Young People and HIV/AIDS

Transcription

1 Young People and HIV/AIDS Young People at e Centre of HIV/AIDS Epidemic The population of Thailand was estimated to be about. million in wi 7% in e - year age group. According to estimates, e HIV prevalence among young people aged - years was.% among males and.3% among females (Figure ). Thailand was e first country in Asia to document e HIV/AIDS epidemic. According to e UNAIDS report e number of people estimated to be living wi HIV in was (33 9 ). The adult Table : Reported AIDS cases by age group (September 9-April ) Age group Male Female (in year) Source: Bureau of Epidemiology, MoPH, Thailand,. HIV prevalence was.% (.7% -.%). The number of reported AIDS cases in e age group of - years (Table ) was more an %. Data from sentinel surveillance system indicates high HIV prevalence among injecting drug users, direct and indirect female sex workers, male sex workers, Figure : HIV prevalence among you () Male You (- years) Female Source: Heal related Millennium Development Goals, WHO. fishermen and male STD clients 3. HIV prevalence among pregnant women has declined from.3% in 99 to.% in 3. HIV prevalence has also decreased among military conscripts from % in 993 to.% in 3 (Table )..3 Table : HIV prevalence in selected high risk groups (3) High risk groups HIV Prevalence Injecting drug users 33% Female direct sex workers.7% Male sex workers 7.9% Fishermen.% Male STD clients.% Female indirect sex workers 3.7% Pregnant women.% Military conscripts.% Blood donors.7% Source: Epidemiological fact sheets on HIV/AIDS & STIs, Thailand, UNAIDS, UNICEF, WHO update THAILAND Fact Sheet Thaileand Option.pmd //, : PM

2 THAILAND The first case of AIDS in Thailand was reported in September 9. HIV originally spread wiin groups at engaged in risk behaviours. Currently, however, e disease has been transmitted to e general population and e rate of spread is highest among young people and women. Though past efforts to control HIV have shown a measurable success in reducing e rate of infection, AIDS is one of e major causes of dea among Thai young people (Table 3). Table 3: Cumulative number and percent of young people s dea due to AIDS (November 9 3 December 3) Sex No. of Total YP cases deas due to AIDS Male Female Total Young People Source: Bureau of Epidemiology, Department of Disease Control, Thailand Young People Are Vulnerable to HIV & STIs Currently, e primary modes of HIV transmission in Thailand include sexual transmission, unsafe injection practices and vertical transmission. Of e AIDS cases reported till 3 wi a known route of transmission, heterosexual contact accounted for %, followed by injecting drug use (%) and perinatal transmission (%) 3. Figure : Rate of STI cases reported per population by age group Figure 3: of STI patients by age group (October September ) < > Age group (in years) 3 Age group (in years) > < Source: Summary data fromannual Report (-) STI Cluster, BATS, Thailand Source : STIs Cluster, Bureau of AIDS, TB & STIs, Department of Disease Control, Ministry of Public Heal Thailand (-). The predominant mode of transmission of bo HIV and STI is sexual intercourse. Increasing sexual risk behaviours among young people increases eir vulnerability to sexually transmitted infections. The presence of an STI increases e risk of HIV transmission manifold. Evidence of increasing risk of young people to HIV includes e progressively lower age of ose attending STI clinics (Figure,3). In 3 young people wi sexually transmitted diseases accounted for almost one ird (3.7%) of e total number of STD cases reported. The proportion of gonorrhoea cases found among -9 year olds increased from.39% in to.7% in. While only 3% of new STI cases were reported among students in, e figure had increased to more an % by. Thaileand Option.pmd //, : PM

