15,716 1,378# 669# 
7,237 748# 363# 
3,294 204@ 99@ 
2,576 158@ 76@ 
1,944 121@ 59@ 
Total annual AIDS mortality 
• AIDS mortality in all adults* 
AIDS mortality in women adults * 
• AIDS mortality in all children 
AIDS mortality in girl children 
20,670 20,422 6,079 248@ 133@ 
20,492 20,325 6,127 167@ 94@ 
Total people living with HIV 
• All adults living with HIV * 
Women adults living with HIV * 
• All children living with HIV 
Girl children living with HIV 
55,531 55,079 12,036 452# 221# 
31,211 30,805 7,153 406# 199# 
20,477 20,270 6,116 207@ 114@ 
683,841 676,005 217,860 7,836# 3,843# 
555,808 544,743 212,351 11,065# 5,428# 
493,932 485,646 199,978 8,286@ 3,998@ 
471,811 464,086 198,013 7,725@ 3,697@ 
445,504 438,629 172,454 6,875@ 3,262@ 
Total population (million) 60.6 63.1 63.9 64.5 65.1 
* Estimation using the ‘AEM’, # Estimation using ‘Spectrum’ in 2013, @ Estimation using ‘Spectrum’ in 
2014 
New HIV infections in adults have declined but are insufficient to reach the national and HLM target The 
number of adults who are newly infected with HIV is continuing to decline but at a slower pace. The 
reduction of new HIV infections during 2000-2010 was 65%. There were an estimated 7,700 HIV 
infections in 2014, a decline of only 23% from 2010. This falls short of the national target by two-thirds 
or the HLM target by half. 
7 
 
Figure 1 Estimated new HIV infections in adult population based on the current response 
Closer to eliminating new HIV infections among children Progress in eliminating new HIV infections 
among children has been dramatic in Thailand. In 2014, 121 children were estimated to be newly-infected 
with HIV. This represents about 41% reduction compared to the level in 2010. The MTCT rate was 
estimated 2.1% in 2014, thus in line for achieving the 2016 target ahead of the National Plan. Thailand 
can be one of the first middle countries in the world to eliminate MTCT. 
AIDS-related deaths remain unchanged in last 5 years The estimated number of AIDS-related deaths 
sharply decreased by 63% between 2000 and 2010 (from 55,531 to 20,670); since then, the number of 
AIDS deaths has remained stable. In 2014, the estimated number of AIDS-related deaths was 20,492. 
These data indicate that, since the early of 2000s, when the ART programme was expanded and rapidly 
scaled up, the Thai program has averted a significant number of AIDS related deaths since that time. 
Although ART coverage still increased during 2010-2014, many PLHIV learn about their positive status 
and receive ART very late in the course of disease. This reduces effectiveness of ART. In addition, 
coverage of screening co-infection such as tuberculosis has not been increased significantly. Thus, a 
significant proportion of PLHIV die within the first six months after diagnosis even though they have 
access to services and treatment. Figure 2 Estimated AIDS-related deaths based on the current response 
8 
 
2. Thailand National AIDS Strategy and Responses 
Thailand  has  committed  itself  to  ending  the  AIDS  epidemic  by  2030.  The  Cabinet  and  National  AIDS 
Committee  (NAC)  approved  the  National  AIDS  Strategic  Plan  (NASP)  for  2014-16. The updated NASP 
has  reinforced  the  original  2012-16  strategies  and  incorporated  additional  measures  that  will  enable  the 
country  to  achieve  the  ending  AIDS  targets  by  2030.  The  costed  Operational  Plan  for  Ending  AIDS  in 
Thailand  for  2015-2019  has  been  developed  and  approved  by  NAC  in  November  2014.  Thailand  has 
implemented  the  new  guideline of antiretroviral treatment by providing antiretroviral treatment to all HIV 
positive people regardless of CD4 nationwide since October 1, 2014. 
The  NSP  (2014-2016)  presents  two  over-arching  strategic  directions;  (i)  innovation  and  change;  and (ii) 
optimization  and  consolidation.  It  is  based  on  the  principles  of  promoting  equality;  implementation  of 
people-centered  approaches;  clear  target  setting;  creating  national  ownership  and  leadership; 
empowerment  and  increasing  self-esteem;  and  working  in  partnership  with  government,  private  and 
non-governmental  sectors.  The Plan focuses on vulnerable populations of MSM, TG, MSW, PWID, FSW 
and their clients in 33 priority provinces. 
The  NSP  (2014-2016)  set  ambitious  targets:  (i)  new  HIV  infections  reduced  by  two-thirds;  (ii)  vertical 
transmission  of HIV less than 2%; (iii) universal access to social protection and quality care and treatment 
for  PLHIV;  (iv)  AIDS related deaths reduced by 50%; (v) TB deaths among PLHIV reduced by 50%; (vi) 
laws  and  policies  which  impede  access  to  prevention,  treatment  and  care  and  other  government  health 
services  revised;  (vii)  human  rights  and  gender  specific  needs  are  addressed  in  all  HIV  responses;  and 
(viii)  number  of  discrimination  and  /or  human  rights  violation  cases  occurring  to  PLHIV  and  KAPs 
reduced by 50%. 
The  Operational  Plan  (2015-2019)  has  been  developed  to  elaborate  critical  activities  to  ensure  the 
achievement  of  the  long  term  ending  AIDS  goals  by  2030.  Main  inputs  were  drawn  from  the  recent 
knowledge  of  early  antiretroviral  treatment  on  prevention  benefits(HPTN052), the evaluation studies, the 
national  consultation  on  strategic  use  of  ARVs,  and  the  national  consultation  of  the  ending  AIDS  in 
Thailand through evidence based responses. 
The  Plan  has  identified  30  high  burden  provinces  (including  the  greater  Bangkok  area)  and  utilizes  the 
preventive  effects  of  ART  in  reducing  HIV  infections  with  the  focus  on  effective  package  of  service  to 
key  populations. Thailand adopts a new approach, the Reach-Recruit-Test- Treat-Retain (RRTTR), as the 
framework  addressing  gaps  in  linkage  between  prevention  and  life-long  treatment  system  by  connecting 
five  critical  components.  The  plan  also  defines  a  tailored  service  package  for  each  key  population,  and 
lays  out  criteria  for  the  intensity  in  which  services  should  be  delivered  at  the  provincial  level.  The  Plan 
has  been  costed,  with  a  total  THB  9,214,862,566  for  5  years  allocated  to  key  action  areas:  providing 
RTTR  services  (77%),  strengthening  health  and  community  system  (4%),  enabling  environment  (6%), 
and programme management (13%). 
9 
 
Figure 3 Framework of the National AIDS Strategic Plan (2014-16) and Operational Plan to End AIDS 
(2015-19) 
Thailand Getting to Zero 
National Strategy on HIV/AIDS 2014 - 2016 
Zero New HIV Infections Zero AIDS-related Deaths Zero Discrimination 
Innovations and Changes 1. Expand rights based, gender sensitive and 
comprehensive prevention services for key populations 2. Enhance protective social and legal 
environments 3. Create sense of ownership to all 
stakeholders 4. Implement a new generation of strategic 
information and monitoring and evaluation 
Optimization and Consolidation 1. Prevention of Mother to Child Transmission 2. Prevention among Young People 
3. Condom Programming 4. Blood Safety and Universal Precaution 5. Treatment, Care and Support 6. Care and Support for 
Affected Children and Families 7. Stigma and Discrimination 8. Public Communication 
Social Justice and human rights based 
People centered Beyond disease 
focus 
Community and 
people Empowerment 
Increased 
Local leadership & 
Partnership& focus 
ownership 
Networking 

10 
 
3. Country Progress towards 10 targets of UN HLM and Thailand’s NASP 
Target 1 HLM: Reduce sexual transmission of HIV by half by 2015 Thai NASP: Reduce sexual 
transmission of HIV by two-third by 2016 
Key Affected Populations (FSW, MSW, MSM, TG) 
Female sex workers (FSW) 
National milestone for 2014 
• 70% of FSW reached with prevention services in the last 12 month 
• 70% of FSW received HTC and know their results in the last 12 month 
• 95% of FSW reported condom use at last sex 
Achievement by the end of 2014 The national estimated number of FSW was 123,530 in 2010, with 
possibly one-fourth working as non-venue-based FSW (NVB-FSW). Based on program data, a 
significant proportion is non- Thai FSW (about 21% based on program reports from the Global Fund sites 
in 2014). HIV prevalence among venue-based FSW has declined steadily from 2.7% in 2010 to 2.2% in 
2012 and 1.1% in 2014. The most recent survey among NVB-FSW in Chiang Mai, Phuket and Chonburi 
in 2010 found HIV prevalence about 5, 1.4, and 1.2% respectively. The next round of IBBS among 
NVB-FSW will take place in 2015. 
Targeted  peer-led  outreach  services  are  conducted  in  41  provinces  with  mainly  financial  support  by  the 
Global  Fund  and  National  Health  Security  Office  (NHSO).  Outreach  activities  are  focused  on  hotspots 
and  conducted  by  445  peer  educators,  staff  and  volunteers  of  NGOs.  This  is  complemented  with 
behavioral  change  activities  at  drop-in  centers,  disseminated  information  materials  and  targeted  condom 
promotion.  Based  on  the  IBBS  in  11  provinces,  there  was  increased  prevention  coverage  from  51%  in 
2010,  to  54%  in  2012  and  58%  in  2014.  However  the  increase  is  still  insufficient to achieve the national 
target  of  70%.  The  number  of  FSW  reached  with  prevention  interventions  (based  on  reports  from  GF 
grantees)  increased  from  43,504  in  2010  to  49,756  at  the  end  of  Fiscal  Year  2014.  A  total  of  8,253 
non-Thai  FSW  were  reached  with  prevention  interventions.  Based  on  IBBS  2014,  there  has  been 
significant  achievement  in  selected  provinces  where  prevention  uptake  has  met  the  national  targets, 
including Lopburi (83%), Srisaket (98%), Udon Thani (69%) and Phuket (75%). 
Uptake  of  HTC  services  from  IBBS  data  has  improved  somewhat  but  is  still  below  the  national  target 
coverage  for  2014  of  70%.  According  to  the  IBBS  2010,  48%  of  venue-based  FSW reported having had 
HTC  in  the  past  12  months  and  received  HIV  test  results.  This  indicator  improved  to  57%  in  2012  and 
54%  in  2014.  There  were  3  out  of  11  sentinel  sites  reported  significant  increases  of  HTC coverage from 
2010  to  2014,  namely  Srisaket  (31%  to  94%),  Phuket  (66%  to  82%)  and  Songkla  (56%  to  88%).  Data 
from  the  national  evaluation  of  services  for  HTC  and  treatment  with  the  survey  among  FSW  in  7 
provinces  in  2013 found that 85.6% of FSW had been ever tested for HIV and 68.3% had tested within 12 
months.  Even  though  mobile  HTC clinics have been deployed in selected sites, the inconvenience and the 
time  required  for  knowing  test  results  has  been  identified  as  major  obstacles  in  addition  to  the  fear  of 
knowing the 
11 
 
results (IPSR, 2013). There was a high proportion of FSWs (30%) who did not return for their HIV test 
results (PPAT, 2015). 
Condom use at last sex with a client is high and stable at over 95%, and this meets the national target. 
The  accomplishments  are  only  known  among  VB-FSW.  Limited  data  exist  to  demonstrate  change  of 
access  to  key  services  overtime  for  NVB-FSW.  Based  on  the previous survey in 2010 and 2007, the data 
indicate  that  access  to  outreach activities, condoms and behavior change communication materials among 
NVB-FSW  was  lower  than  for  the  VB-FSW.  A  similar  pattern  is  found  on  accessing  STI  and  HTC 
services indicating that NVB-FSW had lower access to STI and HTC services. 
Male sex workers (MSW) 
National milestone for 2014 
• 70% of MSW reached with prevention services in the last 12 month 
• 70% of MSW received HTC and know their results in the last 12 month 
• 99%of MSW reported condom use at last sex 
Achievement by the end of 2014 It was estimated there were 18,239 MSW in Thailand in 2010. MSW are 
largely concentrated in large and tourist provinces such as Bangkok, Chonburi, Chiang Mai and Phuket. 
HIV prevalence among MSW has been declining but remains very high: 16.0% in 2010, 12.2% in 2012 
and 11.7% in 2014. 
Peer-led  outreach  interventions  for  MSW  in  5  provinces  were mainly funded by the US government, and 
the  Global  Fund.  In  2014,  USAID  established  incentivized  case-finding  activities  for  MSW in Bangkok, 
Chonburi  and  Chiang  Mai,  while  the  US  CDC  provided  technical  assistance for the MSW programme in 
Phuket  and  Ratchaburi.  The  proportion  of  MSW  who  have  been  given  condoms  (by  peer/outreach 
workers)  increased  sharply  from  73%  in  2010  to  90%  in  2012  and  94%  in  2014.  This  trend  is  similar 
across  the  5  provinces.  However,  the  programme  did  not  achieve  such  improvements  when  using  the 
composite  indicator  of  “have  been  given  received  condoms  and  know  where  to  go  for  HTC.”  The 
prevention coverage among MSW decreased to 64% in 2014 compare to 74% in 2012) 
Uptake  of  HTC  in  MSW  has  improved  a  little  from  49%  in  2010,  to  52%  in  2012  and  54%  in  2014  but 
still  has  not  reached  the  national  target  for  2014  of  70%.  The  strategies  of  rapid  test  results  and  user 
friendly  services  will  become  the  standard  at  MSW  drop-in  centers  in  the  priority  sites  with  an 
expectation to fill this gap in 2015. 
Condom use at last sex with a client was high and increasing over time from 88% in 2010, to 98% in 2012 
and 96% in 2014. 
12 
 
