September 2008 NGO Forum Press Statement
Access to health services for ethnic minorities: Present to future
One of the main problems ethnic minorities in Thailand face is that they struggle to access existing health services, making them prone to having a poorer quality of life, according to discussions held at the monthly NGO Forum held in September 2008. One serious heath problem is HIV/AIDS, especially due to the stigma associated with HIV infection. Although since 2005 the government of Thailand has been providing free Antiretroviral (ARV) treatment to Thai citizens, the ethnic minorities are not covered under this programme. ARV therapy is provided under three government programmes: National Health Scheme, Social Security and Health Scheme of government staff members. Unfortunately, ethnic minorities who live in Thailand are often not covered by any of these three programmes.
The monthly NGO Forum focused on the topic of ‘Access to health services for ethnic minorities: Present to future’. It was held at Health & Development Networks (HDN), Chiang Mai on Tuesday, 30th September 2008, and organized by AIDSNet foundation, Health and Development Networks (HDN) and Partners Thailand – a national partnership on information, dialogue and advocacy on HIV and TB issues in Thailand.
According to the Ministry of Social Development and Human Security, there are about 1.3 million ethnic minorities in Northern Thailand. Major health problems are Malaria and Tuberculosis (TB). For ethnic minorities, language is often a barrier to accessing health information. Statistics show that three times as many non-Thai speaking women don’t know how to prevent HIV, and 60% of non-Thai speakers hold common misconceptions about HIV transmission, nearly double the rate among Thai speakers. In addition, condom use is much lower among non-Thai speaking women, according to the Ministry.
Preliminary data of the NIMH-supported pilot of mobile VCT found that 1.4% of ethnic minorities tested positive for HIV. Assuming that roughly one third of the 1.3 million highland ethnic minorities are vulnerable to HIV, some 6,000-7,000 are likely to be HIV infected.
The NAPHA Extension project, which is supported by Global Fund to Fight AIDS, TB and Malaria (GFATM), provides free ARV to people who cannot access ARV provided by the Thai government. The data shows that although the project can support ARVs for up to 2,000 people in Chiang Mai, only 500 people on ARVs are currently enrolled in this project.
Dr. Surinda Kawichai, from the Research Institute for Health Sciences at Chiang Mai University, is running the PA-THAI project, focusing on HIV/AIDS Community mobilization, Mobile HIV voluntary counseling and testing and post-test support service in rural Thailand. The key success of the project is community participation. “We found that contribution from community leaders, gatekeepers and community health workers was very important,“ said Dr Surinda.
Dr. Gary Suwannarat, director of AIDSNet foundation, raised a concern about the sustainability of HIV response. Dr Gary said that “AIDSNet works with networks of People living with HIV (PLHIV). These networks cannot reach patients in highland and it’s also hard for hill tribes to come to the hospital in town.“
Mr. Somdet Pornnimitsakul, a staff member of the AIDS Ministry, the Church of Christ in Thailand(CAM), said that they are now working in Muang, Mae Tang, Doi Saked and Chiang Dao. Most of their target group is Lahu. He raised concerns on how to sustain the community work. “We build skills of community volunteers, most of them are community leaders or religious leaders, and are responsible of bringing patients to the hospital. In some villages they have to travel almost 80 kilometers to the hospital. From working with our volunteers we found that now the communities have better understanding about HIV and TB,” said Mr Somdet.
Taking ARVs without interruption is a big challenge with ethnic minorities. All projects focusing on ethnic minorities are time-limited and don’t provide prevention, treatment or care on HIV related opportunistic infections (OI). Ethnic minorities need to pay on their own, and face considerable stigma and discrimination, communication problems and must travel for long distances to get health care. They often have little financial means for travel or for the treatment, said Mr Somdet.
A Shan woman participant of the NGO Forum said that “I found that I am HIV positive in 2005. I have had to pay for my medicine since the beginning. I stopped taking ARV for three months because I didn’t have enough money. When later I went back to the hospital, I discovered that I have now become ARV resistant. Now I am on 2 ARV medicines from the Municipal hospital but I still have to buy one medicine [ARV] from the Nakorn Ping Hospital”.
“NAPHA Extension is in community hospital in Sansai and Doi Saked districts. This programme has a limited quota for OI treatments, free-of-cost ,“ said Mr.Surachat Suchakam from the Anonymous Clinic in Chiang Mai.
“Now I am working in prisons, which has ethnic minorities as inmates. It is more difficult for them to access ARVs in prison settings. We are trying to change the policy so that the national health scheme would provide ARV treatment for ethnic minorities because the GFATM project will finish in six years and NAPHA Extension will finish in two years and some other research projects are only for a short time,” said Mr. Boonniam Wongjaikam from Thai Treatment Action Group (TTAG).
Keywords: press statement, september 2008
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