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National AIDS Strategy 2012-2016, Thailand

1. VISION AND GOALS Thailands first version of Getting to Zero started many years back, when interventions were aiming at reducing the number of new HIV infections, free treatment, care and support services were rolledout, and activities were designed and implemented to reduce stigma and discrimination. In many areas the response was very successful, and Thailand is globally considered as best practice for HIV prevention and care services. However, successes in prevention for example the number of new infections declined more than 25% between 2001 and 2009, behaviour change among clients of sex workers (condom use), and young male adolescents (frequenting sex worker much less than 20 years ago) have masked a constant HIV prevalence over the last five years among sex worker (SW), men who have sex with men (MSM), and injecting drug users (IDUs). As a matter of fact (see the epidemiological chapter), new infections among SW, MSM, IDUs and among partners in a relationship in which one of them is either unknowingly or knowingly HIV positive account for more than 90% of new infections in Thailand. Socio-political, legal and environmental factors still hinder access to prevention (i.e. harm reduction for injecting drug users), treatment and care services (i.e. for non-Thai like unregistered labour migrants), and stigma and discrimination, including gender, reproductive and sexual rights related issues, though reduced, continue to negatively impact on people infected and affected by HIV and AIDS. For 2012-2016 dedication to: Thailand is renewing its commitment and

THAILAND GETTING TO ZERO


VISION Goals (by 2016) TO GET TO ZERO NEW HIV INFECTIONS New HIV infections reduced by two-thirds Vertical transmission of HIV less than 2% TO GET TO ZERO AIDS-RELATED DEATHS Equal access to quality treatment, care, support and social protection for all people affected by HIV Reduce AIDS related deaths by half TO GET TO ZERO STIGMA AND DISCRIMINATION All laws and policies which obstruct equal access to prevention, treatment and care services are revised Human Rights and gender specific needs

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TB deaths among people living with HIV reduced by half

are addressed in all HIV responses Stigma and discrimination of PLHIV and key affected populations reduced by half

2. FROM VISION TO STRATEGY Thailands history includes good examples of key-strategies, which, fully resourced, politically supported and rigorously implemented, can change the trajectory of the epidemic and the impact on people, communities and the nation. Best known is the 100% Condom Use Campaign of the early 1990s, but more recent examples are the rapid expansion of free antiretroviral treatment, and the prevention of mother-to-child-transmission (PMTCT). Against the epidemiological background, and the vision of Thailand getting to Zero, the main question asked during the development of the new National Strategy 2012-2016 was: what is Thailand doing well which should continue (eventually being consolidated and optimized), and what needs to change in order to get to zero new HIV infections, zero AIDS-related deaths, and zero discrimination? Thus, two strategic directions were identified: Optimization and Consolidation includes strategies aiming at continuation, optimization, harmonization and sustainability of interventions which are implemented well, and produce the desired results. This is an important area which contributes to all goals, but will have the biggest impact on goal 2 (zero AIDSrelated deaths), and goal 1 (zero new HIV infections) as regards PMTCT and HIV prevention among young people. Services which fall into this strategic direction are well integrated, and are expected to be operationalized and resourced through respective line ministries and/or and health insurance entities. Innovation and Change includes strategies which are focusing on a) the prevention of sustained HIV infection, b) localizing response and ownership at the sub-national level, and c) the socioenvironmental factors which hinder access to prevention and care services, and fuel stigma and discrimination.

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Innovation and change strategies address either a needed change, innovation, or priorities which were already defined in the past but have never been operationalized and/or implemented. The operationalization of these strategies is considered critical to make progress on getting to zero new HIV infections, and to zero discrimination. Discussions are underway as regards the establishment of a dedicated fund (for both domestic and external resources) to resource these strategies and an accountability framework will need to be established for mutual accountability of different partners. Additionally, six core themes were defined which are both the guiding principles for strategy development, and, at a later stage will guide the operationalization of the national strategy in bi-annual plans.

