1. MSM 2003HIV positive 17 % 2005HIV positive 28 % 2007HIV positive 32 %

2. HIV prevalence among MSW Bangkok, Chiang Mai and Phuket, 2005–2007

3. Percent Seroprevalence Year Sources: Army Institute of Pathology Armed Forces Research Institute of Medical Sciences, RTA HIV-1 Seroprevalence of Royal Thai Army Conscripts, 1991-2009

4. HIV-1 Incidence among RTA Conscripts from 2005 – 2009 YearNo ConscriptsNo anti-HIV-1 positives Prevalence (%) No Samples for BED CEIA (%) Estimated Incidence 2005 (Nov)29,6141510-51150 (99.3)0.14 200657,5642980.52286 (96.0)0.19 200758,0162880.50286 (99.3)0.20 200861,4753070.50297 (96.7)0.26 200961,8353310.54309 (93.4)0.25 Sources: Armed Forces Research Institute of Medical Sciences, RTA

5. HIV Incidences at Time of Entry into Royal Thai Army, 2005-2009 Sources: Armed Forces Research Institute of Medical Sciences, RTA

6. Median HIV Prevalence and BED Adjusted Incidence among ANC Pregnant Women in Sentinel Provinces Median prevalence (% per year) BED adjusted incidence (% per year)

7. Median HIV Prevalence and BED Adjusted Incidence among Direct Sex Workers Median prevalence (% per year) BED adjusted incidence (% per year)

8. Median HIV Prevalence and BED Adjusted Incidence among indirect Sex Workers Median prevalence (% per year) BED adjusted incidence (% per year)

9. BED-CEIA Results Group risk %Recent case of HIV in BED Project 200420052006200720082009 ANC 3.742.994.565.396.255.87 DCSW 4.021.571.533.682.782.27 ICSW 1.942.833.494.083.475.87 Total 9.77.49.5913.1612.514.02

10. BED-CEIA Results (cont.)

11. 11 Improving HIV prevention 1.Do better with the strategies that we already have 2.Develop new biomedical technologies to prevent HIV 3.Adopt a more comprehensive approach to HIV prevention

12. July 3, 2012 FDA approved home HIV test

13. 13 Turning to antiretrovirals for prevention The use of antiretrovirals for prevention by… 1.HIV-positive individuals to reduce their risk of transmitting HIV –Treatment as prevention 2.HIV-negative individuals to reduce their risk of infection –Post-exposure prophylaxis (PEP) –Pre-exposure prophylaxis (PrEP)

14. What is pre-exposure prophylaxis (PrEP)? Pre  Before (and after) Exposure  When a fluid containing HIV comes into contact with mucous membranes or non-intact skin Prophylaxis  An action taken to prevent infection or disease 14

15. 15 How does PrEP work? Infection does not occur instantly after an exposure to HIV The virus needs to spread throughout the body This may take up to 3 days after the exposure The “window of opportunity” for PrEP The brief period of time - after an exposure - where HIV has not yet spread throughout the body During this time, PrEP may be able to stop HIV from causing an infection

16. 16 What does the research say about PrEP? iPrExTDF2Partners PrEP Men who have sex with men (MSM) and trans women Heterosexual men and womenSerodiscordant heterosexual couples Daily Truvada pill Daily Viread pill Daily Truvada pill 44%63%62% (Viread) 73% (Truvada) 73%78%- Nausea Headache Decrease in kidney function and bone density Drug resistance Nausea Vomiting Dizziness Nausea Diarrhea