Positive People's Groups: The Story of People Living with HIV Mobilizing to Improve Their Lives in Upper Northern Thailand

This 31-page document, written in English and Thai, is about the Positive People's Group and their function in helping HIV-positive members to access services such as health care, psychosocial support, children's education, and income generation. Positive People - people who know they are living with HIV/AIDS - in the six northern provinces in Thailand established these groups because in the 1980's and 1990's, though this region was home to 50% of the HIV/AIDS population of the country, there was, as stated here, an unsupportive environment of shunning, stigma, and discrimination. In short, groups established themselves under the name of Positive People as community self-help groups.

According to the document, a few government and non-governmental organisations (NGOs) in the region began to offer these new groups technical and financial support and to advocate, ultimately successfully, for a new national strategy, recognising that the epidemic could be approached more effectively by working closely with Positive People. Rather than being ignored or excluded through fear, people living with HIV/AIDS began to participate as part of the development of the new strategy in the mid 1990's. This document analyses the work of Positive People through the lenses of the Northern Thailand regional cultural norms of a strong sense of community and a long-standing tradition of self-help groups and also through, as stated in the report, the Thai government's choice to put Positive People "at the heart" of its policies.

The document reports that, as a result of this national strategy, people living with HIV/AIDS can, through a self-help group access the services they need, training for income generation, and information through peer educators and group networks. Positive People's strategy of lobbying the government for services and price reductions in drug therapy involved drawing attention to services that did not exist or were of poor quality, and then, once they were established, insuring ongoing access to them. These actions drew the government and NGOs into partnership with Positive People to the point that, according to this document and based on information from the Public Health Ministry of Thailand in 2006, enough treatment, including anti retroviral therapy, existed for those that needed it, allowing efforts to turn from establishment of care to quality of care.

However, as detailed in the report, despite availability of care, members of marginalised groups - among them, drug users and men who have sex with men - may not have access to or choose to access a Positive People group, which could limit their access to care. Also, those with some degree of wealth may not choose to join because of the choice of maintaining the privacy of HIV status, thus losing access to information and services. This lack of access is by marginalised groups is borne out in the data showing: a fall of general HIV infection rates as Positive People became visible and active, indicating the effect of their work on the general population, accompanied by a rise in the HIV rates of some marginalised groups, indicating their lack of access to information. Problems also exist, according to the document, in infrastructure shortfalls like districts without hospitals, in remaining stigma preventing Positive People from social and professional development in their communities, in some unresolved discrimination by health personnel, and in budget limitations for healthcare.

As stated here, four factors contribute to the success of these Northern Province groups:

1. Specific individuals living with HIV/AIDS offer leadership.
2. Strong early leaders, determined to have access to the best possible services for themselves and others (NGOs) and local government agencies.
3. Government commitment and funding helped ensure that central planks of national policy included Positive People, reinforcing a reduction in stigma and discrimination.
4. The Thai tradition of self-help groups involved in community life was the model for groups of Positive People - a tradition that is strongest in the Upper North.

Other factors listed that contributed are a strong literacy rate, free-of-charge media sources disseminating information widely, decentralisation of decision-making, and a technically competent medical establishment and government health network.

This publication, which was made possible by the United States Agency for International Development (USAID) and the Bill and Melinda Gates Foundation, may be ordered through publications@aidsalliance.org or accessed on the internet in PDF format (see below).