Expanding community through ARV provision in Thailand

Abstract

Anti-retrovirals (ARVs) have altered the complexion of HIV/AIDS management in Thailand. In 2005, ARVs were included within a subsidised health scheme making provision widespread. Increased access has been brought about through the legal and political advocacy of the Thai Network for People Living with HIV/AIDS (TNP+) who now play a central role in expanded ARV provision. HIV-infected volunteers help the state deliver comprehensive services and assist with follow-up and adherence programs. Alongside improvements in drug provision, a focus on pharmaceutical treatment has left other issues, such as community support of orphans and the social responses to living with HIV, less central within community responses. As they take on new responsibilities, people living with HIV/AIDS (PLHA) groups move from activities focused on reversing local stigma to constitute a new social movement that is increasingly prominent in Thai civil society. Networks of PLHA confront new social and political challenges as they also seek to broaden access to marginalised groups who remain excluded from these services. Many ethnic minority groups without full Thai citizenship have been denied access to subsidised health services including ARVs. As part of a broadening advocacy profile, the PLHA movement is now engaging in a politics of difference defined not simply by presence or absence of HIV but also by wider issues of national identity and belonging.

Acknowledgments

Research on which this paper is based was carried out under the United Nations Research Institute for Social Development (UNRISD)/Training and Research Support Centre project on Community Responses to HIV and AIDS, with the financial support of the United Nations Foundation. We are enormously grateful to many people who helped us with this research. First and foremost, HIV infected members of PLHA groups took the time to explain issues that affected their lives and work. We were helped tremendously by their generosity, patience and insights. Staff members of NGO and government organizations also devoted time and energy to assisting us gather data and understand the large range of projects and factors governing their success. Our gratitude goes to A-fang, A-yii and Khun Or who helped us gather data and converse with highland villagers. Our thanks to the Social Research Institute, Chiang Mai University and Macquarie University for facilitating this research and to Rene Loewenson (TARSC) for providing editorial support. We, the authors, are of course responsible for any errors in this document.