Plhiv & their household impact mitigation by Sukhonta Kongsin

SOCIO-ECONOMIC & MENTAL HEALTH BURDENS OF HIV/AIDS
IN DEVELOPING COUNTRIES
21 & 22 NOVEMBER 2011, Kuala Lumpur, Malaysia

"People living with HIV/AIDS and Their Households:
Impact Mitigation: the Need for Strategic Action"

Sukhontha Kongsin, M.Econ., Ph.D.
Faculty of Public Health, Mahidol University, Bangkok, Thailand
phsks@mahidol.ac.th
Sukhum Jiamton, M.D., Ph.D.
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
srsjt@mahidol.ac.th

Thailand HIV/AIDS Epidemics

Pregnant Youth and
Women
mobile population
Male with
From specific Multiple Partners
to general
populations
Prostitutes

Injection Drug
Users (IDUs) Children

Homo/Bisexuals

1984 ..……..1988 1989 1990 1991 1992 1993

…………..….2004…..2008

Impact Mitigation:
the Need for Strategic Action

State of Art: Impact of HIV/AIDS at the household level;
Poverty; Inequality; Food security; Policy to mitigate the impact;
inter/multi/trans-disciplinary approaches :
What do we know already?

Broad scopes:
- From HIV vaccines through prevention care support and treatment
- Short, medium and long term coping strategies
- Trade-offs between resources for HIV/AIDS vs. other issues

Health System
Health care/services system

Ministry of Public Health, Ministry of
Finance, pharmaceuticals, medical
professions, activists, donors, NGOs,
research groups, etc.

People Living with HIV/AIDS and Their Households:
Impact Mitigation: the Need for Strategic Action

Building
bridges

social scientists, epidemiologists, nutritionists, educators and agricultural economists, etc.

HIV/AIDS Mortality Impact on Household
and its coping

Pitayanon, S., S. Kongsin, et al. (1997). The Economic
Impact of HIV/AIDS Mortality on Households in Thailand.
The Economics of HIV and AIDS. D. Bloom and P.
Godwin. Delhi, India, Oxford University Press: 53-101.

The economic impact of HIV/AIDS morbidity
on households in rural Thailand:
An analysis of household coping strategies

KONGSIN S (*), SIRINIRUND P ($), JIAMTON S (#),
BOONTHUM A (*) , WATTS CH (@)

(*) Facultyof Public Health, Mahidol University, Thailand,
($) Phayao Provincial Health Office, Thailand,

(#) Department of Dermatology, Faculty of Medicine Siriraj Hospital,

Mahidol University, Thailand,
(@) London School of Hygiene and Tropical Medicine,United Kingdom.

Study location: Phayao, Thailand

where reported HIV/AIDS cases were among the highest in Thailand in 1998
multi-sectoral assistance to people and communities affected by AIDS.

Study Communities

Two districts in Phayao:
“Mueng” and “Pong” were
chosen as the study location.
Mueng district represented a
community where there was
an active response to
HIV/AIDS (active villages),
and Pong district as a
community with a less
active response to
HIV/AIDS (less active
villages)

Community mapping to identify
case and control household

April-June 1999, 7000 households were contacted and asked about their
member’s health status, member’s illness, willing to be interviewed or not.
(Physical landscape, household location :ID)

Selection of comparison districts
and sub-districts
Phayao
Province

High prevalence of HIV/AIDS High prevalence of HIV/AIDS
(Active response to HIV/AIDS) (Less active response to HIV/AIDS)

9 sub-districts 9 sub-districts
(a broad range of HIV/AIDS support and care service) (some HIV/AIDS support and care service)

57 villages 60 villages
(3,488 households were contacted) (3,534 households were contacted)

selected household case and control selected household case and control
(inclusion/exclusion criterias) (inclusion/exclusion criterias)

150 case 150 control 150 case 150 control
random sampling random sampling random sampling random sampling

People Living with HIV/AIDS and Their Households:
Impact Mitigation: the Need for Strategic Action

Household level: AIDS, poverty and inequality

Conceptualising form of household impact - HIV/AIDS morbidity:
Production and labour ; Pattern of consumption; Income and expenditure;
Structure and composition; Children ; Elderly

social scientists, epidemiologists, nutritionists and agricultural economists, etc.

