Lessons from Thailand: integrating HIV services into national health schemes

An article from UNAIDS
February 1, 2016
In the late 1990s, the Thai Government started offering free antiretroviral medicines to several thousand people. Apiwat Kwangkaew, currently Vice-Chair of the Thai Network for People Living with HIV, was one of the lucky ones.
 
“Twenty years ago I got really sick because of AIDS. I didn’t think I was going to make it,” said Mr Apiwat. Within a few months of starting treatment, he was healthy again.
“What was really tragic was that antiretroviral medicines existed, but my friends and other people living with HIV were not accessing them,” he said.
 
Because of that experience, ensuring access to HIV treatment has been his life’s passion. He is now one of Thailand’s better known advocates for people living with HIV.
 
Since the 1990s, the situation has vastly improved. In 2002, Thailand became one of the first members of the Association of Southeast Asian Nations (ASEAN) to integrate HIV services into its universal health coverage scheme. Between 2010 and 2014, coverage of people living with HIV receiving antiretroviral medicines increased from 42% to 61%.
 
Suchada Chaivooth, Director of the HIV and Tuberculosis programme at the National Health Security Office, said that Thailand had found many benefits from this integration. “The government can negotiate a good price for antiretroviral medicines because it’s supplying a large number of people living with HIV,” she said.
 
Panya Shoosiri, a gardener from Amphur Thamai village in Chantaburi Province, central Thailand, is one of the many people accessing free antiretroviral medicines. He has been living with HIV for more than 15 years. His monthly income is about US$ 100. “All HIV services are covered by the national plan. It’s a big relief for me,” said Mr Panya.
 
In 2014, Thailand reached a new milestone, becoming the first country in ASEAN to offer free HIV treatment to people living with HIV regardless of their CD4 count, the measurement used to indicate how significantly the immune system has been affected by HIV. Previously, people who tested positive could only access antiretroviral medicines after their CD4 count had decreased to 350 cells/mm3.
 
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