Men who have sex with men (MSM) and Transgender (TG) populations 
National milestone for 2014 
• 50% of MSM and TG populations reached with prevention services 
• 60% of MSM and TG received HTC and know their results in the last 12 month 
• 90% of MSM and TG reported condom use at last sex 
Achievement by the end of 2014 
Men who have sex with men (MSM) There were an estimated 550,000 MSM in Thailand (excluding 
MSW) in 2010. The median estimates of HIV prevalence among MSM have been high and not 
declining,8.0% in 2010 to 7.1% in 2012 and 9.2% in 2014 (BoE, 2015). The 2014 round of the IBBS was 
carried out only in five sites, with a reduction from 12 sites in 2010 and 2012. Therefore the results 
should be cautiously interpreted. For the purpose of comparing data during 2010 to 2014, only five sites 
are included for this report. The studies of HIV in Bangkok among MSM do not show any sign of decline 
or reversal in prevalence and incidence either. HIV prevalence among MSM in the HIV surveillance and 
cross-sectional studies has consistently been around 20-30% for the past 10 years. This high HIV 
prevalence is supported by similarly high HIV incidence of 5 to 6 per 100 person years (PY) among men 
enrolled in observational and synthetic cohort studies conducted in Bangkok during the same period. 
Targeted  HIV  interventions  for  MSM  were  implemented  in  29  provinces  with  funding  support  by  the 
Global Fund, the US government, the NHSO and the Thai Health Promotion Fund. Peer-led interventions, 
targeted IEC/media, condom promotion and distribution, HTC and referral to HIV and STI treatment have 
been  implemented  as  part  of  the  core  service  package.  In  2014,  incentivized  case-finding  has  been 
implemented  in  selected  sites  to  improve  recruitment  of  MSM  and  TG  into  prevention  services.  Public 
information  campaigns  via  the  Internet  and  social  media  have  been  developed  and  launched 
systematically.  However,  the  overall  coverage  of  prevention  interventions  has  not  increased  during  the 
report  period.  According  to  the  IBBS  in  five  sites  (Bangkok,  Chonburi,  Chiang  Mai,  Ratchaburi  and 
Phuket)  uptake  of  MSM  for  prevention  services  rose  from  44%  in  2010  to  53%  in  2012  but  dropped  to 
46%  in  2014.  These  levels  are  insufficient  to  meet  the  national  target.  Through  consultation  with  the 
MSM  community,  the  lack  of  improvement  may  be  partly  due  to  funding  reduction  and  the  trade-off  of 
applying  different  approaches to reach MSM: peer-outreach through venue-based and via social networks 
or  peer  to  peer  networking.  In  addition,  the  IBBS  was  carried  out  using  venue  day  time sampling frame, 
so it is not known what the status is for the NVB MSM for these indicators. 
The  percentage of MSM who had HTC and received the results in the past 12 months increased from 15% 
in  2010  to  26%  in  2012  and  to  31%  in  2014.  The  survey  among  MSM  in  7  provinces  from the National 
Evaluation  of HTC and treatment in 2013 found 61.8% ever been tested for HIV and 41.6% been tested in 
the  last  year.  However,  these  levels  are  still  low  and  far  below  the  national  target  of  60%.  Sub-national 
analysis  shows  that  better  progress  has  been  made  in  selected  sites:  HTC  coverage  among  MSM  in 
Chonburi  doubled  from  2010  compared  with  2014  (14%  vs  27%),  increased  distinctly  in  Chiang  Mai 
(30%  vs  46%),  increased  nearly  four-fold  in  Ratchaburi  (8%  vs  31%)  and  doubled  in  Phuket  (15%  vs 
32%).  These  increases  may  be  the  result  of  the  introduction  of  rapid  tests  with same-day results, offered 
at community-led HTC 
13 
 
clinics  in  six  drop-in  centers  targeting  MSM,  TG  and  MSW.  In  addition,  mobile  HTC  clinics  were 
deployed  in hot spots in partnership with provincial health offices and general hospitals. There were still a 
gap  between  coverage  and  the  national  target  suggesting  that the services are still limited in scale and are 
not yet enough to generate national level impact. 
Condom use at last sex with a male partner was high and stable at 80% - 82% between 2010 and 2014. 
Urban and young men who have sex with men (YMSM) Data from observational and synthetic cohort 
studies found that HIV prevalence among (older) MSM of ≥25 years of age in Bangkok now exceeds 
40%, and the HIV incidence among (younger) MSM of ≤21 years of age ranges from 8.8 to 12.2 per 100 
PY (Van Griensven, 2015). 
Urban  YMSM  (aged  15-22  years  old)  have  been  considered  at  highest  risk  for  HIV  infection.  The 
in-depth  analysis  revealed  that  estimated  HIV  incidence  increased  from  4.1  to  7.6  per  100  PY  during 
2003-2014.  Practice  of  anal  sex  declined  from  99%  in  2003  to  82%  in  2014,  and  playing  the  receptive 
anal  sex  role  increased  from  55%  to  74%.  Always-condom-use  has  remained  stable  at  50%.  Increases 
were  seen  in  reports  of  drug  use.  History  of  HIV  testing  (ever)  increased  from  29%  in  2003  to  47%  in 
2014, but testing during the past 12 months did not, and remains at 27% in 2014. 
Based on this analysis, more determined and rigorous HIV prevention efforts are needed to stop the HIV 
epidemic among urban and YMSM. 
Transgender people (TG) A rough estimate of 75,626 TG in Thailand was used for programme planning. 
The rigorous estimation is planned and will be updated in the near future. A significant proportion of TG 
is concentrated in the major cities. Median HIV prevalence among TG in 2014 in Bangkok, Chonburi, 
Chiang Mai, Chonburi and Phuket was high at 12.7% 
Based on available data from five sites in 2014, the reported condom use among TG was 84%, uptake of 
prevention services was59% and HTC services was 34% 
Trend  data  are  available  for  only  four  sentinel  surveillance  sites:  Bangkok,  Chiang Mai and Phuket from 
2005  to  2014  and  Chonburi  from  2012  to  2014.  The  data  indicate  that  HIV  prevention  coverage  has  not 
increased  in  Bangkok,  Chiang  Mai  and  Phuket  between  2010  and  2014,  or  in  Chonburi  from  2012  to 
2014.  Chiang  Mai  is  the  only  city  where  HTC  coverage  has  increased  over  time,  from  22%  in  2005  to 
43%  in  2014.  These  results  reflect  the  nature  of  prevention  programming  for  TG  in  Thailand,  in  that 
targeted prevention interventions and HTC designed to meet TG needs are few and limited. 
Developments/factors facilitating the achievement of the target 
Political commitment and national financing 
• Reducing sexual transmission among MSM, TG, MSW, and FSW remains a top priority for Thailand, 
and is addressed in the “Ending AIDS” Operational Plan. 
14 
 
•  Thailand  has  reinforced  implementation  of  same-day  HIV  results  at  public  health  facilities  throughout 
the  country  while an introducing national guidelines for using rapid HIV testing. These efforts are making 
community-based HTC services possible and popular. 
•  The  NHSO  and  the  Thai  Health  Promotion  Fund  (THPF)allocated  a  significant  amount  of  budget  to 
scale-up  MSM  prevention  interventions  (25  million  baht  from  NHSO)  in  11  sites, and support for media 
and social media targeting MSM (30 million baht from THPF). 
• The US government has approved additional budget to revitalize MSM/TG and MSW programs, starting 
in 2014 and expected to continue. 
Strong civil society 
•  With  funding  support  from  the  Global  Fund  and  USAID,  civil  society continues to be the backbone for 
delivering  community  services,  safeguarding  treatment  access,  providing  case  management  for  retaining 
MSM,  TG  and  MSW  in  key  services,  providing substantive involvement in program design and planning 
and improving the policy and legal context for these groups. 
• Key implementing organizations for these interventions include Rainbow Sky, SWING, M- plus, the 
Poz, Home Center, Care-Mat, Sisters and Thailand Red Cross. 
Challenges/ factors hindering the achievement of the target 
•  Capacity  of  community  service  organizations  (CSO)  for  delivering  high-quality  key  services  (reaching 
and  recruiting  the  target  population  to key services) is still inconsistent across sites. High staff turnover is 
still a problem among most of CSO. 
•  Task-shifting  to  CSO  and  communities  in  carrying  out  HTC  is  a prerequisite for fast, massive scale-up 
of  HTC  and  early  treatment.  However,  implementing  task-shifting  is  a  challenge,  because  Thai 
government  regulations  do  not  usually  allow  HTC  outside  authorized  health  outlets,  and  most  of  the 
CSO/communities  have  limited  technical  capacity  to  do  HTC.  The health-community interface is not yet 
sufficiently strong. 
• HIV prevention interventions should be extended to cover NVB FSW, MSW, MSM and TG, including 
non-Thais. 
• Tailored programs and key services are needed to address the needs of young MSM, TG and Sex 
workers. 
• There is a need to ensure sustainable domestic budget support for CSO and community involvement in 
delivery of interventions for MSM, TG and SW. 
Conclusion Reported condom use at last sex among FSW, MSW and MSM, TG remains at a high level. 
While uptake of prevention and HTC services has increased slowly, service coverage has not reached 
optimal levels and not be able to meet national targets. Progress has been made in reaching venue-based 
FSW but still limited among NVB-FSW. HIV prevalence and incidence remain high or increasing among 
MSM, TG including YMSM. Services need to be adapted to the local context and address specific needs 
across the spectrum of MSM groups and sub-groups to increase service utilization. 
The Way Forward: Priority Actions 
1. Urgently mobilize efforts and resources to rapidly expand the tailored package of 
services for MSM, TG, MSW, and FSW to meet the targets by 2016 in priority provinces. 
15 
 
2. Adjust and apply innovative approaches to reach and recruit diverse group and more 
number of SW, MSM, and TG including incentivized case finding and expand options including 
community based HTC and self-test of HIV to increase percentage of knowing HIV status. 3. Develop 
and implement the innovative program monitoring system including real-time 
monitoring among the key populations using national, single, unique identifiers; and integrating database 
of the Routine Health Information System (RHIS) and NAP database. 
Youths and General Population 
National milestone for 2014 
• 60% of youth aged 15-24 year reported condom use at last sex 
• 55% of adult population (aged 15-49) who had more than one partner reported condom use at last sex 
Achievement by the end of 2014 In 2014, prevalence of HIV among pregnant women age 15-24 years 
and male military recruits is stable about 0.5%. 
Risk  of  HIV  for  persons  who  are  in  the  reproductive  age  groups  has  not  changed  significantly  in  recent 
years.  The  2014  round  of  the  behavioral  surveillance  (BSS)  found  that  Male  factory  workers  had  more 
than  one  concurrent  sex  partner  ranged  from  16%  to  22%  and  female  factory  workers  ranged from 4% - 
5%.  Further,  condom  use  in  these relationships ranged from 48% to 54% for males and from 27% to 31% 
for  females.  The  proportion  of  factory  workers  who  had  been  tested  for  HIV  in  the  last  12  months 
remained at 18% to 19%. 
HIV  prevention  interventions  for  youth  have  been  funded  by  the  Global  Fund  against  AIDS,  TB  and 
Malaria  (GF)  through  the  ACHIEVED  Project.  An  external  evaluation  of  the  Project  sampled  youth  age 
12  to 24 years in school, factories, and the community in Bangkok, Udon Thani, Petchburi, Nakornsawan, 
Nakhon  Pratom  Pattalung  and  Phuket  Provinces.  The  evaluation  found  that,  overall,  youth  had  a  good 
knowledge  of  condoms,  but  did  not  have  improved  HIV  knowledge  levels.  Youth  in  school  had 
knowledge/understanding  and  positive  attitudes  toward  PLHIV  less  than  the  factory  and  community 
youth.  About  32%  of  school  youth  used  a  condom  for  all  episodes  of  sex  in  the  past  year  with  a 
non-regular  partners.  The  comparable  rates  of  condom  use  for  youth  in  the  community  and  factory 
workers were 41.7% and 25%, respectively. 
Developments/ factors facilitating the achievement of the target 
Policy Improvements 
•  The  clinical  guidelines  for  HTC  in  young  people  have  been  successfully  changed  so  that  persons  aged 
under  age  18  are  no longer required parental consent for HIV testing. The NAP also produced operational 
guidelines  on disclosure of test results and referral for, or receipt of, ART. These measures are intended to 
help  youth  with  HIV  risk  to  enter  the  diagnosis  and  treatment  system sooner, and help providers create a 
youth-friendly service; 
•  The  National  AIDS  Programme  produced  a  National  Condom  Strategy  for  the  period  of  2015-  19  as a 
framework  and  guide  for  implementation  to  promote  use  of the male and female condoms, and lubricant. 
This strategy addresses issues of demand, supply and creation of an 
16 
 