Conceptualising household coping
(1999-2000): Short term

Household coping mechanisms include :
• Adjustment of Household available resources, Borrowing, Transfer in/out,
Increase market activities
Community and relatives for household coping include :
• Community donate or lend food, material, money; e.g. District AIDS Fund,
Established community and home based care, Provision of child care,
Provision of labour, Community participation and perceived changes,
Transfer money in/out
Support from GO/NGO for household coping include :
• Child and elderly care, Counselling, Health services utilisation, Schooling
and nutrition program, Training to care providers, Job training, Group
therapy, meditation practice, Support group of PLHA, Self help group of
PLHA, Information support basic care for PLHA

Summary of main economic indicators from
the historical simulation
Indicators Control Case Percentage
change
Total income per capita 3923* 1218* -69
Total income of income 19978 3871* -81
earner (sick)
Total income of income 1919 3345 74
earner (non-sick)
Total Consumption per capita 3531* 1863* -47
Total savings per capita 392 -645 -265
Total loans per capital 339
Total debt per capita 1486
• * indicates that the figures are from the survey data, while others computed from the
simulation
• The modelling is based on a simple economics identitiy, Y=C+S

The modelling is based on a simple Keynesian income function focusing on
income consumption and saving

Summary of consumption indicators
from the historical simulation
Indicators Control Case % change
Total income per capita 3923* 1218* -69
Total consumption per capita 3531* 1863* -47
Total consumption food per capita 1052 594 -43
Total health care for non PLWHA per 237 49 -79
capita
Total health care for PLWHA per capita 939
Total schooling consumption per capita 529 239 -55
Total other consumption per capita 2016 937 -54

from the alternative simulation
Alternative Simulation
20% decrease in health care
Indicators % change % change
PLWHA (control- (historical-
case alternative
household) simulation)
Total consumption per capita 1835 -47 -1
Total other supports per capita 620 -8
Total money transfer in per 278 -8
capita
Total selling assets per capita 31 -8
Total loans per capita 311 -8
Total debt per capita 1340 -9
Total saving per capita -617 -257 -4
Before 2003, not much support on the UC program for PLWHA,
therefore household had to bear the cost

from the alternative simulation
Alternative Simulation
20% increase in health care
Indicators PLWHA % change % change
(control- (historical-
case alternative
household) simulation)
Total consumption per capita 1891 -46 1
Total other supports per capita 670 0.06
Total money transfer in per capita 303 0.06
Total selling assets per capita 34 0.06
Total loans per capita 339 0.06
Total debt per capita 1746 17
Total saving per capita -672 -271 4

If health care expenses were subsidised by government, then better off !!

Household coping: Follow up studies
• Action taken to minimise distress, provide follow up support
• Follow up studies: approved by renewal IRB (Mahidol
University): willing to participate in the studies
– 1999-2000: 600 households
324 cases from 300 case households (and 300 control households
enrolled- neighbourhood control non AIDS families )
– 2004: 501 households - linked with HH-ID
319 cases from 266 case households + 56 previous control
households (and 235 control households enrolled)
– 2006: 312 households - linked with HH-ID
285 cases from 121 case households + 81 previous control
households (and 191 control households enrolled)
– 2008: 278 households (303 cases) - people are moving out,
mobilisation or urban migration, etc.

Household impact and
coping mechanism (2004, 2006)
• Household and community level (treatment dynamics and
access to support + Universal access to ARTs in 2003,
both first and second line):
– social and economic impacts - disability grant, support group
– socioeconomic status/poverty impact of HIV/AIDS
– HIV/AIDS Orphans - missing generation
– nutrition status - food security, food production, food
supplements
– livelihoods - maintain household income/expenditure patterns,
alleviating labour shortage
– behaviour - effect of ARV
• Married persons significantly more likely to have commenced
treatment (p<0.001)
• More productivity, could earn more money

Scope of Accessibility (2004-2008)
• Medical services:
– VCT & Screening
– OI prophylaxis and treatment
– ARV therapy for appropriate patients
– Specific laboratory access (CD4,VL)
(Thira Woratanarat and Anupong Chitwarakorn, 2005)

• Psychological support: counseling networks and
psychotherapy services for infected people and
affected family/household
• Socio-economic services: co-operate among various
ministries, multisectoral collaboration for support
(those who need support)

Socio-economic determinants of
HIV/AIDS in Thailand

KONGSIN S (*), LERTCHAYANTEE S ($), JIAMTON S (#),
WATTS CH (@)

(*) Facultyof Public Health, Mahidol University, Thailand,
($) Phayao Provincial Health Office, Thailand,

(#) Department of Dermatology, Faculty of Medicine, Mahidol University,

Thailand,
(@) London School of Hygiene and Tropical Medicine,United Kingdom.

