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Prevention With Positives. Anupong Chitwarakorn Senior Expert Department of Disease Control. Epidemiology of HIV infection in Thailand: 1989-2020*. Estimated HIV infection in 2008 · Cumulative HIV infected cases 1,137,836 Cumulative deaths 697,757
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Prevention With Positives Anupong Chitwarakorn Senior Expert Department of Disease Control
Epidemiology of HIV infection in Thailand: 1989-2020* Estimated HIV infection in 2008 ·Cumulative HIV infected cases 1,137,836 Cumulative deaths 697,757 ·PWHA(HIV+AIDS) 440,079 PLWA (AIDS) 59,029 New AIDS cases in 2008 47,681 ·New HIV infections in 2008 12,766 Reduction of new HIV infection New HIV infections in 1991 142,819 New HIV infections in 1996 60,749 New HIV infectionsin 2001 25,790 New HIV infections in 2010 11,685 New HIV infectionsin 2020 7,919 * Scenarios based on data as of year 2000 ( PMTCTimplemented in 2000, Access to ARV in 2003)
New HIV Infections in Thailand by Risk Group Per Year (East West Center)
การป้องกันปฐมภูมิ: กิจกรรมการป้องกันในประชากรกลุ่มที่ยังไม่ติดเชื้อโดยเฉพาะกลุ่มเสี่ยง - ผู้ให้บริการทางเพศ - ผู้ฉีดยาเสพติดเข้าเส้น - ชายรักชาย - ผู้ที่มีคู่นอนหลายคน - ผู้ที่มีเพศสัมพันธ์โดยไม่ได้ป้องกัน การป้องกันทุติยภูมิ: กิจกรรมการป้องกันในประชากรที่ติดเชื้อเอชไอวี การป้องกันการติดเชื้อเอชไอวี การให้คำปรึกษาและตรวจเลือดโดยสมัครใจ และส่งต่อเข้าสู่ระบบบริการ
Strategies for Primary HIV Prevention Activities directed to keeping an HIV negative person staying negative • ABC (Abstinence, Be faithfulness, Condom use) • Voluntary Counseling and Testing (VCT) • Behavior intervention • Testing and treatment of STIs • Needle exchanges programs • Male circumcision • Cervical barriers: vaginal diaphragms • Exposure prophylaxis: PEP • Pre-Exposure prophylaxis (PrEP) • Microbicides • Immunization vaccines • HSV-2 suppressive therapy
Area of intervention for PLWHA • Psychological counseling and support • Disclosure, partner notification, testing and counseling • OI treatment and prophylaxis • STI and reproductive tract infection • PMTCT • Harm reduction; NSP, substitution • Family planning • Selected vaccine for preventable diseases • Nutrition, water, sanitation and hygiene • Preventing malaria Ref: Essential Prevention and Care Interventions for adults and adolescences living with HIV in Resource Limitedsettings. WHO. 2008
Secondary HIV Prevention “Prevention With Positives” To make sure the infected person: • Does not transmit HIV to others • Remains healthy over time • Does not become re-infected with the virus (if the person is reinfected with strains of the virus that are resistant to specific antiretroviral medications, this could have a significant impact on disease treatment) HIV transmission prevention among HIV-positive persons MMWR 2003;52 (RR-12)1-25
Prevention With Positives: Why Sexual Risk Behaviors of HIV+ Clients receiving HIV care at Bamrasnaradura Institute (July 2005- February 2006) • N = 894; 395 (44%) men and 499 (56%) women • Median age: 36 years • 64% received ARV with good adherence (missing doses last 3 days < 1%) • Median CD4 cell count 246 cell/mm3 • Partner HIV testing 56% (39% HIV negative) • 82% of women and 66% of men had disclosed their HIV status to their partners (p-value<0.01) • Increased access for antiretroviral treatment • Sexual activity may increase • Sexual risk behavior may increase • PLHA can live longer increase number of PLHAs • 61% reported active sexual intercourse in the last 3 months • Among the sexually active persons, • 65% men and 82% women reported using condom last sex with a steady partner (P-value < 0.01) • 40% men and 14.3% women reported having sex with casual partners (p-value <0.01) (range 1-10) and 52% used a condom last sex • 44/178 (25%) men reported having sex with men. Of these, 20/33 (60.6%) had UAI last sex with partners • 43/223 (19%) men bought sex and only 7/26 (27%) used a condom during last sex • Combined syphilis, gonorrhea, and chlamydial infection prevalence ranged from 8% to 30%1 in women and 4% in men2
Sexual risk behaviors of 100 MSM HIV+ Bangrak hospital, 2006-2007 Preliminary data analysis • Median age 29 years old • 88% had sex in last 3 months • 15% had female sex partner in last 3 months • 61% had steady partner • 94% had male steady partners (44% had UAI last sex) • 13% had female steady partners (14% used no condom last sex) • 48% had casual partners • 93% had male casual partners (38% had UAI last sex) • 12% had female casual partners (40% used no condom last sex) • Partner HIV testing 38% • HIV disclosure to male steady partner 35% Palanuvej T, Sirivongrangsan P and team, Bangrak hospital
Prevention With Positives: Why • High HIV discordance rate (30-53%) Bennetts A, et al. AIDS care 1999 Hong DS , et al. AIDS Educ Prev 2006 • Awareness of serostatus among persons with HIV leads to decreased HIV Transmission. Fleming, 9th CROI, 2002. CDC unpublished data • Providing prevention services to people with HIV is beneficial to people with HIV, partners of people with HIV, families and communities
Prevention with Positives: Why Now? • Increases in funding and scale-up of antiretroviral therapies availability will dramatically increase: • HIV testing rates • Identification of HIV infected individuals • Opportunities for treatment, care, and prevention services for infected persons Modified from slide’s set of Belcher L, Ph.D, GAP, CDC, Atlanta
6 กลยุทธ์ในการดำเนินการป้องกันในกลุ่มผู้ติดเชื้อเอชไอวีแนะนำโดยสำนักโรคเอดส์ วัณโรค โรคติดต่อทางเพศสัมพันธ์ • การส่งเสริมการลดพฤติกรรมเสี่ยง • การคัดกรองโรคติดต่อทางเพศสัมพันธ์ และรักษา • การส่งเสริมการเปิดเผยผลเลือดให้กับคู่นอน • การส่งเสริมการตรวจเลือดให้กับคู่นอน • การส่งเสริมการกินยาต้านไวรัสอย่างเหมาะสม • การลดการตั้งครรภ์ไม่พึงประสงค์และป้องกันการติดเชื้อเอชไอวีจากแม่สู่ลูก