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ZERO NEW HIV INFECTIONS

ZERO AIDS-RELATED DEATHS

ZERO DISCRIMINATION

INNOVATION AND CHANGE

OPTIMIZATION AND CONSOLIDATION

Social Justice Respecting, protecting and fulfilling gender equality, sexual, reproductive and human rights

People Centered Responses which go beyond HIV as a disease and promote the quality of life

CORE THEMES Increased Leadership focus, and Locally Efficiency owned and mutual responses accountabilit Sharing y vision and defining strategy and actions to sustain the AIDS responses locally

People Inclusive Mobilizing and empowering people and communities

Partnership s Synergies maximized and efficiencies achieved with government and nongovernment services integrated and united

The national strategy defines the main thrust of Thailands response to HIV, and will guide the operationalization of an expanded response at all levels, and prioritize resource allocation. Both strategy and operational plan are contextual and are only valid in a specific situation. Monitoring of the epidemiological and social context, the effectiveness of the defined strategies, and the adequate operationalization and implementation will be crucial for Thailand getting to zero. As experience shows that implementation is the most difficult aspect of strategy, the national leadership, and an adequate management has to ensure that: o The strategy is translated to operational terms; o That the organization of an expanded response is aligned to the strategy; o That the strategy is a continual process; and o That change is mobilized trough executive leadership
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3. STRATEGIES 3.1. Strategic Direction: Innovation and Change Strategies within this strategic direction address change and innovation. Change, as the strategies acknowledge present realities and propose a new way of doing things, for example as regards the administrative and financial decentralization, the variations in prevention interventions, unprioritized and unfocussed use of resources, and the weak evidence base to inform national and sub-national responses. Innovation, as the implementation of new prevention technologies, the development of new financing mechanisms, and a new accountability framework align the strategic framework to the challenges of the next decade. Innovation and Change contains four key strategies and a number of sub-strategies:
Key-Strategy/Sub-Strategy

1. Expand rights based and gender


sensitive comprehensive prevention services for populations/ risk behaviour with highest number of HIV transmission 1.1 Increase Focus 1.2 Increase Efficiency and Coverage 1.3 Implement new Technologies for prevention 2. Expand the protective social and legal environment essential for HIV prevention and care 2.1Change Laws and Policies which hinder access to Prevention and Care Services

Strategic Objective Reach at least 80% of SW, MSM and IDUs (Thai and non-Thai) in priority provinces with comprehensive and integrated prevention services

All legal and policy barriers as regards comprehensive prevention and care are removed. Laws and policies in support of essential HIV prevention and care services are effectively implemented.

2.2 Establish mechanisms to effectively implement and monitor laws and policies which support HIV prevention and care
3. Localize Ownership and Response 3.1Increase local ownership and funding for an expanded response to HIV 3.2Strengthen local competence and capacity to ensure quality services

In priority provinces, local areas develop and implement HIV responses with substantial contribution of their resources. Strategic information is used at the national and local level to develop, guide and monitor evidence based responses

4. Implement a new generation of


strategic information to inform and guide the national response at all levels

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Key-Strategy/Sub-Strategy 4.1Develop and implement a localized strategic information system 4.2Ensure that programme evaluation including cost-benefit and costeffectiveness data are generated as evidence for planning and interventions 4.3Initiate, document and disseminate research on new approaches and technologies related to prevention, treatment and care

Strategic Objective to HIV and AIDS.

Key Strategy 1:Expand rights based and gender sensitive comprehensive prevention services for population/ risk behavior with highest number of HIV transmission Objective: Reach at least 80% of SW, MSM and IDUs (Thai and non-Thai) in priority provinces with comprehensive and integrated prevention services