Table 1: Demographic characteristics of PLWHA
PLWHA Phayao p-value
Results Characteristic (n=324
cases)
age (mean) = 31.98, age<=31
[51.5%]
age >= 40 [%] 9.7 20.8 <0.0001
male sex [%] 46.3 57.6 <0.0001
no school education [%] 3.7 8.9 0.005
no or primary school education. 42.9 71.0 <0.0001
[%]
unemployed 3.2 1.6 <0.0001
[% of labourer, male]
agriculturer /labourer [% of 64.6 71.4 >0.05
employed]

• The age and sex distribution among PLWHA differs significantly from the general population in
the study location.
• The proportion of PLWHA aged 40 and above is 9.7 % among 324 PLWHA, compared to 20.8 %
in the general population. The respective proportions for male sex are 46.3% and 57.6%. The
percentage of PLWHA with no formal education is 3.7%, compared to 8.9% in the general
population. Including primary education, the respective proportions are 42.9% and 71%
respectively. Unemployment is higher among PLWHA (3.2 % vs. 1.6%).
• Among those who are employed, the proportion of farmers and labourers is slightly lower than in
the general population (64.6% vs. 71.4%) but this is not statistically significant. Significance levels
for the statistical tests and results are shown in Table 1.

Socio-economic indicators
PLWHA Phayao p -value
Indicator (n=300 households)
household income 85,740 82,278 0.0084
household members 3.8 4.1 0.0095
per capita income 23,889 20,052 0.0059
household expenditure 4,157 4,435 >0.05
per capita food 679 685 >0.05
poverty [%] 23.4 17.5 <0.001

(Thai Baht: THB)

• Average household incomes (THB 85,740 vs. THB 82,278) and per capita incomes
(THB 23,889 vs. THB 20,052) are significantly higher among PLWHA than in the
general population in Phayao.
• A small but significant difference exists for the average number of household
members (3.8 vs. 4.1).
• The proportion of persons with household per capita incomes below the poverty line
is significantly higher in the patient group (23.4% vs. 17.5%).
•Significance levels for the statistical tests and results are shown in above table

Household assets
PLWHA Phayao
Possession of household (n=300 households)
assets
[% of households]
car 13.4 12.4
truck 6.7 7.3
motorcycle 59.7 47.5
stove 61.2 61.5
refrigerator 54.8 49.2
rice cooker 71.4 69.1
radio 71.7 70.8
Television 81.3 80.3

• Household assets are presented at similar proportions in households of PLWHA and
the general population.
• This observation is made for both "luxury" (e.g., car, television) and "regular"
household assets (e.g., rice cooker, stove).
• All items (motorcycle, refrigerator) were found slightly more frequently in PLWHAs'
households than in the general population

Age distribution of socio-economic indicators
Age - age distribution socio-economic indicators by age-group poverty distribution [% of total]
group [% of total]
primary percapita per capita poverty prevalence
educatio income expendit- [%]
n [%] [Baht] ure [Baht]
Phayao PLWHA all male female crude age adjusted Phayao
data
20-25 18.8 12.3 66.9 34,056 17,292 12.6 14.5 9.4 4.0 21.2 7.5
26-30 21.4 32.5 72.9 36,518 17,940 15.4 16.7 11.1 11.1 24.9 24.6
31-35 20.4 27.4 90.3 28,265 16,620 18.0 16.5 22.4 15.8 19.1 24.0
36-40 18.6 19.4 93.0 26,971 11,964 17.8 11.4 30.6 14.3 12.1 18.5
>40 20.8 8.2 95.5 21,702 11,676 35.0 30.3 42.8 54.8 22.8 25.1
Total for age / sex 73.7% 30,502 16,098 18.9 Total 100 100 100
adjusted data

Phayao 75.87 21,618 15,215 16.3

To assess whether the high prevalence of poverty among PLHA (age>40) is different from that observed in
the general population, we analysed the age distribution of PLHA with incomes below the poverty line. Fifty
five percent of all poor PLHA are 40 years or older in the crude data set. This proportion decreases
substantially to 22.8% if the data are age- and sex adjusted. In the general population, 25.1% of all poverty
occurs among people older than forty, indicating that the prevalence of poverty in this age group is similar in
both PLHA group and general population.
Incomes and expenditures, educational achievements, as well as the prevalence of poverty among PLHA
are dependent on age and sex. The lowest levels of education, lowest income, and highest prevalence of
poverty occurs in PLHA of age 40 or older (30.3% for male, 42.8% for female). Except for the age group
20-30, poverty occurs more frequently among male than female.

