Readers of [him] will remember the people living with HIV who were left behind when Medicins sans Frontieres (France) left Mae Sot. The [him] moderator has called the organisation Medicins sans Racines. Here is more.
Does anyone know what happened to the people living with HIV who were left behind when MSF (France) left Myanmar five years ago?
[him] moderator
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Gaps in ART for displaced PLHIV in Thailand risk surge in drug resistance
“Burma Spotlight” – Reporting from the Thai National AIDS Seminar Bangkok, 29-31 March 2011
Wisa S.
“When I saw that the year’s supply of ARVs was close to finished, I became scared and thought that perhaps it meant I would die soon.”
Yin Mon, an HIV-positive migrant woman in her mid-thirties, talks about the time in October 2010 when the end of the one-year ART 'buffer supply" provided by an international non-governmental organization (INGO) that left Thailand in 2009, loomed near and would leave her and 64 other positive migrants and displaced people in and around Mae Sot without access to their essential daily regimen of HIV medicine.
The said international organization had been managing a combined TB-HIV program and at the time of their departure, concerns had been raised around the problematic issue of drug adherence, admittedly not easy when the target population consists of people who tend to move around a lot. Drug resistance becomes a very real threat when people living with HIV and/or TB stop taking their medication, even only for a short time. The danger lies in the fact that drug resistance is irreversible and new strains of the resistant disease can be passed on to others. Particularly virulent are MDR (multiple drug resistant) and XDR (extensively drug resistant) TB, occurring more frequently now both in Burma and Thailand.
However, the majority of the individuals who were given the drugs led relatively stable lives in Mae Sot, and showed up regularly every month to pick up their regimens.
Responding to the gap, the Mae Tao Clinic (MTC) in November 2010 finally took over treatment and support of this group of PLHIV, coordinating drug dispensation and related health care. MTC is a clinic providing health care services to migrants and displaced people near the Thai-Burma border. Its extensive HIV program includes voluntary confidential counseling and testing (VCCT) services, home-based care, peer educators, OI treatment and access to an active network of PLHIV in the area.
Yin Mon was very grateful for this, as she’d “been taking ARVs since 2007 and knew my life depended on them. Once I began ART, my health improved to the point that I took on piece work from a local garment factory and even adopted a child from an HIV-positive mother who was unable to care for her baby.”
All of this, including her relationship with her (HIV negative) husband, would come under strain if she stopped taking medicine.
However, an MTC staff noted that the provision of ARVs to all patients who require them is still not a sustainable process. MTC does not receive its delivery of ARVs directly; the drugs come from the nearby Thai hospitals and/or private donors. ARVs from hospitals come via the extension program of the Thai National Access to Antiretroviral Program for People living with HIV/AIDS, or NAPHA. The extension is an initiative launched some years ago in response to the need for treating disadvantaged people outside the formal health care system, such as undocumented workers and ethnic minorities. It is still only considered a temporary stop-gap measure; if the Thai health authorities have come up with a more stable, long-term solution, they have not yet shared this with health practitioners or the public, let alone organizations providing services directly to the target groups.
A related problem, as a representative of the Thai Northern Network of People Living with HIV shared, is that quite a number of Thais, who are afraid of stigma and wish to remain anonymous, will seek treatment under the extension program instead of the regular NAPHA. Of course this takes away precious spaces that should be reserved for those who have no other option.
Given these obstacles to adequate and appropriate treatment, it is not surprising that HIV-positive migrants may, for example, start with a TB six-month short course, but then stop taking the drugs once they feel better. Or, as was the case with one of the 65 patients, they may already have become resistant to first line ART and require second line treatment, which is costly and harder to procure (the woman has now simply stopped all ART). Losing hope, they may also move away, further complicating consistent compliance and follow up by medical staff.
Still, Thailand is better off than many other countries: NAPHA extension is available, there is a clear understanding among Thai health professionals regarding the extent of need within the migrant communities across Thailand, some Thai organizations like MAP Foundation run excellent interventions and we have received broad financial support over the years from the Global Fund to fight HIV/AIDS, TB and Malaria (GFATM).
Yin Mon’s recent supply problems, and the threat of drug resistant HIV and TB, therefore raise some uncomfortable questions for us: How is it possible that we somehow still cannot manage to take care of our most vulnerable fellow humans – particularly when this can only benefit us Thais as well? What is needed to ensure a more reliable, long-term supply of ARVs (and other drugs, including for TB, Hepatitis C and second line ART) for those HIV positive migrants living in our country?
Let’s be honest, here: migrants living with us do much, if not most, of our dirtiest work; we owe them, at the very least, the same health care granted to our fellow Thai citizens.
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More on Mae Tao Clinic at: http://maetaoclinic.org/
More on MAP Foundation at: http://www.mapfoundationcm.org/