1.1 Increase focus: 1.1.1 Geographic focus on areas where 80% on new infections occur 1.1.2 Target population groups among which 90% of new infections occur (MSM, SW, IDU, Spousal transmission) More than 90% of new HIV infections happen among MSM, SW, IDU and from one partner to another. Getting to Zero new HIV infections means for Thailand to focus primarily on these groups and provide the needed gender sensitive and human rights based HIV prevention services in the quantity and quality needed! High quality prevention for SW, MSM and IDU will also address spousal transmission, as will the planned expansion of VCT, PICT, early treatment and couple counseling. Special attention will be paid to key affected populations in closed settings for which the same prevention services need to be available. Different provinces in Thailand are differently affected by HIV, and estimations shows that nearly 2/3 of new infections occur in about 1/3 of the provinces. Especially big cities contribute to the number of new HIV infections (.i.e. Bangkok alone 25%) and the key strategic prevention focus will be to cover those provinces (and cities) with the highest number of new infections in the next 5 years.
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1.2 Increase efficiency and coverage: 1.2.1 Standardize prevention interventions focusing on the identified target populations 1.2.2 Outsource targeted prevention interventions to NGOs and key population for more reachable 1.2.3 Increase financial allocation for prevention through innovative models (i.e. country fund for prevention) Experience shows that interventions targeting key affected populations (i.e. SW, MSM, IDU) are often best done by non-governmental organizations. In order to expand needs based prevention services, predefined interventions will be outsourced to civil society organization, based on standardized and integrated service packages. Comprehensive prevention services for key affected populations have to include as a minimum: peer-led behaviour change communication, condom and/or needles and syringe distribution and promotion, STI diagnosis and treatment, counseling and testing, and address enabling environment, community ownership and M&E. In order to sustain an expanded prevention response, new and innovative financing models will be piloted. This includes a country prevention fund (AIDS envelope) which could be resourced from different sources like national budget, national health and security office, and external donors, to a more fund like construction in which the government keeps normative functions, but out sources operational activities. 1.3 Implement new technologies for prevention 1.3.1 Expand provider initiated counseling and testing (PICT) and early treatment for prevention, couple counseling and prevention for discordant couples 1.3.2 Follow Good Participatory Practice (GPP) for new biomedical interventions One of the big challenges will be to implement new prevention technologies. Over the next 5 years PICT and test and treat for prevention, microbicides, pre-exposure prophylaxis for certain key affected populations, vaccine trials and male circumcision will be implemented in selected sites and documented. This can only happen in close cooperation and partnership with communities and civil society organizations. GPP will be used to ensure full participation of keystakeholders. Key principles for implementation are ensured
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confidentiality, consent to participate (opt-in or opt-out), quality assurance and control, and monitoring and evaluation. New technologies and approaches mean of course also a change in procedures and protocols. For example, provider initiated testing and counseling (PICT) requires that HIV test results are available in a very short time and therefore the testing thesaurus needs to be aligned with these requirements. The operational plan will list all the necessary steps for implementation of these strategies.

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Key Strategy 2:Expand the protective social and legal environment essential for HIV prevention and care Objectives: All legal and policy barriers as regards comprehensive prevention and care are removed.

Laws and policies in support of essential HIV prevention and care services are effectively implemented. 2.1 Change Laws and Policies which hinder access to Prevention and Care Services 2.1.1 Decriminalize drug use and sex work 2.1.2 Revise laws and policies as regards adequate access to basic health services for non-Thai 2.1.3 Ensure equal access to services for all gender and age groups Social division, inequality and exclusion drive the HIV epidemic. Stigmatization of people living with and affected by HIV and legal/policy environments that do not protect access to HIV programmes but often actually pose obstacles to access need to be addressed to pave the road of getting to Zero. This section deals with the need to review, modify or remove laws and policies which were identified to pose obstacles to services. The operational plan will have to describe the steps necessary to advocate for changes in law and policies, and to establish a new partnership between the executive and the legislative in Thailand in order to maximize HIV prevention, treatment, care and support. Law enforcement drives sex workers (including FSW, MSW, MSM and transgender) from a direct into an indirect form of business which is hard to reach, or even to go underground, preventing easy access to prevention, treatment and care services. The unauthorized production, consumption, possession and sale of a wide range of drugs are punishable. This in fact criminalizes drug use and gives law enforcement wide powers of search, seizure and arrest, and authorizes police to conduct drug testing. While the Narcotic Addict Rehabilitation Act incorporates a different approach to drug use by creating a legal regime to provide alternatives to incarceration for some drug offenses, a true implementation of harm reduction measures is virtually impossible as long as law enforcement has any incentive to arrest drug users.
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With regard to migrant workers, especially those who entered and work into the country illegally, and ethnic groups who do not have a 13-digit number to identify themselves as Thai citizen, unclear policies in dealing with these communities has led to the issuance of a number of laws and strict regulations with regard to entry, stay, and residence. Some of those are obstacles to provide adequate prevention and care services for non-Thai and will need to be reviewed. Young people who are under 18 years of age (considered as minors) is another group affected by legal requirements. These young people need to have a parental consent before receiving services on HIV prevention, especially VCT, treatment and care services. Such requirements have become an obstacle for young people to access HIV-related services they need. Particular focus needs to be put on gender related obstacles to access. Not only women and girls are more vulnerable to exclusion from services, but transgender and men-who-have-sex-with men are also often discriminated. 2.2 Establish mechanisms to effectively implement and monitor laws and policies which support HIV prevention and care Key affected populations (this includes people living with HIV, sex workers, MSM, IDUs and their respective partners) are often confronted with rights violations by either authority or service providers. While many laws stress a non-judgmental approach free of discrimination and stigma, local realities often proof to be different. This strategy aims to establish adequate mechanisms for key affected populations at the local level to provide counseling, advise, and, if necessary, legal assistance. Key Strategy 3:Localize Ownership and Response Objective: In priority provinces, local areas develop and implement HIV responses with substantial contribution of their resources.

