Ending AIDS and TB, Restoration of Hope for the Vulnerable Population
“It is because I am Myanmar, a migrant and a doctor.” This short statement tells us about the inspiration of Doctor Nyan, who has dedicated the past 18 years to serving his fellow migrant communities in Thailand with World Vision Thailand. Today, he is the Migrant Populations Program Manager, Principal Recipient of Global Fund, overseeing the Stop TB and AIDS through RRTTPR Project, funded by the Global Fund.
Having started his career in TB elimination 18 years ago, Doctor Nyan is now considered a key figure in driving efforts to end both AIDS and TB. He had also been serving as one of the 15 members of Civil Society Task Force on TB constituted by global TB program of World Health Organization between 2019-2023. Now, he is a core member of WHO PPM working group and still serving active member of children and adolescent TB working group led by Global TB program.
Communicable diseases are more prevalent among vulnerable groups
“I arrived in Thailand 18 years ago. Back then, the migrant communities were in a much more vulnerable state. They had no access to any kind of welfare or healthcare. HIV prevalence was particularly high among migrant workers, especially in the southern region, and there were no NGOs working on these issues in the area at that time. I started working with World Vision Thailand on TB issues for migrant populations since then. Later, I expanded my work to HIV, starting with providing knowledge for behavior change and counseling, which were considered the best form of ‘treatment’ back then as there were no antiretroviral drugs available. Although behaviour change takes time, I have witnessed significant improvements over the years.”
Doctor Nyan shared another reason for his dedication to this field. “I have a background in medicine and public health. I am particularly interested in communicable diseases because they are deeply intertwined with social issues such as education, poverty, and social welfare. These diseases disproportionately affect vulnerable populations. Unlike non-communicable diseases, which can be managed through individual behavioural changes, communicable diseases require proper treatment and prevention, which often require government intervention. Vulnerable groups often face barriers in accessing these services.”
RRTTPR for sustainable TB and AIDS elimination
“AIDS and tuberculosis often go hand in hand. HIV is frequently followed by tuberculosis. Communicable diseases do not discriminate based on nationality. While I believe what I am doing now can save lives, it is only a part of ending the epidemic. It is not a sustainable solution. Strong policies and enforcement are the foundation for a sustainable end to HIV in Thailand. Looking at global migration, we see differences in policies, law enforcement, and practices, all affecting sustainability. For me, knowing but not acting is the same as not knowing at all, because there is no action to create change.”
Under the implementation of the project to end TB and AIDS, driven by World Vision Thailand, supported by the Global Fund, the key principle of RRTTPR is being adhered to: Reach, Recruit, Test, Treatment, Prevention, and Retain, to achieve the Sustainable Development Goals 3.3; the target is to reach zero deaths due to AIDS-related reasons by 2030. Doctor Nyan highlighted the key focus areas to drive the work towards sustainability:
“The Stop TB and AIDS project encompasses both prevention and treatment of HIV-infected individuals through the use of ARV medications. The project closely monitors patients’ adherence to ARV treatment to achieve an undetectable viral load, rendering them untransmittable. For high-risk populations, pre-exposure prophylaxis (PrEP) is emphasised. In the coming year, the project will expand its focus on treatment by establishing public private partnership to create a network of healthcare facilities for project patients. This will not only enhance access to healthcare for migrant populations but also foster collaboration with various agencies to achieve the sustainable goal of ending TB and AIDS.”
U=U concept: “Undetectable” means “Untransmittable”
Parallel to providing support for vulnerable groups and migrant populations to access services and treatment, awareness-raising to reduce stigma and discrimination against people living with HIV and AIDS are crucial for the sustainable end of AIDS and TB.
“Thailand’s goal is to reduce new HIV infections to fewer than 1,000 per year by 2030. However, the current rate remains as high as 9,000 new infections annually, posing a significant challenge. The ‘Undetectable=Untransmittable’ (U=U concept), which emphasises that people with undetectable viral loads cannot transmit HIV, is a crucial strategy in controlling the HIV epidemic in Thailand. Beyond changing the perceptions of people living with HIV and their quality of life, ‘U=U’ aims to foster societal understanding and eliminate stigma and discrimination. The concept of ‘Zero Discrimination’ is another Sustainable Development Goal that the project is actively pursuing alongside the effective implementation of the RRTTPR approach.”
Restoration of hope and enabling people living with HIV to return to their normal lives
Dr. Nyan shared his pride in what he does: “Saving lives is my greatest honour. Before, access to antiretroviral (ARV) medications for migrant populations was minimal. Thanks to various projects undertaken by World Vision Thailand and in collaboration with partners, over 90% of migrant populations now have access to ARVs. Without ARVs, infected individuals chance of living a full and healthy life would not be possible. I still vividly remember a case of a Myanmar woman who had been bedridden for a month due to HIV and TB. Through our project, she received assistance, and within three months, she recovered and could leave her bed. Continuous treatment led to undetectable HIV and TB, allowing her to resume a normal life. Today, she has served as a migrant health volunteer (MHV) for World Vision Thailand for approximately two years before starting a family.”
Sustainability is the ultimate goal for all development workers, including Doctor Nyan. It is proof that our efforts have truly led to meaningful development. World Vision Thailand is committed to continuing its ministry in promoting the health of migrant populations to achieve sustainable development. Nyan Win Phyo, or Doctor Nyan, will continue to be a vital force in driving our ministry to end AIDS in Thailand.
