The issue of HIV infection is suddenly in the national spotlight once again, following recent reports of the death of a 22-year-old woman from Loei province whose father claimed she died of HIV complications. The father said his daughter along with three other friends contracted HIV after getting a tattoo in Bangkok's Klong Lot area in March.
Although later the truth unfolded that it was not HIV that killed the four women, the story did trigger a long, hot debate among the public, medical practitioners and even tattoo artists about whether the virus could actually be transmitted through tattoo needles. Prior to the autopsy results, many frowned upon the incident, believing these four victims might have in fact been infected from somewhere else. A number of doctors came out and said HIV is not likely to develop and kill at such a pace. Some went so far as to conclude that getting a tattoo would never lead to an HIV infection.
Deputy director of the Hospital for Tropical Diseases at Mahidol University Dr Sant Muangnoicharoen said that whether or not people could get an HIV infection from a tattoo parlour depends largely on safety and sanitary protocols practised by tattoo artists.
"There is a risk, of course, that one can get infected through a shared tattoo needle if tattoo artists fail to dispose of needles after each use," explained Dr Sant. "If a needle is used with more than one person, you never know if the person who gets a tattoo before you is infected with HIV or not."
According to Dr Sant, HIV is transmitted through contact between broken skin, wounds or mucous membranes with blood or bodily fluids infected with the virus. This means it can be transmitted through sexual intercourse, shared needles, blood transfusion, mother-to-child transmission during labour and other occupational exposure to the virus such as accidental needle sticks. According to data from the US Centers for Disease Control and Prevention, HIV is not spread through saliva.
The 2017 statistics from the World Health Organisation (WHO) reveals 25.7 million people living with HIV in Africa, making it the region with the highest number of HIV-infected patients. Southeast Asia comes in second, with 3.5 million people living with the virus followed by the Americas, where 3.4 million HIV patients were reported. In Thailand, according to figures from the Bureau of Epidemiology, the Ministry of Public Health, the number of HIV-infected patients as well as new cases have steadily fallen. From over 520,000 patients above 15 years old in 2005, Thailand only saw around 430,000 patients in 2015. New cases also plunged from over 17,000 in 2005 to only around 6,700 in 2015. It is expected that the country will see only about 3,700 new HIV cases in 2030.
Dr Sant cited the HIV Manual, a medical publication jointly produced by the Stanley Ho Centre for Emerging Infectious Diseases, the Chinese University of Hong Kong and the Centre for Health Protection, the Department of Health, with regard to the transmission risk by exposure category. It turns out that receptive anal intercourse poses the highest risk of contracting the virus, with a 1-30% chance. Then it is followed by needle sharing (0.67% risk) and needle stick injury (0.3%). Insertive anal intercourse and vaginal intercourse are at an equal risk of 0.1 to 1%
"These numbers do explain why men who have sex with men are a high-risk group. Anal sex is likely to cause fissures which can then be a pathway through which the virus can get into the body," said Dr Sant.
Medical personnel like doctors and nurses are at occupational HIV risk. Despite universal precaution protocols, Dr Sant said, there were cases where needle sticks resulted in medical practitioners becoming infected.
In such cases, the situation and the risk must be assessed immediately.
"If the risk is high, that person will be given antiretroviral drugs right away. Although antiretroviral medication is generally used as a treatment for the HIV-infected, it can also be prescribed as a post-exposure treatment. Antiretroviral drugs given in such a case would be highly effective, especially if they are given within 72 hours after the suspected scenario."
Thailand is among countries at the forefront for the development of a vaccine against HIV. A large research project that involves thousands of participants is being carried out at a vaccine centre at Mahidol University's Faculty of Tropical Medicine. According to Dr Sant, although the research shows great improvement, it is still not enough for the vaccine to be distributed on a commercial scale.
"The vaccine is indeed coming," he said. "The research sees a plunge in the infection rate among those who have the vaccine compared to people who do not get the shot. It makes good progress but we cannot say when it will be available in the market."
Although people's attitudes towards the HIV-infected are much better when compared to 30 years ago, Dr Sant admitted that there are still a number of those in society who consider the disease a stigma and discriminate against patients at work and elsewhere.
"HIV/Aids patients have to face a lot of issues," he added. "One is the lack of understanding from society and the people around them. People still despise HIV/Aids patients for fear of being infected. This creates an emotional scar among patients. Some of them choose to travel to another province to get their antiretroviral medication, so as to hide the truth from people in their neighbourhood. Worse, some patients choose to not be treated at all."
Despite the decline in the number of new cases, Thailand is in desperate need of education when it comes to the illness, especially among the younger generations, advised Dr Sant.
"Shockingly, we have found that HIV infections do surge among young people. Students increasingly become HIV patients. This is an extremely important issue, a challenge for policymakers and public-health advocates to do something so that they can get to these people and lower the infection rate. Education is ideal, but how to make it appropriate and accessible for the young is a daunting task.
"When it comes to HIV, prevention is best. Do whatever it takes to not get infected -- like protected sex, for instance. This will in turn help with other social issues, including teen pregnancy, pregnancy out of wedlock and so forth. For those already infected, it is vital to get educated. Clinics and healthcare providers across the country are there to provide knowledge as to what they can or cannot do, how to protect themselves from spreading the virus, whether or not they can have a relationship or a social life. Do not be shy to get help."
