Global Trends by Martin Khor

Monday 12 July 2004


The fight against the worldwide HIV-AIDS epidemic is highlighted this week by the International AIDS Conference in Bangkok.   Asia is projected to bear the brunt of the next wave of the epidemic, unless something is done fast.  Required are bold measures for both prevention and cure, including getting cheaper medicines to the victims.

So much publicity has been given to the threat of the HIV-AIDS epidemic.  But so little has yet been achieved in fighting it. 

The International AIDS Conference, now taking place in Bangkok with 15,000 participants, will hopefully raise awareness, especially in Asia, on how much more needs to be done.

While AIDS has usually been portrayed as mainly an African problem, the next explosive increase in the epidemic is expected to be in Asia, and soon. 

According to the United Nations Programme on HIV/AIDS (UNAIDS), moves to fight AIDS have been failing overall with five million more infections last year.

“It is a failure of reaching infected people and of treating them,” said Peter Piot, UNAIDS executive director, last week. 

The problem is the lack of priority and leadership. Despite such isolated cases of success as Uganda and Thailand, only one in five persons who need access to prevention (such as education, condoms and clean needles) has it, said Piot.

On the curative side, the picture is even more bleak.  Only 440,000 people have access to anti-retroviral drug treatment for the disease.  That may be double the number of two years ago.   But it is miniscule compared with the 38 million people living with HIV-AIDS, a significant part of who already require the medicines.

More than 20 million have died so far of AIDS, 3 million in 2003 alone.   The worst hit region so far is Africa, where over 15 million have died of AIDS, 30 million now have HIV-AIDS and one in 12 African adults are infected. The prevalence rate among adults is shockingly high at 37% in Botswana, 21% in South Africa and 24% in Zimbabwe.

However, UNAIDS warns that it will be Asia’s turn to face even greater devastation.  If the region fails to have effective prevention programmes, “we will see an epidemic the likes of which we never imagined despite what has happened in Africa,” said Kathleen Cravero, deputy executive director of UNAIDS.

The facts on Asia, obtained from the UNAIDS and WHO reports, are sobering:

·        By end-2003, there were 7.4 million Asians living with HIV.  Last year, half a million died, and 1.l million were newly infected.

·        India has 4.6 million people with HIV, the largest number in the world besides South Africa.  In China, 10 million may be infected by 2010 unless effective action is taken.

·        Cambodia, Thailand and Burma have percentages that are considered facing an AIDS epidemic, with 2.6% of the Cambodian population suffering from HIV and 1.5% of Thais.   These percentages may be lower than those in Africa, but UNAIDS says Asia is “potentially worse off than Africa because of the numbers or people affected”

·        Injections by drug users is a major cause.  The HIV prevalence rate among Indonesia’s 125,000 to 195,000 injecting drug users trebled from 16 to 48 percent between 1999 and 2003, and in the last two years, HIV prevalence ranged from 66 to 93 percent among injecting drug users taking tests in Jakarta.  In China, HIV prevalence is also 35-80 percent in Xinjiang and 20% in Guangdong. 

On the curative side, a major problem has been the high cost of medicines to treat HIV-AIDS patients.  In many counties, the drugs are patented, enabling the companies to price them so high they are out of reach to all but a few patients.

Governments can try to get the patent-holding companies to reduce their prices to a low enough level. If that fails, there are measures that governments can take to offset these patents, that are consistent with international law such as the World Trade Organisation’s agreement on intellectual property rights.

A few countries have so far adopted such measures, that can include issuing compulsory licenses to companies to produce or import generic versions of the medicines, or “parallel importing” of the same brand of the patented drug at a cheaper price.

Malaysia is one of these pioneering countries.  The government gave permission to a local company to import three kinds of HIV-AIDS anti-retroviral drugs from a company in India, Cipla,  producing cheaper  generic versions of the drugs that had been granted patents in Malaysia.

The permission was granted under a provision in the patents law that allows “government use” of the drugs for a non-commercial purpose.

In June, the Health Ministry began prescribing the imported generic medicines, which are being distributed through government hospitals. 

Health Minister Dr Chua Soi Lek announced on 6 June that the monthly cost of treating a patient would be reduced from RM1,200 to RM 200-220, after the drugs were imported from India.   “With the cheaper cost, we can treat at least 4,000 HIV patients compared to the presently 1,500,” he said.  (The Star, 7 June 2004).

According to reports, there are 59,000 people in Malaysia infected with HIV, only 6,000 have gone for follow-up treatment in government hospitals, and up to a few months ago only 1,500 of the estimated 4,000 HIV-positive people on the verge of developing full-blown AIDS were receiving treatment (Sunday Star, 4 July 2005). 

These figures show how large is the challenge to provide treatment to all those with HIV-AIDS. 

The new Health Ministry initiative of obtaining cheaper generic drugs is a first step towards meeting this challenge. But it is a big and bold step indeed.

At the AIDS Conference in Bangkok, this Malaysian initiative is likely to be a subject of great interest from other countries which are eager to learn how to supply drugs cheaper to their HIV-AIDS patients.

Besides the few success stories from around the world, it must be admitted that the global situation in the war against HIV-AIDS remains grim, and humanity will continue to lose that war unless much more is done.

The Bangkok Conference on AIDS is expected to conclude later this week with rousing calls for increased political will and leadership, concrete prevention programmes, measures to make medicines more accessible to the victims, and more funds to make these happen.

It remains to be seen what will concretely be achieved by end of the conference. In any case, it is fortunate it is being held so close to home, for the heat of that high-profile meeting will hopefully generate the high-priority attention required to get action really going in Asia.