2. Revitalizing a multi-sectoral response: Thailand has in the last few years reverted to a narrow public health sector response to HIV/AIDS. The chairmanship of the National AIDS Committee has been delegated to the Minister of Health, non-health ministries are not adequately involved, and spending on AIDS has fallen by half. Non-health ministries must urgently formulate their own operational HIV/AIDS plans and allocate resources for their implementation. In addition, HIV/AIDS prevention and care, as well as management of the social and economic impact on households and communities, need to be better integrated into provincial- and Tambon-level strategic development planning and programmes, especially in hardest hit areas.

3. Shifting the focus of prevention: While still keeping the pressure on brothel-based HIV transmission, attention must now shift towards young people in general who are highly vulnerable to infection. Evidence shows that young people are having more sex, starting at an earlier age, while only 20 to 30 percent are using condoms. Less than 5% of young people are now being reached by adequate prevention services, while public awareness campaigns have all but disappeared. Simultaneously, prevention efforts must also shift focus to effectively target specific vulnerable groups such as mobile populations, MSM, and IDUs. Evidence shows that HIV prevalence has reached 17% among young gay men (up from 4% in 1991), 50% among IDUs (up from 35% in 1996), and 6% among mobile labourers in some industrial locations.

4. Mobilising the school system: A major soft-spot for Thailand’s current response to HIV/AIDS is the fact that the school system is not adequately mobilised. On an urgent basis, the Ministry of Education needs to include non-judgemental AIDS and sex education in school curriculum, going well beyond the current old fashioned biology lessons. Life skills programmes, open debate about sexual health, condom promotion, and peer education need be introduced in a systematic manner in all schools and universities across the country as part of Thailand’s national education straPHP has encountered an Access Violation at 01800AFDtegy.

5. Achieving universal access to ARV treatment: It is estimated that around 20,000 people have access to ARVs out of a bare minimum of 100,000 who urgently need such treatment today. As a country with a well organized health system and the capacity of producing generic ARVs at less than USD 300 per patient per year, Thailand should aim at becoming a leader in the global campaign for access to ARVs by going well beyond the WHO target of 50% coverage set for less developed countries. But for this to happen, Thailand needs to allocate more resources to treatment (but not at the expense of prevention), incorporate ARVs into its universal health coverage, and at the same time seek out alternative and multi-sourced financing to ensure sustainability.