Thread: Stigma remains the leading killer in Thailand’s HIV fight

While medical advances now allow people with HIV to live normal lives, the fear of being stigmatised remains as intense as ever.


“People fear being diagnosed as HIV-positive – not because they are anxious about dying but because they worry about how to keep living,” said Yupha Sukreuang, chairperson of the Thai Network of People Living with HIV/AIDS (TNP+), speaking ahead of World Aids Day.


Marked on December 1, this year’s World Aids Day carries the theme “Take the Rights Path” to highlight the critical role of protecting and promoting human rights in the fight against the HIV/Aids epidemic.

Pain of stigma


Living in Lamphun province, Yupha has witnessed firsthand how HIV-positive people face discrimination, such as being required to produce blood test results to join village funeral assistance funds or even to ordain at a monastery.


“People now know they won’t die from catching HIV. But they also know they won’t be able to live the same way as before in their communities,” she said.
Yupha pointed out that an individual’s HIV diagnosis often becomes public in communities after being leaked by medical staff.


Apiwat Kwangkeaw, vice chair of the TNP+, said the public still perceives HIV as a disease caught through “immoral” acts. “Such attitudes explain why HIV-positive people are subject to disgust,” he said.


He pointed out that many employers, both in the public and private sectors, require job candidates to undergo an HIV test prior to recruitment. If the result comes back positive, the candidates are eliminated from the hiring process.


The Foundation for Action on Inclusion Rights (FAIR) points out that the Royal Thai Police, for example, exclude candidates with HIV or Aids from serving in the force.


According to FAIR, certain educational institutes discriminate against HIV-positive applicants in the same way. Even worse, individuals with HIV/Aids can be refused treatment at hospitals or clinics, under the pretext of inadequate facilities or due to discriminatory attitudes among staff.


Some dental clinics are known to bar HIV-positive individuals while others will only treat them as the last patient of the day.


FAIR’s findings are in line with a 2020 survey that showed 68% of hospital staff still subjected HIV-positive patients to discriminatory treatment. Those living with HIV have also found themselves barred from joining the activities of various associations and clubs.


These discriminatory attitudes often extend to HIV-positive individuals themselves.


A 2023 survey revealed that nearly half of HIV-positive people aged 18 to 24 held self-stigmatizing beliefs.


In the same survey, 7.5% of respondents complained their rights were violated because of their HIV-positive status and 9% felt their community treated them differently.

Stigmatization hinders battle against Aids


Yupha noted that the fear of stigma made many at-risk individuals reluctant to take a blood test, even if it was offered for free. She said this was one reason why Thailand has fallen short of its goal to ensure that at least 95% of HIV-positive individuals are aware of their status by 2025.


The goal is part of the 95-95-95 target for 2025 set by the UNAIDS, the Joint United Nations Programme on HIV/AIDS, to control the spread of HIV.


Dr Chureeratana Bowonwatanuwong, president of the Thai Aids Society, said the other targets are that at least 95% of individuals aware of their status receive treatment, and at least 95% of those in treatment have levels of HIV suppressed, so they are undetectable in blood tests.


At undetectable levels, HIV is non-transmissible, paving the way for individuals to live normal lives, including having children without passing on the virus. Treatment entails taking just one pill a day.


“Scarier than the infection itself for HIV-positive individuals are the attitudes people have about them,” Dr Chureeratana observed.


Dr Niti Hetanurak, deputy director-general of the Disease Control Department, cited a 2022 survey showing that over a quarter (27.9%) of Thais still held prejudices against people living with HIV.


“We hope to reduce that figure to no more than 10%. By curbing stigmatisation and discrimination, we will step closer to ending Aids,” he emphasised.

Thailand’s performance


Overall, Thailand is recognised for its strong performance in controlling the spread of HIV/Aids. Over 95% of individuals aware of their HIV-positive status receive antiviral drugs, while 98% have non-transmissible levels of the virus. The only target where Thailand falls short is awareness of HIV status, at a little over 90%.


“That’s why we still have to worry about people who have not yet developed symptoms infecting others,” Dr Chureeratana said.


About 580,000 people live with HIV in Thailand as of 2023, according to official data. Of them, over 470,000 are taking antiretrovirals. The number of new infections recorded last year was 9,100. Of them, 4,612 or about 52% of the newly infected cases were between 25 and 49 years old. About 47% or 4,115 were between 15 and 24 years old.


Men who have men with sex (MSM) accounted for 67% of new infections, while sex workers accounted for no more than about 1%. Unprotected sex was the biggest cause of new infections, accounting for 96% of cases. Needle-sharing was responsible for 4%.

Focus on doing better


Dr Chureeratana said efforts to combat the spread of HIV/Aids must now focus on the general population, not just groups such as MSM.


“The latest data shows a sizeable number of new HIV cases among members of the general population. People think they can have unprotected sex because they are not in a so-called at-risk group,” she said. “After they catch the virus, they remain unaware of their infected status for a long time because they never think about getting a test.”


In fact, all citizens under the Universal Health Coverage Scheme are entitled to two free blood tests per year to check if they have HIV.


However, this entitlement has not yet been widely promoted among the general public. Instead, awareness campaigns usually target MSM, drug users and sex workers.


Dr Chureeratana cited data showing that 12,000 HIV-positive people died last year in Thailand. In many cases, their deaths were blamed on late blood tests and treatment.

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