Thailand leads the way in the Asia-Pacific region on ensuring children are born HIV-free
“When I was 30 years-old, I was surprised to learn that I was pregnant,” said Prem Paika, who lives in Chiang Mai, a big city in the north of Thailand. “My partner, who I had been with for the past eight years thought he was infertile, so we did not use any birth control.”
Ms Paika was also concerned, because she and her partner had been diagnosed with HIV five years earlier. She had been taking antiretroviral medicine (ARV) for the past few years and went to consult with the doctor overseeing her HIV treatment at a public hospital.
“I was very worried my baby would have HIV, but my doctor reassured me that the ARV medicine would protect my baby,” said Ms Paika.
Untreated, HIV-positive women have an up to 45% chance of transmitting the virus to their children during pregnancy, delivery or breastfeeding. However, the risk drops to just over 1% if ARVs are given to both mother and child.
Thailand has made the elimination of new HIV infections among children a priority and has constantly adapted its prevention of mother to child transmission programme (PMTCT) as research has pointed to better ways of prevention. The country is currently following the World Health Organization’s guidelines to provide lifelong ARVs to all pregnant women living with HIV. The Ministry of Public Health has implemented measures in its hospitals to ensure mothers living with HIV receive key services.
“We have developed a system in hospitals where the mother’s confidentiality is guaranteed. Health sector staff have been trained to communicate well with their patients,” said Dr Danai Teewanda, Director of the Bureau of Health Promotion in the Ministry of Public Health.
Ms Paika found her regular attending doctor supportive and she was happy because the hospital provided psychological counselling for her throughout her pregnancy and until her child was one year-old. She could also access her HIV treatment and receive her antenatal check-ups in the same hospital and did not have to travel from one part of town to another, visiting different specialists.
Thailand’s health authorities have made creating a supportive environment for people living with HIV a priority. However, stigma is still present in specialties outside of HIV. Ms Paika found the hospital’s gynecologist treated her badly and was often largely misinformed.
“From my first antenatal examination, the gynecologist encouraged me to have an abortion. He wouldn’t let me see the sonogram as he said in any case there was no point. He told me my baby only had a 2% percent chance of being born HIV free.”
Ms Paika turned to her HIV treatment doctor for comfort and her partner complained to the hospital’s director. After this, she found the gynecologist treated her better, though never reached the expected standard of professional and non-stigmatizing behaviour.
Finally the big day arrived: she gave birth to a baby girl. “They provided her with an ARV prophylaxis and she was tested at one month and then every six months. She was HIV-negative each time. I am so happy she is free of HIV,” said Ms Paika.
Through its efforts, Thailand has achieved remarkable progress in eliminating new HIV infections among children. In 2014, country programme data showed that almost 96% of HIV-positive pregnant women received ARVs to reduce the risk of HIV transmission and almost 98 % of their babies were born free of HIV.
The country is hoping to further reduce new infections among children. “We have a few weak spots, such as early detection. We are encouraging women to seek ANC tests within the first 12 weeks of their pregnancy,” said Dr Danai.
Since 2013, Thailand provides free antenatal services to pregnant women at all health facilities promotes HIV counselling and testing for couples and provides ARVs to infants as soon as possible after birth. The country hopes by 2016 to have virtually eliminated new HIV infections in children. Senior government health authorities from Thailand will be among representatives from 20 countries, who will be attending the 10th Asia-Pacific United Nations Elimination of Parent-to-Child Transmission of HIV and Syphilis Task Force meeting in Beijing, China from 15-17 September. The meeting will examine regional successes, but also roadblocks to eliminating new HIV infections in children.
For mothers living with HIV like Ms Paika, HIV treatment has transformed their fears into hope. Her words of advice to other pregnant HIV-positive women sound much like every mother.
“Stop worrying that your child will be born with HIV. Rather, it’s really important to take care of yourself so the baby will be healthy. Don’t worry, spend time looking after yourself.”