3.1 Increase local ownership and funding for an expanded response to HIV 3.1.1 Integrate HIV prevention in local development plans as a routine measure

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3.1.2 Implement HIV related joint KPIs for local authorities 3.1.3 Establish local partnerships between authorities, civil society and private sector 3.1.4 Establish an incentive system for private sector partnerships (ISO, CSR, tax exemption) The localization of an expanded response to HIV and respective local ownership and leadership are key in getting to zero. Although decentralization in Thailand started in 2002, and budget allocations for centrally (vertically) organized HIV prevention activities were sharply decreasing since 2005, neither the overall strategic approach, nor respective policies were aligned to this reality. The strategies to increase local ownership and funding address the gap between centrally developed plans (which were hardly ever implemented), and local responses which often were based on good intention, rather than on evidence. One of the main strategies in this respect is the facilitation and support for new local partnerships (formal or informal) with government, local authorities, civil society, private sector and key affected populations. The implementation of formal accountability mechanisms (like joint KPIs) at the local level, the inclusion of HIV in sub-national development plans, and the establishment of incentive systems for private sector partnerships should lead to mutual accountability and ownership. 3.2 Strengthen local competence and capacity to ensure quality services 3.2.1 Establish dedicated technical assistance services at the national and sub-national level 3.2.2 Implement procurement standards for goods and services 3.2.3 Establish a QA+QC system for HIV related interventions 3.2.4 Plan and manage investments for capacity building of government and non-government stake-holders In order to localize ownership, leadership, response and services, capacity at the local level needs to be strengthened. While for example this strategy guides the overall prioritization and focus (e.g. prevention for key affected populations), a localized operational plan will need to translate the strategy into context specific results and action. In order to strengthen local capacity and to facilitate evidence based planning, implementation and monitoring at the sub-national level,
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these strategies prioritize the establishment of a dedicated technical assistance service, the development of procurement standards, implementation of a quality assurance and quality control systems at all levels, and finally an investment plan for human resources. Key Strategy 4:Implement a new generation of strategic information to inform and guide the national response at all levels Objective: Strategic information is used at the national and local level to develop, guide and monitor evidence based responses to HIV and AIDS.

