Developing National HIV Prevention Guidelines Among MSM and TG

The HIV prevalence among men having sex with men (MSM)  and transgender people (TG) remains at a crisis level in the country, the highest reported in Bangkok at 31.1 % among MSM and 16.7%  in 2010 and the highest among all key affected populations.  TGs and MSM in urban areas of Thailand today are said to be twenty times more likely to be living with HIV than people in the general Thai population.

A national guideline for HIV prevention among MSM and TG which informs  policy makers and implementers of the country’s minimum standards when it comes to HIV prevention among MSM and TG, is both an important tool for quality management of HIV services and an important input to operational planning and budgeting HIV interventions among MSM and TG.

The Thailand National AIDS Strategy (2007-11) aims to reduce new infections by half; identified MSM and TG as a priority population, and intends to create a “policy enabling environment that support intervention among MSM and TG.” As Thailand prepares to embark with its new National AIDS Strategy (2012-2016) with its Getting to Zero vision, focus is being given to scale up prevention among key affected populations, particularly MSM and TG.

This includes a specific provision on managing quality services delivery and increased coverage for MSM and TG interventions. It is expected that the strategy will be finalized this year and the operational plan to follow after. Guidelines by which MSM and TG strategies and activities will be implemented are critical to the success of the response in Thailand. Thailand has existing national HIV guidelines on PMTCT, VCT, ARV and harm reduction but it has no existing guideline regarding prevention among MSM and TG. This initiative will directly address this policy gap. Contributing to this, a national guideline is an essential tool to operationally manage the planning and budgeting of HIV interventions among MSM and TG in Thailand and manage quality of the prevention services at the ground.

In 2010, the Bureau of AIDS, TB and STI, Department of Disease Control, Ministry of Public Health supported by UNDP Thailand launched “A Road to National Guidelines for HIV Prevention among MSM/TG in Thailand” project which is expected to generate existing practices in MSM and TG HIV prevention as evidence for recommendation on the national guidelines for MSM HIV prevention in Thailand. In the recently concludedPerformance Management of HIV Prevention among MARPs by Promoting Integrated Outreach and Networking: CHAMPION” organized by Rainbow Sky Association of Thailand and AIDSnet underscored the need to prioritize and ensure quality and consistency to HIV prevention among MSM and TG.

Other initiatives are currently being implemented including UNESCO’s  study on health seeking behaviour of MSM and TG in Thailand and ILO’s standards and guidelines for MSM saunas and venues. The HIV thematic provision in the next United Nation Partnership Framework (2012-16) is aligned with the national strategy and focuses on MARPs, with a specific output on developing “national guidelines and standards of prevention and care services are appropriate to Thailand’s context and consistent with international best practice and quality standards.

As early 2004, regional discussions that germinated the concept of comprehensive package of services  from technical experts, MSM and TG community representatives have ball rolled that provided a framework that provided guidance on how MSM and TG interventions could be designed in many countries in Asia Pacific, including those implemented by Global fund for AIDS, TB , and Malaria. In 2009, several regional initiatives and a high-level consultation on MSM programming supported by USAID/HPI together with APCOM and UNDP were conducted including the Hong Kong conference that “recognized the need for a widely endorsed, single, comprehensive regional reference package to better inform national responses”; and “the implementation of a ‘highly active’ range of interventions was recommended for settings with high HIV prevalence and incidence among MSM and TG”. The international guidance recommended by these international consultations becomes a reliable foreground when preparing the frameworks by which national guidelines can be built.

In three decades of epidemic, Thailand registered success in curbing the infection most notably in sex work through the 100% national condom use programme and scaling up its ARV treatment program. The universal access scheme has steered the country’s AIDS financing mostly on treatment, particularly on access to ARV. Pact Thailand’s  report on community care and support for MSM with HIV in Bangkok underscored that the lived experience of PLHIV and fieldwork experience of service providers demonstrated that MSM are not reached at the level needed to secure sustained population-level health

Recommendations to Develop National Guidelines for HIV Prevention Among MSM and TG:

Based on the consultations and documents that provide recommendations on how to improve service delivery of HIV prevention among MSM and TG, the following specific recommendations included to guide the development of national guideline for MSM and TG:

  • The overall HIV prevention among MSM and TG is better implemented by the community of MSM and TG, with very close collaboration with national and local government agencies, particularly on linking prevention with testing, care and support services. Peer based approach remains the most effective option in reaching out MSM and TG. Outsourcing of HIV prevention services to the CSOs is seen as a critical option, with continued capacity building support to the MSM and TG community.
  • As essential characteristics, the guideline should be technically sound, feasible, and acceptable to the stakeholders.
  • The process in developing the guideline should be participatory, with strong SOGI dimension, and geared at advocacy-focused engagement. The guideline should look into the implementation component and participants who will write should come from government, CSO and academia.
  •  The guideline should focus on young MSM and TG and the context and setting where they find sexual network including spaces and virtual sites. Anent this, the guideline should give emphasis on young MSM and TG who frequent sex and cruising venues.
  • The guideline focus on the following settings:  entertainment venue, sex venues, schools, streets and create one for internet based intervention. Internet based interventions should ultimately link to access of face-face accessing of other services.
  • The guideline focus on sub-populations is better delineated based on their SOGI (hetero, bi, homo). Nonetheless, MSM, TG, MSW/TGSW should be incorporated including positive MSM/TG. Other sub population will need further understanding:  MSM/TG in prison, MSM/TG in migrant populations and MSM/TG among IDU.
  • At the minimum, the guideline should include the priority interventions are: peer education, peer outreach, drop in centers, condom and lubricant distribution, VCT and STI. The guideline on VCT and STI are community actions leading to access to VCT and STI services, and should include elements how to make these services MSM and TG friendly.  Subject to further agreement, it was highlighted the need to develop guideline also for MSM/TG in closed setting, positive prevention and stigma and discrimination prevention.
  • The guideline should include language sensitivity guide based on Thai context.

The following activities have been accomplished:

1. Formulation of outcome and specific output questions,  terms of reference, procedures and protocols in writing of the national guideline and establish committee per component to provide input and support in writing national guidelines.

2. Shared of models and experiences from other countries (AVAHAN Project in India) in developing standards and guidelines for HIV prevention among MSM and TG.

3. Conducted workshop on national guidelines.

The content of the guidilines is under the development process by the writing teams which composed of representatives from Gov, CSOs, academia and UN agencies. The project plans to conduct the pilot testing of the guideline in two pilot provinces which are Bangkok and Lopburi.

Who finances it?

Total resources required:            
    $ 95,000

-    UNDP  HIV TTF          $ 75,000 

-    UNDP APRC                $ 20,000

Delivery in Previous Fiscal Year?

Year Delivery (USD)
2011 37,326.48