Publication: Scaling up HIV Treatment for MSM in Bangkok: What Does It Take? – A Modelling and Costing Study
Loading...
Published
2015-05-01
ISSN
Date
2015-06-25
Editor(s)
Abstract
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.
Link to Data Set
Citation
“Zhang, Lei; Phanuphak, Nittaya; Henderson, Klara; Nonenoy, Siriporn; Srikaew, Sasiwan; Shattock, Andrew J.; Kerr, Cliff C.; Omune, Brenda; van Griensven, Frits; Osornprasop, Sutayut; Oelrichs, Robert; Ananworanich, Jintanat; Wilson, David P.. 2015. Scaling up HIV Treatment for MSM in Bangkok: What Does It Take? – A Modelling and Costing Study. © World Bank. http://hdl.handle.net/10986/22066 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication West Africa HIV/AIDS Epidemiology and Response Synthesis : Implications for Prevention(Washington, DC, 2008-11)This synthesis paper describes the HIV epidemics in 15 West African countries - Benin, Burkina Faso, Cote d'Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone. It focuses particularly on the degree to which the epidemics in each country are concentrated or generalized, and the implications for effective prevention. The urgent need for rigorous analytic work to equip countries with a sound, situation-specific analytical base for action motivated this study. The analysis team critically reviewed and interpreted all available surveillance, survey and research data (the amount and quality of which varied considerably by country). For the first ten countries listed, short country visits enabled interviews and more thorough search for data and other information, and the programmatic response to the HIV/AIDS epidemic was also assessed to develop recommendations for improving resource allocation and program effectiveness.Publication The Global HIV Epidemics among Men Who Have Sex with Men(World Bank, 2011-05-27)Men who have sex with Men (MSM) are currently at marked risk for HIV infection in Low- and Middle-Income Countries (LMICs) in Asia, Africa, Latin America and the Caribbean, and in Eastern Europe and Central Asia. Estimates of HIV prevalence rates have been consistently higher among MSM than for the general population of reproductive-age men virtually wherever MSM have been well studied. Although scarce, HIV incidence data support findings of high acquisition and transmission risks among MSM in multiple contexts, cultural settings, and economic levels. Research among MSM in LMICs has been limited by the criminalization and social stigmatization of these behaviors, the safety considerations for study participants, the hidden nature of these populations, and a lack of targeted funding. Available evidence from these countries suggests that structural risks social, economic, political, or legal factors in addition to individual-level risk factors are likely to play important roles in shaping HIV risks and treatment and care options for these men. Services and resources for populations of MSM remain markedly low in many settings. They have limited coverage and access to HIV/AIDS prevention, treatment, and care services with some estimates suggesting that fewer than one in ten MSM worldwide have access to the most basic package of preventive interventions.Publication HIV in the Caribbean : A Systematic Data Review, 2003-2008(Washington, DC, 2008)This report is the result of a comprehensive, regional, data-driven review of the HIV epidemic in the Caribbean. Several reports have been published about the Caribbean but none have specifically focused on a thorough review of data sources, data collection strategies and detailed epidemiology of the HIV epidemic. In the past, the Caribbean epidemic has largely been characterized as a generalized, heterosexual epidemic on the verge of explosion. The purpose of an HIV epidemiological synthesis is to assess and analyze new or recent data to provide strategic direction for the program development and implementation. New data sources include any unpublished, unexplored or unanalyzed data, the latest surveillance data, as well as, biological and behavioral surveys, STI data, program monitoring data and quantitative or qualitative research data. The synthesis also tests and explores an existing hypothesis about the epidemic and discusses relevant data-based policy implications. For the Caribbean synthesis, aimed to: 1) analyze HIV transmission patterns; 2) determine epidemiological and behavioral drivers in the Caribbean; and 3) analyze the national and regional responses relative to findings from the analysis.Publication AIDS in South Asia : Understanding and Responding to a Heterogeneous Epidemic(Washington, DC: World Bank, 2006)South Asia's HIV epidemic is highly heterogeneous. As a result, informed, prioritized, and effective responses necessitate an understanding of the epidemic diversity between and within countries. Further spread of HIV in South Asia is preventable. The future size of South Asia's epidemic will depend on an effective two-pronged approach: firstly, on the scope and effectiveness of HIV prevention programs for sex workers and their clients, injecting drug users and their sexual partners, and men having sex with men and their other sexual partners; and secondly, on the effectiveness of efforts to address the underlying socio-economic determinants of the epidemic, and to reduce stigma and discrimination towards people engaging in high risk behaviors, often marginalized in society, as well as people living with HIV and AIDS.Publication Risky Business?(World Bank, Washington, DC, 2010-11)This study focuses on, what is believed to be, a key client group of sex workers: mobile workers. While several studies have been conducted in Turkey on sex workers, little evidence exists on their clients, the demand side of the commercial sex market. Research from other countries has shown that mobile workers, who are often working-age males spending significant time away from home, are more likely to have multiple sexual partners and visit sex workers (World Bank, 2009; Kulis et al., 2009; Marck, 1999). The objective of this study is to determine the HIV knowledge, awareness, and behaviors among four mobile worker groups in Turkey that may have elevated risks for HIV infection and transmission: sailors, truck drivers, construction, and tourism workers. International transportation, construction, and tourism are some of the fastest growing sectors of Turkey's economy, and mobile workers in these sectors are believed to be one of the main HIV transmission routes for future infections (Tumer and Unal, 2006). It is important to note two caveats of this study. First, no biomarker data (e.g., HIV testing) was collected from these workers, so conclusions regarding HIV prevalence or concentration of the epidemic cannot be made. Second, the sample did not include other at-risk groups or the general population, so it is difficult to know whether the behaviors are more or less risky in other population groups. Where possible, comparisons with other studies or countries are presented, but there are likely important differences in sampling and methodology. The major contribution of this study, however, is that it characterizes the risk factors within the mobile worker population in Turkey.
Users also downloaded
Showing related downloaded files
Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication The Journey Ahead(Washington, DC: World Bank, 2024-10-31)The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECA’s demographic and socioeconomic disparities. Yet, migration’s full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migration— forced displacement as well as high-skilled and low-skilled economic migration—and from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.Publication Morocco Economic Update, Winter 2025(Washington, DC: World Bank, 2025-04-03)Despite the drought causing a modest deceleration of overall GDP growth to 3.2 percent, the Moroccan economy has exhibited some encouraging trends in 2024. Non-agricultural growth has accelerated to an estimated 3.8 percent, driven by a revitalized industrial sector and a rebound in gross capital formation. Inflation has dropped below 1 percent, allowing Bank al-Maghrib to begin easing its monetary policy. While rural labor markets remain depressed, the economy has added close to 162,000 jobs in urban areas. Morocco’s external position remains strong overall, with a moderate current account deficit largely financed by growing foreign direct investment inflows, underpinned by solid investor confidence indicators. Despite significant spending pressures, the debt-to-GDP ratio is slowly declining.Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.