Strategic Information is the cornerstone of evidence-based planning and decision-making for programme components at all levels, and integral to national health systems strengthening. Evidence based analysis, planning and monitoring ensures a response aligned to realities, and the availability and use of local and/or disaggregated data will increase both ownership and focus of interventions. A new generation of strategic information is needed to balance the overall epidemiological and routine surveillance data of the HIV epidemic and the response, with more qualitative contextual socio-economic, political and behavioural information. 4.1 Develop and implement a localized strategic information system 4.1.1 Harmonize data collection and reporting systems and increase inter-operability 4.1.2 Make strategic information locally available, owned and user-friendly (know your epidemic, know your response) While Thailand collects routinely a lot of data as regards HIV and AIDS, no system exists to integrate different information and data. To ensure that national, sub-national and the local level have a complete picture of both the epidemic and the response. Thailand will harmonize data collection and systems through integration and systems of increased interoperability. STI, HIV counseling and testing, ARV treatment, PMTCT and clinical care information systems will be integrated in an overall strategic information system, and programme and community data for prevention, care and support for adults and children affected by HIV/AIDS will be added. A new generation of surveillance in Thailand will include incidence measurement and estimation, mode of transmission studies, localized data on key affected populations, but also information on stigma and discrimination at all level, and gender data.
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Complementary to outcome and impact monitoring, routine programme output monitoring provides data on programme performance and quality. Real time access to these data will help to improve local understanding, ownership and programme management. Thailand will develop innovative and user-friendly tools to collect and disseminate community based data related to prevention and care & support. In facility based settings, Thailand will optimize HIVQUAL and STIQUAL and will implement these tools nationwide. All data will be available at the sub-national level as localized strategic information in formats useable for decision making, planning, and monitoring. 4.2 Ensure that programme evaluation including cost-benefit and cost-effectiveness data are generated as evidence for planning and interventions. This strategy aims at providing evidence to sustain both programmatic and financial resources for an expanded response to HIV and AIDS. Evaluation is needed to provide credible information and actionable recommendations to determine a) whether the right programmes are being implemented, b) whether the programmes are implemented well, and c) to estimate the overall impact of the programme. Evaluation and economic studies (including cost analysis, cost benefit and cost effectiveness studies) of standardized interventions will be critical both as regards programme management, and sustained resource mobilization and resource allocation. The present socioeconomic context requires, and most likely will continue to require, cost optimization of services, cost efficiency savings through integration and economies of scale, and well founded justifications including cost-benefit analysis. 4.3 Initiate, document and disseminate research on new approaches and technologies related to prevention, treatment and care. Thailand is well known as a global laboratory undertaking state of the art research in new knowledge areas related to HIV/AIDS (vaccine, microbicides, treatment as prevention and others). While Thailand will continue its role as contributor to global knowledge, this strategy aims at breaking new ground as regards research on implementation and integration of new technologies and/or socio-economic, cultural and
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other contextual factors in existing and/or future service delivery systems.

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3.2. Strategic Direction: Optimization and Consolidation This strategic direction covers strategies aiming at maintaining, consolidating and optimizing interventions in which Thailand has either done very well, and/or interventions which would benefit of stronger management and resource allocation by respective government institutions (line ministries). Optimization and harmonization will address service variations, possible cost efficiencies, and integration of services, while consolidation will focus on standardization, usage of new technologies for service delivery, and addressing identified human resource gaps through investments in training and learning. As already mentioned, strategies under this strategic direction will be operationalized and implemented by a wide variety of key stakeholders and partners. The formulated strategies aim at guiding partners to identify areas to optimize and to consolidate in respective programmes. In this strategic direction the strategies are grouped by the following main thematic areas: 1. 2. 3. 4. 5. 6. 7. 8. Prevention of Mother to Child Transmission (PMTCT) Prevention among Young People Condom Programming Blood Safety and Universal Precaution Treatment, Care and Support Vulnerable Children Stigma and Discrimination Public Communication Strategic Objective Increased access to PMTCT services for different ethnic groups and non-Thai. PMTCT includes strengthened reproductive health services.

Thematic Area/Highlights 1. PMTCT 2.1 Adjust PMTCT services for different ethnic groups and nonThai. 2.2 Promote male involvement and integrate couple counseling and reproductive health services into PMTCT 2.3 Use IT and modern communication channels for better service delivery 2. Prevention among Young People