enabling  environment.  There  are  five  sub-strategies  as  follows:  (1)  Promotion  of  the  acceptance  and 
reduction  of  negative  stigma  of  condoms  and  lubricant;  (2)  Promotion  of  access  to  and  use  of  condoms 
and  lubricant;  (3)  Development  of  a  system  of  management  and  control  of  condom  quality;  (4) Creation 
of  an  enabling  environment  for  condom  use;  and  (5)  Implementation of monitoring and evaluation of the 
condom promotion activities. 
AIDS and sex education 
•  School-based  AIDS  and  sex  education  for  youth  has  continued  to  implement  and  expand  in  the  43 
priority  provinces  receiving  GF  support.  An  additional  34  provinces  are  implemented  with  support  from 
the  Thai  Health  Promotion  Foundation  (THPF).  In  2014,  a  total  of  1,380  schools  delivered  the 
GF-supported  sex  education  curriculum  through  6  to  16  sessions  (or  28%  of  the  5,001  schools  in  the 43 
provinces). A total of 372,599 school youth were exposed to the curriculum. 
•  Sex  education  was  designated  as  one component of health promotion in the school setting. Participating 
schools  were  evaluated  to  assess  the  degree  to  which  they  were  prepared  to  deliver  the  curriculum  as 
intended.  The  evaluation  found  that  the  sex  education  curriculum  was  well-accepted  by the participating 
schools  and  is  consistent  with  the  quality  assurance  system  of  schools,  and  linked  with  the  policy  and 
principles  of  health  promotion,  care  and  assistance  for  students.  There  has  been  a  clear  hand-over  of 
responsibility for maintaining and expanding the sex education curriculum; 
•  In  2014,  an  evaluation  was  conducted  among  students  to  measure  their  knowledge,  attitudes,  and 
accuracy  of  self-risk  perception,  and  life skills. The evaluation was conducted in schools which delivered 
16  sessions  of  the  GF-supported  sex  education  curriculum  in the previous academic year. The evaluation 
documented  significant  improvements  in  these  schools  in comparison with a control group which had not 
yet  implemented  the  curriculum.  In  addition,  an  external  evaluation  of  ACHIEVED  found  that  the 
comprehensive  sexuality  education  curriculum  was  well-accepted  by  participating  schools,  and  capacity 
of  teachers  was  strengthened  in  delivering  the  curriculum.  Attitudes  toward  sex  are  becoming  more 
positive,  and  this  is  helping  spur  a  trend  among  implementers  to  work  more  constructively  with  youth. 
Expansion these success at larger scale with domestic funds is needed. 
Prevention of HIV and STI in youth 
•  The  Bureau  of  AIDS,  TB and STI (BATS) of the Department of Disease Control (DDC) of the Ministry 
of  Public  Health  (MOPH)  collaborated  with  schools  at  all  levels  in  Bangkok  and  the  provinces  to 
implement  the  youth-focused  project  called  the  Anti-AIDS  Academy  (AAA).  The  purpose  of AAA is to 
build  awareness,  understanding  and  motivation  for  youth  to  practice  prevention  of  HIV/STI.  The project 
uses  a  variety  of  strategies  including  expanding  the  network  of  youth-friendly  services  to increase youth 
access and utilization of sexual health services; 
•  The  NAP  has  promoted  public  information dissemination to improve the image of the condom so that it 
is  seen  as  a  health  product  for  safe  living  and  healthy  sex  lives  for  all  members  of  the  reproductive  age 
group.  In  the  report  period,  the  NAP  requested  cooperation  of  all  the  provincial  health  offices  and 
regional  disease  control  centers  throughout  the  country  to  conduct  campaigns  on  prevention  of  HIV/STI 
in  conjunction  with  Valentine’s Day using the slogan ‘Sex Roawp Koawp Toawp OK’ (Say Yes to caring 
sex) 
17 
 
Integrated activities for youth The DDC, Department of Mental Health, and the Department of Health 
collaborated in the development and implementation of an integrated health promotion program for youth 
to address problems of alcohol and cigarette consumption, unsafe sex, reproductive health problems, and 
mental health disorders. The programme used a variety of strategies such as creation of an enabling 
environment in the workplace, stricter enforcement of laws, training in life skills and sex education, and 
screening to identify and assist school-based youth in need. Hospitals set up youth-friendly clinics, 
including contraception for sexually-active single teens. The program supported communities to create 
spaces for youth, host outreach services, and implement a ‘parents school’ to help improve 
communication between the generations about sex and other challenges which today’s youth face. 
Challenges/factors hindering achievement of the target/ 
• Proven comprehensive sexual and life skill curriculum existed. Institutionalized these models in the 
educational system is still challenge. There is a lack of integration of implementation at national scale, 
and there is a lack of a formal host to champion the response. 
•  Motivation  for  HIV  prevention  and  availability  of  youth-friendly  services  need  to  be  refined  and 
expanded  given  the  diversity  of  lifestyles  and  behavior  of today’s youth. There need to be more effective 
methods to identify at-risk youth in need of services. 
• It remains a challenge to formally integrate AIDS into the routine health and reproductive health plans 
for youth at all levels of the system. 
Conclusion Progress of activities for young people has continued buthas limited positive change in the 
trends of awareness, risk behavior and incidence. The population has not been sufficiently motivated to 
know HIV status and stay in healthy behaviors. 
The Way Forward: Priority Actions 
1. Improve policy, coordination and strategies/measures of HIV prevention for young 
people with integration of sexual and reproductive health, drugs, and other development issues. 2. 
Conduct public campaigns with wide reach to increase awareness and motivation for 
prevention behavior s particularly the right to free HTC twice a year. 3. Support and coordinate with 
relating agencies, organizations to take joint 
responsibility of programmes and progress for the target populations of youths and other general 
population using a set of joint key performance indicators. 4. Support government agencies to serve as 
models of good practice, to be emulated by 
business and the private sector in creating an environment for prevention and response to HIV/AIDS in 
the workplace. 
Migrant Workers (MW) 
The actual number of non-Thai livings in the country is unknown. The latest attempt to estimate was 3.7 
million in 2013 (2014 Migration report). The estimated number of workers from Cambodia, Lao and 
Myanmar was 2.7 million with work permits 1.1 million and irregular status 1.6 million. Registered 
migrants have access to the Thai health-care insurance system through either the social security scheme 
(SSS) for those employed in the formal sector or the migrant health insurance scheme for the rest. In 
August 2013, the MOPH announced a policy to provide 
18 
 
health insurance (with ART coverage included) for cross-border migrant workers who are not covered by 
social security, including both registered and unregistered migrants. As of September 30, 2014, the 
number of migrants who registered with the migrant health insurance increased 1,423,831. 
Developments Significant improvement has been made on migrant health policies. In August 2013, the 
Cabinet revised its policy on health check-ups, and included ARV treatment in the health insurance 
package. A subsidy of 500 THB was approved at first enrollment for documented and undocumented 
migrants from Myanmar, Lao PDR and Cambodia. 
In  June  2014,  the  Government  has  established  one-stop  service  center  for  migrant’s  registration  and  the 
MOPH  has  reduced  the  health  insurance  fees.  The  “Samutsakorn  Model”  where  migrants  can  be 
registered  and  enrolled  on  health  insurance via a one-stop service has been expanded and implemented to 
other provinces. 
Challenges Migrants still have limited access to HIV diagnosis treatment and care due to legal, financial 
and language constraints. Fears of job loss and interactions with the Ministry of Labour, police and 
immigration authorities are not supportive to positive health seeking behavior among undocumented 
migrants. 
The  implementation  of  the  MHI  scheme  is  ongoing,  but  the  system  is  not  fully  rolled  out  due  to 
management  and  financial  challenges.  There  are  also  gaps in coverage. Hospitals are still reluctant to sell 
MHI  for  fear  of  incurring  net  losses  or  administrative  procedures.  Therefore,  access  for  migrants  to 
prevention and care services for HIV and TB, while improving, is still limited. 
In  order  to  encourage  migrants  to  subscribe  to  health  insurance,  they  must  feel  that  it  is  to  their  benefit. 
The  development  of  “Migrant  Friendly”  services,  which  primarily  incorporates  Migrant  Health  Workers 
and community-based services, has been in process some time, but needs for institutionalization. 
Conclusion The management of the Migrant Health Insurance scheme needs to be further developed to 
increase willingness of the hospitals to cover additional migrant workers and their dependents. Risk 
mitigation in this respect should be advocating for policy change to ensure that hospitals have finance 
mechanisms in place that will support the provision of health services for migrants, especially for HIV 
prevention and treatment services. 
The Way Forward: Priority Actions 
1. Improve coordination mechanism and management of migrant health insurance scheme, 
social security scheme at central level in order to effectively translated policy into implementation. 2. 
Reorganize fund management of MHI to assure that hospital will be able to recover their 
costs. 3. Institutionalize Migrant Assistant Health Workers and Migrant Health Volunteers in the 
government’s health services for migrants. 
19 
 
Refugees 
Key accomplishments in 2014 As of 31 December 2014, Thailand was hosting more than 118,000 
refugees including approximately 110,000 refugees from Myanmar residing in 9 temporary shelters along 
the Thai- Myanmar border, and approximately 8,560 refugees and asylum seekers of various origins 
living in urban areas across Thailand. The HIV prevalence among refugees is low, both in camps and in 
urban settings. Refugees are provided access to HIV prevention, care and treatment through activities 
supported by UNHCR and its partners, under the umbrella of the Royal Thai Government. Refugees and 
asylum seekers have access to male condoms. Information, education and communication (IEC) materials 
were disseminated to reinforce the messages of HIV/AIDS prevention and stigma reduction as well as to 
promote gender equality and non-violence, ensuring that women and children were also targeted to 
receive the messages. 
HTC  services  was  available  free  of  charge  and  focused  on  but  not  limited  to  key  affected  populations, 
new  arrivals  and  pregnant  women. Comprehensive HIV/AIDS care and treatments have also been offered 
to  the  refugees,  partly  under  the  specific  national  ART  scheme  for  migrants  and  Non-Thai  population 
(NAPHA  extension  programme),  partly  under  the  financial  contribution  of  international  donors.  As  a 
result,  almost  100  people  living  in  temporary  shelters  and  11  people  living  in  Bangkok  have  received 
ART as per Thailand’s National Guidelines on HIV/AIDS Diagnosis and Treatment. 
Anticipating  a  possible  future  voluntary  repatriation  of  refugees  living  in  the  temporary shelters, in 2014 
UNHCR  has  developed  contacts  and  facilitated  exchange  of  information  between  the  Myanmar  national 
AIDS program and the NGO’s working in Thailand. A referral protocol has been established. 
The Way Forward: Priority Actions: 
Continue to prioritize and include HIV in the agenda of health and all preparation for the repatriation 
process. 
20 
 
Target 2 HLM: Reducing HIV transmission among PWID by 50% by 2015 Thai NASP: Reduce 
HIV transmission among PWID by two-third by 2016 
HIV prevalence among people who injection drug (PWID) has been on the decline but remains high 
(21.9%, 25.2% and 19.0% in 2010, 2012 and 2014 respectively). Substance use patterns have been 
changing and diverse by local context, with non-injecting substance use replacing the injections in some 
settings. 
National milestone for 2014 
• 65 % of PWID reached with prevention services 
• 60% of PWID received HTC and know their results in the last 12 month 
• 65 % of PWID reported condom use at last sex 
• 81% of PWID reporting the use of sterile injecting equipment the last time they injected 
Achievement by the end of 2014 
Thailand  has  an  estimated  40,300  people  who  inject  drugs  in  2010.  According  to  IBBS  data  collected 
from three provinces (Bangkok, Chiang Mai and Songhkla), the proportion of PWID who reported the use 
of  a  condom  at  last  sexual  intercourse  were  still  less  than  50%.  There  has  been  an  increase  in  the 
percentage  of  people  who reported using sterile injecting equipment the last time they injected (from 42% 
in  2009  to  85%  in  2014  in  Figure  3).  Other  achievements  include  the  number  of  people  testing  for  HIV 
and  knowing  their  status  has  increased  from  40%  in  2009  to  61.2%  in  2014 (Figure 4). The median HIV 
prevalence  declined  from  25.2%  in  2012  to  19.02%  in 2014. However, IBBS data for PWID is limited to 
3 sites only and should be interpreted with caution. 
Figure 4 Percentage (%) of people who inject drugs who reported using sterile injecting equipment the 
last time they injected, IBBS data 
Percentage (%) of people who inject drugs who reported using sterile injecting equipment 
the last time they injected 
100% 
Target 82% 80% 
78% 
80% 
85% 
Target 60% 
42% 
2016 2009 40% 
2010 20% 
2012 0% 
Target 2016 
2009 2010 2012 2014 
21 
 
Figure 5 Percentage (%) of people who inject drugs that have received an HIV test in the past 12 months 
and know their results 
Percentage (%) of people who inject drugs that have received an HIV test in the past 12 
months and know their results 
100% 
80% 
Target 60% 60% 
40% 41% 
61% 
Target 2016 44% 
2009 40% 
2010 20% 
2012 0% 
Target 
2009 2010 2012 2014 2016 
In  2014  there  were  42  sites  which  distributed  needles  and  syringes  at  no  cost,  this  includes  some 
pharmacies.  The  average  number  of  needles  and  syringes  distributed  to  the estimated toal PWID in 2014 
was 14, improved from the previous year but far from reaching the country target of 88. 
The  number  of  opioid  substitution  therapy (OST) sites in 2014 was 140, decreased from 147 in 2013, and 
the  number  of  people  on OST through those sites was 3,646 individuals, decreased from 4068 individuals 
on OST in 2013). 
It  is  noted  that  OST  is  appropriate  in  the  treatment  of  the  dependence  on  Opiate  (Heroin  and  Opium) 
whereas  no  specific  treatment  has  been  developed  for  treatment  of  the  dependence of ATS and MA with 
injection. 
Developments/ factors facilitating the achievement of the target 
Political commitment Thailand has been demonstrating sustained political commitment to curb the HIV 
epidemic. The country has been one of the first to take on board the goal of ending the AIDS epidemic by 
2030. In February 2014 the Thai Office Narcotics Control Board (ONCB) launched a new harm reduction 
strategy. The strategy was the first multi-sectoral coordinated harm reduction project involving key 
government agencies and civil society. In November 2014, the NAC endorsed the policy and strategies on 
harm reduction for drug use to support the Ending AIDS measures. It is first time that harm reduction is 
formally approved in the HIV programme after a long struggle with the negative law interpretation from 
the State Council. NAC further authorized the Department of Disease Control to use government budget 
to procure needle and syringe to support harm reduction programme. 
National financing Much of the funding for harm reduction services on outreach and NSP comes from the 
Global Fund grant through the PSI Champion IDU project which was based in 19 provinces over the year. 
But, that grant came to an end in 2014. The prioritization process was undertaken to reach 
22 
 
