The Thai authorities are working alongside UN businesses to not simply enhance the supply of providers following the change in the way in which individuals are sentenced for medication crimes, but additionally scale back the stigmatization of people that use medication and guarantee they’ve entry to providers the place they really feel snug.
UN Information spoke with the UNAIDS Nation Director, Patchara Benjarattanaporn, and Karen Peters, Regional Medication and Well being Programme Officer for the UN Workplace on Medication and Crime (UNODC), concerning the alternatives for individuals who use medication to entry care.
Patchara Benjarattanaporn: New HIV infections in Thailand are on the decline, in comparison with 2010. Nevertheless, the decline is just not practically sufficient to realize the tip of AIDS by 2030, which is a dedication made by all nations underneath Sustainable Growth Objective three, SDG 3. So, HIV nonetheless a important well being concern.
There are about 57,000 individuals in Thailand who inject medication. In keeping with our most up-to-date survey in 2020, 7.8 per cent of these individuals are contaminated with HIV. One other an infection that is quite common amongst individuals who inject medication is hepatitis C, which impacts the liver. Some 42 per cent had been contaminated, which is extraordinarily regarding to UNAIDS.
Karen Peters: At UNODC, one of many points we deal with is lowering the well being and social penalties linked to drug use via supporting hurt discount interventions. Individuals who inject medication are at the next threat of contracting HIV because of the sharing of needles and different dangerous behaviours, for instance, participating in sexual activity with out utilizing a condom.
Patchara Benjarattanaporn: Analysis means that individuals who inject medication are 35 instances extra more likely to purchase HIV than people who find themselves not injecting. The prevalence is excessive as a result of these dangerous behaviours, nonetheless there are different vital structural boundaries to accessing therapies. The extraordinarily punitive authorized framework that existed prior to now in addition to stigma and discrimination have been vital elements stopping individuals from accessing care and providers.
Karen Peters: UNODC has been supporting the nationwide hurt discount response via convening a variety of stakeholders, authorities, civil society organisations, and UN businesses to debate plans to implement hurt discount measures underneath the auspices of the brand new legislation. Ozone Basis, for instance, which has its headquarters within the capital of Thailand, Bangkok, is a peer-led community-based organisation aimed primarily at lowering the hurt brought on by medication. It was established and is run by individuals who have expertise utilizing medication, who present recommendation and providers in a non-judgmental, non-discriminatory atmosphere. Shoppers who come to Ozone admire being counselled by like-minded individuals.
Patchara Benjarattanaporn: Locations like Ozone assist to scale back the stigmatization that individuals who use medication face and encourage them to hunt remedy. A major transformation of Thailand’s well being system has additionally performed an vital function. Common well being protection (UHC) was launched in Thailand in 2002 and has paved the way in which for complete care, together with important providers like HIV testing, pre-exposure prophylaxis, or PrEP, remedy referrals, and screening and remedy for sexually transmitted infections (STIs) and hepatitis C.
There may be nonetheless plenty of work to do; fairly a low proportion of people that inject medication are enrolled in antiretroviral remedy, or ART, which is used to deal with HIV. Within the normal inhabitants, round 90 per cent of people that have HIV obtain ART, however it’s beneath 50 per cent amongst individuals who inject medication.
Karen Peters: A brand new narcotics legislation launched in December 2021 has additionally shifted the narrative in a optimistic method round individuals who use medication. Traditionally, Thailand has had very punitive legal guidelines which criminalize drug offenders. The brand new legislation supplies for differentiated sentencing on drug crimes and options to imprisonment for some offences. For the primary time, it appears the well being and wellbeing of people that use medication are being thought-about.
Patchara Benjarattanaporn: We’re engaged on HIV prevention throughout a number of UN businesses in Thailand, particularly UNAIDS, UNODC, the UN Growth Programme (UNDP) and the World Well being Group (WHO). We’re specializing in these key teams, these hidden populations, by selling community-led providers, which have to be delivered near the individuals who want them in a scenario the place the shoppers don’t really feel stigmatized. Integrating hepatitis C and HIV testing collectively as a part of a remedy package deal underneath UHC encourages extra individuals to get examined. This built-in method may embrace hurt discount providers.
Karen Peters: We’re discussing methods and frameworks for implementing community-based remedy. The Ministry of Public Well being, the Workplace of the Narcotics Management Board, completely different civil society organizations, and worldwide donors and technical specialists are all sitting across the desk advising and suggesting methods during which this could transfer ahead in a extra sustainable option to have higher outcomes for Thai individuals.
Patchara Benjarattanaporn: We’re additionally specializing in supporting the Thai authorities in a nationwide technique to assist these underserved teams, utilizing state-of-the-art analysis and evidence-based options with a purpose to generate a excessive influence intervention. A multisectoral method and group engagement are important to handle the difficulty.
When the federal government demonstrates a dedication to dealing with as much as challenges, good issues occur when it comes to creating each equitable entry to providers and the combination of providers, and, much more so, when civil society and companions just like the UN have a voice on the desk. On this respect, Thailand will be thought-about a mannequin for the area.