Scaling up HIV Treatment for MSM in Bangkok : What Does It Take? – A Modelling and Costing Study
The HIV epidemic amongst men who have sex with men (MSM) in Bangkok is substantial. The population size of MSM in Bangkok is 120,000-250,000, with approximately one-third (33.5 percent) considered high-risk, characterized by their young age, multip...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2015
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2015/05/24497789/scaling-up-hiv-treatment-msm-bangkok-take-modelling-costing-study http://hdl.handle.net/10986/22066 |
| Summary: | The HIV epidemic amongst men who have
sex with men (MSM) in Bangkok is substantial. The population
size of MSM in Bangkok is 120,000-250,000, with
approximately one-third (33.5 percent) considered high-risk,
characterized by their young age, multiple partnerships,
frequent unprotected anal intercourse, and sexual activities
around MSM hotspots. In metropolitan Bangkok, HIV prevalence
among MSM reportedly increased from 21 percent to 28 percent
between 2000 and 2012. The Thai Working Group of Estimation
and Projection (2013) projected an estimate of 39,000 new
HIV infections would occur in Thailand during 2012-2016,
based on the AIDS Epidemic Model (AEM). MSM will account for
44 percent of these new HIV cases, and 25-30 percent of
these infections will likely to occur in Bangkok. In 2011,
the United Nations held a high-level meeting on HIV/AIDS
where they adopted the ambitious epidemiological targets of
the United Nations Political Declaration on HIV/AIDS (UNPD),
to be met by 2015. Attaining these specific targets would
lead to substantial progress towards ending AIDS. UNAIDS has
also been prioritizing the “Getting to Zero” initiative
(“Zero new HIV infections. Zero AIDS-related deaths. Zero
discrimination.”). The Bangkok Metropolitan Administration
(BMA) recently responded with the “Bangkok: Getting to Zero”
initiative, which strategizes an increased focus on
prevention amongst MSM in the city. The clinical trial,
HPTN052, demonstrated a 96 percent reduction of HIV
transmission among heterosexual discordant couples who
received ART. “Treatment as prevention” has become an
increasingly accepted strategy to prevent new infections. A
cost-effectiveness analysis comparing current levels of
investment in targeted HIV prevention interventions for MSM
in Bangkok (including treatment), with scenarios of
increased coverage, would provide evidence to shape
efficient national and metropolitan strategies. A
return-on-investment analysis would provide an economic
rationale to finance this strategy in allocating sufficient
resources to address the epidemic at the most appropriate
scale. Demonstration by the study that a significant
reduction in transmission (including potential elimination)
are both feasible and cost effective, may galvanize global
political support. |
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