larger  number  of  PWID  despite  fewer  number  of  provinces.  In  2015,  the  GF  provided  support  for 
community  outreach  in  12  provinces,  whilst  the  domestic  budget  is  supporting  the  MMT  service.  The 
effort  has  been  made  to  request  funding  to support from government and National Health Security Office 
for the 7 demonstration sites. 
Strong civil society Civil Society groups have played a key role in accessing the target group of drug 
users, especially with harm reduction interventions, including community outreach and peer educators. 
The outreach workers provide prevention information and services, and motivation for other PWID to go 
for HIV VCT and harm reduction services. Civil Society has been also a key player in the needle/syringe 
exchange programme and community-based MMT. 
Challenges/factors hindering the achievement of the target 
•  The  closing  down  of  the  Champion  IDU  project  in  7  of the 19 provinces has resulted in fewer outreach 
and  NSP  sites  nationally  to  offer  the  required  Harm  Reduction  services,  although  the  targeted  numbers 
from the previous grants have been maintained. 
• The laws and policies on drug often conflict with each other, and this causes confusion and different 
practice of intervention programmes. The guidelines for harm reduction view drug dependence as a health 
problem which requires therapy and care. However, the 1979 Narcotics Control Act views drug use as a 
crime, subject to arrest and imprisonment. 
•  While  Thailand  now  has  a  policy  to  support  harm  reduction,  the  implementation  of  this  policy  is 
incomplete,  and  the  responsible  authorities  and  staff  at  the  provincial  level  do  not  have  a  good 
understanding  of  the  policy  and  implementation  guidelines.  The  provincial  task  forces on drugs have not 
been  established  yet,  and  this  could  be  a result of the political upheaval in recent years. Many people still 
have inadequate knowledge, understanding and negative prejudice against harm reduction. 
•  The  current  status of harm reduction is not consistent with the needs and context of the local community 
where  PWID  live.  There  are  gaps  in  outreach  by  the  Civil  Society  groups,  and  gaps  in  static  services  in 
the  public  sector.  There  is  a  need  for  more  integrated  effort  among  the  government  and  Civil  Society 
groups  to  link  outreach  with  government  clinics,  ensure  better  coverage  of  clean  needle/syringe 
distribution, and spur greater uptake of MMT services in the community and clinic settings. 
Conclusion There has been considerable progress in harm reduction policy and programs, resulting in 
improved access to related services. However, challenges remain particularly in achieving full 
implementation of the policy and strategies to achieve optimal coverage. Implementing staff, especially in 
the public sector, from the top levels down to the front-line services, need to have better knowledge and 
understanding of harm reduction. Thus, there needs to be a shift in strategy toward more genuine 
implementation, including changes to the relevant laws so that drug addiction is viewed as a public health 
problem and not a criminal offence. Thailand should eliminate the practice of arresting and imprisoning 
drug users. There should be more access to quality services for drug users and protection of their basic 
human rights. 
The Way Forward: Priority Actions 
1. Support, monitor and evaluate the implementation of harm reduction services in the 19 
pilot provinces as demonstration of translating policy into effective actions. 
23 
 
2. Increase the role of government in expanding harm reduction services and reduce 
negative attitudes of government personnel toward drug users, 3. Develop and improve service model 
e.g. government’s role in clean needle/syringe 
distribution, the community-based program MMT service, education on HIV and hepatitis C, prevention 
of drug overdosing, operational guideline for harm reduction services, and static and outreach services 
through collaboration among the government, private, civil society and the population of drug users. 4. 
Advocate for change the laws which conflict with policies in order to create a more 
enabling  environment  for  prevention.  There  should  be  consideration  of  eliminating  the  policies  which 
criminalize drug use, and there should be provision of MMT in the prison setting. 
24 
 
Target 3 HLM: Elimination of mother-to-child transmission (PMTCT) of HIV and 
significant reduction of AIDS Mortality Thai NASP: Vertical transmission of HIV 
less than 2% 
National milestone for 2014 95.5% of Thai and non-Thai HIV positive pregnant women received ARV 
drugs to reduce the risk of MTCT 80% of infants born to HIV-infected women received virological tests 
for HIV within 2 months of birth. 2.5% of infants born to HIV infected mothers are infected 
Achievements by the end of 2014 
The  rate  of  MTCT  declined  from 2.3% in 2013 to 2.1% in 2014 which suggests good progress toward the 
goal  of  under  2.0%  MTCT  by  2016.  Data  from  2014  indicate  that  the proportion of pregnant women not 
receiving any kind of ART declined from 4.9% in 2013 to 4.2% in 2014. 
The  proportion  of  newborns  to  HIV+  mothers  who  received  PCR  screening  for  HIV  in  the  first  two 
months  of  life  increased  from  73%  in  2013  to  76%  in  2014.  However,  to  reach  the  2016  target  of  90%, 
there  need  to  be  new  and  intensified  strategies  for  neonatal  HIV  screening  for  infants  of  HIV  infected 
mothers. 
Coverage of couple testing for HIV in the ANC increased from 38% in 2013 to 41% in 2014, though this 
level is still far below the 2016 target of 60% coverage. 
Developments/ factors facilitating the achievement of the target 
Increased coverage of PMTCT 
•  The  MOPH  announced  the  policy  to  provide  free  ANC  to  all  couples  who  register  for  care  within  the 
first 12 weeks of the pregnancy in order to reduce the problem of late initiation of ANC and no ANC 
•  Since  August  2014,  the  MOPH  has  implemented  an  outreach  program  to  diagnose  HIV  infection  of 
newborns  and  promote  earlier  initiation  of  ART  among  infected  infants.  This  effort  includes  training  of 
relevant staff in PMTCT and immediate blood testing of the infants (of HIV+ mothers) at birth 
•  In  October  2014,  new  HIV  treatment guidelines were introduced, including guidelines and regimens for 
PMTCT  from  the  original  protocol  of  AZT+3TC+LPV/r  to  be  changed  toTDF+3TC+EFV.  ART  is  to 
begin  at  the  time  of  diagnosis,  regardless  of  the  age  of  gestation or CD4 level. All cases are counseled to 
continue  ART  post-partum  in  accordance  with  the  new  treatment  guidelines  for  adult  cases  of  HIV 
infection.  This  should  help  increase  coverage  of  ART  for  new  and  repeat  cases  of  pregnancy  among 
HIV+ women, and further reduce MTCT in the coming years. 
• Implementation of a program to improve control, monitoring and evaluation of the PMTCT service. 
This includes a various following steps: 1. Meeting of the national committee and regional health centers 
to develop the system 
and handbook for use of M&E data on PMTCT; 2. Meeting of the Task Force to promote monitoring 
of implementation progress, 
planning the monitoring system, database maintenance, and applied use of the data 
25 
 
in the ICT system to feed into the GIS and website graphs to inform decisions and use of data from the 
PHMIS and NAP. 3. Workshop for national committee members, resource persons and regional health 
centers to improve use of M&E data. 4. Inspect and feed data back to managers and relevant others 5. 
Present results of implementation of PMTCT for managers and relevant other 
stakeholders. 
Promoted HTC for pregnant women and their partners 
• Develop and produce a handbook with guidelines for promoting and expanding couple ANC HTC. 
• Support activities at service outlets, educational media, flip charts on ANC HIV testing, a couple 
counseling handbook, and videos on couple ANC HTC. 
• Follow-up results of couple counseling services using the PHMIS to assess coverage, expose gaps, and 
identify target areas for supervision; 
• Conduct monitoring at the level of the zone and service outlet by the program staff with service 
providers to increase knowledge, understanding and confidence in service provision. 
Challenges/ factors hindering achievement of the target 
•  Coverage  of  the  couple  counseling  program  in  2014  was  only  in  60%  of  service  outlets,  and  this 
prevented  more  complete  identification  of  discordant  couples  as  evidenced  by  the  finding  that  only 42% 
of  ANC  couples  received  HTC.  This  low  level  of  coverage  threatens  to  increase  partner  HIV 
transmission,  reduces  confidence  in  the  service  system,  and exposes the need for more training of staff in 
couple counseling; 
•  There  remain  a  significant  number  of  pregnant  women  who  have  not  registered  for ANC and, thus, the 
full  picture  of  ANC  infection  is  not  known.  This  impedes  care  for  pregnant  and  delivering  women,  and 
limits achievement of the PMTCT target goals; 
• Access to PMTCT for non-Thai pregnant women in Thailand is not universal, in part because they have 
to pay for service; 
• Fully 40% of the pregnant women diagnosed with HIV do not return to the delivering facility for 
on-going care post-partum; 
•  The  progress  reports  on  PMTCT  do  not  include  data  from  private  hospitals  and  large  hospitals  outside 
the  MOPH  system,  and  these  facilities  could  have  a  different  level  of  performance  than  the  MOPH 
outlets. 
Conclusion Thailand succeeded in reducing HIV transmission from mother to child. The MTCT rates fell 
to 2.1 % in 2014, coincided with the national target that is below 2% by 2016. The country could be 
among the first countries in the world to achieve the target of getting zero PMTCT related infection. 
The Way Forward: Priority Actions 
1.  Review  data  on  PMTCT,  and  reflect  these  data  back  to  those  locations  which  are  below  the  national 
target  for  coverage  so  that they will implement improvements to services, improve laboratory procedures, 
and  extend  coverage  of  the  right  to  receive  care  for  the  target  groups,  toward  the  goal  of  eliminating 
MTCT. 
26 
 
2. Increase coverage of PMTCT for migrant women in Thailand through increased coverage of the 
insurance for migrants so that HIV+ pregnant migrant women and their newborns receive equal and 
quality care. 3. Conduct evaluation on the impact of policy changes, the coverage and retention into the 
ART system of HIV+ pregnant women, and identify obstacles to couples counseling. 
27 
 
Target 4 HLM: Reach15 Million PLHIV with lifesaving antiretroviral treatment Thai NASP: All 
PLHIV residents in Thailand receive social protection and access to 
quality treatment and care, AIDS-related deaths reduced by half 
National milestone for 2014 
• 75% of eligible adults and children with HIV (CD 4 < 350) receiving antiretroviral therapy (NASP) 
• 60% of adults and children with HIV received anti- retroviral therapy (OP target) 
• 86% of adults and children with HIV still alive and to be on treatment 12 months after initiating 
antiretroviral therapy 
• 81% of people on ART for 12 months having viral load suppression 
Achievements by the end of 2014 
Thailand  has  been  one  of  the  first  countries  to  adopt  the  Test  and  Treat  Strategy  with  revised  HIV 
treatment  guideline  that  recommend  the  provision  of  anti-retroviral  treatment  to  all  HIV  positive  people 
irrespective  of  CD4  count.  This  policy  has  been  fully  implemented  nation-wide  on  October  1,  2014. 
Previously,  the  guidance  was  to  initiate  treatment  at  CD4  350  or  less  per  mm3,  at  which  level  Thailand 
had ART coverage of 80.3% in 2013. 
A  total  of  426,274  adults  and  children  were  enrolled  in  HIV  care  by  2014,  of  which  271,652  were 
receiving  ART.  Of  these,  267,150  were  adults  and  4,502  were  children  aged  below  15.  Of  these, 35,282 
patients  were  newly  enrolled  in  2014.  The  coverage  of  ART  was  61%  of  all  HIV  positive  adults  and 
children. 
ART  was  delivered  via  949  health  facilities  (that  can  initiate  or  provide  follow  up  for  PLHIV  on  ART). 
Retention  in  treatment  at  the  end  of  12  months  was 83.0%. The rate among men and women was slightly 
different  (82.4%  among  men  vs.  83.8%  among  women),  and  higher  among  children  than  adults  (87.3% 
vs.  82.9%,  respectively).  The  2014  retention  rate,  compared  with  the  2013  results,  was  very  similar 
(83.0%  in  2014  vs.  82.7%  in  2013).  The  loss  to  follow-up  was  8.5%,  mortality  was  8.3%  and  0.13% 
people  chose  to  stop  ART.  The  trend  of  death  rate,  lost-to-  follow  and  those  who  stopped  therapy  was 
also  stable.  Longer  term  retention  at  24  and  60  months  was  77.9%  and  74.6%  respectively.  However, 
mortality at 24 months was 11.5% and increased to 17.4% at 60 months. 
Coverage of ART 
Access to ART has continued to improve in Thailand at a rapid rate, with coverage increasing from 64.6% 
in 2011, and increasing more than 15% only two years later in 2013 to 80.3%. It should be noted that this 
increase is based on a different treatment initiation criterion than what is used now. Apart from 
improvements in treatment access and high retention rates, Thailand has made exception progress in 
improving the quality of ART. This is seen through the improvements in access to viral loads testing and 
levels of viral load suppression – in 2014, 96.1% of ART patients who tested for viral load during the 
reporting period had suppressed viral loads. It is also notable that in Thailand, ART stock outs are very 
rare – in 2014, only 3.1% facilities reported ART stock-out. 
28 
 
Many  HIV  positive  people  are  unaware  of  HIV  status  and  seek  HIV  services  late.  It  is  critical that rapid 
diagnosis  and  massive  scale  up  of  HIV  Counseling  and  Testing,  strong  linkages  are  in  place  to  support 
early  treatment  initiation  and  retention.  This  will  in  turn  require  well-functioning  referral  linkages,  task 
sharing, and consistent promotion of early diagnosis and treatment adherence. 
Figure 6 Percentage of adults and children with HIV currently receiving antiretroviral therapy 
Developments/ factors facilitating the achievement of the target 
Political commitment Thailand has been demonstrating sustained political commitment to curb the HIV 
epidemic. The country has been one of the first to take on board the goal of ending the AIDS epidemic by 
2030. In doing this, Thailand has very quickly utilized new scientific knowledge, and been able to 
translate that into context specific policy and implementation practice. This has been reflected in the 
HIV/AIDS Operational Plan (2015-2019), which is focused on combination prevention approaches and 
early treatment (including bio-medical interventions). This has been endorsed by the National AIDS 
Council. 
National financing The National HIV response is largely funded by domestic resources. In particular, 
where treatment is concerned, a 100% of resources are domestic. All three health insurance schemes for 
Thai nationals offer a comprehensive benefits package addressing the entire continuum of diagnosis, 
treatment, and follow up (including free first and second line ARV, salvage regimens, viral load and 
resistance monitoring). 
Conclusion Thailand is on track to meet the HLM and National Targets for access to life saving ART. 
The country performed well both in terms of the coverage of ARV and the quality of ART services. 
29 
 
