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Targets and results - Asia
Thailand
China
India
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Access to public health provided ARV treatment is still scarce in
Asia, though Thailand is leading the way in providing the drugs.
Some countries have committed to providing treatment in the near
future, with India and China being by far the most significant, due
to their massive population and consequently the potential for many
millions to become infected and therefore need treatment.
In Thailand, the Ministry of Health began providing
ARV monotherapy in 1992 and dual therapy in 1995. In 2000, the
Ministry began promoting triple therapy as the norm, using mainly
branded drugs. However, since then the use of generic copies has
widened. The Government Pharmaceutical Organisation (GPO) produces
seven ARV preparations, which are two to twenty-five times cheaper
than the cheapest brand equivalents. Before 2000, the cost of a
year's treatment of ARVs (2 NRTIs and a Protease Inhibitor) was
US$600; by 2002 this had dropped to US$150. When cheap generic
versions of ARVs became available in Thailand, the triple
combination of d4T/3TC/nevirapine dropped to B1200 (US$18) per
month, a price a lot of Thais could afford.
The use of generics allowed the treatment programme
to expand more than eight-fold between 2001 and 2003 with only a 40%
increase in budget.6 The ARV budget of Baht300 million for 2003 then
increased to Baht800 million for 2004.
he Thai Red Cross and the Ministry of Public Health
supply all HIV-positive women with AZT and nevirapine during
pregnancy, and milk formulas after the birth of their infant. ARVs
are available through at least 914 public hospitals in the country,
and may require part-payment by the patient.
It is thought that 45,000-55,000 people were
receiving ARVs at the end of 2004, so the government target of
50,000 may have been reached. More than twice that number - 114,000
- are estimated to be in need. Thailand has also improved
availability of CD4 testing and viral load testing, in conjunction
with expanding access to ARVs.
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The Chinese government for many years denied the
existence of HIV in the country. After years of denials, the
government is now publicly addressing the problem. UNAIDS estimates
that 840,000 people are livi
ng with HIV/AIDS. With a population estimated at
over 1.2 billion, China has the potential to become the worst
affected country in the world, and UN forecasts state that as many
as 10 million could be infected by 2010.
In November 2003, the health minister Ga Qiang
promised to expand the policy of 'four frees': free HIV testing,
free ARVs, free care for HIV+ mothers and free education for AIDS
orphans. Signs are hopeful that the government will indeed take the
problem seriously, and on World AIDS Day 2003, the prime minister
visited an AIDS care centre and shook a patient's hand, a highly
symbolic move in a country still plagued by attitudes of stigma and
discrimination. Whether these words are put into action will have to
be seen, but with an estimated 122,000 in need, treatment cannot
come soon enough.
Around 7,500-9,500 (7%) of those in need were
receiving drugs in December 2004. As with most estimates about
China, the size of the population makes it difficult to be clear on
any exact figures. What is clear is that there are many more people
in need of drugs than are actually receiving them.
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India has the second highest number of people living
with HIV in the world, at 5.1 million. In December 2003, the
government announced a US$43.6 million plan to offer free ARVs
through the public health system, beginning April 2004. The drugs
are expected to be provided by the three large generic drug
manufacturers in India, who are currently making cheap ARVs for
other developing countries. The plan by the government was to
initially treat 100,000 people in the first year, beginning with
HIV+ pregnant women, all children under 15 and eventually all people
with an AIDS defining illness in the six states with the worst rates
of infection.
The plan has however been criticised by
non-governmental organisations as too ambitious. Problems which have
yet to be overcome include the government agreeing to reduce tax
rates on drugs produced to reduce the overall cost of the drugs,
financing the whole initiative and improving laboratory monitoring
and improving healthcare systems. In January 2004, the head of Cipla,
one of the manufacturers involved, said that "if the government
wants to buy, they must let us know for how many, when, and do they
have the money"8. Another problem to be overcome is the issue of the
generic drugs losing their patent protection from 2005, when the WTO
agreement on intellectual property rights comes into effect9, 10.
About 20,000-36,000 people were receiving drugs at the end of 2004
(mostly through the private sector), out of an estimated 770,000 who
needed them.
At the moment, despite the fact that India is a
major producer of cheap generic copies of many HIV/AIDS drugs that
are being sold to many countries all over the world, they are
affordable to a tiny fraction of people in need of treatment in
India.
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