Integrated Behavioral Surveillance Survey among MSM in Bangkok Dr. Chantapat Brukesawan, Director of Health Center 26 Chaokhunprayurawong, Health Department Bangkok Administration,Thailand
Outline Introduction - Bangkok Administration - Bangkok AIDS Situation - Bangkok HIV/AIDS Response Integrated Behavioral Surveillance Survey among MSM in Bangkok Result & Discussion Conclusion Action
Introduction
1,568 sqkm 2 50 districts 17,762 Workplaces 438 BMA Schools Population 5,686,252 2,694,921 2,991,331 2,051 registered communities ~2,000-6,000 Sex establishments ท มา : หน งส อสถ ต กทม. ป 2558
Organization Chart of Bangkok Metropolitan Administration Governor Permanent Secretary for BMA BMA Civil Services commission BMA Council Office of Permanent Secretary for BMA Strategy and Evaluation Dept. Education Dept. Finance Dept. Drainage And Sewerage Dept. Public Works Dept. City Planning Dept. Social DevelopD ept. Culture Sports And Tourism Dept. Disaster Prevention And Mitigation Dept. Medical Service Dept. 8 Hospital 68 Health Center Health Department 12 Division BMA Budget Dept. 50 District Offices Environment Dept. Traffic and Transportation Dept. City Law Enforcement Dept.
Bangkok AIDS Situation
Increased focus where of new infections occur with effective package of intervention 100% 90% 80% 70% 6% 30% Casual and Extramarital sex Spousal transmission 65% of new 60% 50% 40% 30% infections 20% 44% 10% 10% 11% Injection Drug User Sex worker and clients Male who had sex with male 0% - 66% of new infections occur in 33 provinces
Estimated number of new infection by route of transmission 12000 10000 8000 6000 4000 2000 0 Needle sharing Male-male sex Casual sex Wife to husband Husband to wife Sex Work 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 Source : Aids Epidemic Model(AEM), AIDS TB & STIs Division, Bangkok 2015
Bangkok shares 1/3 of total new infections, 40% among MSM, SW & clients and IDU % 100 80 60 43,040 New infections in Thailand 28,747 New infections in Thailand 40 20 11,643 27% In Bangkok 9,667 36% In Bangkok 0 Total MSM, SW & clients and IDU Number of new infections ( Total, MSM, SW & clients and IDU) In Bangkok compared to Thailand
Bangkok shares 31.53% of among MSM total new infections in Thailand 31.53% 1,087 1 Bangkok 68.47% 2,361 2 Other Province Source : Aids Epidemic Model(AEM), AIDS TB & STIs Division, Bangkok 2015
Estimated number of Key Population in Bangkok 2016 PWID,10,155 คน FSW, 27,519 คน MSM, 77,301 คน TG, 43,082 คน High risk 38,650 Low risk 38,651 MSW, 3,856 คน MSM MSW TG FSW PWID Source : Aids Epidemic Model(AEM), AIDS TB & STIs Division, Bangkok 2015
1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025 2027 2029 Estimated number of new infection, people living with HIVand death in Bangkok Thailand 100,000 New Infection PLHIV Death 80,000 60,000 40,000 20,000 - ป 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 PLHIV 78,080 77,555 76,716 75,575 74,233 72,633 70,909 69,075 67,139 65,411 63,877 62,319 60,785 59,275 57,784 New HIV Infections 2,289 2,201 2,078 2,047 2,009 1,966 1,922 1,878 1,832 1,786 1,747 1,711 1,677 1,642 1,609 Death 2,409 2,727 2,917 3,188 3,351 3,566 3,645 3,712 3,768 3,514 3,281 3,269 3,210 3,153 3,099 Source : Aids Epidemic Model(AEM), AIDS TB & STIs Division, Bangkok 2015
Estimated number of new infection by Kay Population in Bangkok 2016 people living with HIV 78,080 new infection 2,289 6 Person / Day HIV prevalence in Bangkok 2015 Kay Population Prevalence (%) MSM 28.9 IDU 27.6 FSW 2.9 ANC 0.7 Male conscript 0.9 Source : Aids Epidemic Model(AEM) of Bangkok and Survey of HIV prevalence in Bangkok 2015
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 HIV prevalence by year: general population, Bangkok : 1991-2015 % 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 ANC Blood donor Male conscript PMCT Health for all ARV for any CD4 0.90 0.46 0 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