3 Effective STI services were a key element in e early and rapid success of Thailand s response to HIV. However, e increasing proportion of new STI infections among you at makes em more vulnerable to HIV indicates at ere is an urgent need Girls and young women to strengen efforts towards preventing, diagnosing and treating STIs in is age group. Special attention is also needed for e especially vulnerable young people who are at risk of adopting high-risk sexual or drugusing practices. Many Young People Are Especially at High Risk New epidemic trends in e country reveal increasing levels of HIV/AIDS among women. This is evident from Thailand s changing HIV epidemic scenario where e transmission of e virus is affecting a diverse population. Figure : Estimated percent of new HIV infections in Thailand showing changing mode of transmission or regular partnerships where condom use tends to be very low 7. Along wi biological vulnerability, e socio-cultural and economic disadvantages faced by girls and young women greatly increase eir risk of contracting HIV. They have limited access to reproductive heal services and gender power imbalances often prevent em from insisting on adopting prevention meods such as condoms in eir relations wi eir sexual partners. THAILAND Years Figure shows e changing mode of infection in Thailand wi heterosexual transmission of HIV in cohabiting partners increasing dramatically over HIV transmission rough sex work. Marriage and oer long-term monogamous relationships do not protect young women from HIV. A 999 study in Thailand found at 7% of HIV infected women were likely to be infected by eir husbands. Nearly half of ese women reported sex wi eir husbands as eir only HIV risk factor. Male clients of sex workers also infect eir wives and girlfriends, as a result of which as many as half of e new HIV infections each year occur wiin marriage Estimated percent of new HIV infections Sex worker Spouse IDU MTCT Source: Report on e global AIDS epidemic, Global report, UNAIDS, 9 Young sex workers HIV prevalence among direct female sex workers was found to be.7% at e end of 3 3. The main factor responsible for e explosive spread of HIV in e late 9s and early 99s in Thailand was sex work. An effective national response resulting in high levels of condom use in commercial sex and rapid control of sexually transmitted infections (STIs) marked e turning point at was effective in changing e risk behaviour patterns in e country resulting in e percentage of adult men visiting female sex workers falling from % to % annually. The use of condoms wi sex workers also reached consistent levels. However, ere are indications of a rising number of STI cases among sex workers and an increase in e numbers of indirect sex workers who are out of reach of prevention efforts. In Bangkok alone, an estimated 3 women were trading sex in non broel settings such as massage parlours in 3 7. Consequently, e epidemic reatens to regain momentum in vulnerable populations such as young sex workers. Young men who have sex wi men (MSM) In 3, Thailand s Ministry of Public Heal surveillance reported % HIV prevalence among male sex workers. The TUC (Thai MoPH U.S. CDC Collaboration) Bangkok study in reported HIV 3 Thaileand Option.pmd 3 //, : PM

4 THAILAND infection rates of.% among freelance male sex workers and.% among venue-based male sex workers. Though age-specific data on young men who have sex wi men (MSM) is unavailable, recent studies indicate signs of increased HIV infection among men having sex wi men in Thailand. Between 3.3% to.% of Thai males report having had some kind of same sex sexual experience in commercial or non commercial setting. A recent study in Bangkok found 7% MSM to be HIV-positive and at one quarter of em had sex wi women as well 7. Since many MSM also buy and sell sex along wi having sex wi women, e potential for HIV transmission wiin and beyond MSM social networks is high. Marginalization and discrimination also inhibit HIV prevention services to reach MSM making em more vulnerable. Young injecting drug users (IDUs) Use of contaminated injecting equipment to inject drugs is a highly efficient mode of HIV transmission which has played a major role in e spread of Thailand s HIV epidemic. HIV prevalence among injecting drug users remained highest in Thailand at 33% nationally in 3 and poses a major challenge to e control of e virus. Recent findings show at HIV prevalence in drug injectors has risen in every region of Thailand over e past years reaching % in e Norern Region and % or higher in Bangkok and Figure : Drug and substance use among nd year ( grade) secondary school students,... e Central and Souern Regions. It has been estimated at as many as one-fif of new HIV infections in e past years has been due to unsafe modes of injecting drugs 7. Findings of e round of e National Behavioural Surveillance () revealed e presence of drug and substance abuse among secondary school students wi a higher percentage of young males using drugs as compared to females of e same grade (Figure ). In, a study of 93 students in all types of educational institutions found at e main reasons for student involvement wi drugs were curiosity, peer pressure, lure of a trendy practice and family problems coupled wi lack of awareness of e consequences. Besides, students were able to obtain ese drugs easily. Young female drug injectors too were found to be engaging in risky sexual behaviours along wi e sharing of needles. High rates of unprotected sexual activity and multiple partnerships were also reported (Figure ). Figure : Profile of young female drug users in Norern Thailand admitted to drug treatment centres (999-) Criteria HIV positive Ever used condom Multiple sex partners 7 Sharing needles < years IDU Source: Women who use drugs and eir HIV risks in norern Thailand. Srirak, Namtip, et.al.,. Six International Congress on AIDS in Asia and e Pacific, Melbourne, Australia 3 Meamphetamine Glue / Thinners Marijuana Males Opium Ecstacy Females Kratom Oer Substances Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, High HIV prevalence among injecting drug users for nearly two decades has increased e need for HIVrelated services. Established guidelines for management of HIV infection for IDUs and no specialized services providing Anti Retroviral Therapy (ART) in tandem wi drug dependence treatment services are required. Thaileand Option.pmd //, : PM