• Age- and sex standardisation of patient data results in a decrease of the average poverty level
from 23.4% to 17.9% (vs. 17.5% in the general population). Standardised data also show
slightly higher per capita expenditures in the PLWHA (THB 16,098 p.a. vs. THB 15,215 p.a.),
while the relation is the reverse for unadjusted data (Table 3). Standardisation substantially
decreases the proportion of PLWHA with no or primary education (from 42.9% to 73.7%, vs.
75.9% in the general population).

• From our study, we are unable to determine whether our finding is based on more recent
developments or represents a chronic disease distribution within the Thai population. The age-
group 20-39 years, which is strongly affected by the HIV epidemic in study population, is also
the age group that has the highest average income among PLWHA households (Table 2). This
observation may indicate a spread to more specific groups under the impact of the HIV
epidemic.

• While the prevalence of poverty in PLWHA (age>40) is very high, this finding is again a
reflection of the situation in the general population of the study location (Table 5). We can
therefore not identify poverty as a risk factor to explain the higher incidence HIV/AIDS among
this group in our sample.

• It should be noted that our results could not be interpreted as a refutation of claims about the
importance of socio-economic factors for susceptibility to HIV/AIDS. It is possible that most of
or all of the unreported cases have low incomes that higher deter them from attending
government services. In addition, treatment services in Thailand are still centralised at district
hospitals, so that travel expenses are required for many PLWHA to visit these hospitals.
Although these expenses are considered to be "minimal", people with incomes below poverty
line may nevertheless be unaffordable for most cases whose expenditure is most likely to be
stressed directly on their basic necessities like food consumption (Table 3).

Household impact and
coping mechanism (2006, 2008)
• Impact Mitigation: Community strengthening to support
long term and continuous care
– environmental and institutional factors: Physical/geographical
– increase investment from local authority in impact
mitigation
– community coping responses: traditional grassroots or indigenous
organisations, formal community-based organisations (external
support from NGOs or other agencies)
– migration and complex emergencies - drug resistance
– health services and policy (including access to health care, quality
of care, and health sector reform)
– development policy- Healthy Public Policies, Social Safety Net

The HIV/AIDS Continuum of Care
Primary Health
Community coping responses Care

Secondary -Health posts
Health -Dispensaries
Care District -Traditional
Hospitals -Orphan care
HIV Clinics
Social/legal
Support Community Care
Hospice
Voluntary NGOs
Churches
Counseling Youth Groups
Testing Volunteers

Specialists Palliative
and Specialised PLHA emotional and
Care facilities spiritual support
The entry self care
point Peer support
Tertiary Health
Care Home care
Thira Woratanarat and Anupong Chitwarakorn, 2005

Mainstream HIV/AIDS to
Impact Mitigation

Policy Nexus: What evidence is needed to help policy-makers
make informed decisions? What challenges do policy-makers
face in using research on economic impacts of HIV/AIDS to
inform their policymaking process? What policies is this
impact mitigation
best able to inform?

Initiative mainstream HIV/AIDS to
impact mitigation
• nourishing families
• incentives for the vulnerable to re-invest in productive
farming
• food security, nutrition, gender, methods, targeting, M&E
and impact assessments
• nutritive value - genetic/ post-harvest fortification, for
example, aflatoxin reduction
• scaling out improved varieties with market traits, and
• strengthen partnerships.

Potential focus areas for strategic mainstreaming
at the household level in impact mitigation

• Strengthen partnerships: partnership between the
communities, governments, donor agencies, international
NGOs, local NGOs, private sector and others in mitigating
the impacts of HIV/AIDS.
• The relationship between households and social networks:
including both how these networks affects the impact of
and responses to the epidemic and how they, in turn, are
affected.
• Greater focus on the informal economy and possible
support mechanisms: looking at the links between
HIV/AIDS and households' ability to generate income, etc.

