Thais battle for affordable HIV drugs


nevirapine (courtesy of AP)APIWAT KWANGKAEW can still remember the day, nearly five years ago, when Thailand began producing nevirapine, a generic anti-retroviral drug. Within an hour of the announcement, hospital wards across the country were backed up with patients.

These were people who knew they were sick but could not afford treatment. With a population of 64 million, Thailand has more than 1 million people living with HIV/AIDS. Some believe the figure is much higher.

The drug helped save Mr Apiwat's life. Now he is fighting to save others, taking on the US pharmaceutical giant Merck for the right to break the patent on the anti-retroviral drug efavirenz, and produce another generic HIV-AIDS treatment.

When 32-year-old Mr Apiwat learned he was HIV-positive 10 years ago, treatment was so expensive it might as well not have existed. At 10,000 baht a month, it was double the monthly salary of a shop assistant. Seven years ago, he came to the Mercy Centre, an AIDS hospice run by Father Joe Maier in the Bangkok slum of Klong Toey, to die among friends.

"When I came here, I couldn't help myself, I was being attacked by a fungus in my brain, I didn't have any hope, I only wanted to die with people who sympathised with me, to feel the warmth of brotherhood," he told the Herald.

He is now the director of the hospice and an ardent advocate of access to reasonably priced drugs. The nevirapine still works for him, but many at the hospice have a growing resistance to it.

The answer for them is efavirenz, made by Merck, but it is expensive, and supplies have been unreliable. The Government says the company does not have enough stocks to supply the drug while the company says "we have the medicine but your government has not paid for it".

Before it was ousted by the military in September, the business-oriented Thaksin Shinawatra government was pushing for a free trade agreement with the United States, which included extension of drug patent rights to 25 years and protection of intellectual property rights for pharmaceutical companies.

Mr Apiwat said the agreement, if passed, would have overridden World Trade Organisation rules that allow a country to issue a compulsory licence to make a patented product without the consent of the patent owner in the event of a public health crisis.

Fierce protests by health activists in the northern city of Chiang Mai in January forced the then government to put the negotiations on hold.

This month the breakthrough came. At the urging of AIDS activists, the new military-appointed interim government issued a compulsory licence for the generic production of efavirenz. The Ministry of Health says it can have it on the market in six months, increasing access to the treatment from the present 20,000 patients to 100,000.

Father Joe, the founder of the Mercy Centre AIDS hospice, says the Merck efavirenz costs 2700 baht a person a month, while the generic version will cost 600 baht. "AIDS will be with us for 1000 years, we have to learn to live with it."

Merck has reportedly asked the US Trade Representative and the State Department to pressure the Thai Government to rescind the decision.

source - The Sydney Morning Herald