HIV prevalence by year, Bangkok : 2003-2016 % 50 40 30 20 10 0 28.3 17.3 18.9 30.7 27.0 24.7 11.5 10.0 13.7 16.7 MSM MSW TG 31.1 28.9 19.2 28.6 12 5.6 9.9 2003 2005 2007 2009 2010 2012 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
HIV Prevalence among MSMs by venue Bangkok, Thailand % 50 Bar Sauna Non-venue Event 47.9 40 30 20 16.9 13.0 22 23.0 31.9 30 34 29.2 28.8 21.1 25.7 32 26.5 13 30.7 28 29.5 29 25.0 25.9 10 0 2003 2005 2007 2009 2010 2012 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
HIV Knowledge (UNGASS) % 100 MSM MSW TG 80 60 40 20 28 30 21.9 39 32.9 33.3 30.8 21 18.5 21.5 0 2007 2010 2012 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
use of condoms among male-male sex(msm) with male regular partner % 100 80 60 40 20 0 consistent condoms in 3 month last sex 84.4 88 89.1 82.1 70.5 67 60 61 63.3 65 66 54 2003 2005 2007 2010 2012 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
use of condoms among male sex workers(msw) % consistent condoms in 3 month last sex 100 80 60 40 20 87.6 82.8 86.8 78.2 81 93.7 93.8 95 89.4 87.6 0 2005 2007 2010 2012 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
Use of condoms among transgender women(tg) with male regular partner % consistent condoms in 3 month last sex 100 80 60 40 41.8 64.7 63.6 33.3 43.2 86.7 20 0 2005 2010 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
Access to prevention information/supplies among MSM 100 % Received education Received condoms 80 60 40 41 54.5 49 31.8 66.4 67.8 47.3 54.8 20 0 2007 2010 2012 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
Access to prevention information/supplies among MSW % Received education Received condoms 100 80 60 47.3 76.1 80.5 67.1 64.1 80.8 84.5 95.9 40 20 0 2007 2010 2012 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
Access to prevention information/supplies among TG 100 80 60 % 82.1 Received education 74.4 Received condoms 52.5 63.5 40 20 0 2010 2014 Source : AIDS TB & STIs Division, Bangkok Metropolitan Administration
9470 9071 11362 10934 12690 12618 9537 9390 10212 9996 24843 18344 Access to prevention information/supplies among MSM 40000 35000 30000 25000 20000 15000 10000 5000 0 knowledge condoms %knowledge %condoms 64 36.7 41.1 47.4 30.6 30.8 33 35.4 40.8 29.3 30.4 32.3 2010 2011 2012 2013 2014 2015 100 80 60 40 20 0 SOURCE : ม ลน ธ ร กษ ไทย, RSAT, SWING, บางกอกเรนโบว, NGOกทม., หน วยงานส งก ดกร งเทพมหานคร
Bangkok HIV/AIDS Response
Michel Sidibé 2012
Getting To Zero Zero new HIV infection Zero AIDS-related Death Zero discrimination
Bangkok Getting to Zero Vision To get to zero new HIV infections To get to zero AIDS-related deaths To get to zero discrimination Goals by 2030 - New HIV infections reduced by 1/2 - Equal access to quality of treatment, care and support for all PLHIV - TB deaths among PLHIV reduced by half - Stigma and discrimination towards PLHIV and key affected populations reduced by half
Overview of the vision, strategic direction, and core themes of the Bangkok HIV/AIDS Strategy in 2012-2016 Zero new HIV infection Zero AIDS-related deaths Zero discrimination Strategy 1 Increase local and community ownership for HIV/AIDS response Strategy 2 Expand implementation of comprehensive prevention services with rights based and gender sensitive Strategy 3 Increase equally access to quality and comprehensive of treatment, care and social protection services to all PLHIV Strategy 4 Promote human rights capacity and expand activities to decrease stigma and discrimination Strategy 5 Strengthen strategic informatin systems to increase efficiency and effectiveness in HIV/AIDS response Innovation and Change Optimization and Consolidation People inclusive People centered Increased focus Social justice Leadership and locally owned response Partnerships