A year on, gaps showing in Thai AIDS drug plan

BANGKOK, Aug 17: Nearly a year after Thailand rolled out Asia's biggest AIDS drug programme, Boripat Bonmon is among those who slipped through the cracks.

The 43-year-old shopkeeper-turned-activist went off treatment eight months ago after his daily cocktail of antiretroviral drugs stopped working.

He needs expensive ''second-line'' drugs that are not covered by the publicly funded drug plan launched last October.

''I decided to stop because I can't pay,'' said Boripat, whose health insurance covered less than a third of the monthly 18,000 baht (480 dollar) cost of an imported second-line drug.

Thailand has won international praise for its swift roll-out of the National Access to Antiretroviral Programme for People Living with HIV/AIDS (NAPHA), the latest weapon in the country's battle against the disease.

A former hotspot for the virus, Thailand has more than halved the number of new infections over the past decade and gradually expanded drug treatment since 2000.

But as people live longer and treatment gets more expensive, the government's commitment to provide universal access to care will face serious challenges, health experts say. Thailand's efforts are among the initiatives discussed at the 16th international AIDS conference in Toronto this week.

''It's quite impressive how they rolled out this programme so quickly, but it has some teething problems,'' said Paul Cawthorne, the Thailand representative for Medicins Sans Frontieres.

NAPHA provides antiretroviral treatment for 80,000 Thais, the most extensive programme in a region where the virus infects more than 8 million people, including 580,000 Thais.

Under the plan, a patient can walk into a hospital or rural clinic and pay 30 baht (80 US cents) for drug treatment now included in the national healthcare scheme for the country's 63 million people.

PATENT PROBLEM

But Cawthorne worries about gaps in coverage for drug users and prisoners, and for illegal migrant workers and ethnic minorities who do not have access to the public health system.

Nurses and doctors are also feeling the strain of handling more patients, he said.

MSF is training HIV-positive volunteers to help educate patients on their drug regimens and provide counselling.

''Getting these people into the system and treating them is not like surgery. This is lifelong treatment,'' Cawthorne said.

Costs will also rise in the next four to five years as more people like Boripat develop a resistance to their current treatment and need second-line drugs, he said.

Many of these drugs are patented, produced and sold by big pharmaceutical firms, and a regimen can cost more than 22,000 baht (589 dollar) a month in Thailand.

By comparison, GPO-vir, a generic triple-drug combination made by Thailand's state drug firm, costs 1,200 baht (32 dollar) a month. ''If the government wants to encourage local production of these drugs, they will have to issue compulsory licences or put pressure on the multinationals to give them a better price,'' Cawthorne said.

TRADE WORRIES

Under World Trade Organisation rules, governments can declare a ''national emergency'' and issue so-called compulsory licences, allowing others to produce a patented drug without consent from a foreign patent owner.

Such a move could help Thailand reduce its drug costs, said a World Bank study which projected second-line therapy would account for more than half of NAPHA's spending by 2010.

It said spending could reach 500 million dollar a decade later, up from a 2006 budget of 70 million dollar.

But overriding drug patents would require ''high-level political resolve'' because it would probably carry trade repercussions, the study said.

Critics of Bangkok's free trade talks with Washington, disrupted by protesters at a January meeting in Thailand and now stalled by a domestic political crisis, fear Thai negotiators will give away the override rights and gut its generic drug industry.

Sombat Thaenprasertsuk, director of the Public Health Ministry's HIV-AIDS division, played down those concerns.

''I can assure the public that we are keeping a close eye on this compulsory licensing issue. If the situation fits within the law, we will move ahead,'' he told Reuters.

But he added quickly that talks with drug companies had gone well, with some firms offering discounts of up to 20 percent on second-line combination therapies.

The government is currently offering second-line drugs through a pilot programme to 1,600 patients and hopes to begin rolling them out more widely through the national health plan by the end of the year.

''We are going to launch this very soon. I can't say when for sure, but by the end of the year,'' he said.

Activists like Boripat say they will keep pressure on the government.

He has refused second-line treatment from MSF, saying most other Thais in his position do not have a similar way out.

''Of course I'm worried something will happen to me. I might get sick or my CD4 could drop fast,'' said Boripat, referring to his immunity level which his doctor says is already low enough to put him at risk of opportunistic infections like tuberculosis.

''People who need second line don't have the money. If we don't shout, nothing will be done,'' he said.

REUTERS