In Thailand, patient activism is crucial to expanding treatment

ALT Espen Rasmussen

Access to antiretrovirals in Thailand has increased eight-fold in the last three years, with 50,000 people due to receive treatment by the end of this year. People living with HIV/AIDS have been the crucial actors.

There are currently more than 700 groups of people with HIV/AIDS in Thailand, mostly hospital-based and government-funded, co-ordinated by TNP , the Thai Network for People Living with HIV/AIDS. Particularly crucial has been their support for the production of generic antiretrovirals (ARVs) by the Government Pharmaceutical Organisation.

In December 1999, over 300 people with HIV/AIDS demonstrated outside the Public Health Ministry for three days, in support of a request by GPO for a compulsory license to allow it to make generic versions of the ARV didanosine (ddI). It was the first time in Thailand that HIV positive people had braved stigmatisation to stage public demonstrations and it proved to be a watershed event.

When the application for a compulsory licence was rejected by the Thai government for fear of US trade retaliation, patient groups then led a challenge on the didanosine patent itself, filing a lawsuit against its patent-holder Bristol-Myers Squibb in May 2001.

Their challenge was successful: after a year and a half, the Central Intellectual Property and International Trade Court set an important precedent ruling that, because pharmaceutical patents can lead to high prices and limit access to medicines, patients are injured by them and can challenge their legality.

These political efforts to promote access to generic medicines went hand in hand with efforts to ensure that, as the cost of treatment decreased, availability increased.

In order to distribute ARVs throughout the country, TNP , AIDS Access Foundation and MSF set up a Buyers' Club in October 2000. Medicines are made available within a supportive environment -- doctors write a prescription, which the patient takes to their patient group, which dispenses the medicines together with appropriate treatment information, counselling and assistance in planning dosage schedules.

At its peak in June 2002, 21 Buyers' Club branches across the country enabled 1081 people with HIV/AIDS to access treatment. Since then, more patients have gained access to treatment through Ministry of Public Health programmes.

This mixture of practical and political support for access to treatment, with patients and health care providers working together on an equal basis, has built firm foundations for the rolling out of antiretrovirals across the country.