Thailand's HIV response can provide important learning for other Southeast Asian countries, with the experience of having already reached 90-90-97 in the treatment cascade in 2022, on the way to the achieving the "triple 95s". The country was first in the region to eliminate mother-to-child HIV transmission. AIDS-related deaths have declined by 65% since 2010. With support from Australia's Department of Foreign Affairs and Trade (DFAT), UNAIDS helped organise for Thailand to share lessons it has learned in its HIV response with Indonesia through a south-to-south learning exchange mission of Indonesian delegates to Thailand.
On day one, the Indonesian Ministry of Health and Thai Ministry of Public Health delegates discussed the HIV epidemic, trends, and challenges in each country. They shared insights on HIV prevention, treatment and stigma reduction in the HIV response. The following day, the mission team visited community organisations- including the Service Worker in Group Foundation (SWING), a non-governmental organization working for sex worker rights, and the Rainbow Sky Association of Thailand (RSAT), an organization that offers sexual healthcare for men who have sex with men, migrants, people who use drugs, sex workers and transgender people.
Multidisciplinary care is provided in Thailand to people living with HIV and to key populations through community service providers, incorporating certified community counsellors, medical technicians and caseworkers at the community facilities, and through doctors, nurses, pharmacists and laboratory scientists through the telehealth system.
Indonesia's delegates on the visit highlighted that they had found helpful areas to improve community engagement in their national HIV programme, with a focus on effectively addressing the barriers and limitations in the HIV response that are interlaced with stigma and discrimination across Indonesia.
"We learned how Thailand prioritised zero discrimination, one of which is developing an e-learning curriculum for healthcare workers to minimise stigma and discrimination in healthcare facilities," said Dr Endang Lukitosari, who heads the National AIDS Programme of Indonesia's Ministry of Health.
Thailand's delegates shared experiences from their community complaint support and crisis response system. Health workers, communities and clients can use QR codes at various locations to report rights violations, promoting accountability and coordination between health facilities and community organisations.
The Ministry of Public Health of Thailand noted that community workers are actively involved in the HIV response throughout a robust system of accreditation for both individual community health workers and community organisations. There are health insurance options for all users, including three that can be accessed by migrants. These initiatives help create an enabling environment, led by the government, to connect communities with marginalised groups and tackle issues such as loss to follow-up.
Indonesia's delegates noted the significance of community mobilisation in the HIV response and envisaged that by putting community in the centre they would reach the most marginalised and underserved groups across different islands and highlands in Indonesia.
"Thailand's comprehensive service delivery inspired me, especially through the Ministry of Public Health's accreditation and certification system for communities. This cooperative mechanism across the government and community stakeholders is the one we haven't sufficiently addressed in Indonesia. Perhaps by applying this approach, we can minimise the gaps in the treatment cascade by ensuring we leave no one behind", said Irfani from GWL-INA, Indonesia's network of men who have sex with men and transgender people.
Over the five days, Indonesian delegates explored public HIV service centres and treatment facilities in Bangkok, Thailand and learned about how efforts of communities and government in HIV prevention and control could be streamlined and coordinated by enhancing the continuum of care and minimising loss to follow up. Notably, Thailand emphasised integrated, One-Stop, services as pivotal for a successful HIV response. Indonesia's delegates sought a pathway for sustainability in the HIV programme through lessons from the continuity of HIV treatment services in Bangkok, which connects clients with community clinics and public health facilities through referral system and telehealth.
Delegates agreed that this learning mission highlighted key features in efforts to reduce stigma and discrimination, mobilise communities in HIV response, and improve access to quality healthcare by tackling barriers. In addition, the mission underscored efforts to support the delivery of client-centred services for key populations. The debriefing concluded with a commitment to continue the technical partnership on HIV between the two countries.
"I believe Indonesia can do it," said Krittayawan Boonto, UNAIDS Country Director of Indonesia. "Indonesia is in a similar situation to the one Thailand faced a few years ago. Thailand's strategies contributed to getting closer to their goals. I see potential in Indonesia to accelerate progress towards triple 95s. I hope these learnings from Thailand mission can advance the HIV response in Indonesia. UNAIDS Indonesia will keep supporting efforts to end AIDS by 2030."