5 Oer young people especially vulnerable to HIV/ AIDS in Thailand include streetchildren, young people from enic minorities, mobile and border populations, Early initiation of sexual activity Why Young People Are More Vulnerable Recent data from e National Behavioural Surveillance among secondary school students () indicates at young men and women in Thailand are initiated early into sexual activity. The average age of first sex among sexually active grade students was 3 years for bo boys and girls (Figure 7). Figure 7: Average age of first sexual encounter nd among sexually active year ( grade) secondary school students, young people from slum communities, and ose in remote rural communities. Figure : Partner types of sexually active male secondary school students in THAILAND Age in years 3 3 grade male students grade male students Female sex worker Girlfriend or lover Oer women Oer males Males Females Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, The most common reported sexual partner by sexually active male students were eir girlfriends followed by casual partners and female sex workers. Homosexual relationships were also reported by bo e eigh and eleven grade students (Figure ). National Behavioural Surveillance data from 99 to shows a significant rise in e proportion of secondary school students who are sexually active (trends for bo male and female students of year of secondary school are shown in figures 9-). Anoer study among vocational students in Chiang Rai province revealed at while 7% of e young men surveyed bought sex almost half of bo male and female students were sexually active. Results of oer studies also reveal an increase in Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, premarital and casual sex among young Thai men and women, compared to earlier generations. Adolescent boys and girls also engage in risk behaviours more frequently an eir peers did a few years ago, ereby exposing emselves to HIV infection. Figure 9: Sexual behavior of year ( grade) male secondary school students classified by year and partner type Female sex worker Girlfriend or lover 3 Oer women Oer males Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, Thaileand Option.pmd //, : PM

6 THAILAND Figure : Sexual behaviour of year ( grade) female secondary school students by year and partner type Young people lack informations and skills Most young people have heard of HIV/AIDS in Thailand (9%). However, National Surveillance () data among secondary and vocational students show at less an % of bo male and female students of secondary and vocational schools could answer all questions about HIV/AIDS correctly (Figure ). Figure : of year secondary and nd year vocational school students answering all questions about HIV/AIDS correctly, Boyfriend or lover Oer male Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, Young people, especially girls and young women, are also more susceptible to coercive sex. National Behavioural surveillance () data on grade secondary school students reveals at e first sex experience for % girl students was forced (Figure ). Violent or forced sex also increases e risk of transmitting HIV as forced vaginal penetration commonly causes cuts at allow e virus to cross e vaginal walls more easily. Anoer survey conducted among 7 female students across provinces of Thailand found of em to be already sexually active. About female students reported at eir first sex experiences were forced and at ese first time partners were mostly older men while students admitted to having more an casual partners 9. nd Figure : First sex of sexually active year female secondary school students, Grade female students Wi boyfriends or lover Involuntary Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, Figure 3: Condom use among sexually active male secondary school students classified by partner type, 3.9 M (VSS) F (VSS)^ M (SSS) F (SSS) grade male grade male students students Wi female sex worker Wi oer women Wi girlfriend or lover Wi oer males Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, grade Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, VSS - Vocational school student ^ SSS - Secondary school student Recent surveillance assessing risk behaviours vis-à-vis HIV infection show at Thai you continue to engage in risky sexual practices. These include high rates of unprotected sexual activity among sexually active you, wi consistent use of condom being lowest wi steady partners and oer males (Figure 3). Thaileand Option.pmd //, : PM

