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UNAIDS - Joint United Nations Programme on HIV/AIDS
HIV and Health-Care Reform in Phayao: From Crisis to Opportunity
UNAIDS Best Practice Collection Case Study
Description of Work
UNAIDS - Joint United Nations Programme on HIV/AIDS, Geneva, April 2000, 107 pp

Reproduced with the kind permisison of UNAIDS.


" What is the secret behind the observed progress on HIV/AIDS in Northern Thailand? While at first, HIV/AIDS hit people in Phayao Province (population 500,000) very severely, they have responded in remarkable fashion. HIV seroprevalence among pregnant women decreased from 11 per cent in 1992, to 4.9 per cent in 1997. Among military conscripts, HIV seroprevalence decreased from 20 per cent in 1992 to around five to seven per cent in 1997. In 1997, 66 per cent of male workers declared consistent condom use with commercial sex workers. Use of commercial sex services seems to have decreased, as shown by the decrease of the number of direct and indirect commercial sex establishments, and by parallel decreases in the total number of commercial sex workers. Communities are adapting their culture to the presence of HIV/AIDS. People with HIV/AIDS recognize that the quality of their lives has improved. Governmental and nongovernmental agencies have been very active: in 1996, Phayao Province allocated two US$ per capita to 75 projects in response to HIV/AIDS. In 1994, it set up the Phayao AIDS Action Centre (PAAC) to help implement a multisectoral response. What main lesson did Phayao Province learn over the past ten years? The outcome of the battle against AIDS is decided within the community. People, not institutions, ultimately decide whether to adapt their sexual, economic and social behaviour to the advent of AIDS. Governmental and nongovernmental organizations can only influence, either constraining or facilitating, people’s responses to HIV and AIDS. Hence, their single most important role is to strengthen the capacity of people to assess how AIDS affects their lives, to act if needed, and to learn from their actions. Supporting communities in such a process represents a major challenge to institutions involved. The PAAC considers that the following institutional factors may have contributed to progress over the past ten years: 1) the combination of short-term action to reduce risk and longer term action to reduce vulnerability, 2) the establishment of partnerships across sectors whereby planning, decision making and resources are shared, 3) the continuous adaptation of strategy as the province was learning how to deal with AIDS, and 4) a human development strategy emphasising not only technical skills but client-oriented attitudes as well."

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