April 23, 2001
The report, entitled "Prevention of Mother-to-Child Transmission of HIV: Thai Red Cross Zidovudine Donation Programme" (pdf file 3.4 Mb), documents this programme, which is under the patronage of Her Royal Highness. This vital programme has successfully raised funds from public donations to subsidize the drug for HIV-infected pregnant women. Zidovudine is a drug that has been shown to significantly reduce the transmission from mother to child of HIV, the virus that causes AIDS.
Her Royal Highness Princess Soamsawali spearheaded the zidovudine donation programme from the mid-1990s, after realizing the drug was financially beyond the reach of most infected Thai women. The programme is a partnership between, the Thai Red Cross Society, the Thai Ministry of Public Health, and the public.
As Her Royal Highness Princess Soamsawali states in the report's Preface:
"The rapid spread of HIV/AIDS is threatening gains made in child health over the past two decades. The epidemic significantly affects children and their families leaving many without protection, care or income. Because of their loyalty and great respect to His Majesty the King and royal family members, the Thai population continuously donated wholeheartedly and with determination and in full cognizance of the importance of prevention of mother-to-child transmission of HIV. What needs to be done cannot be accomplished by one agency or group alone. It takes the shared commitment, decision making, resources and efforts of all sectors of society to achieve the goals of protecting children from HIV and its effects."
"The donation programme is a tremendous public service because women infected with HIV are often poor and might not be able to afford treatment otherwise," said Dr Kathleen Cravero, Deputy Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), at the official launch ceremony. "The donations raised by the Thai Red Cross will allow for the purchase of zidovudine in large quantities at low cost and help its free distribution to HIV-positive pregnant women and to the infected children who have been born as a result."
Today an estimated 695,000 adults and children live with HIV/AIDS in Thailand. The most common mode of HIV transmission in the country is heterosexual, hence women are at significant risk of contracting HIV. When they become pregnant, HIV-infected women can then pass on the virus to their unborn children.
In 1999 approximately 2% of pregnant women attending antenatal care clinics were HIV-infected. Based on this finding, it is estimated that 15,000-20,000 HIV-infected women will give birth every year. The transmission rate from HIV-infected pregnant Thai women to their infants is between 19-25%. Recent national projections by the Thai Working Group on HIV/AIDS Projections estimated 4200 new infections in children during the year 2000.
The success of this programme is just one aspect of Thailand's successful programme of prevention of HIV infection. A progressive and energetic response to the epidemic from all sectors of Thai society and leadership of successive Prime Ministers resulted in some major changes in behaviour. The success of this response has been recently recorded in the February 2001 report from the Thai working Group on HIV/AIDS Projection. The report finds that:
The report concludes that these behavioural changes have prevented approximately 5.7 million adult HIV infections. Without the behavioural changes that began in 1990, almost 4.7 million men and 2 million women in Thailand would have become infected with HIV by the year 2000. However, experts agree there is no room for complacency. Should the sense of urgency be lost and these efforts begin to falter at any level the epidemic could begin to grow rapidly again. To achieve the level of human and financial resources needed for these efforts, it is critical to mobilize partnership from all sectors and levels of society.
The Thai Red Cross Zidovudine Donation Programme was conceived during a meeting between the administrative members of the Thai Red Cross Society and Her Royal Highness Princess Soamsawali, who expressed her concerns about the alarming number of Thai children born to HIV-infected mothers. At that time, the zidovudine regimen was already proven to be effective in reducing HIV transmission from mothers to infants if given during pregnancy, during labour and to the infant. Her Royal Highness envisioned that the only way HIV infected women would have an immediate access to the medication was through public donation and suggested that the Red Cross was in the proper position to initiate such a programme. The Thai Red Cross Research Centre took on the responsibility of setting up the donation programme, which began on 26th February 1996. Her Royal Highness accepted the role of patron and was the first donor to provide funds.
After a pregnant woman has been provided with voluntary counselling and testing, and has been tested positive for HIV, her health care provider can request zidovudine for her from the Thai Red Cross. Once the request is approved, the medication will be delivered to the health care provider periodically. The drug supply will be sufficient for a pregnant woman and her infant according to the prophylactic regimen, which should be started anytime between 14 and 34 weeks' gestation and should be continued until delivery. The infant will receive zidovudine during the first six weeks of life.
Blood samples are taken to determine whether the infant has acquired HIV from the mother. The test result is made available to the health care provider, who will inform the parents of their child's infection status.
Because the HIV/AIDS epidemic continues in Thailand, the Thai Red Cross foresees the necessity of maintaining the donation programme. Since the medical knowledge in the field of HIV evolves rapidly, the Thai Red Cross recognizes that this programme may need to be frequently updated to provide the greatest benefit to the target population. The Thai Red Cross, a UNAIDS collaborating centre, will expand the role of the organisation in this region; the model of this programme can possibly be used as a demonstration or provide lessons learned for other countries in this region.
UNAIDS welcomes the success of this programme and has assisted the Thai Red Cross in publishing the story as a UNAIDS Best Practice document.
For more information, please contact:
Dr Praphan Phanuphak -- Director, Thai Red Cross Society Programme on HIV/AIDS, Tel. (+ 66 2) 256 4107-8, Fax (+ 66 2) 254 7577 Website http://www.redcross.or.th
Sompong Chareonsuk, UNAIDS Country Programme Advisor, Thailand, Tel. (+ 66 2) 288 1882, Fax (+ 66 2) 280 0556
Pensri Tasnavites, UNAIDS Media Advisor, Bangkok, Tel. (+ 66 2) 257 0300, Fax (+ 66 2) 257 0312
You may also visit the UNAIDS Home Page on the Internet for more information about the programme (http://www.unaids.org).