Estimated number of new HIV infections, projected
by utilising Asian Epidemic Model

Year MSM, Sex Spousal Casual and Total
workers and transmission extramarital sex
clients, IDU
2012 5,608 3,231 634 9,473
2013 5,461 2,920 579 8,959
2014 5,331 2,674 530 8,535
2015 5,221 2,475 488 8,184
2016 5,126 2,313 450 7,890
2012-2016 26,746 12,613 2,681 43,040
% of total 62% 32% 6% 100%
new HIV
infections
31

Coverage of PLHIV in need for ART, Thailand
2004-2009

ART Need Current Receiving

300,000 75.8 %
67.1 %
250,000
56.4 %
51.5 %
200,000
42.5 %
2,983,773,000 Baht
150,000 32.5 %
4,382,400,000 Baht
100,000
3,855,600,000 Baht

50,000

0
2547 2548 2549 2550 2551 2552
(2004)
Source: UNGASS 2010 Report

National AIDS Spending Assessment
Cost categories 2008 2009

Mil. Baht % Mil. Baht %

1. Prevention 1,500 21.7 987 13.7

2. Care and treatment 4,560 65.8 5,483 76.1

3. Assistance for children affected by AIDS 50 0.7 52 0.7

4. Management and strengthening 397 5.7 250 3.5
planning
5. Compensation for staff 44 0.6 208 2.9

6. Rights protection and social service 219 3.2 171 2.4

7. Improving environment and community 2 0.0 8 0.1
development
8. Research 156 2.3 49 0.7

Total 6,928 100.0 7,208 100.0

Domestic source (%) 85 % 93%

Remarks
# 6 : care for children is not included
# 8: operational research is not included

Possible key questions are:
• How do the social networks that exist affect vulnerability to
HIV/AIDS (specific emphasis on economic vulnerability/ poverty)?
• How do social networks mitigate impact and affect responses to the
pandemic?
• How does HIV/AIDS at an individual/household level impact on social
networks (e.g. issues of extended family support; foster parents; social
support mechanisms, effects on types of income sources and
migration)?
• On the basis of a greater understanding of social networks, how can
one (re)define an 'affected household' to try to achieve a more accurate
assessment of impact?

Overarching issues
• Quality and representativeness of data
• Produce information appropriate for policy
development (not “policy evidence base”)
• Extend focus beyond the rural economy
• Interdisciplinary, multidisciplinary approach
• Methodological innovation (nature of attrition bias,
statistical power, econometrics: two-step model,
results may be specific to context/setting)
• Be prepared for the unexpected
• Better dissemination of information

Thailand Getting to Zero
National Strategy on HIV/AIDS 2012 - 2016

Vision and Goals
Vision: To get to Zero New HIV Infections
Goal for 2016:
• New HIV infections reduced by two-thirds
• Rate of vertical transmission of HIV less than 1%

Vision: To get to Zero AIDS-related Vision: To get to Zero
Deaths Discrimination
Goal for 2016: Goal for 2016:
• Equal access to quality treatment, • All laws and policies which block
care and support for all people living effective responses removed
with HIV in Thailand • Reported violence related to
• People living with HIV and gender reduced by ..
households affected by HIV are • Reported incidents related to
addressed in social protection stigma and discriminations
strategies and have equal access to reduced by 50%
quality care and support
•TB/HIV deaths reduced by 50%

Zero
discrimination
Access to Access to
prevention treatment

Treatment as
Zero prevention Zero
AIDS-related
new HIV infection
deaths

38
Enough resources
for all PLHIV

Acknowledgements
My household respondents
Tony Barnett and Alan Whiteside Charlotte Watts
Sukhum Jiamton Anne Mills
Viroj Tangcharoensathien Yot Teerawattananon
Petchsri Sirinirund Swarup Sarker
Anita Albun Kanchit Limpakarnchanarat
Martha Ainsworth Wiwat Rojanapithayakorn
Mead Over Wichai Choakwiwat
Germano Mwabu Professsor Pirom kamolrattanakul
Wiput Phoolchareon Pasakorn Akarasewi
Suwit Wibulpolprasert Caitlin Wiesen

