Kai was born with HIV but did not know until he was 11. Depressed and unsure of his future, he sometimes postponed his anti-retroviral (ARV) drug doses or did not bother taking them at all. When his doctor asked whether he had taken his medicine on time, Kai would always answer "yes".
"When I was younger, I did not care about taking ARV," says Kai, who is still a teenager and sports both a tattoo and a pierced ear. "Also, I did not want my friends to see me taking the pills, so I skipped them sometimes."
This is an extremely dangerous practise, as ARV medication helps to protect people living with HIV from opportunistic infections as well as helping to suppress _ and even stop _ the progress of the virus. In short, it helps people with HIV to remain both healthy and alive. Yet many young people like Kai fail to take their medication every day, while some fail to take them at the same time every day, which makes the medication less effective and can lead to drug resistance.
According to Dr Pope Kosalaraksa, a project manager who led a study to provide holistic care for adolescents living with HIV/Aids at Khon Kaen University's Srinakarin Hospital, one in four adolescents living with HIV who participated in the study have difficulties following their medication schedules. In addition, one in five adolescents have had sexual relationships, and most fail to use condoms regularly.
In order to address these issues, Unicef is working with partners on an innovative project aimed at keeping young people on their ARV medication schedules and also practising safe sex. The adherence project is co-funded by ViiV Healthcare's Paediatric Innovation Seed Fund through Treat Asia/amfAR. Srinakarin Hospital and HIV-Nat/The Thai Red Cross Aids Research Centre are the leading organisations working with Unicef on this.
"This holistic care model is the first in Thailand to provide both clinical and psychosocial support for young people," says Dr Witaya Petdachai, a senior paediatrician at Prachomklao Hospital in Phetchaburi, which is one of the partners working on the project.
Under the project, 85 young people with HIV aged between 13 and 24 years of age are being assisted, with services provided to them with the support of Srinakarin Hospital, Prachomklao Hospital, the Thai Red Cross Aids Research Centre in Bangkok, the Aids Access Foundation and seven community hospitals in Chiang Rai, and the We Understand Group. All of the young people taking part in the project, which began in August last year, were born with HIV and have ARV medication adherence levels below 95%.
The project is aimed at improving the adherence to medication schedules by helping the young people to have better understanding of the HIV virus, giving them hope for the future and teaching them to manage negative attitudes towards their situation.
"I volunteered to participate in this project," says Som, 20, who makes a living working at a factory. "It has helped improve my adherence. I used to take my ARV late, but I am more disciplined now."
Som says she has learned more about the HIV virus and how ARV medicine helps protect her, which in turn has helped keep her on a regular schedule.
"The ARV keeps me healthy and allows me to work like anyone else," says Som, whose pay cheques from the factory are used to support herself and the aunt who raised her.
The project is using mobile texting technology to achieve its goals. An SMS system conceived and developed by the Thai Red Cross Aids Research Centre has been programmed to send out a short message to each young person taking part in the project at the time of day they are supposed to take their medication. The text is written in such a way that if someone other than the patients involved in the project happened to read it, they would not know what it was about.
When the young people receive the message, they are required to send an SMS back to confirm whether or not they took their medication. If they reply is "no", the system will send them another SMS to remind them again. If the young people reply that they need even more encouragement, a nurse working on the project will call them to see what the problem is and encourage them to take the medicine. To objectively measure adherence, Thai Red Cross and Treat Asia have organised for hair samples to be collected from the participants every three months, which are then tested at a lab in the US. The samples can be used as reliable indicators as to whether they have taken their regular dose of drugs over the past three to six months, and it is a much more accurate way of measuring adherence than doing a pill count or using other methods.
"After joining the project, I realise how important it is for us to take ARV [drugs] on time," says Kai, who dreams of becoming a soldier and of having a family one day. "If we take them on time, it will control the virus and keep us strong. No one can tell just from looking at us that we have HIV."
Another major focus of the project is promoting safe sex. Adolescents living with HIV are taught about the virus, sexual activities that lead to the spread of the virus, how to practise safe sex and how to go about disclosing their HIV status to partners.
Mac said he used to have very little knowledge about safe sex, but the project has helped him understand how to use positive prevention methods and how to talk to his partner about his status.
"I have a girlfriend," says Mac, 18. "I used what I learned from the project to explain to her, little by little, about HIV. When she understood everything about the virus, I told her about my HIV status. I knew she might not be able to accept that I have HIV and that she could easily walk out of my life.
"It turned out that she accepted my status and did not leave me," he says with a smile.
The lessons learned and experience gained by Unicef and its partners through the project will be shared with others working on HIV so that they can be applied more widely to helping young people with the virus.
"If the model proves successful in terms of improving adherence and in promoting safe sex, Unicef and partners will advocate that it be adopted at the national level and that such services be expanded to other hospitals and communities in Thailand," said Nonglak Boonyabuddhi, HIV/Aids officer of Unicef Thailand.
"Unicef firmly believes that all young people living with HIV should be able to live a normal and healthy life so that they can make sustained and positive contributions to the lives of their families and the communities they live in," Nonglak said.
All names of HIV-infected persons have been changed.
For a video of this story, visit www.youtube.com/unicefthailand.
