Stigma and discrimination are significant barriers to accessing healthcare services, especially concerning HIV/ AIDS and TB, across all population groups. These barriers hinder people from seeking necessary treatment promptly. Delays in diagnosis and treatment increase the risk of disease transmission. Therefore, social stigma and self-stigma related to HIV and TB among key populations with high infection rates remain obstacles for them to accessing healthcare services. Addressing these issues is crucial for improving the mental health of service recipients. This highlights the need to change societal attitudes to foster acceptance and understanding of patients’ rights, promoting equal treatment and non-discrimination based on factors such as social status, gender, religion, or nationality.
According to the People Living with HIV Stigma Index 2.0 in Thailand (2022-2023), 5% of respondents have experienced stigma in the community, particularly among sex workers, people who use drugs, and transgender. Stigma affects the discontinuation of antiretroviral treatment, with those who have experienced stigma being significantly more likely to stop treatment compared to those who have not. Stigma also leads to HIV-positive youth facing eviction from their homes or delays in school enrollment, posing significant obstacles to daily life and access to essential services.
Meanwhile, the HRG Rapid Assessment report found that migrants were dismissed from their jobs and students were expelled from school due to their TB diagnosis. Many migrants faced obstacles in accessing medical services, whether due to language barriers or discrimination from healthcare providers, hindering them from seeking treatment when ill.
From the operations of World Vision Thailand and its network partners, it has been found that at the local level, national-level policies for protecting basic rights, such as rights to healthcare, employment, and education, have not yet been implemented. There is also a lack of enforcement mechanisms. If in every context, legal rights protection could be enforced through various mechanisms, such as the proposed Anti-Discrimination Act, it would lead to concrete changes, including access to other fundamental rights, which are crucial factors affecting the improvement of quality of life, especially in terms of health justice.
For this reason, in March 2025, World Vision Thailand, the principal recipient of the Global Fund’s project ‘Stop TB and AIDS through RRTTPR for 2024-2026,’ held a meeting to review lessons learned on reducing human rights and gender-related barriers to accessing TB and HIV services for key populations. The aim was to review past operations and develop the Human Rights and Gender (HRG) strategy to support the National Strategic Plan to End AIDS 2017-2030 and the National Tuberculosis Control Plan Phase 2 (2023-2027). The focus was on linking efforts to reduce barriers to healthcare access and eliminate stigma and discrimination in all dimensions, both at policy and local levels, which directly impact equitable access to diagnosis and treatment.
In this meeting, human rights and gender network partners, including Raks Thai Foundation, Dreamlopments Foundation, Foundation for Action on Inclusion Rights (FAIR), Service Workers in Group Foundation (SWING), and the Country Coordinating Mechanisms (CCM), exchanged opinions and experiences. They also discussed operational plans aimed at improving the response to the needs of migrant populations, particularly in terms of access to TB and HIV/AIDS services.
The main proposal from the 2024 implementation review is to integrate Human Rights and Gender work into service provider in both community-based organisations and public service facilities. This includes measures to reduce stigma and discrimination at every stage of RRTTPR (Reach – Recruit – Test – Treat – Prevention – Retain). Additionally, there should be reforms criminal laws to Harm reduction from drug use, legalizing the profession of sex worker, and policies that negatively impact the work to help reduce the burden on local community-based organisations. Communities should receive legal assistance to access the justice process through law enforcement. If all these measures are fully implemented, it will help service recipients, including people living with HIV and key populations, to access proper services, receive appropriate treatment, and improve their quality of life. The efforts of World Vision Thailand and its network partners aiming to eliminate barriers to equitable access to healthcare services are as follows:
- The M-FUND project, implemented by Dreamlopments Foundation, plays a crucial role in expanding health insurance coverage for undocumented migrants without discrimination. In 2024, there were 17,420 new registrations, bringing the total to 89,205. Of these, 30,106 received services from partner hospitals.
- Crisis responses, implemented by FAIR and SWING, influence policy change by focusing on decriminalising sex workers and strengthening the watchdog system. Community mechanisms have been established in Bangkok and Chonburi, assisting 642 individuals whose rights have been violated due to, for instance, HIV status, TB diagnosis, drug use, domestic violence, and discrimination.
- The formation of a new committee to study the problems and obstacles of stigma and discrimination related to TB for key populations (TB Task Force Related S&D), which is a collaborative mechanism between the government and civil society. It aims to push for the elimination of stigma and discrimination in accessing TB services. The task force is evaluating the TB O-9 S&D study at the community level, gathering in-depth information for improved national policies and practices of relevant ministries.
- The development of the TB-CRG National (Costed Action Plan) aims to ensure the appropriate allocation of resources to reduce stigma and discrimination.
- Evaluating key indicators to monitor progress in expanding the scope of projects aimed at eliminating human rights barriers, along with continuously reporting the project implementation to the Global Fund.
Supporting the human rights of key populations is crucial because stigma and discrimination are not only driven by fear of HIV or TB infection but also by the stigmatisation of key populations themselves. Addressing this issue requires collaboration from all sectors to reduce barriers and promote equity in accessing healthcare services, ensuring that everyone receives appropriate care and has the right to equitable access to healthcare services.
Despite progress in driving the elimination of stigma and discrimination against TB presumptive patients and people living with HIV, there are still several limitations and challenges, such as project discontinuity, political changes, policy data collection constraints, and societal awareness and attitudes. These are significant issues and obstacles in accessing TB and HIV services for key populations. Additionally, they may impact Thailand’s ability to achieve the goal of ending TB and AIDS by 2030.
