Thailand needs to work faster to reduce stigmatisation against young people living with HIV (young PLHIV) in healthcare settings, experts say, as it is deterring them from seeking treatment and hindering the global goal of ending the Aids epidemic.
At the 2nd Southeast Asian Regional Workshop on HIV-related Stigma and Discrimination recently held in Bangkok, stakeholders drawn from the civil and justice sectors and the media shared their experiences in addressing HIV-related discrimination.
"Social justice and human rights are fundamental in addressing the issue of unequal accessibility to healthcare," said Ye Yu Shwe, the Strategic Information Officer of the UNAIDS Asia and the Pacific Regional Office.
Even though Thailand has been doing well in providing healthcare to young Aids victims aged 18 to 24, about one in four still experience discrimination in healthcare settings. This pushes patients away from accessing medical treatments and health services, he said. Such stigmatisation and discrimination is widespread globally, he noted.
In Thailand, young HIV patients are stigmatised not just by the general population but also within the HIV community, experts say.
"To pinpoint the reason is complicated because stigmatisation varies according to the social context," he said.
"However, Thailand should address the issue and healthcare workers need to be well-trained to understand that PLHIV are no different from other patients, and [they] should be treated with dignity and equal respect," said Mr Shwe.
Ye Yu Shwe: An issue of human rights
Niwat Suwanphattana, the UNAIDS Thailand Stigmatisation and Discrimination Reduction coordinator, said most young PLHIVs in Thailand have experienced discrimination while using healthcare services. Young transgender women living with HIV are the most discriminated against.
Many believe young PLHIV contracted the disease from sexual relationships. "They are often criticised during health screenings for having sexual relationships at a young age," he said, adding that such a presumption is a violation of their rights.
Meanwhile, young patients growing up with HIV, despite their gender identity, would be criticised by healthcare providers over the possibility of them spreading the disease to their partners. Many are warned not to have children, Mr Niwat said.
In the case of transgender women, some assume that their being transgender was a cause of their having contracted HIV. These young PLHIVs are likely to develop self-stigmatisation and label themselves as bad people. "They would avoid treatments as they do not want to be criticised by healthcare providers," he said.
Such self-blame would lead them to devalue themselves and affect how they live their lives. "They will feel hopeless, especially in building a relationship or a family," he added.
Mr Niwat said Thailand has been trying to solve the destigmatisation of PLHIV in healthcare settings for more than 10 years. But the number of recent cases means the nation needs to work harder.
The Global Aids Strategy 2021-2026 seeks to battle inequalities and put PLHIV and communities at the centre to get the world on track, he said.
The target for 2025 includes having key populations aware of their blood status and 95% of PLHIV to get the treatment they need, and be able to suppress their viral loads.
It also aims to push for punitive laws and policies against countries where PLHIV have limited access to healthcare, reduce gender-based inequalities and violence towards PLHIV, and enhance integrated HIV health services.
He said healthcare personnel in Thailand should consider these approaches because these are the factors that push PLHIV away from the healthcare system.
"We are still far behind. We need to work more on reducing stigmatisation against PLHIV," Mr Niwat said.
Niwat: Young transgenders most affected
Dr Chewanan Lertpirayasuwat, chief of the HIV/Aids and Sexually Transmitted Disease Division under the Department of Disease Control, said Thailand has seen a surge of HIV/Aids infections in the past two years.
Some 9,000 new cases of HIV infections are reported in Thailand each year, she said, adding that half are adolescents.
Troublingly, she said, young patients tend to ignore the doctor's instructions and fail to take medication regularly.
She said there are free HIV self-test kits available at hospitals under the universal healthcare scheme. People at risk of infection should consider getting the test because early medical treatment is crucial in controlling the epidemic, Dr Chewanan said.
She said the Ministry of Public Health plans to enhance the system for sexually transmitted disease screening, so results are available within one day.
However, she said the challenge is most people often miss their appointment to hear the result. She also raised concerns about pregnant adolescents who don't receive prenatal care or health examinations. Youngsters who are infected with sexually transmitted diseases are more likely to transmit them to their offspring, she said.
Chewanan: 9,000 new cases yearly