HIV Situation and National
AIDS Strategy Thailand

Thailand
IBBS 2010: Integrated Bio-
Number of people living Behavioural Surveillance
with HIV:
HIV prevalence:
Low 418,070 / average FSW 2.7% MSW 16.3%
532,461 / high 662,143 MSM 10.1% IDU 26.0%
HIV prevalence: Condom use:
Low 0.78 / average 1.30 / FSW 97.9% MSW 77.5%
high 1.6 MSM 64.7% IDU 49.0%
HIV incidence: 0.03 / 0.04 Use sterile injecting equipment 75.8%
Total population: 68.1 mil HIV testing in last 12 months:
FSW 56.3% MSW 42.0% MSM 27.9%

Reported AIDS cases and Deaths from AIDS
1984-2010, Thailand

Source: Bureau of Epidemiology

Sentinel sero-surveillance among most-at-risk
population groups Thailand, 1989 - 2007
HIV Prevalence (%)
N=97
N=183
N=73

N=128
N=97
N=474

N=48

Surveillance round
Remarks : 1. 2 surveillance rounds during 1989 – 1994 (Rnd 1-12)
2. In 1995 (Rnd13) all CSW included in Indirect CSW
Source: Bureau of Epidemiology, MOPH, Thailand

Estimated number of new HIV infections, projected by
utilising Asian Epidemic Model

Year MSM, Sex Spousal Casual and Total
workers and transmission extramarital sex
clients, IDU
2012 5,608 3,231 634 9,473
2013 5,461 2,920 579 8,959
2014 5,331 2,674 530 8,535
2015 5,221 2,475 488 8,184
2016 5,126 2,313 450 7,890
2012-2016 26,746 12,613 2,681 43,040
% of total 62% 32% 6% 100%
new HIV
infections
45

Coverage of PLHIV in need for ART, Thailand

ART Need Current Receiving

300,000 75.8 %
67.1 %
250,000
56.4 %
51.5 %
200,000
42.5 %
2,983,773,000 Baht
150,000 32.5 %
4,382,400,000 Baht
100,000
3,855,600,000 Baht

50,000

0
2547 2548 2549 2550 2551 2552
Source: UNGASS 2010 Report

National AIDS
Committee

National AIDS
Management Center

Subcommittee for Subcommittee Subcommittee Subcommittee
plan / budget and to advance for AIDS for vaccine trials
implementation HIV Rights
coordination prevention protection and
Promotion

Provincial AIDS Provincial AIDS
Committee Action Center

Zero
discrimination
Access to Access to
prevention treatment

Treatment as
Zero prevention Zero
AIDS-related
new HIV infection
deaths

51
Enough resources
for all PLHIV

2 Strategic Directions
Innovation and Change
• New HIV infections reduced by
• Expand rights based and gender sensitive
two-thirds
comprehensive prevention services for
• Rate of vertical transmission of HIV
population/risk behavior with high number of HIV
less than 1%
transmission
• Change laws and policies which hinder access to •Equal access to quality treatment,
prevention and care services care and support for all people living
• Increase shared responsibility: local ownership with HIV in Thailand
and funding to an expanded response to HIV • People living with HIV and
households affected by HIV are
• Develop a new generation of strategic addressed in social protection
information to inform and guide the national strategies and have equal access to
response at all levels quality care and support
Maintain, Optimize and Consolidate • TB/HIV deaths reduced by 50%

• Treatment, Care and Support • All laws and policies which block
• PMTCT effective responses removed
• Reported violence related to
• Prevention among Young People gender reduced by ..
• Mass communication • Reported incidents related to
stigma and discriminations reduced
• Comprehensive condom program by 90%
• Stigma and Discrimination
• Blood Safety and Universal Precautions

Innovation and Change

Maintain, Optimize and Consolidate

Core Themes
• People centered : Empowering people and community
• Working paradigm: HIV is not only a disease but is about life
• Rights respect Rights based prevention and care services
• Focus: Increased focus, efficiency and mutual accountability
• Leadership and locally owned sustainable responses
• Partnership:
Synergies maximized sand efficiencies achieved with GO, CSO and private sectors

Getting to Zero New HIV Infections
Focus where most new infections occur...
Population Groups: Geographic Focus:
(Mode of Transmission)
100%
6% Casual and
90% Extramarital sex
80%
32% Spousal
transmission
70% 41%
60% Injection Drug
10%
94% of User
50%
new 11% 70% of new HIV
infections Sex worker and
40%
clients infections happen in
30%
Male who had sex
27 provinces
41%
20% with male

10%

0%
2012-2016

Plhiv & their household impact mitigation by Sukhonta Kongsin

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