Zeroing in on AIDS

This virus affects an estimated 1.5 percent of the population and is currently the leading cause of death in the country. MSF staff care for people living with HIV/AIDS in the capital city of Bangkok, in Kalasin, Mahasarakam, Nonthaburi, Petchaburi and Surin provinces and throughout the country as part of a national network promoting access to treatment.

In July 2004, Thailand will host the XV International HIV/AIDS Conference in Bangkok, bringing together AIDS specialists from across the globe, including a number of MSF staff who will present information about MSF's success in providing treatment in resource-poor settings.

Scaling up AIDS treatment

In 2003, the Thai Ministry of Public Health announced a plan to scale up access to life-extending antiretroviral medicines (ARVs) for people living with HIV/AIDS. The initiative aims to provide 50,000 people with ARVs in 800 public hospitals across Thailand by the end of 2004.

MSF is working closely with partners such as the Thai Network of People Living with HIV/AIDS (TNP ) and the Access Foundation, a local NGO, to support the plan.

Together, they form the "Access Network" offering training, supervision and technical support to staff at comprehensive care centers in 100 hospitals across Thailand's six regions. An additional 100 centers are planned during 2004. A key component to the strategy is facilitating the participation of people living with HIV/AIDS in comprehensive care and activities which support adherence to treatment.

Currently, about 1,100 people are receiving ARVs supplied by MSF in Thailand. MSF is active in seven district hospitals in Thailand as part of a pilot project to decentralize HIV/AIDS treatment. In Bang Kruai district hospital (Nonthaburi province), Ban Laem district hospital (Petchaburi province), Kuchinarai district hospital (Kalasin province), and in Surin province district hospitals in Sikhraphum, Thatum, Prasat and Sangha.

Teams also work in two provincial hospitals located in the provinces of Surin and Maharasakam.

MSF teams provide comprehensive HIV/AIDS care, including voluntary counseling and testing, prevention and treatment of opportunistic infections, ARV treatment, training and support of health staff, psychosocial care and home visits. In Bangkok, MSF runs a home and community care project for people living with HIV/AIDS who have limited access to existing health services, such as women prisoners and migrant workers. Activities include palliative care and crisis intervention, follow-up for those taking ARVs, and training and support for home care workers and family members. Community care is offered in partnership with hospices and shelters in Bangkok.

A focus on children

Children living with HIV/AIDS have been identified as a population in need of better care in Thailand. In response, MSF began a pilot project in late 2002 targeting HIV-positive children in Petchaburi province. Together with local partners, MSF is working to provide training, technical support and drug supply to the pediatric department of the provincial hospital in order to establish a model of treatment and care for children. Other activities include the development of tools and activities targeting children.

MSF hopes to have 100 children receiving ARVs through this program by the end of 2004. In Surin and Maharasakam, 79 children have been put on ARVs so far and 66 are still on treatment.

Assisting refugees

MSF's first projects in Thailand targeted refugees along its borders, and teams continue to provide assistance to these and other vulnerable populations. In Maela camp in Tak province, MSF works to provide basic health care to 38,000 refugees, primarily members of the Karen ethnic minority. MSF teams run two inpatient and two outpatient health facilities as well as managing the water supply.

MSF also provides food to the sick and to pregnant and breastfeeding women. It has also set up a therapeutic and supplementary feeding program. People living with HIV/AIDS in Maela camp have access to ARVs through MSF. Currently 15 people are on treatment.

Karen nurses work closely with MSF staff to provide home-based care and follow-up for patients, as well as epidemiological surveillance. MSF is also present in Tham Hin camp, located in Ratchaburi province. MSF provides water and sanitation for the 9,000 Karen refugees living in the camp and carries out more than 2,000 health consultations per month. In both camps, MSF also works to prevent and respond to epidemics, which are a danger due to the overcrowded living conditions.

In December 1999, MSF extended tuberculosis (TB) activities in Maela camp to the surrounding communities, particularly migrant workers who live in this border region and often have no access to health care. By expanding the "TB village" in Maela camp, MSF was able to reach 493 TB patients in 2003, including some patients with multi-drug resistant (MDR) TB. MSF is working closely with the Thai authorities in order to improve access to the medicines needed to treat this more difficult type of TB.