The Way Forward: Priority Actions 1. Increase the proportion of people who know their sero-status by 
investing in demand 
generation programme, HTC services, and reduction of stigma and discrimination. 2. Improve access to 
simplified and decentralized diagnostic technologies as well early 
diagnosis and completed referrals into care and treatment. 3. Improved mechanisms to support 
adherence and life-long treatment as part of the Test and 
Treat approach. 4. Ensure universal access to ART and quality treatment for unregistered migrants. 
30 
 
Target 5 HLM: Reduce tuberculosis deaths in PLHIV by half by 2015 Thai NASP: TB deaths 
mortality among PLHIV reduced by half by 2016 
National milestone for 2014 
• 32 % of estimated HIV positive incident TB cases that received treatment for TB and HIV All HIV 
positive patients are screened for TB in HIV care settings at each visit 
• 95% of TB patients will be tested for HIV and have their test result recorded in the TB Register 
• 8% of people with HIV and TB co-infection die after beginning of treatment 
Achievements by the end of 2014 At the end of 2014, the Bureau of Tuberculosis reported 50,670 TB 
patients had been tested for HIV at the time of TB diagnosis or had a known HIV status. Among these, 
6,831 were HIV positive. Of these, 4,691 were on ART and 4,359 were receiving co-trimoxazole 
preventive therapy. 
Reporting  for  HIV  -TB  indicators is not complete in Thailand, and there is significant under- reporting of 
HIV  testing  and  treatment  among  TB  patients  from  specific  sites.  Data  to  report  on  GARP  HIV  –TB 
indicators  5.2,  5.3  and  5.4  are  not  routinely  collected  at  a  nationally  representative  level.  However some 
other  data  sources  allow  some  conclusions  to be drawn. For example, the HIV performance measurement 
for  hospital  quality  improvement,  namely  HIVQUAL-T,  in  which  patient  charts  who  visited  clinics 
during  the  review  period  were  abstracted  using  a  sampling  methodology  to  achieve  90%  confidence 
interval  (+/-  8%  random  error)  are  available.  This  database  specifically  provides  information  on  the 
percentage  of  PLHIV  receiving  care/treatment  services  at  HIV  clinics  that  had  TB  screening  at least one 
time during the reporting year. In 2014, coverage of at least one-screening for TB was 98.8% according to 
HIV  –QUAL  data.  Data  on  TB  screening  for  each  visit  are  not  routinely  collected  and  reported  at  the 
moment. 
Coverage of ART for TB patients with HIV There are an estimated 12,000 HIV positive incident TB case 
in Thailand. The proportion of estimated HIV positive incident TB cases that received treatment for TB 
and HIV has gone up steadily in Thailand from 26.07% in 2010 to 39.1% in 2014 (4,691/12,000). 
However, as a proportion of those diagnosed TB patients with HIV, this is 68.6% (4,691/6,831). This 
number has also steadily improved compared to 2013, when it was lower at 59.6%. However, this 
increase in the proportion is a result of a decline in the number of TB patients who were recorded to be 
HIV positive. This is a reporting issue rather than a decline in actual testing rates. 
Developments/ factors facilitating the achievement of the target 
National financing The National HIV-TB response is largely funded by domestic resources. In particular, 
where treatment is concerned, a 100% of resources are domestic. All three health insurance schemes for 
Thai nationals offer a comprehensive benefits package addressing the entire continuum of diagnosis, 
treatment, and follow up (including free first and second line ARVs, first line and 
31 
 
second line TB treatment, molecular diagnostics, viral load and resistance monitoring). HIV testing is also 
free for all Thai citizens and registered migrants. 
Challenges/ factors hindering the achievement of the target For HIV-TB, inadequate diagnosis of TB 
among HIV patients remains a gap, specifically due to the large proportion of smear negative cases, 
extra-pulmonary and asymptomatic TB noted in this group, (which is poorly diagnosed in routine verbal 
screening algorithms). The main intervention to address this gap in detection of TB infections is to 
improve the quality of diagnosis by using Gene-Xpert, even though asymptomatic patients will need 
ongoing evaluation and investigations. Overall HIV testing rates among TB patients are high, but still not 
universal and extra effort to ensure 100% testing coverage among TB patients is required. Finally, clinical 
practice among TB care providers which may lead to delayed initiation of ART in TB patients needs 
revision. While this has been addressed in the National HIV and TB treatment guidance, more 
consultation and capacity building to give clinicians adequate confidence to treat with ART early is still 
needed. 
Conclusion Thailand has made considerable progress in alignment of HIV and TB programmes over time. 
Overall, the proportion of estimated HIV positive incident TB cases in Thailand who are receiving ART 
is still low and requires ongoing focus and commitment in order to achieve the targets set for 2016. It is 
notable that this is not a financial resource or technical guidance issue, as adequate financing and 
technical tools are already available. The focus needs to be on monitoring and improving clinical practice 
to ensure early detection of HIV and or TB and prevention of leakage in the treatment cascade. 
The Way Forward: Priority Actions 1. Improve case finding of TB among those living with HIV 
including adequate diagnosis of smear negative and extra-pulmonary TB patients to ensure early 
diagnosis, and antiretroviral treatment using new molecular diagnostic technology and initiation of ART. 
2. Ensuring universal testing for HIV among TB patients and completed referral for ART for all 
those with a HIV positive test result. 3. Improve and harmonize information system of TB and HIV 
co-activities in order to monitor 
progress and identify gaps for improvement. 
32 
 
Target 6 HLM: Close the global AIDS resource gap by 2015 and reach annual global 
investment of US $22-24 billion in low-and middle-income countries Thai NASP: Increase budget 
proportion for prevention in priority provinces by 2016 
Based  on  the  recent  NASA  in  2013, total HIV expenditure was 8,827 million THB, reflecting an increase 
of  14%  from  2010  (7,733  million  THB).  Thailand  was  financing  89%  of  the  total  HIV  expenditure 
through  domestic  funds  (7,889  million  THB),  which  is  an  increase  from  85%  or  6,588  million  THB  in 
2010. 
The  spending  on  prevention  increased  from  1,015  in  2010  to  1,506  million  THB  in  2013,  or  48% 
increased.  Domestic  financial  resources  were  still  a  major  funding  source  of  prevention  activities 
accounted for 78% in 2013. However, the proportion of spending for prevention among MSM, female and 
male  SW,  and  PWID  was  only  13%  of  the  total  prevention expenditure in 2010 (134 million THB), 18% 
in 2011 (247 million THB), 11% in 2012 (166 million THB) and 11% in 2013 (167 million THB). 
The  Global  fund  is  the  main  funding  source  for prevention among key populations: 73% in 2010, 86% in 
2011, 86% in 2012 and 78% in 2013. Even though the proportion of domestic funds for prevention among 
key  populations  increased  from  6%  in  2010  to  14%  in  2013,  there  remains  a  large  gap  to  achieve 
self-reliance of domestic financing for the HIV response among key populations. 
National priorities for 2014: Closing the AIDS resource gaps for prevention services among key 
populations, in particular for community-based/led service delivery in priority provinces, is a national 
priority. Thailand has made efforts through different mechanism of central budgeting system including 
AIDS Care Fund, and Thai Health Promotion Fund to support prevention services. In the meantime, 
Thailand is focusing on preparing for the transition to fully self-reliance to ensure sustainable domestic 
financing of the HIV response. Thailand is establishing, advocating and accelerating leadership at the 
sub-national level, including Local Administrative Organizations (LAO), for a sense of local ownership 
and contributing budget to fund the HIV response in local areas. 
Key achievements by 2014: 
Political commitment 
•  The  costed  five-year  Operational  Plan  for  ending the AIDS epidemic was finalized and endorsed by the 
National  AIDS  Committee.  Informed  by  quality  up-to-date  evidence,  the  Ending  AIDS  Strategy  and 
Operational  Plan  prioritized  combination  prevention  (including  treatment  as prevention), early treatment, 
and  reduction  of  stigma  and  discrimination;  placed  a  strong  emphasis  on  reaching  with  quality  services 
the  key  populations  of  MSM,  PWID,  SW  and  migrant  workers;  and  accentuated  the  shift  to 
community-based/led service delivery. 
•  The  Joint  Key  Performance  Indicators  for  HIV  response  (Joint  KPI)  has  been  approved  by the NAC to 
be  used  by  relating  Ministries  for  2015-16  on  measuring  progress  of  HIV  response  across  government 
organizations and line ministries. 
• The National Health Security Office with the endorsement from NAC agreed to establish prevention 
service category in the AIDS Care Fund for 2015. The 2015 budget request was 
33 
 
initiated  at  500  million  THB  to  support  the  prevention  services  for  key  populations.  Unfortunately,  the 
budget  allocation  in  2015  of  NHSO  was  not  increased  due  to  economic  constraints.  The  2015  HIV 
prevention  budget  has  been  postponed.  However,  the  prevention  budget  has  been  requested  again  for 
fiscal  year  2016.  The  initial  approval  is  endorsed  at  186  million  THB  for  delivering  prevention  services 
and 14 millions for service strengthening. 
National financing The Global Fund New Funding Model (NFM) concept note was developed and viewed 
as a means of strategic short-term support that would cushion the transition to a full, domestically-funded 
HIV and TB response. This front-load investment will allow Thailand to sustain and expand the gains in 
the HIV response while concentrating on mobilizing diversified domestic financing. The total amounts to 
US$ 39.75 million over a two-year period from 1st January 2015 to 31st of December 2016. The budget 
for HIV (about US$ 24 million) is focused on service delivery for key populations in prioritized 
provinces, as epidemiological and cost-benefit investment analysis indicate that the highest return on 
investment will be obtained by that focus. To fill country gaps, over a third (38%) of the budget is 
allocated for prevention and HTC for KPs; with the largest share going to prevention and HTC activities 
for MSM and TG populations (reflecting the highest burden of infections in this group). The second 
largest allocation goes to PWID interventions, and the remainder of the investments addresses 
heterosexual transmission. 
With  the  updated  NSP  reinforced  additional  measures,  the  National  Health  Security  Office  (NHSO) 
continued  its  support  to  prevention  and  STI  services  for  key  populations  (22  million THB in Fiscal Year 
2014).  Prevention  activities  include  peer-led  interventions,  community  mobilization,  demand-generation 
for  HTC  through  social  and  health  networks,  linkage  of  services  provided  at  the district, sub-district and 
community levels, and quality of counseling services in the community and health outlets. 
Steps  were  taken  in  preparing  for  the  transition  to  self  –reliance  and  ensuring  sustainable  domestic 
financing  of  the  HIV  response.  A  review  of  funding  mechanisms  and  alternative  funding  sources  and 
management  as  well  as  a  prioritization  of  services  is  underway. An alliance with CSO was established to 
support  an  analysis  of  existing  and  potential  domestic  funding  mechanisms  and  sources,  including 
examining government-NGO financial models that could be adapted to Thailand’s context. 
Increase involvement and local ownership 
The national sub-committee on promoting provincial and local stakeholder ownership fully preformed its 
functions throughout 2014. A number of approaches have been developed to promote involvement and a 
sense of ownership in the expansion of the HIV response at local levels including; 
•  Established  a  memorandum  of  understanding  (MOU)  between  the  Department  of  Provincial 
Administration,  Ministry  of  Interior  and  Ministry  of  Public  Health  to  integrate the HIV response into the 
“district health system”. 
•  Supported  the  “ASEAN  Cities  Getting  to  Zero”  initiative,  and  four  provinces  in  Thailand  namely 
Bangkok,  Phayao,  Ubonratcha  Thani  and  Lopburi  were  selected  for  pilot  activities. These cities received 
support  from  BATS  and  UNAIDS  to  effectively  translate  the  Ending  AIDS  strategy  into  actions  with 
inclusive  effort  from  relevant  key  partners  and  stakeholders  within  each  city.  The  goal  is  to  enhance  the 
response to HIV and 
34 
 
mobilize all resources by the local team to support the Ending AIDS operations in an effective and 
harmonized manner. 
•  Promoted  the  use  of  the  “AIDS  ZERO  PORTAL”  as  an  innovative  interactive  tool  for  policy  makers 
and  program  managers  to  provide  quality  and  up-to-date strategic information to guide the HIV response 
at sub-national levels. 
• Translated the national Ending AIDS operational plan into actions, including a “Flagship Project” to 
accelerate the HIV response in 13 priority provinces. 
•  The  Health  Promotion  Fund  provided  financial  support  for  implementation  of  Ending  AIDS  in  three 
provinces  with  inclusive  engagement  of  key  stakeholders  and  LOA.  Systematic  documentation  of  this 
process will be undertaken for future replication. 
Nakhon  Ratchasima  Province  was  successful  in  mobilizing  financial  support  for  the  HIV  response  from 
local  organizations,  in  particular  for  HIV  prevention  for  youth.  In  early  2015,  165  out  of  232  (75%)  of 
LAO  provided  financial  support  for  HIV-related  activities  in  the  amount  of  30  million  THB.  This 
represents  an  average  LAO  contribution  of  182,000  THB  and  a significant increase over the contribution 
during2006-2008  which  ranged  from  39,000-81,000  THB  per  LAO  per  year  (UNDP,  2010).  There  was 
effective  implementation  of  the  joint  KPI  at  the  provincial  level,  with  a  clear  HIV  strategic  framework 
and establishment of standard operation procedures to support HIV activities for local organizations. 
Challenges/ factors hindering the achievement of the target 
•  There  is a need to ensure sustainable allocation of domestic financing for continued engagement of CSO 
and  communities  in  delivery  of  an  appropriate  response  by  targeting  the  key  populations  of  MSM,  SW, 
PWID and migrants. 
•  The  capacity  of  local  organizations  to  mobilize  financial  support  is  still  modest.  A  more  systematic 
approach is needed for this, including skills-building in sharing lessons learned between provinces. 
Conclusion Thailand achieved top–level commitment in policy endorsement towards Ending AIDS by 
2030. Progress was made with additional financial support for prevention, targeting MSM and FSW, from 
domestic funds in 2014, but the amount is still limited. Steps were taken in establishing prevention 
category in AIDS Care Fund of NHSO and preparing for the transition to self-reliance. Both existing 
mechanism and new model are needed to ensure sustainability of financing the HIV response to continue 
engagement of CSO and communities in delivery of appropriate HIV interventions targeting key 
populations. Scale up good practices of mobilization of local ownership as well as leveraging financial 
support for the HIV response at the sub-national level are also important mechanism to support the ending 
AIDS strategy. 
The Way Forward: Priority Actions 
1. Develop new funding mechanisms for sustainable and flexible domestic financing 
support of the HIV response particularly the CSO activities. 2. Capacitating and empowering CSO 
and communities for effective engagement in policy 
work related to sustained financing of the HIV response. 3. Engaging leadership and accelerating 
capacity-building at the provincial level, including local organizations to strengthen ownership of the HIV 
response, including creating more opportunities for CSO and communities. 
35 
 
