InterPress News Service (IPS) - Wednesday, June 17, 1998
Satya Sivaraman

Under other circumstances, the loss of such a small amount of money, provided for by a local state-run social welfare agency, would not have meant much for the 32-year-old Anan. But Anan happens to be HIV-positive and is in no condition to earn a decent living.

Indeed, while the economic downturn has been hitting all Thais hard, health experts say the worst sufferers could be the country's estimated one million HIV-positive people.

Already battling problems at the personal and social front for many years and facing ever-dwindling job opportunities, Thais with HIV are now also reeling from the shock of being denied subsidised medical care and financial support due to deep cuts in government budgets.

Health workers say the sudden dry-up of state subsidies for expensive drugs like AZT may jeopardise the lives of people with HIV in Thailand, which is one of Asia's AIDS hot spots.

Anan, for example, now has to depend on handouts from a Buddhist monastery to survive. "I was taking a regular course of drugs like AZT used to treat HIV patients," he says, "but the government hospitals no longer provide them and so I have switched to some herbal remedies."

AIDS drugs are characteristically costly, with price tags of 10 dollars a tablet. That makes them out of reach for many people in a country where the average annual income in most parts reaches a maximum of 13,000 baht (300 dollars).

But since 1992, all HIV/AIDS patients in Thailand have received free AZT through a special budget for the purchase of anti- retroviral drugs initiated by the National AIDS Prevention and Control Committee, under the Anand Panyarachun government.

At that time, Thai HIV cases were only between 40,000 and 50,000, and the AZT for them cost only about 35 million baht. But the number of Thai HIV cases has risen 20 times since, and while the state budget for anti-retroviral drugs increased to 295 million baht in 1995, it could not keep up with the steep climb in HIV infections.

Worse, the health budget has been slashed drastically due to the economic slide. Last year, the Public Health Ministry proposed an annual budget of 300 million baht for AIDS drugs. The figure approved was just 100 million baht - now 35 percent less its year- ago value.

Before the financial crisis struck, the Thai baht was trading at 28 to the dollar. It sank to around 44 before recovering and held steady at 38 until recently when the yen's free fall dragged it and other Asian currencies down again.

"The economic crisis is certainly hurting our ability to deliver modern medicines," says Dr Chavalit Natpratan, director of the Communicable Disease Control Regional Office here. "(So) we have begun emphasising the need for holistic care for HIV patients instead of the medical aspect alone."

`Holistic care' for HIV patients often means they have to rely on a regimen of good diet, herbal medicine and disciplined living to survive-without any access to crucial but prohibitively expensive modern medicines.

Health workers say even the recent decision of AZT maker Glaxo Wellcome to provide the drug at just 25 percent of its original cost to pregnant women with HIV/AIDS in the developing world may make little difference to Thai mothers who have HIV.

Glaxo's 1997 worldwide AZT revenue was reported to be 471 million dollars. Joint United Nations Programme on HIV/AIDS (UNAIDS) officials hope the drug giant's announcement last March regarding a lower price for AZT for infanticipating HIV mothers may trigger similar action from other AIDS drug manufacturers.

Last November, UNAIDS launched an initiative to bring public and private sectors together to help increase access to HIV/AIDS drugs in developing nations. While governments are expected to ensure effective distribution and use of the medicines, participating pharmaceutical and diagnostic firms would subsidise purchases of these drugs.

But health workers here say Glaxo's move, while laudable, may benefit very few pregnant Thai women with HIV/AIDS, given the severe shortage of state funds for providing AZT even at its cheaper price.

This lack of funds for AZT, they add, could make a mockery of recent tests that show the effectiveness of the drug in the prevention of the transmission of the AIDS virus from infected mothers to their newborn babies.

Hailed as a major medical breakthrough last February, clinical tests conducted jointly by the US-based Centre for Disease Control and Prevention (CDC) and Thailand's Ministry of Public Health showed that a short course of AZT given late in pregnancy and during delivery halved the rate of HIV transmission to infants of infected mothers.

The Thailand study, which began enrollment in 1996, provides the first conclusive scientific data on the preventive effectiveness of a short-course regimen of AZT. The trials, however, had attracted much criticism from US-based non-government organisations (NGOs) for its use of placebos as part of the study.

The rationale behind studying the efficacy of administering a short course of AZT to pregnant women arose from concerns over the prohibitive costs of the longer courses, which are used regularly for preventing HIV transmission to newborn babies in developed countries.

The short regimen is expected to cost 80 dollars as against the nearly 1,000 dollars for the longer course. The drastic reduction in costs is hailed as being beneficial to developing countries like Thailand where almost 90 percent of HIV infections occur.

Dr Timothy Mastro, director of the Thai-US collaboration for the AZT study, said the CDC will continue to give AZT support to patients at hospitals where the trials were carried out. But there are more HIV mothers who are outside the reach of these few hospitals.

"We are looking for new sources of funding to raise the 2.4 million baht (about 56,000 dollars) per month that is required to supply AZT to patients under our care" says an official with the Thai Red Cross, a major distributor of the drug in Thailand that has stopped receiving state funding for the purpose.

Meanwhile, public health officials claim that if all goes as planned, the monthly medicine expenses for Thais with HIV/AIDS may soon be reduced by half -- from 6,000-10,000 baht (140 to 232 dollars) down to 3,000 baht (70 dollars) a month.

This would be largely through the effort of the Government Pharmaceutical Organisation that has been trying for years to lower the cost of AIDS drugs by making them locally.

The state agency says it can now produce AZT and other anti- retroviral drugs such as DDI within Thailand, thereby lowering their costs substantially. The nagging worry of many, however, is that the current economic crunch may make the drugs remain inaccessible for most Thais with HIV. (END/IPS/AP-HE/SS/CB/98)

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