Guideline on a method to approach and deliver an HIV prevention package in MSM and TG: Why and How ? Petchsri Sirinirund Advisor to HIV/AIDS Policy and Programme Department of Disease Control, Thailand ICAAP 11, 19 Nov 2013, Bangkok THAILAND

Country context Population: 68 million Middle Income Country GDP per capita: 7,995 US$ Universal Health Coverage Robust Health Infrastructure 87% of AIDS spending is from domestic resources (US$ 267 M) THAILAND

Epidemic Mature epidemic with naturally declining incidence Peak in the mid-90’s with around 160,000 new HIV infections per year 2012: less than 10,000 new HIV infection per year Estimated 500,000 PLHIV Mother-to-child transmission: 2.7% THAILAND

Whom and where most new infections occur... Projection using AEM Model Geographic Focus: Population Groups: (Mode of Transmission) 6% 32% 41% 65% of new HIV infections happen in 31 provinces 10% 11% MSM 41% 27% of new infections occur in BKK 43,040 new infections THAILAND

National AIDS Strategy, 2012-2016: Vision and Goals Vision: To get to Zero New HIV Infections Goal for 2016: New HIV infections reduced by two-thirds Rate of vertical transmission of HIV less than 2% Vision: To get to Zero AIDS-related Deaths Goal for 2016: Equal access to quality treatment, care, support and social protection for all people affected by HIV AIDS related deaths reduced by half TB deaths among people living with HIV reduced by half Vision: To get to Zero Stigma and Discrimination Goal for 2016: All laws and policies which obstruct equal access to prevention, treatment and care services are revised Human Rights and gender specific needs are addressed in all HIV responses Stigma and discrimination of PLHIV and key affected populations reduced by half THAILAND

National AIDS Strategy 2012-2016 Relating key points At scale - coverage More accessible Ensure quality Strategic information Sustainability (Local administrative organization) THAILAND

Public Health Questions for the program Are we doing the right things? What are contributing factors? What interventions can work? What interventions and resources are needed? Are we doing them right? Are we doing them on a large enough scale? “ Source: “A Public Health Questions Approach to HIV/AIDS Monitoring and Evaluation” UNAIDS

Process to develop national guideline for HIV prevention among MSM Evidence Assessment of practices Synthesis of the findings from various sources Study visit to Avahan project in India Workshop training for the multi-sectoral team on SOP (Standard Operating Procedure) THAILAND

Synthesis of findings… as formative assessment Sources of Information Assessment of practices Lessons learned from CHAMPION project Consultation for development of national guideline Study on MSM network (Draft) National AIDS Strategy 2012-2016 THAILAND

Main issues Management Innovation Target population Subgroups Core package of services Outreach / Facility based services BCC, VCT, STI Condoms and lubricant Enabling environment Continuum of services Understanding and positive attitudes (Policy, implementation, community, public) Management Strategic information Routine HIV Integrated HIV Information System (RIHIS) Micro-planning Innovation PrEP ART for prevention THAILAND

Target population By people By place By context Age group (young MSM:<15, 15-19, 20-24 yrs) Sexual identity (Gay, TG) Multiple risk (sex work, drug use) Potential barriers (Muslim, migrant) HIV status Multiple risk (drug use) Formal education Entertainment Public place Internet Closed setting By context City Rural THAILAND

National Guideline Development Characteristics Process Technically sound Feasibility Acceptability Participatory Advocacy SOGI understanding Participants Policy / Implementation GO / CSO / Academia THAILAND

Technical support and administration Working structure Advisory committee Technical task force Technical support and administration Experts Members: Gov, NGO, Community, Academia (national and international) THAILAND

Participatory – Technically and Feasibility sound National consultation at the first step Technical task force with experts First draft of national guideline Working with selected provinces to review feasibility Final draft of national guideline Oversight by advisory committee THAILAND

More Focus Area-based planning THAILAND

Three levels of program intensity Most intensive implementation - BKK Intensive implementation Minimum implementation Criteria HIV prevalence Number of KAPs Social context Intensivity Spectrum of interventions Resources Monitoring and evaluation THAILAND

Acknowledgement UNDP World Bank Thailand MOPH – US CDC Collaboration UNAIDS Stakeholders (Gov and NGO and CSO) Avahan THAILAND