Target 7 HLM: Eliminate gender inequalities and gender-based abuse and violence and increase 
the capacity of women and girls to protect themselves from HIV Thai NASP: Human rights and 
gender specific needs are addressed in all HIV Responses 
Data on Violence against Women (VAW) and Intimate Partner Violence (IPV) 
•  The  National  Statistical Office (NSO) survey of 27,000 sampled households on the status of women and 
children  in  Thailand  and  found  that  13.1% of women aged between 15-49 think that physical violence by 
a  husband  is  justifiable  in  cases  in  which  the  wife  leaves  the  house  without  informing  the  husband,  not 
being attentive in taking care of children, refusing to have sex with the husband and burning the food. 
•  Data  from  the  One Stop Crisis Center (OSCC) in 829 hospitals of the MOPH for 2013 show that 12,637 
women  and  19,229  children  received  services  from  the  OSCC.  The  majority  of  clients  receiving  the 
services  were  victims  of  either physical or sexual violence from their intimate partners or boyfriends. The 
VAW  was  highest  among  the  population  age  of  24-45  years.  Fifty-three  percent  of  perpetrators  were 
spouses.  These  findings  are  consistent  with  the  national  survey  conducted  in  2013  by  the  MSDHS.  That 
study  identified  2,976  cases  of  domestic  violence,  who  were  mostly  women,  children  and  elderly.  Of 
these,  85.2%  suffered  from  emotional  violence,  69.9%  from  physical  violence  and  21.6%  from  sexual 
violence. The majority of perpetrators were spouses, siblings or intimate partners. 
Achievements by the end of 2014 
Empowerment of Women Living with HIV (WLHIV) Network 
•  Participation  in  Reproductive  Health  (RH)  Services.  The  WLHIV  network  was  empowered  to 
participate  in  RH  services  for  pregnant  women  at  ANC  clinics in 13 hospitals across nine provinces. The 
RH  services  include  provision  of  knowledge  on  prevention  and  care  for  HIV/AIDS,  rights-based 
information,  assistance  for  cases  of  gender-based  violence,  as  well  as  life  planning  for  couples.  The 
gender perspective was applied to solve the problems regarding STI, AIDS, RH and human rights. 
•  Strengthening  the  network  and  capacities  of  women  living  with  HIV  (WLHIV).  In December 2014, 36 
WLHIV  attended  a  workshop,  organized  by  UN Women, Mahidol University, the Raks Thai Foundation, 
the  Network  of  WLHIV  and  government  agencies.  This  workshop  provided  an  opportunity  for 
participants  to  brainstorm  on  progress,  gaps,  challenges,  lessons  learnt  and  strategic  directions  for  the 
network  of  WLHIV.  Three  key  issues  were  identified  and  addressed.  Firstly,  the  WLHIV network needs 
to  be  reconstructed  to  reflect  its  organizational  capacity.  That  is,  the  network  needs  to  be  re-formulated 
into  either  an  association  or  a  foundation,  at  the  sub-national  or  national  level.  Secondly,  the 
representatives  of  the  WLHIV  network  identified  challenges  in  building  a  new  generation  of  WLHIV 
leaders.  Thus,  there  is  a  need  for  capacity  building  to  groom  the  new  generation  of  WLHIV  leaders. 
Thirdly,  the  network  identified  priority  areas  for  implementation  in  RH  and  rights. Also, it is essential to 
advocate  for  other  rights,  such  as  economic,  social  and  cultural  rights.  These are reflected in some of the 
activities  of  the “Strengthening Evidence and Empowerment Living with HIV/AIDS in Thailand Towards 
Gender-Sensitive  and  Rights-base  HIV/AIDS  Prevention  and  Response”  Project,  which  was launched in 
2015 by Mahidol University and the Raks Thai Foundation, supported by UNWOMEN and UNAIDS. 
36 
 
Legal framework for gender equality The draft Gender Equality Law was submitted to the National 
Assembly in December 2014, and subsequently approved by the National Assembly in January 2015. 
Article 3 includes the statement that sexual expression that is different from one’s sex at birth’ as a basis 
for gender discrimination is prohibited1. There was also policy advocacy on the laws related to who 
constitutes a “marital partner.” 
Evidence and knowledge generation Mahidol University, supported by UNWOMEN and UNAIDS, 
conducted a study to document and analyze the contribution of gender in the cause and consequence of 
HIV and the extent to which gender issues are considered and integrated into HIV policy and programmes 
at the national and sub-national level, as well as provide policy recommendations in 2015. 
Developments/factors facilitating the achievement of the targets Policy commitment Gender equality is 
one of the core concepts of the National AIDS Strategy (NAS) 2014-2016 related to social justice and 
“promoting equality in the society through respect and protection of full enjoyment one’s rights and 
gender equality”. Gender is incorporated in Strategy 1 of the NAS 2014-2016 by virtue of “expand 
rights-based and gender-sensitive comprehensive prevention services for population/risk behavior at 
highest risk of HIV transmission.” In addition the Gender Equality Law was presented to the National 
Assembly in late 2014 and was approved by the National Assembly in January 2015. 
Policy space for participation of women living with HIV In 2014, the Network of WLHIV participated in 
policy advocacy for the draft Gender Equality Legislation (GEL) in consultation brokered and supported 
by UNWOMEN, including input by Civil Society, for submission to the National Assembly Working 
Group for consideration. The Network of WLHIV also participated in consultations to review the progress 
of the Beijing Platform for Action adopted at the Fourth World Conference on Women in Beijing, China 
in 1995 as well as coordination of inputs on women and health, as brokered and supported by 
UNWOMEN, and organized by the Foundation for Women and Social Watch, Thailand. In addition, the 
Network of WLHIV also participated in consultation and advocacy forums to identify key issues and to 
tender proposals from the women’s groups to the Constitution Drafting Committee, as brokered and 
supported by UNWOMEN and the Women’s Reform Network. 
Challenges/factors hindering the achievement of the targets The overall challenge hindering the 
achievement of the target lies in the lack of follow-through of policy commitment/gender equality in the 
policy space for implementation. 
Stigma & Discrimination and Rights Violations against WLHIV 
•  Universal  access  to  ARV  and  health  services, comprehensive services for PLHIV, and options in caring 
for  one’s health are commendable policies. However, WLHIV still face discriminatory attitudes in service 
provision.  In  many  cases,  service  providers  adopt  a  ‘superior’  position  in  provision  of  counseling,  and 
make decisions for WLHIV, including 
1 Article 3: Unjust gender discrimination refers to an action or an omission of action of distinction, exclusion or 
restriction of benefits, either direct or indirect that is unjust on grounds of self-identified sex or of sexual expression 
that is different from sex at birth. 

37 
 
decisions  to  terminate  or  continue  pregnancy.  Regarding  prevention,  many  WLHIV  are  ‘forced’ to bring 
their  spouse/intimate  partners  to  receive  services.  Disclosure  of  HIV  status,  as  recounted by the majority 
of  WLHIV,  leads  to  intimate  partner  violence,  both  verbal  and  physical,  for  ‘infecting’  the 
husband/spouse,  regardless  of  the  reality.  WLHIV  whose husband passed away face pressure to leave the 
household.  Children  of  WLHIV  and girls living with HIV are often stigmatized and discriminated against 
by the community. 
• WLHIV also face discrimination and stigmatization in the workplace, receiving lower pay than 
others/minimum wage and being forced to work in involuntary positions. 
Limited Capacities and Policy Platform for Advocacy by the Network of WLHIV While progress has 
been made, the Network of WLHIV remains rather weak in their collective capacity for policy advocacy, 
influencing gender-sensitive services and addressing discrimination, stigmatization and VAW & IPV. 
The Network of WLHIV, which was formed in 1999, remains an informal and loosely formed network, 
with a number of committed WLHIV, with technical support mainly from the Raks Thai Foundation. 
Identified gaps include inadequate and uneven understanding and exposure to rights, particularly 
reproductive health and other rights related to gender equality, women’s human rights, discriminatory 
issues, and limited managerial and organizational capacities. The Network is still a small, informal, and 
loosely formed operation. The effectiveness of the network ebbs and flows depending on project-based 
funding, challenges in recruiting new generations of members of the WLHIV network, as well as the need 
to strengthen opportunities and space for formal advocacy at the policy level, with a corresponding 
capacity to do so. 
Intimate Partner Violence (IPV) Many women living with HIV experience IPV, mostly physical violence, 
when disclosing the HIV status to their partners. 
No indicators on gender and gender-based violence (GBV) 
• Gender issues were incorporated in the review undertaken during the preparation and development of 
the National AIDS Strategy 2014-2015. Despite success of having CEDAW and gender mentioned in the 
strategy, there is no mechanism to follow up with regards to specific strategies and actions. 
• There are no gender-specific indicators. Gender indicators are now under development. However, all 
indicators related to gender issues are quantitative and only focused on key affected populations and their 
spouses, including discordant couples, and PLHIV. Therefore, it is difficult to capture the situation and 
trend of comprehensive gender inequalities in the context of HIV. In addition, there are no indicators to 
capture rights violations and discrimination against WLHIV, as well as capturing the risks and 
vulnerabilities of women to GBV. 
• There are no indicators that capture GBV amongst women and men, violence against women, violence 
against people with gender diversity, or violence amongst same-sex couples. 
Lack of coordination for the implementation to achieve the targets There is no institutional cross-cutting 
mechanism on gender and HIV among the relevant government organizations. While the National 
Strategy on HIV/AIDS 2014-2016 encourages using the Convention on the Elimination of All Forms of 
Violence against Women (CEDAW) as a direction in HIV and AIDS-related service provision, there is no 
clear implementation nor monitoring mechanism for the integration of gender into the rolling out of the 
strategy. Similarly, the National Plan on the Advancement of Women 2012-2014 refers to HIV/AIDS in 
its 
38 
 
Strategy 3 on the Promotion of Well-being, Quality and Security of Life, but primarily from the health 
and prevention perspectives. In addition, reference to HIV work in the plan and its implementation 
framework is minimal. On top of this, there is no platform nor formal mechanism to coordinate the work 
of gender and HIV in Thailand. Given the lack of formal coordination mechanisms on gender and HIV, 
there is no platform for policy discussion and recommendations towards a vision of “Getting to Zero 
Stigma and Discrimination” for Thailand, a goal for 2016, in which ‘human rights and gender-specific 
needs are addressed in all HIV responses’. 
Lack of sex-disaggregated data There is no systematic collection of sex-disaggregated data with regard to 
IPV beyond married women, violence against women, women’s vulnerabilities to HIV infection or 
vulnerabilities of women affected by HIV. 
Conclusion VAW and IPV remain a common issue in Thailand, but systemic empirical data on GBV, 
either at the national or sub-national levels, is still limited. The NAS still lacks mechanisms to translate 
strategy in to the implementation. It is not clear how gender perspective be integrated into the roll-out 
strategies. 
The Way Forward: Priority Actions 
1. Establish a formal platform for coordination of the work on gender and HIV. 
Strengthen national coordination among government agencies for the full protection of rights of WLHIV 
and their access to gender-sensitive, rights-based and effective services, as well as implementation of the 
multi-sectoral coordination mechanism at the provincial level. 2. Strengthen capacity of the national and 
sub-national networks of women and girls 
living with HIV, including individual and organizational capacity building, and government funding. 
Engage the network of women and girls living with HIV in national platforms to amplify their voice and 
reduce gender inequality. Engage the network of women and girls living with HIV in the mainstream 
work of PLHIV. 3. Improve attitudes of service providers so that they are non-discriminative and 
respectful toward WLHIV, and ensure the provision of gender-sensitive services, with participation from 
WLHIV. Ensure a comprehensive approach for women’s empowerment in service provision, instead of 
taking the social welfare approach. 4. Strengthen accountability frameworks and mechanisms, including 
clear targets, 
indicators, sex-disaggregated data collection and analysis which will enable reporting under Target 7. 
Support active use of strategic information relevant for gender-sensitive services and GBV protection. 
39 
 
