“When I was 30 years-old, I was surprised to learn that I was pregnant,” said Prem Paika, who lives in Chiang Mai, Thailand. “My partner, who I had been with for the past eight years, thought he was infertile, so we did not use any birth control.”
Ms Paika was also concerned because she and her partner had been diagnosed with HIV five years earlier. She had been taking antiretroviral medicine for the past few years and went to consult with the doctor overseeing her HIV treatment at a public hospital.
“I was very worried my baby would have HIV, but my doctor reassured me that the antiretroviral medicine would protect my baby,” said Ms Paika.
Untreated, women living with HIV have a 15–45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. However, that risk drops to under 5% if antiretroviral medicines are given to both mother and child through the stages when infection can occur.
Thailand has made the elimination of new HIV infections among children a priority and has consistently adapted its prevention of mother-to-child transmission programme in accordance with the latest research findings. The country is currently following the World Health Organization’s guidelines to provide lifelong antiretroviral medicine to all pregnant women living with HIV. The Ministry of Public Health has implemented measures in its hospitals to ensure that mothers living with HIV receive key services.
“We have developed a system in hospitals where the mother’s confidentiality is guaranteed. Health sector staff have been trained to communicate well with their patients,” said Danai Teewanda, Director from the Bureau of Health Promotion at the Ministry of Public Health in Thailand.
Ms Paika found her regular doctor supportive and she was happy because the hospital provided psychological counselling for her through her pregnancy and until her child was one year old. She could also access her HIV treatment and receive her antenatal check-ups in the same hospital and so did not have to travel from one part of town to another, visiting different specialists.
However, despite efforts by Thailand’s health authorities to create a supportive environment, stigma remains a problem among staff working in other health areas. Ms Paika found that the hospital’s gynaecologist treated her badly and was often misinformed.
“From my first antenatal examination, the gynaecologist encouraged me to have an abortion. He wouldn’t let me see the sonogram as he said in any case there was no point. He told me my baby only had a 2% chance of being born free of HIV.”
Ms Paika turned to her HIV treatment doctor for comfort and her partner complained to the hospital’s director. After this, she found that the gynaecologist treated her better. Finally, the big day arrived: she gave birth to a baby girl.
“They provided her with an antiretroviral prophylaxis and she was tested at one month and then every six months. She was HIV-negative each time. I am so happy she is free of HIV,” said Ms Paika.
Through its efforts, Thailand has achieved remarkable progress in eliminating new HIV infections among children. In 2014, country programme data showed that almost 95% of HIV-positive pregnant women received antiretroviral medicines to reduce the risk of HIV transmission and almost 98% of their babies were born free of HIV.
The country is hoping to further reduce new HIV infections among children. “We have a few weak spots, such as early detection. We are encouraging women to seek antenatal care within the first 12 weeks of their pregnancy,” said Mr Danai.
Since 2013, Thailand has provided free antenatal services to pregnant women at all health centre facilities, promoted HIV counselling and testing for couples and provided antiretroviral medicines to infants as soon as possible after birth. The country hopes by 2016 to have virtually eliminated new HIV infections among children.
Senior government health authorities from Thailand were among representatives from 20 countries who attended the 10th Asia–Pacific United Nations Elimination of Parent-to-Child Transmission of HIV and Syphilis Task Force meeting in Beijing, China, from 15 to 17 September. The meeting examined regional successes, but also roadblocks to stopping new HIV infections among children.