Education on sexual and reproductive health in schools is 15

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Thematic Area/Highlights 2.1 Implement a quality assurance and quality control system for school based sexual and reproductive health education 2.2 Strengthen Youth friendly services for in and out-of-school youth through increased youth participation and human resource development 2.3 HIV prevention for young people is an integral part of youth development programme 2.4 Use IT and modern communication channels for better service delivery 3. Condom Programming 3.1 Reposition condoms as sexual and reproductive health tool 3.2 Establish condom management systems including public-private partnerships at all levels. 3.3 Generate strategic information on condom demand and usage, supply, affordability and accessibility as the basis for informed decisions on future condom programming. 4. Blood Safety and Universal Precaution 5. Treatment, Care and Support 5.1 Harmonize and standardize the treatment protocol and service entitlements for all health insurance schemes 5.2 Integrate and strengthen services provided by PLHIV networks into the prevention to care continuum 5.3 Ensure adequate and easily accessible treatment, care and support services for key affected populations 5.4 Improve and increase VCT on order to enable early diagnosis and treatment.

Strategic Objective fully implemented and monitored Essential HIV prevention and care services are responsive to the specific needs of young people Safe sexual behaviour among Youth

Thailand has functioning systems to ensure universal access to condoms

Donated blood is guaranteed of 100% safety All people eligible for treatment and care receive the same standard of services across the respective health insurance schemes People living with HIV and households affected by HIV receive holistic care and support

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Thematic Area/Highlights 6. Care and Support for Children affected by AIDS 6.1 Increase responsiveness of service providers to the needs of children 6.2 Establish a strategic information system for improvement of services to vulnerable children 6.3 Standardize service packages for vulnerable children 6.4 Integrate and strengthen social protection systems, health system and community systems for effective service delivery 7. Stigma and Discrimination 7.1 Provide continuous learning and training opportunities for health and other identified keypersonnel 7.2 Ensure that stigma and discrimination is monitored through local and national mechanisms and tools with a focus on critical areas like work place, health sector, education and social welfare 7.3 Strengthen community interventions to change attitudes and behaviour towards stigma and discrimination 7.4 Strengthen the human rights capacity and empower key affected populations to access rights protection services 8. Public Communication 8.1 Establish a long term public communication plan in support of Thailand getting to Zero 8.2 Define adequate coordination and management structures 8.3 Monitor impact of public communication on peoples perception on HIV and AIDS

Strategic Objective HIV sensitive health and social protection packages reach vulnerable children

Increased awareness of adverse effects of stigma, discrimination and human rights violations on HIV prevention and care among communities and service providers All HIV related services are provided free of judgment, stigma and discrimination and respect human rights including sexual rights.
Rights protection mechanisms for key affected populations are functional in 30 provinces

Changed attitudes and increased understanding in support of reaching Zero New Infections, Zero AIDS related Deaths, and Zero Stigma and Discrimination

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Key Area 1:

Prevention of Mother to Child Transmission (PMTCT)

Objectives: Increased access to PMTCT services for different ethnic groups and non-Thai. PMTCT includes strengthened reproductive health services. Strategies: 2.1 Integrate couple counseling into reproductive health services 2.2 Promote male involvement 2.3 Use IT and modern communication channels for better service delivery PMTCT in Thailand is globally recognized as best practice and 97% coverage at present will hopefully lead to a virtual elimination of mother to child transmission in Thailand. Still some areas were identified which could be optimized: couple counseling both for sero-negative and discordant couples will address spousal transmission, but also sexual rights of people living with HIV. Active promotion of male involvement in PMTCT will strengthen reach and programme, and the use of modern communication channels will close gaps in follow-up and service delivery. Key Area 2: Prevention among Young People Objectives: Education on sexual and reproductive health in schools is fully implemented and monitored Essential HIV prevention and care services are responsive to the specific needs of young people Safe sexual behaviour among Youth Strategies: 2.1 Implement a quality assurance and quality control system for school based sexual and reproductive health education 2.2 Strengthen Youth friendly services through increased client orientation and human resource development 2.3 Standardize Youth friendly comprehensive services 2.4 Use IT and modern communication channels for better service delivery Key Area 3: Condom Programming Objectives: Thailand has functioning systems for sustainable condom programming at all level Strategies:
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3.1 Reposition condoms as sexual and reproductive health tool 3.2 Establish condom management systems including publicprivate partnerships at all levels. 3.3 Generate strategic information on condom demand and usage, supply, affordability and accessibility as the basis for informed decisions on future condom programming.