7 The trends show at over a period of time condom use by young males has gone down even wi highrisk partners such as female sex workers. Condom use by sexually active male secondary students wi female sex workers was 73.9% in 99 but had come down to 3.% by. Use of condom was less an % for all oer partner types as well (Figure ). Figure : Condom use among sexually active year ( grade) male secondary school students classified by year and partner type Wi female sex worker Wi girlfriend or lover 3 Wi oer women Wi oer males Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, Condom use patterns among sexually active grade female secondary students show almost negligent use wi males who are not boyfriends and less an % use wi boyfriends (Figure ). Anoer study in Norern Thailand revealed at less an one ird of all e young men who reported buying sex said ey always used condoms 7. Young people adopt risky behaviours as ey are often Figure : Condom use among sexually active year ( grade) female secondary school students classified by year and partner type Wi boyfriend or lover 3 Wi oer males Disease Control, Ministry of Public Heal. Report on e HIV/AIDS Situation in Thailand, poorly informed about e consequences of unsafe sex. At times ey also lack e skills to say no to unwanted sex or to negotiate safer sex. Sometimes awareness and knowledge of risks does not translate into safe sexual behaviour due to a variety of factors like social norms, lack of education or unavailability of services consistent wi eir needs. This results in exposing young people to HIV. Issues identified by young people emselves include increased access to information about HIV/AIDS, especially at which is consistent wi eir needs. Young people also want to acquire life skills to protect emselves from infection wi HIV or to live better wi HIV. They need access to services, such as counselling which is friendly, and condoms. THAILAND Focusing on e Young to Halt e Spread of HIV/AIDS HIV prevention and control was declared a national priority in Thailand in 99. Several important steps have since been taken to help slow e epidemic and e reduction in STIs and HIV prevalence is evident in nearly all monitored population groups. The initiatives taken by e government include: Massive public information campaign on HIV/ AIDS: Anti-AIDS messages aired every hour on e country s state-owned radio and television stations, and every school required to include information on HIV/AIDS in its curriculum. percent condom program : This programme aimed at enforcing consistent condom use in all commercial sex establishments. Condoms were distributed free at broels and massage parlours and sex workers and eir clients were required to use em. The second National Plan for Prevention and 7 Thaileand Option.pmd 7 //, : PM

8 THAILAND Alleviation of e AIDS Problem which covered e period from 997 to, continued wi e previous effective programmes, while adopting a more holistic approach which included mobilizing e efforts of communities and people living wi HIV/AIDS. The ird National Plan for e Prevention and Alleviation of HIV/AIDS in Thailand (-) was launched in end-, and continues e work of e previous National Plan (99-). There are ree specific targets in relation to is plan. to effective interventions in high- risk commercial sex settings. However, recent HIV and behavioural data suggests at currently e most important source of new infections is from HIV-positive men, many previously infected rough commercial sex, to eir wives, followed by injecting drug users. Increasing sexual and drug-using risk behaviours among young people continue to increase eir vulnerability and provide conditions at could support a resurgence of HIV in e country. Different strategies are needed to reduce is evolving epidemic. To reduce adult HIV prevalence to less an % by e end of e Plan period. To provide access to care and support for at least % of e people living wi HIV/AIDS and oer affected individuals, and To enable local administrations and community organisations roughout e country to bo plan and carry out work on HIV/AIDS prevention and alleviation. Thailand has achieved a substantial success in controlling e spread of HIV/AIDS wi e number of new infections falling progressively each year due Key strategies have been identified by e government as a priority in tackling e HIV/AIDS epidemic: Individuals, families and community organizations to be made aware of e role ey play in e prevention and alleviation of HIV/AIDS. Heal and social welfare services will be established for e prevention and alleviation of HIV/AIDS. Knowledge and research will be developed along wi international cooperation. A management system will be developed to integrate e tasks of HIV/AIDS prevention and alleviation. References:. Mahidol University. Mahidol Population Gazette volume,. Nakhorn Paom: Institute for Population and Social Research,. (Accessed 3 October, report on e global AIDS epidemic, a UNAIDS anniversary special edition. Geneva: UNAIDS 3. World Heal Organization. Epidemiological factsheets on HIV/AIDS & STIs. Geneva, (Accessed 3 October, Chitwarakorn A. National Plan for e Prevention and Alleviation of HIV/AIDS in Thailand, -. Bangkok: Ministry of Public Heal, Department of Communicable Disease Control. (Accessed October, PlanAIDS.doc).. External review of heal sector response to HIV/AIDS in Thailand. New Delhi: World Heal Organization, Regional Office for Sou-East Asia and Bangkok,. (Accessed October, News_and_Events_ThailandProgrammeReviewNEW.pdf#search=%external%review%of%heal%sector% response%to%hiv%faids%in%ailand%).. Report on e global AIDS epidemic. Geneva: UNAIDS,. (Accessed on October : GAR_html/GAR en.htm). 7. AIDS epidemic update: December. Geneva: UNAIDS / WHO,. (Accessed 3 October, /doc/ EPIupdate_pdf_en/epi-update_en.pdf).. HIV/AIDS in Asia and e Pacific Region. New Delhi: World Heal Organization, Regional Office for Sou-East Asia and Regional Office for e Western Pacific Region, ( Accessed 3 October, pub_99.htm). 9. Situation review on adolescents and HIV/AIDS in East Asia and Pacific. UNICEF, June.. Young people and HIV/AIDS: opportunity in crisis. Geneva: WHO / UNICEF / UNAIDS, (Accessed 3 October, Thaileand Option.pmd //, : PM