[procaare] Limited AIDS Drugs Force Doctors to Play God

[IPS <procaare@healthnet.org>]

Limited AIDS Drugs Force Doctors to Play God
Inter Press Service (14.10.03)
*****************************

RIGHTS-THAILAND: Limited AIDS Drugs Force Doctors to Play God
Inter Press Service - October 14, 2003
By Marwaan Macan-Markar

BANGKOK, Oct 14 (IPS) - Annop Lekhakul's early steps into the world of medicine have led
him to a role that comes close to playing God. After all, he holds the power over longer
life or quick death for the patients with HIV at the government hospital he serves here in
Thailand.

Tuesdays leave the young doctor drained. That is the day 60 people with HIV call at the
hospital in Non Jok, some 40 kilometres east of the Thai capital Bangkok, for their weekly
course in counselling and treatment.

Among them are the 19 patients the 26-year-old Annop has chosen to receive the
anti-retroviral (ARV) drug cocktail, which slows down the spread of AIDS in the body. The
consequence of that decision - that he also has to face the 41 other HIV patients who have
no access to the anti-AIDS drugs - does not sit lightly on him.

"It is a troubling decision to make about who will get the drugs and who won't," Annop
said on a recent morning in the lime-green painted room the hospital uses for its Tuesday
afternoon sessions with the HIV patients from the vicinity. "We base it on a combination
of factors - who needs it most, good compliance to the ARV treatment and who came first."

Doctors in other government hospitals across Thailand are not immune from this predicament
either. Currently, there are 400 hospitals dispensing free anti-AIDS drugs to HIV patients
in the same way the 60-bed Non Chok hospital does - based on a quota system.

Under this mechanism - the Extended Access to Care programme - which was launched by the
government in October last year, small state-funded hospitals such as the one where Annop
works receive ARVs to treat 20 patients at a time. Larger hospitals receive a quota of
drugs to care for 40 patients.

As a result, a little over 20,000 of an estimated 200,000 HIV patients who need anti-AIDS
drugs for their survival are enjoying a fresh lease of life in this South-east Asian
country, say public health workers and activists seeking to secure wider coverage of ARV
treatment.

"The government is aiming to get 50,000 HIV patients on ARV treatment by the end of 2004,"
Dr Koen Frederix of the medical relief agency Medicins Sans Frontiers (MSF) told IPS.
"This effort reflects the dramatic change in Thailand over the past two years to provide
ARVs to the many people who could not afford to pay for the drugs."

Such an achievement in Thailand, which has an estimated 670,000 people living with
HIV/AIDS out of a population of 63.5 million people, is considered remarkable when set
against the pattern across the Asia-Pacific region.

Currently, only 43,000, or some four percent, of the one million people with HIV across
the continent who need the anti-AIDS drugs have access to them, states a report released
this year by the Bangkok-based Economic and Social Commission for Asia and the Pacific
(ESCAP), a regional U.N. agency.

By contrast in Thailand, where over 300,000 people have died due to the pandemic since HIV
was first detected in the 1980s, ARV coverage hovers around 10 percent of those who need
it. Officials aim to reach 20 percent coverage in a year.

But as recent reports and statements reveal, there is little room for optimism that both
Thailand and Asia will witness a manifold increase in the supply of the ARV drug cocktail,
which has been available globally since the mid-1990s, to people who desperately need it.

A shortfall in the funds needed to inject more life into ARV therapy is a key reason.

Once again, Thailand helps illustrate this point. In 1996, the country spent over 85
million U.S. dollars on HIV/AIDS programmes, 92 percent of which came from the government
and local resources, says Swarup Sarkar of the Joint United Nations Programme on AIDS
(UNAIDS). "But the government investment for HIV/AIDS programmes in 2002 was 35 million
U.S. dollars."

Preliminary estimates of the amount Asia-Pacific countries have committed this year
through public sector funding to tackle HIV/AIDS - including the provision of anti-AIDS
drugs - comes to around 200 million U.S. dollars.

But according to Sarkar, this is a number that is woefully inadequate, given that this
region needs "an investment of 1.5 billion U.S. dollars for 2003 to tackle HIV/AIDS".

The United Nations' point man on HIV/AIDS asserts that governments must take the lead to
change this unhealthy picture. "The money must come from local governments to begin, with
help from outside," Peter Piot, executive director of UNAIDS, told IPS in an interview.

The drop in the price of anti-retroviral drugs has made such therapy accessible to many,
he added. "Countries that cannot produce the drugs can now import it to provide the
treatment."

Piot's call to governments to demonstrate that their hearts lie with those afflicted by
HIV/AIDS comes at a time when the Asia-Pacific is facing a worrying picture.

Already, there are seven million cases of HIV in the region, with one million new
infections reported every year, states UNAIDS. It adds that the annual death toll from the
epidemic has now reached half a million people.

Sudjai Tapa is one face among those statistics. The 39-year-old Thai from the country's
north-east has been living with HIV for the past 10 years. But he considers himself
fortunate, since he has been on the ARV regimen for the past three years.

"I was near death till I began taking the drugs," he said, a pensive look in his eyes.
"The medicines enabled me to return to a normal life. So it is painful to think of my
friends with HIV who don't have access to the ARV drugs."

Forwarded to SEA-AIDS by Nenet L. Ortega at nenetgem@yahoo.com  15 October 2003

Cross-posted from SEA-AIDS (20.10.03)

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