Key Area 4: Blood Safety and Universal Precautions Objective: Donated blood is guaranteed of 100% safety Strategies: 3.1

Key Area 5: Treatment, Care and Support Objectives: All people eligible for treatment and care receive the same standard of services across the respective health insurance schemes People living with HIV and households affected by HIV receive holistic care and support Strategies: 5.1 Harmonize and standardize the treatment protocol and service entitlements for all health insurance schemes 5.2 Integrate and strengthen services provided by PLHIV networks into the prevention to care continuum 5.3 Ensure adequate and easily accessible treatment, care and support services for key affected populations 5.4 Improve and increase VCT on order to enable early diagnosis and treatment. Treatment, care and support is one of the success areas in Thailands response. A competent health service system with a wide reach covers at present more than 80% of people in need of ARV and provides counseling and support services. A local generic drug production (under compulsory licensing agreements) caters for most of the needed ARV drugs for Thai citizens, and different health insurance schemes provide the necessary financial resources for virtually free treatment.
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However, a harmonization and standardization of respective insurance entitlements and protocols would facilitate administration and costefficiency. Services already provided by networks of people living with HIV could be better integrated in a formal health system delivery mechanism, and could expand in areas like adherence counseling, patient follow-up, home visits and family counseling, and rights protection. Social protection services could be fully integrated in treatment and care programmes. Thailands generic drug production is at present not WHO pre-qualified. That means that Thai generic drugs cannot be used in externally financed programmes, nor can they be sold to other countries. If all requirements for WHO pre-qualifications are met, Thailand could not only market locally produced drugs, but also use them for externally funded interventions.

Key Area 6: Care and Support for Children Affected by AIDS Objectives: HIV sensitive health and social protection packages reach vulnerable children Strategies: 6.1 Increase responsiveness of service providers to the needs of children 6.2 Establish a strategic information system for improvement of services to vulnerable children 6.3 Standardize service packages for vulnerable children 6.4 Integrate and strengthen social protection systems, health system and community systems for effective service delivery

Key Area 7: Stigma and Discrimination Objectives: Increased awareness of adverse effects of stigma, discrimination and human rights violations on HIV prevention and care among communities and service providers
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All HIV related services are provided free of judgment, stigma and discrimination and respect human rights including sexual rights. Rights protection mechanisms for key affected populations are functional in 30 provinces Strategies: 7.1 Provide continuous learning and training opportunities for health and other identified key-personnel 7.2 Ensure that stigma and discrimination is monitored through local and national mechanisms and tools with a focus on critical areas like work place, health sector, education and social welfare 7.3 Strengthen community interventions to change attitudes and behaviour towards stigma and discrimination 7.4 Strengthen the human rights capacity and empower key affected populations to access rights protection services Stigma and discrimination needs to be addressed and monitored in all services provided. This applies not only to health services, but also especially to education, social welfare, law enforcement, and the workplace. Not only people living with HIV, but also key affected populations like sex workers, transgender people, MSM, and drug users are facing frequent discrimination and are confronted with stigmatized opinions. The strategy proposes to address this issue through a) building legal literacy among key affected populations, and b) a bigger investment in human resource competence and capacity through retraining and learning opportunities for identified key personnel like health service providers, law enforcement personnel, and teachers. Monitoring of stigma and discrimination needs to be formalized, that means data as regards stigma, discrimination and human rights violations for key affected populations need to be routinely collected and reported. Respective mechanisms must be included in the national and sub-national monitoring system. Experience shows that a combination of community interventions with mass media and/or campaigns to address stigma and discrimination are more effective than using solely mass media. The strategy encourages a combination of interventions to effectively address stigma and discrimination. Key Area 8: Public Communication Objectives:

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Changed attitudes and increased understanding in support of reaching Zero New Infections, Zero AIDS related Deaths, and Zero Stigma and Discrimination Strategies: 6.1 Establish a long term public communication plan in support of Thailand getting to Zero 6.2 Define adequate coordination and management structures 6.3 Monitor impact of public communication on peoples perception on HIV and AIDS

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