This year's theme for World Aids Day, which will be marking its 30th anniversary today, is "Know your HIV status".
Significant progress has been made in Aids response since 1988, and today three in four people living with HIV know their status. But, we still have much to achieve and that includes reaching people living with HIV who do not know their status and making sure they are linked to quality care and prevention services.
HIV testing is essential for expanding treatment and ensuring that all people living with HIV can lead healthy and productive lives. It is also crucial to achieving the "90–90–90" target and empowering people to make the right choice about HIV prevention so they can protect themselves and their loved ones.
Unfortunately, many barriers to HIV testing remain. Most notable of these are stigma and discrimination. When people perceive such high levels of HIV-related stigma, they are more likely to stay away from HIV clinics and delay enrolment in care until they are very ill.
The good news, however, is that there are many new ways of expanding access to HIV testing. Self-testing and community-based testing are all helping people learn their HIV status.
On World Aids Day, Thailand can celebrate important achievements in overcoming Aids. In just one generation, the country has gone from having the fastest rate of Aids growth in Asia to the slowest. The country also has among the highest anti-retroviral treatment coverage in the region, an achievement which should not be overlooked.
These achievements are a result of the country's bold leadership which has mobilised key institutions, expertise and resources to deliver proper services. The mobilisation effort involves multiple ministries, civil society organisations, communities and partners.
In 2014, Thailand committed to achieving the global "90-90-90" target (90% of living people diagnosed with HIV, 90% of those diagnosed on anti-retroviral treatment, and 90% of those people receiving antiretroviral therapy having viral suppression) by 2020. Thailand's achievements in HIV response have been a result of timely adoption of best practices as well as innovations in delivering services to people in need including pre-exposure prophylaxis to reduce the risk of new HIV infections among the most vulnerable populations.
Despite immense progress, the Aids epidemic is not yet over. HIV remains concentrated among key populations: 40% of new HIV infections in 2017 were among men who had sex with men. Moreover, there are troubling signs that an increasingly younger group of gay men are becoming vulnerable to the virus. These key populations remain under-served by HIV testing services and are much less likely to be linked to treatment and care. Low uptake of HIV testing is related to the acceptability of services, stigma, and discrimination, which limits access to HIV diagnosis, prevention and care.
Thailand is one of the countries that has succeeded in putting people at the centre of its universal health coverage plan. It champions the scale-up of community-led prevention services in which individuals work closely with civil society and communities. So much has been achieved because the Aids movement has prioritised people from the early days of the epidemic. Civil society has also played a key role in expanding access to HIV services. In Thailand, the government earmarks funds for health-care facilities to team up with community groups and hospitals to work in partnership with the communities to expand prevention services.
While Thailand has used its public health infrastructure effectively in delivering HIV services, there is a need to further tailor testing services to meet the needs of key populations and ensure no one is left behind. A diverse mix of strategies is needed to effectively reach people with HIV testing services. These include both stand-alone testing, voluntary testing, self-testing, community-based testing services and counselling. HIV self-testing is another step towards the goal of increasing patient autonomy, decentralising services and creating a demand for HIV testing among people who do not have access to existing services.
Self-testing should also include detailed information about how to seek referrals and counselling services at the point of purchase or acquisition. Expanded use of community-based approaches is also an option whereby community members trained in HIV testing offer communities home-based, mobile and workplace HIV testing -- bringing HIV testing within reach of the people, especially those who are most marginalised.
Linkages between the site where the test is conducted and appropriate treatment, care, prevention and other services, in an environment that guarantees confidentiality of all medical information, needs to be assured.
Ensuring that everyone who is alive today and diagnosed with HIV receives treatment is able to live a full and complete life free of stigma and discrimination is certainly possible.
As Thailand scales-up innovations, programmes, and related services geared towards controlling the HIV epidemic, it has a window of opportunity to ensure that everyone is able to learn their status and live life without stigma.
Dr Suwannachai Wattanayingcharoenchai, Director-General, Department of Disease Control, Ministry of Public Health and Dr Patchara Benjarattanaporn, UNAIDS Country Director for Thailand.
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