Target 8 HLM: Eliminate stigma and discrimination against people living with and affected 
by HIV through promotion of laws and policies that ensure the full realization of all human rights 
and fundamental freedoms by 2015 Thai NASP: Reduce stigma and discrimination by 50% in 2016 
Expand the protective social and legal environment essential for HIV prevention and care 
National priorities Thailand has identified stigma and discrimination (S&D) as key drivers of epidemic 
and barriers in making progress to end the AIDS epidemic. Non-discrimination and promoting human 
rights and gender equality remain a priority of Thailand’s HIV response. The national plan focused on 
revising laws and policies on drug use, age of consent for HIV testing among young people (<18 years), 
health policy related to non-Thais accessing health services, expanding implementation of the national 
code of conduct to reduce S&D at workplaces, implementation of “normalizing HIV” and developing and 
rolling-out tools to routinely measure HIV-related S&D, and human rights violations. 
Achievements by the end of 2014 
Political commitment 
• Progress was made in revision of certain laws and policies as well as enhanced implementation: 
1. The ONCB launched the order and operational plan for implementation of harm reduction in 19 
provinces for 2014-15 and the National AIDS Committee (NAC) endorsed the policy and strategies on 
Harm reduction for drug user in November 2014. A Task Force was established and serves as a platform 
for effective coordination, enhancing collective efforts among all relevant organizations. Nineteen priority 
provinces have been identified to implement a comprehensive harm reduction programme, and the 
evaluation at the end of the first year of its implementation is to be finalized; 2. An official declaration 
was made by the Medical Council of Thailand eliminating the requirement of parental consent for HIV 
testing by clients age below 18 years; the NAC acknowledged the statement and has disseminated it 
widely; 
•  Because  S&D  still  exist  in  many  worksites,  the  Bureau  of  AIDS  and  STI,  (BATS)  worked  in  close 
collaboration  with  12  Regional  Department  of  Disease  Prevention  Control  units  to  reinforce  the 
implementation  of  “the  national  code  of  conduct”  at  public  workplaces  throughout  the  country.  During 
the  report  period,  human  rights,  gender  equality  and  reduction  of  S&D  towards  people  living  with  HIV 
(PLHIV)  were  cornerstones  of these efforts. 93 workplaces participated an initiative to create workplaces. 
These  best-practice  worksites  were  acknowledged  and  received  awards  at  the  2014  National  AIDS 
Seminar  and serve as models for replication. The AIDS Standard Organization (ASO) certification is used 
as  a  tool  for  promoting  good  AIDS  policy  at  companies  and  private  workplaces  with  no  HIV  testing  for 
job applicants, and support for HIV+ employees. 
•  Led  by  the  National  AIDS  Management  Center  with  strong  involvement  of  civil  society,  PLHIV  and 
key  population  networks,  academia  and  international  organizations  (RTI/USAID  and  the  UN  Joint  team 
on  AIDS)  made  significant  progress  on  developing  tools  to  routinely  measure  S&D  in  various  settings, 
including the following: 
40 
 
1. Successful introduction of six S&D questions including a new indicator that was first introduced in the 
2014 Global AIDS Progress Report Guidance on measuring attitudes towards PLHIV among the general 
population in a population-based survey for the first time ever; 2. The tool for routinely monitoring S&D 
in healthcare settings and among PLHIV, along with the respective manuals, was completed. A total of 51 
professionals from 10 regions and 22 provinces were trained in using the tool. Currently, the tool is being 
rolled out throughout the country. In particular, eight provinces have committed to participate as the 
national sentinel sites to systematically monitor the situation and response toward S&D in healthcare 
settings. PLHIV and key populations in the community are fully engaged in the tool development and 
roll-out, and its findings are informing stigma-reduction action at the national and sub-national levels; 3. 
Completed development of optimal sets of question to be integrated in the integrated biological and 
behavioral surveys among key populations (MSM, SW, PWID) and migrant workers. 
National financing Results from a pilot study in two provinces showed HIV-related to S&D in health care 
settings and among PLHIV are common and very resilient even in a country with a mature epidemic like 
Thailand. Health facility staff still displayed a high level of enacted and observed stigma. PLHIV reported 
experiencing S&D as well as avoiding health services because they anticipated stigma at the health care 
settings. This evidence is critical information and is used to inform design of the national operational 
plan. In 2014 the Ministry of Public Health took action in designing a S&D reduction curriculum and 
sustained in-service training of health care staff, including enhanced implementation of universal 
precautions, and developed communication strategies for raising awareness related to S&D and rights of 
PLHIV and key populations. Through the Global Fund/NFM, activities will be implemented in 2015 on 
expansion of protective mechanisms in response to human rights violations and S&D in four provinces. 
Creating an enabling environment is proposed as one of core approaches under the National Ending AIDS 
operational plan for 2015-2019. Securing funding support to implement comprehensive activities as 
planned is underway. 
Civil society involvement Stigma reduction was at the core of the National AIDS Campaign/ World AIDS 
Day activities in 2014. Civil society and communities carried out stigma-reduction campaigns, including 
media coverage. The campaign culminated at the National AIDS Seminar. In the build-up to the Seminar, 
civil society implemented a series of public awareness and social mobilization campaign activities, 
involving media representatives and companies which targeted various audiences. These campaigns 
produced and disseminated material in support of provincial campaigns. As a result, CSO-media 
partnership grew and public awareness on S&D increased. Throughout 2014, key affected population 
networks continued to campaign and disseminate communication materials to promote use of clean 
needles and syringes and reduce drug-use- related stigma. NGOs 12D, TDN led the CSO/ community 
effort. 
Challenges/ factors hindering achievement of the target Revision of some conflicting laws, policies and 
harm reduction operational guidelines regarding recreational and illegal drugs is needed. For example, the 
harm reduction policy considers drug users as patients while the Criminal Drug Law for 1979 defined 
drug users as criminals who 
41 
 
must be jailed. Distribution of sterile needles is not yet widely accepted, and this prohibits clean needle 
distribution in certain provinces; 
Fragmented  evidence  is  available  related  to  various  types  of  drug  dependence  treatment centers, and this 
information  would  facilitate  effective  transition  towards  community-based  drug  dependence  treatment 
and supporting services. 
Conclusion Progress was made in removing certain legal and policy barriers that impede access to key 
services among PLHIV and key populations. Continued efforts are still required to maintain momentum 
towards eliminating remaining including ensuring effective implementation at the sub-national level. 
Tools  for  routinely  measuring  S&D  in  the general population, health care setting (health facility staff and 
PLHIV)  and  among  key  populations  exist.  Rolling  out  these  tools  demonstrated  has  achieved significant 
progress.  Evidence-informed  design  and  implementation  of  S&D  reduction  interventions  at  the  health 
care setting and public campaign are occurring. 
The way forward: Priority actions 
1. Remove conflicting laws and policies related to drug users and sex workers. 2. Develop a ‘reduction of 
S&D’ curriculum for health facility staff, and conduct training in selected provinces. In addition, scale up 
implementation of national the code of conduct at public and private workplaces. 3. Establish mechanisms 
that effectively response to human rights violations, and S&D in 
selected provinces including empowering PLHIV and key populations on AIDS rights protection, and 
reduce internal stigma. 4. Create the enabling environment with public communication and campaigns to 
“normalize HIV”. 
Target 9 HLM Eliminate Travel Restriction Thai NSP Thailand has no travel restriction 
42 
 
Target 10 HLM: Eliminate parallel systems for HIV-related services to strengthen 
integration of the AIDS responses in global health and development efforts Thai NSP: No specific 
target 
Overview The Global-Fund-supported CHILDLIFE program aims to strengthen the community system 
by building capacity and providing support to 1,160 Child Action Groups (CAGs) in 257 districts in 29 
provinces. CAGs works as the first-contact point to recruit vulnerable children and assess their needs in 
order to provide appropriate services, including referring them to social and protection services. CAGs 
also follow up the referred cases in both sectors to ensure the needs are fulfilled. Activities and services 
provided by CAGs are child’s camp to provide psychosocial support in groups, quarterly peer-group 
support, and training for parents and caretakers, in addition to services given to individual cases based on 
special needs. Throughout the three years of the program, a total of 107,200 children affected by AIDS 
(CABA) and other vulnerable children (OVC) were reached by the CAGs. 
Achievements by the end of 2014 
From  October  2012  –  September  2014,  81,141  children  (aged  0  –  18  years)  were  enrolled  into  the 
CHILDLIFE  program  and  83%  were  considered  as  OVC  in  accordance  with  the  MSDHS’s  definition. 
Nearly  70,000  CABA  and  OVC  in  the  29  provinces  received  services  under  the  CHILDLIFE  program, 
provided by CAGs. 
The  MSDHS  has  provided  support for people affected by HIV/AIDS including CABA. In 2014, a total of 
15,674  children  received  support  from  the  MSDHS.  The  support  included  provision  of  four  orphanage 
shelters,  located  in  Bangkok,  Chiang  Mai,  Udonthani  and  Songkhla,  where  CABA  have received special 
support  in basic needs including education, child development and foster family placement. A total of 211 
CABA were placed in foster families in 2014. 
A  Child  Status Index (CSI) survey was conducted to measure child well-being status and external support 
among  902  families  with  CABA  and  OVC  in  five  provinces.  The  survey  found  that  only  29.7%  of 
children  were  living  in  circumstances  that  could  be  rated  as  satisfactory,  and  79.1%  of  families  with 
CABA and OVC received economic support in the three months prior to the survey. 
Challenges / factors hindering the achievement of the targets The cessation of support by the Global Fund 
for the CHILDLIFE Project presents the biggest challenge. The linkages among community systems and 
government support service systems have only just been initiated. However, there is an on-going effort to 
maintain these mechanism using local resources. 
Conclusions Strengthening system and collaboration across the sectors (e.g., community, health, and 
social protection) as well as reduction of stigma and discrimination towards CABA and OVC is essential. 
The end of GF support has created major challenge to promote a community-based holistic care program 
for CABA and OVC in the HIV-affected provinces. 
43 
 
The Way Forward: Priority Actions 
1. Continue functions of Child Action Group through collaboration of the MOPH and MSDHS, 
and integrate these functions into the MSDHS structure. 2. Enhance the Provincial Child Protection 
Committees (PCPC), which are a legally-binding 
mechanism of the MSDHS, to be more proactive in addressing problems of children and youth at 
different levels, and translate the Child Protection Act into strategies and action plans at the provincial 
level with meaningful participation of the CAGs. 3. Restructure the Child Department under the MSDHS 
to be more effective in 
implementation of the Child Protection Act; the support should also cover non-Thai children. 
44 
 
Summary GARP Indicators for all targets between 2009 and 2014 TARGET 1: 
Reduce sexual transmission of HIV HLM Target: Reduce sexual transmission of 
HIV by 50% by 2015 Thai NASP: Reduce new HIV infections by 2/3 by 2016 
Indicators Indicator Description GARP UA 
National target by 2016 
2009 2010 2011 2012 2013 2014 
General population 
1.1 Percentage of young women and men aged 15-24 who 
correctly identify ways of preventing the sexual transmission of HIV and who reject major 
misconceptions about HIV transmission 
● ● Data not available 
1.2 Percentage of young women and men aged 15-24 who 
have had sexual intercourse before the age of 15 
● ● Data not available 
1.3 Percentage of adult (woman and men) aged 15 - 49 
who have had sexual intercourse with more than one partner in the past 12 months 
● ● Data not available 
1.4  Percentage  of  adult  (woman  and  men)  aged  15-49  who  have  had  more  than  one  sexual 
partner  in  the  past  12  months  who  reported  the  use  of  a  condom  during  their  last  sexual 
intercourse 
● ● Data not available 
1.5 Percentage of women and men aged 15-49 who 
received an HIV test in the last 12 months and who know their results 
● ● Data not available 
1.6 Percentage of young people (woman) aged 15-24 who 
are living with HIV ● ● 0.33% 0.58% 0.44% 0.44% 0.40% 0.43% 0.52% 
45 
 
National Indicators Indicator Description GARP UA 
target by 
2009 2010 2011 2012 2013 2014 2016 Sex workers B1 Estimated number of sex workers (man 
and woman) ● 141,769 141,769 141,769 
Female sex workers 
1.7 Percentage of sex workers reached with HIV 
prevention programmes 
● ● 80.00% 50.45% 53.89% 57.74% 
1.8 Percentage of sex workers reporting the use of a 
condom with their most recent client 
● ● 95.00% 95.56% 93.60% 96.09% 
1.9 Percentage of sex workers who have received an HIV 
test in the past 12 months and know their results 
● ● 90.00% 47.76% 55.60% 54.19% 
1.10 Percentage of sex workers who are living with HIV ● ● 1.00% 2.69% 2.16% 
1.13% Male sex workers 
1.7 Percentage of sex workers reached with HIV 
prevention programmes 
● ● 80.00% 61.00% 73.77% 64.04% 
1.8 Percentage of sex workers reporting the use of a 
condom with their most recent client 
● ● 99.00% 88.00% 98.18% 95.52% 
1.9 Percentage of sex workers who have received an HIV 
test in the past 12 months and know their results 
● ● 90.00% 49.00% 52.38% 54.37% 
1.10 Percentage of sex workers who are living with HIV ● ● 10.20% 16.00% 
12.20% 11.66% Man who have sex with man 
B2 Estimated number of men who have sex with men 
● 
550,000 550,000 550,000 1.11 Percentage of men who have sex with men reached 
with HIV prevention programmes 
● ● 80.00% 43.79% 52.65% 45.92% 
1.12 Percentage men reporting the use of a condom the last time they had anal sex with a male 
partner 
● ● 95.00% 80.22% 85.49% 82.08% 
1.13  Percentage  of  men  who  have  sex  with  men  that  have  received  an  HIV  test  in  the  past  12 
months and know their results 
● ● 90.00% 14.93% 25.58% 30.85% 
1.14 Percentage of men who have sex with men who are 
living with HIV 
● ● 6.00% 8.02% 7.13% 9.15% 
46 
 
National Indicators Indicator Description GARP UA 
target by 
2009 2010 2011 2012 2013 2014 2016 Counseling and testing 
1.15 Percentage of health facilities that provide HIV testing 
and counseling services ● 100% 100% 100% Number of Health facilities 1324 1365 1480 1.16 
Number of women and men aged 15 and older who 
received HIV testing and counseling in the past 12 months and know their results (including 
pregnant women) 
● 1,054,334 1,146,093 1,344,165 1,357,350 
Number of HIV+ 22,339 21,907 22,122 22,650 Number 
of women and men aged 15 and older who received HIV testing and counseling in the past 12 
months and know their results (excluding pregnant women) 
● 307,114 356,816 527,373 609,079 
Number of HIV+ 17,464 16,984 17,031 18,061 1.16.1 
Percentage of health facilities dispensing HIV rapid test kits that experienced a stock-out in the 
last 12 months. 
● Data not available 
Sexually transmitted infections 
1.17 Sexually Transmitted Infections (STIs) 
1.17.1 Percentage of women accessing antenatal 
care (ANC) services who were tested for 
● 91.55% 95.78% 96.84% 
syphilis at first ANC visit 1.17.2 Percentage of antenatal care attendees who 
were positive for syphilis 
● 0.06% 0.05% 0.07% 
1.17.3 Percentage of antenatal care attendees 
positive for syphilis who received treatment 
● 93.10% 97.87% 97.79% 
1.17.4 Percentage of sex workers with active 
syphilis 
● 
Median 0.26% 0.00% 0.00% NA Mean 0.62% 0.54% 0.69% NA 
47 
 
