Thailand challenged on health plans for men with HIV

This article is more than 22 years old. Click here for more recent articles on this topic

Report updated 2 September (see below).

According to the Christian Science Monitor, the new national health programme planned by Thailand’s government is being challenged on the basis that its proposed coverage of AIDS treatment is too limited.

The new scheme, under which medical consultations would be subsidized to cost just 30 baht (75 US or euro cents / just under 50 UK pence) at first excluded antiretroviral treatment altogether. After vigorous campaigns by community groups, this was reconsidered. The policy shift was underpinned by the development of low-cost generic antiretroviral treatment options by the Thai Government Pharmaceutical Organization, a division of the Ministry of Public Health.

Glossary

generic

In relation to medicines, a drug manufactured and sold without a brand name, in situations where the original manufacturer’s patent has expired or is not enforced. Generic drugs contain the same active ingredients as branded drugs, and have comparable strength, safety, efficacy and quality.

perinatal

Relating to the period starting a few weeks before birth and including the birth and a few weeks after birth.

exclusion criteria

Defines who cannot take part in a research study. Eligibility criteria may include disease type and stage, other medical conditions, previous treatment history, age, and gender. For example, many trials exclude women who are pregnant, to avoid any possible danger to a baby, or people who are taking a drug that might interact with the treatment being studied.

antenatal

The period of time from conception up to birth.

malaria

A serious disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. 

The scheme is now apparently set to exclude HIV positive men from coverage, while providing some antiretroviral therapy for HIV positive women and children. This has been criticised by Senator Jon Ungphakorn, a longtime campaigner on AIDS issues, who is urging wider coverage even though it would increase the cost of the scheme as a whole.

Thailand’s scheme is being closely watched by other middle-income countries as a model for how to deal with unequal access to healthcare and its effect on poverty. There remain important unanswered questions about how it will be funded, and whether it will be possible to maintain standards of healthcare.

The Global Fund to fight AIDS, TB and Malaria has promised funding to Thailand which is supposed to increase the provision of HAART treatment from 3,000 people to 70,000 over the next five years.

In rolling out its programme for antenatal HIV counseling, testing and treatment to prevent transmission to babies, the Thai health authorities have recognized the importance of involving male partners of pregnant women and offering them testing too. It is therefore surprising that they should appear to be setting discriminatory conditions on access to treatment for HIV/AIDS.

  • In Botswana, Southern Africa, as reported here, programmes that give priority to parents are treating both women with HIV and their male partners, if they meet the clinical criteria for treatment. The thinking behind this is that if only the women were provided with treatment, then those women might feel obliged to share their drugs with their partner in a way that could make the drugs ineffective for both of them.

Important clarification

Senator Jon Ungphakorn issued the following statement through the AIDS Access Foundation on 2 September, in response to the report that appeared in the Christian Science Monitor:

'In fact, under the new national health care insurance program (where

patients are charged Baht 30 or US Cents 75 per hospital or health center

visit, except for patients from low income families who do not have to pay

anything) - every person living with HIV/AIDS is eligible to treatment for

opportunistic infections.

'It has now been accepted in principle that the program will also provide

ARV triple therapy to PWA, but in a step by step process (eg. this year

around 7,000 will get ARV, next year hopefully at least double this

number). There is no distinction between men and women.'

'However, the Thai government (through the Ministry of Public Health) is

also providing free ARV to all HIV+ pregnant women during the last month

of pregnancy so as to reduce perinatal transmission. There are plans to

provide long term triple ARV treatment to some of these mothers after

delivery - separate from the national health-care insurance program, and

under a different (and smaller) quota. This may explain the

misunderstanding.'

'Also, I did not say that insurance co-payment should be increased to

approximately $48 per patient per year, rather that the health insurance

program should eventually insure the population for around US$40 per

person per year (at present it is around US$30 per person) so as to

provide a higher standard of treatment and also to cover ARV and long term

kidney dialysis for all who need such treatments. The national health-care

insurance funds mainly come from general taxation, not from co-payments.'