BANGKOK, May 22 (Reuters) Each morning, Somying waits on the canal near her Bangkok slum for the iceboat that has become her lifeline.
''It's expensive but I need ice every day,'' the 33-year-old said of the 0.37 dollar purchase that keeps her lifesaving AIDS drug, Kaletra, from perishing in hot season temperatures nearing 40 degrees Centigrade.
A version that does not need refrigeration is available in the United States and some African countries hard hit by AIDS, but not in Thailand where the army-backed government is embroiled in a patent dispute with its maker, US pharmaceutical giant Abbott Laboratories.
Abbott will not register the new version, Aluvia, until Bangkok renounces its January decision to invoke a compulsory licence under world trade rules which allow governments to make or buy copycat versions of drugs for public health measures.
Thailand, which has taken similar action on another AIDS drug and a heart disease medicine in what it says is a bid to widen access for its poor, wants Abbott to cut its prices more.
The company is sticking to its last offer of 1,000 dollar per patient a year, down from 2,200 dollar, but higher than generic versions available for 695 dollar.
''The new pills would make it easier,'' said Somying, whose monthly ice bill eats up nearly half the 800 baht she earns at home tying ribbons for a garland maker.
''I wouldn't have to buy ice or carry around the cooler anymore,'' she said outside the two-room shack she shares with her two children, including a 13-year-old son with AIDS.
Still, they are among the lucky ones.
Of the 8,000 Thais who need Kaletra, a so-called second-line drug for people who develop resistance to initial treatment, only 600 are receiving the drug -- and the older version at that.
Somying, who was forced to leave her cleaning job at a sausage factory due to AIDS-related illnesses, still pays 500 baht a month into an employee health plan to receive Kaletra.
Without charitable donations, Somying, who lost her husband to AIDS a decade ago, said her family would not survive.
Her son, back in school six years after he walked out when teachers tried to keep him away from other children, gets the drug through the national health scheme, which covers 80 per cent of Thailand's 63 million people.
A former AIDS hotspot, Thailand has won praise for reducing infections and expanding drug treatment to 100,000 of the 580,000 Thais living with AIDS. But it now faces budget pressures as more people need treatment, including expensive second-line drugs.
Somsit Tansuphaswadikul, a doctor at Bangkok's main infectious disease hospital, said he has 30 patients on Kaletra but could treat 70 more.
''There is a quota for second-line patients because of the budget. Some patients may not get access because it's not available, so they keep on with the old regimen,'' he said.
The drug industry's defenders say Thailand, which is spending 0 million on HIV-AIDS programmes this year, is a middle-income nation that can afford higher drug prices.
Bangkok says health care is already its second biggest budget item after education, but it is worried about the impact on trade relations with its major partner, the United States.
Health Minister Mongkol na Songkhla is in Washington this week to meet trade officials who put Thailand on a ''priority watch list'', citing a ''weakening of respect for patents'' which could open the country to trade retaliation.
''We only want access to drugs for people who have no access. We can't let them down,'' Mongkol told Reuters before the trip he said was aimed at countering ''bad information'' about his policy.
Mongkol, who acted after a coup ousted pro-business Prime Minister Thaksin Shinawatra last year, said he may target two more drugs, not the 20-30 some reports have cited.
Mongkol has won support from health groups such as Doctors Without Borders and former US President Bill Clinton, whose foundation brokers deals with generic drug makers to provide lower-priced drugs for developing nations.
''No company will live or die because of high price premiums for AIDS drugs in middle-income countries, but patients may,'' Clinton said in backing Thailand and Brazil, which has followed Bangkok in overriding the patent on Efavirenz, an AIDS drug made by US-based Merck&Co Inc.
Washington has urged the Thais and drug firms to negotiate.
Its envoy in Bangkok has also criticised a campaign waged by the lobby group USA for Innovation, which has indirect links to the drug industry.
It accuses Bangkok of stealing American intellectual property for military benefit and forming part of an ''axis of IP evil''.
Thailand plans to hire a US public relations firm to counter the attacks, but others say the slanging match should be replaced by a serious multilateral debate on how to provide affordable medicines to the world's poor.
''Drugs are not a tape or CD or something like that. We need to think about the human right to receive treatment. It's the same all over the world,'' Somsit said.
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