National Indicators Indicator Description GARP UA 
target by 
2009 2010 2011 2012 2013 2014 2016 1.17.5 Percentage men who have sex with men 
with active syphilis 
● Data not available 24.36% NA 
1.17.6 Number of adults reported with syphilis 
(primary/secondary and latent/unknown) in the past 12 months 
● 2,273 2,990 
1.17.7 Number of reported congenital syphilis cases 
(live births and stillbirths) in the past 12 months 
Data not available 
1.17.8 Number of men reported with gonorrhea in 
the past 12 months 
● 
Data not available 
● 6,409 5,210 
1.17.9 Number of men reported with urethral discharge in the past 12 months 
● NA NA 
1.17.10 Number of adults reported with genital ulcer 
disease in the past 12 months 
● NA NA 
1.19 Diagnosis of HIV and AIDS cases (New 2014) 
1.19.1 Number of HIV cases diagnosed by age and 
● 40,069 38,602 37,922 54,840 37,287 sex from 2010-2014 (New 2014) 1.19.2 Number 
of AIDS cases diagnosed by age and 
sex from 2010-2014 (New 2014) 
● 28,759 39,753 25,598 27,424 29,627 
48 
 
TARGET 2: Reduce transmission of HIV among people who inject drugs HLM 
Target: Reduce transmission of HIV among people who inject drugs by 50% by 
2015 Thai NASP: Reduce new HIV infections by 2/3 by 2016 
Indicator description GARP UA 
National target by 2016 
2009* 2010 2011 2012 2013 2014 
B3 Estimated number of People who inject drugs (PWID) 
● 40,300 40,300 40,300 40,300 
2.1 Number of Syringes distributed per person who injects drugs 
per year by Needle and Syringe Programmes 
● ● 88.0 9.79 11.52 12.02 13.79 
2.2 Percentage of people who inject drugs who report the use of 
a condom at last sexual intercourse 
● ● 95.0% 39.18% 46.02% 49.06% 47.16% 
2.3 Percentage of people who inject drugs who reported using 
sterile injecting equipment the last time they injected ● ● 82.0% 42.02% 77.68% 80.45% 
84.88% 
2.4 Percentage of people who inject drugs that have received an HIV test in the past 12 months 
and know their results 
● ● 90.0% 39.99% 40.71% 43.65% 61.15% 
2.5 Percentage of people who inject drugs who are living with HIV ● ● 21.0% 17.20% 21.87% 
25.20% 19.02% 2.6 Estimated number of opiate users (injectors and non-injectors) Number of 
people on opioid Substitution therapy (OST) 
2.6a Estimated number of opiate users (injectors and non- injectors) 
● Data not available 
2.6b Number of people on opioid substitution therapy (OST) ● 4,500 2,201 2,612 3,735 
4,068 3,646 2.7 Number of needle and syringe programme (NSP) sites Number of substitution 
therapy (OST) sites (WHO) 
2.7a Number of needle and syringe programme (NSP) sites ● 39 49 42 36 38 42 
2.7b Number of substitution therapy (OST) sites ● 49 
Data not available 
147 147 147 140 
49 
 
TARGET 3: Eliminate mother-to-child transmission of HIV HLM Target: 
Eliminate new HIV infections among children by 2015and substantially reduce 
AIDS-related 
maternal deaths Thai NASP: Vertical transmission of HIV less than 2% 
Indicator Description GARP UA 
National target by 2016 
2008 2009 2010 2011 2012 2013 2014 
3.1 Percentage of HIV-positive pregnant women who received 
antiretroviral medicine to reduce the risk of mother-to-child transmission 
● ● 98.80% 93.60% 95.00% 94.20% 93.98% 93.75% 95.15% 95.78% 
3.1a Percentage of women living with HIV who are 
provided with antiretroviral medicines for themselves or their infants during the breastfeeding 
period 
Indicator not relevant 
3.2 Percentage of infants born to HIV-positive women receiving 
a virological test for HIV within 2 months of birth 
● ● 90.00% 75.80% 73.13% 77.23% 72.87% 76.14% 
3.3 Estimated percentage of child infections from HIV-infected 
women delivering in the past 12 months 
● ● 2.00% 3.75% 3.04% 2.74% 2.30% 2.13% 
3.4 Percentage of pregnant women who were tested for HIV and 
received their results - during pregnancy, during labour and delivery, and during the post-partum 
period (<72 hours), including those with previously known HIV status 
● 99.70% 99.30% 99.50% 99.87% 99.14% 99.74% 99.83% 
3.5 Percentage of pregnant women attending antenatal care 
whose male partner was tested for HIV in the last 12 months ● 60.00% 32.30% 38.41% 41.08% 
3.6 Percentage of HIV-infected pregnant women assessed for 
ART eligibility through either clinical staging or CD4 testing 
● 44.00% 85.56% 88.16% 88.30% 
50 
 
National Indicator Description GARP UA 
target by 
2008 2009 2010 2011 2012 2013 2014 2016 
3.7 Percentage of infants born to HIV-infected women receiving 
antiretroviral prophylaxis to reduce the risk of early /mother to child transmission in the first 6 
weeks 
● 96.50% 99.30% 99.40% 99.00% 99.17% 99.47% 99.48% 
3.8 Percentage of infants born to HIV-infected women (HIV- 
exposed infants) who are provided with antiretrovirals (either mother or infant) to reduce the risk 
of HIV transmission during the breastfeeding period. 
● Indicator not relevant 
3.9 Percentage of infants born to HIV-infected women started on 
cotrimoxazole (CTX) prophylaxis within two months of birth ● 35.90% 42.00% 51.99% 
57.34% 52.55% 
3.10 Distribution of Outcomes of HIV-Exposed Infants (WHO) 
● 
3.10.1 Number of infants born to HIV positive mothers 
(“HIV-exposed infants”) born in 2013 (or latest data available) 
● 4589 
3.10.2 Number of infants, born in 2013 (or latest data 
available) to HIV positive mothers, classified as indeterminate (i.e.: all lost to follow up, death 
before definitive diagnosis, indeterminate lab results) 
● 1103 
3.10.3 Number of infants born in 2013 (or latest data 
available) to HIV positive mothers that are diagnosed as positive for HIV 
● 70 
3.10.4  Number  of  infants  born  to  HIV  positive  mothers in 2013 (or latest data available) that are 
diagnosed as negative for HIV 
● 3416 
3.11 Number of pregnant women attending ANC at least once 
during the reporting period 
● 
772,772 747,967 783,305 804,484 737,150 
51 
 
National Indicator Description GARP UA 
target by 
2008 2009 2010 2011 2012 2013 2014 2016 
3.12 ANC and EID Facilities (WHO) 
3.12.1 Number of antenatal care facilities providing HIV 
testing and counseling services 
● 

468 3.12.2 Number of antenatal care facilities providing HIV 

testing and counseling services and dispensing antiretrovirals 
● 949 
3.12.3 Percentage of health facilities that provide 
virological  testing  services  (e.g.  polymerase  chain  reaction)  for  diagnosis  of  HIV  in  infants  on 
site or from dried blood spots 
● 
7
7% Number of Health facilities 700 
52 
 
TARGET 4: Anti-Retroviral Treatment HLM Target: Reach 15 million people 
living with HIV with lifesaving antiretroviral treatment by 2015 Thai NASP: All 
PLHIV residents in Thailand receive social protection and access to quality 
treatment and care AIDS- related 
deaths reduced by half 
Indicator Description GARP UA 
National target by 2016 
2009 2010 2011 2012 2013 2014 
4.1 Percentage (%) of eligible adults and children 
currently receiving antiretroviral therapy 
- CD4 <200 cell/ml 
● ● 
90.0% 75.76% 71.80% 77.00% 
- CD4 <350 cell/ml 59.10% 64.61% 69.96% 80.25% 
- any CD4 Level 53.55% 60.98% 
4.2  4.2a  Percentage  of  adults  and  children  with  HIV  known  to  be  on  treatment  12  months  after 
initiating antiretroviral therapy 
● ● 95.0% 85.14% 80.70% 83.12% 82.11% 82.70% 83.03% 
4.2b Percentage of adults and children with HIV still alive and known to be on treatment 24 
months after initiation of antiretroviral therapy (among those who initiated antiretroviral therapy 
in 2010) 
● 79.80% 79.80% 78.89% 78.38% 77.90% 
4.2c Percentage of adults and children with HIV 
still alive and known to be on treatment 60 months after initiation of antiretroviral therapy 
(among those who initiated antiretroviral therapy in 2007) 
● 
Data not available 
75.91% 74.59% 
53 
 
National Indicator Description GARP UA 
target by 
2009 2010 2011 2012 2013 2014 2016 
4.3 Number of health facilities that offer ART(i.e. 
prescribe and/or provide clinical follow-up) 
- Adult 
● 1014 943 937 949 978 949 
- Pediatric 
672 675 640 
4.4 Percentage of health facilities dispensing 
antiretroviral drugs that have experienced a stock- out of at least one required ARV in the last 12 
months (WHO) 
● 3.14% 
Data not available 
3.55% 3.05% 
4.5 Percentage of HIV positive persons with first CD4 cell 
count < 200 cells/μL in 2014 
● 57.03% 
4.6 HIV care ● 
4.6a Total number of adults and children enrolled in HIV care at the end of the reporting period 
● 407,046 426,274 
4.6b Number of adults and children newly 
enrolled in HIV care during the reporting period 
● 
52,521 35,282 
4.7 Viral Load 
4.7a Percentage of people on ART tested for viral load who have a suppressed viral load in the 
● 95.38% 96.09% 
reporting period 4.7b Percentage of people on ART tested for viral load with VL level ≤ 
1000 copies/ml after 12 months of therapy 
● 92.54% 94.81% 
54 
 
National Indicator Description GARP UA 
target by 
2009 2010 2011 2012 2013 2014 2016 
4.7c Percentage of people on ART tested for viral load (VL) with undetectable viral load in the 
reporting period 
● 90.72% 
55 
 
TARGET 5: Reduce tuberculosis deaths in people living with HIV HIV HML 
Target: Reduce tuberculosis deaths in people living with HIV by 50% by 2015 
Thai NASP: TB deaths among people living with HIV reduced by half 
Indicator Description GARP UA 
National target by 2016 
2009 2010 2011 2012 2013 2014 
5.1 Percentage of estimated HIV-positive incident TB cases that received treatment for TB and 
HIV 
● ● 50.00% 25.53% 26.07% 36.19% 27.84% 38.37% 39.09% 
5.2 Percentage of adults and children living 
with HIV newly enrolled in care who are detected having active TB disease 
Data not available 
Data not available 
5.3 Percentage of adults and children newly 
enrolled in HIV care (starting Isoniazid Preventive Therapy (IPT)) 
● 
Data not available 
Data not available 
Data not available 
Data not available 
Data not available 
5.4 Percentage of adults and children 
enrolled in HIV care who had TB status assessed and recorded during their last visit 
● 
Data not available 
Data not available 
Data not available 
● 94.98% 
Data not available 
56 
 
TARGET 7: Eliminating gender inequalities HML Target: Eliminating gender 
inequalities and gender-based abuse and violence and increase the capacity of 
woman 
and girl to protect themselves from HIV Thai NASP: Human rights and gender 
specific needs are addressed in all HIV Responses 
Indicator Description GARP UA 
National target by 2016 
2012 2013 2014 
7.1  Proportion  of  ever-married  or  partnered  women  aged  15-49  who  experienced  physical  or 
sexual violence from male intimate in the past 12 months 
Data not available 
● NA 
Data not available 
57 
 
TARGET 8: Eliminating stigma and discrimination HML Target: Eliminating 
stigma and discrimination against people living with and affected by HIV through 
promotion of 
laws and policies that ensure the full realization of all human rights 
and fundamental freedoms Thai NASP: Expand the protective social and legal 
environment essential for HIV prevention and care 
Reduce stigma and discrimination by 50% in 2016 
Indicator Description GARP UA 
National target by 2016 
2006 2012 2014 
8.1 Percentage of women and men aged 15-49 who report discriminatory 
attitude towards people living with HIV 
Data not available 
Data not available 8.1.1. Percentage of women aged 15-49 who would buy fresh 
vegetable from a shopkeeper or vendor who has HIV 
● TBD 
58.7% 
8.1.2. Percentage of women aged 15-49 who think children 
living with HIV should be able to attend school 
Not available 8.1.3. Percentage of women aged 15-49 who would not want 
to keep secret if a family member had HIV 
53.6% 
8.1.4. Percentage of women aged 15-49 who believe that a 
female teacher with HIV should be allowed to continue teaching 
70.0% 
8.1.5. Percentage of women aged 15-49 who are willing to care 
for a family member with HIV in own home 
92.1% 
58 
 
TARGET 10: Strengthening HIV Integration HML Target: Eliminate parallel 
system for HIV- related services to strengthen integration of the AIDS response in 
health 
and development efforts Thai NASP: No specific target 
Indicator Description GARP UA 
National target by 2016 
2006 2012 2014 
10.1 Current school attendance among orphans and non-orphans (10–14 years 
old, primary school age, secondary school age) 
● NA 
Part A: Current school attendance rate of orphans aged 10-14 primary school age, secondary 
school age 
93.6% 91.70% NA 
Part B: Current school attendance rate of children aged 10-14 primary school age, secondary 
school age both of whose parents are alive and who live with at least one parent 
96.3% 97.70% NA 
10.2 Proportion of the poorest households who received external economic 
support in the last 3 months ● 80.19% NA 
59