A Cross-Cultural Comparison of Perinatal HIV Transmission In the United States and Thailand

Abstract

Background: Human immunodeficiency virus (HIV) damages the body by destroying cells that help the body fight off disease and thus the immune system begins to fail. Today, there areover 33 million people living with HIV globally. HIV transmission can occur via the transfer of blood, vaginal fluid, semen, pre-ejaculate, breast milk, and/or perinatal transmission. Perinatal transmission can occur though trans-placental infection, infection during labor and delivery, and through infection via mother’s breast milk. While in utero, there are situations that increase the risk of transmission that vary between western healthcare delivery systems like The Untied States and developing nations like Thailand. Understanding the differences of perinatal HIV transmission and standards of care in both countries can lead to better care and treatment worldwide. This investigation documented current standards of care for both countries, including diagnosis, treatment, and drugs used. Methods: Structured interviews were conducted to in the United States and Thailand with health care providers that manage care for pregnant women to address study aims. Findings: In general, similarities between the US and Thailand include the use of the ELISA (enzyme-linked immunosorbent assay) for diagnosis and screening of all expectant mothers. Findings also suggest that the availability of antiretroviral drugs is higher in the in the United States, and treatment for prevention may differ. Although combination antiretroviral drugs are used in Thailand, and in similar combinations, the United States uses a variety of drugs to treat severe side effects of the antiviral drugs. Differences were also found when contrasting the healthcare systems of each country. Implications: The universal healthcare system that exists in Thailand provides an opportunity for significant reductions of HIV transmission during the perinatal period. However, some questions exist about the availability of antiretroviral medications and the ability of this system to access the population at risk. Non-traditional treatments utilized in Thai medicine to manage side effects of HIV treatment may offer some economic and health advantages, but more study is needed to fully describe this contrast.