Unsafe injecting drug use is the second biggest transmission route.7 Increased access to prevention services has resulted in new infections decreasing among some groups, however they are rising among others.
For example, while the rate of new infections through injecting drug use steadily decreased between 19, the rate of new infections through male-to-male sex dramatically increased over the same period.8 Of all new infections, 50% were among men who have sex with men (sometimes referred to as MSM), male sex workers, and transgender people, making this population a priority for prevention work.9 Overall, in Thailand 9.15% of men who have sex with men are living with HIV, although prevalence varies greatly depending on location.1011 For example, in Bangkok prevalence is estimated at 28.6%.12 Condom use among men who have sex with men is high, estimated at more than 82.1%.13 But, although the availability of prevention services has improved, new infections have not declined as much as intended.14 Prevention programmes also haven’t reached as many young men who have sex with men, meaning they are less likely to know where to obtain an HIV a test, or understand their risk.15 This, alongside a perception of low risk and multi-partner sex fuelled by performance enhancing drugs, can result in low condom use.16 A 2013 study of men who have sex with men in Bangkok found HIV incidence to be much higher in younger men (8.8 per 100 person-years among those aged 18 to 21, compared to 3.7 per 100 person-years among men over 30).17 Pre-exposure prophylaxis (Pr EP), antiretroviral treatment taken by HIV negative people before potential exposure to HIV in order to stop transmission, is currently being piloted in five sites in Thailand for men who have sex with men.18 This includes the Thai Red Cross Anonymous Clinic, which has been trialing Pre P since 2014.
Overall, it found young female sex workers to be the least likely to test.46 New approaches have been introduced to increase access to and demand for HTC among key affected populations, including the following: One such programme is the USAID and PEPFAR-funded LINKAGES programme.
This is a five-year project which started in 2015 and is being implemented in Thailand by FHI 360 and local community based organisations.
LINKAGES sees members from key populations (known as ‘peer mobilisers’) reach out to their peers in order to link them to HTC services.