1. Stigma Research and Prevention Taweesap Siraprapasiri, MD National AIDS Management Center Disease Control Department Ministry of Public Health Evidence based responses for stigma reduction in Thailand: experiences and the way forward

2. Evolving Situation and Future Trend of HIV, Thailand People living with HIV 464,000 Women living with HIV 200,000 New HIV 8,700 Deaths 20,080 2012 100% condom PMTCT ART TNP+TNCA

3. ART Coverage among Persons Living with HIV Number of PLHA Receiving ART (2001-2013) PLHA-CD4 ≤ 500 Source: AIDS Epidemic Model (AEM), NHSO – NAP-Plus, SSO, CSMBS, GF, and Thai GPO PLHA-≤ 350 246,049 Estimated persons living with HIV by CD4 levels 80% Coverage of ART need (CD4<350)

4. Late Access to ART CD4 at newly HIV+ diagnosis and ART initiation, 2008-2013 CD4 among newly diagnosed HIV+ (1) CD4 at ART initiation among newly ART PLHA (2) Median CD4 Data source: NAP Database, National Health Security Office

5. The Silent Killers: Challenges of Stigma How to determine status in a systematic way Are we doing better in stigma reduction What are effective and meaningful measures How to translate them into actions

6. Taking the stocks Survey of stigma index in PWHA by PWHA (2009) Annual review of HIV related human rights situation since 2007 Civil society’s agenda for HIV and AIDS Inclusive and participatory process of National HIV Strategic plan on human rights and gender issues

7. Zero New HIV InfectionsZero AIDS-related DeathsZero Discrimination Stigma and discrimination of PLHIV and key populations reduced by half Laws and policies which obstruct equal access are revised Human rights and gender specific needs are addressed in all responses Thailand Getting to Zero National Strategy on HIV/AIDS 2012 - 2016 Innovations and Changes 1.Expand rights based, gender sensitive and comprehensive prevention services for key populations 2.Enhance protective social and legal environments 3.Create sense of ownership to all stakeholders 4.Implement a new generation of strategic information and monitoring and evaluation Optimization and Consolidation 1.Prevention of Mother to Child Transmission 2.Prevention among Young People 3.Condom Programming 4.Blood Safety and Universal Precaution 5.Treatment, Care and Support 6.Care and Support for Affected Children and Families 7.Stigma and Discrimination reduction 8.Public Communication Social Justice and human rights based People centered Beyond disease focus Empowerment Local leadership & ownership Partnership& Networking Increased focus

8. Development of S&D indicators and tools  Determine and standardize measurement tools to systematically monitor situation and progress for Zero discrimination  Better understand stigma issues, status, progress at national and sub-national level  Utilize information for better intervention  Three dimentions are targeted  Attitudes and perception in general population  S&D towards key populations  S&D in health care settings

9. Development of Assessment tools, and tracking status and system 1. General population  Identify 6 questions and integrate into National Health Exam Survey (2014)  Opinion poll of Disease Control Department before World AIDS Day 2. Key populations:  S&D module (limit to 10 questions) within Integrated biological and behavioral surveillance (IBBS)  Men who have sex with men and transgender people  Sex workers  People who injecting drugs  Migrants 3. Health Care settings Develop measurement tool at two pilot provinces  Health administrator (from 13 to 8 questions), Health facility staff (from 65 to 7-14 questions)  People living with HIV (From 33 to 17 questions)

10. Measuring HIV-related S&D in health care settings in Thailand Piloting questionnaires for health care staff and PLHIV adapted from global efforts, and developing methods for data collection and analysis for Thailand Will produce brief questionnaires to be used in routine monitoring of S&D reduction interventions Bangkok (14 facilities) Chiang Mai (18 facilities) Health facility administrators 1317 Health facility staff379359 PLHIV365350

11. Fear of HIV transmission: Worry about getting HIV infection when doing the following  Touching the clothing of a patient living with HIV : Bangkok (38 %), Chiang Mai (31%) Use of unnecessary precautions: Typically do the following when caring for a patient living with HIV Wear Double gloves: Bangkok (47%), Chiang Mai (57%) Attitudes: Agreement with Statement: PLHIV should be ashamed of their status oBangkok (48%), Chiang Mai (37%) Observed Enacted Stigma (Discrimination): Reported observing a health provider, at least once in past 12 months : Unwilling to care for a patient living with HIV oBangkok (25%), Chiang Mai (14%) Pilot Survey in Health Facility Setting

12. Key actions taken further  Assessment tools  Expand assessment tool to other sentinel sites for national estimate and priority provinces for local use  Develop training modules and expand interventions for health care settings that linked to stigma assessment  Resources  Domestic budget in the ending AIDS measures  International collaboration  Normalize HIV and promote positive attitude and awareness on HIV, human rights, gender diversity and key populations  Enhance the implementation of enabling policies and establish human rights protection mechanism at sub-national level