OTGV #57 - Aids Memorial

Broadcast Date: 17/05/04

There are a few reasons why HIV/AIDS patients aren't called patients, but sufferers.

They suffer the burden of knowing that their affliction has no cure;
That the only medication that can prolong their life may be far too expensive for them to buy;
And that the society will stigmatise them.

Hi Welcome to On the Grapevine with me Chong Ching Liang.

In Singapore, the media highlights the disease only in two occasions, the AIDS Candlelight Memorial on May 16th, and World AIDS Day on December first.

Action for Aids or AFA organiser for the Candlelight Memorial, Kelvin Wee on its significance.

"May 16th is the date that everyone in the world will be observing the AIDS Candlelight Memorial. It's an event that is held in over 85 countries and by 3000 communities. Singapore is just one of that many that's just doing it."

AFA's Vice-President Brenton Wong says it's the reluctance by the society to deal with HIV bug openly that hampers Singapore's fight against AIDS.

World Health Organisation's Director General Lee Jong Wook on why the world's losing the battle against the AIDS pandemic.

"We've been talking about prevention using condom without talking about mentioning the ability of medicine. Nobody told them that this is too expensive for them to buy so that you just go back and wait and die but people in the other parts of the world can live another ten, 15 years more. Nowadays, eight thousand people a day dying is equivalent to 30 jumbo jets crashing every day."

The costs of one year of HIV/AIDS medication in the form of the "triple cocktails" of required anti-retroviral may cost up to $10 thousand yearly.

Not many in Singapore can afford this exorbitant price tag so some go over to Thailand where the cheaper generic drugs are available.

Generic drugs are cheaper copies of brand-name drugs that cost about US$400.

The World Trade Organisation allows generic drugs to be produce if HIV/AIDS is classified as public healthcare threat by the country.

AFA's Brenton says developing countries have taken advantage of this provision but not developed economies like Singapore.

"The Doha declaration which states very specifically that it is public health over everything else which very few countries invoke because of the threat of sanctions from the US. Well, basically Singapore has signed off most of its rights with the American free trade agreement. So it is countries like Brazil who have flouted those rules by declaring an emergency and then producing their own drugs and they give 100 percent to their patients. And this is a developing country."

The UN health agency head Dr Lee Jong Wook talks about the W-H-O plans known as "3 by 5", to take the battle to the HIV/AIDS virus.

"Three million comes from the number 6 million who need the medicine today. People said at the time that this is a really ambitious, unattainable plan. When my staff presented this to me, I was under whelmed because we need to provide the drugs for six million people. Depending on where you stand, this can be overly ambitious or it is really too small."

Thailand, the country most hit by HIV/AIDS in Southeast Asia now has access to generic drugs

The sufferers here who couldn't afford the HIV drugs here but can afford to travel go to Thailand for the generic drugs.

But the sheer inconvenience of this may result in some of the HIV sufferers lapse in their medication.

This will create a more serious problem of cultivating drug-resistance strains of the HIV bug says Brenton.

"From our experience in talking to HIV-positive people in Singapore, we know that more than half of them cannot afford name-brand anti-retroviral so many of them either have to look for it elsewhere or go without medication. When a person takes HIV medication, it has to be for life to suppress the virus. Now if a person does not consistently take the drug, the chances of resistance developing is much higher. It has public health implications because if this person infects another person, then it would be a resistance strain."

That, incidentally, is Dr Lee Jong Wook's greatest fear.

"At this stage we have to be very very careful that this '3 By 5' if unwisely implemented can be an invitation for massive scale of drug resistance. With a limited number of drugs still effective for HIV-AIDS, this will be a real catastrophe."

Dr Lee says the government and public health planners must get into the act.

In Singapore, because of the social stigma and the costs of medication a HIV-positive diagnosis is viewed as a semi-death sentence.

This sense of fatalism that accompanies a diagnosis presents the most danger to society.

The existence of this mindset won't help the public health planners in their fight against HIV/AIDS says Brenton.

"I have spoken to many people and they say why bother to go for testing when I can't afford treatment in Singapore and there's no support anyway. So it shows up in our figures because more than half our patients who discover that they are HIV-positive discover it only when they are very sick and they are hospitalised and the doctors suggests an HIV-test. That means there are many people out there who are HIV-positive but do not know it because they do not want to be tested."

If not all "at-risk" Singapore residents go for HIV screening, then the total population of sufferers in Singapore will never be known.

This makes the silent risk even more silent, and even riskier.

This is Chong Ching Liang for Newsradio 938.

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Related Links:

Newsradio 938 (now 938Live)
http://www.938live.sg/

UNAIDS
http://www.unaids.org/en/default.asp

Ministry of Health
http://www.moh.gov.sg/corp/about/newsroom/pressreleases/details.do?id=8519689

Action for AIDS
www.afa.org.sg

OTGV #56 - WHO AIDS Fight

Broadcast Date : 10/05/04

HIV/AIDS is an infectious disease that has plagued the human society for more than two decades.

The World Health Organisation or W-H-O has been leading the fight since the beginning, but the UN agency is better known for its role in fighting SARS.

This is an indication of the taboo associated with the illness and the low priority the world gives to HIV/AIDs as a public health threat.

Hi, Welcome to On the Grapevine with me, Chong Ching Liang.

Some 8,000 people or 30 jumbo jets worth of passengers are dying from HIV/AIDS everyday

It is no wonder that W-H-O Director General, Lee Jong Wook, was in town recently, focused on this issue for his public lecture here

"Right now 40 million people around the world are infected with HIV-AIDS and 6 million people need the medicine today but only about 50 thousand people have access in the developing world. In India, officially there are 5 million people; In China, last year for the first time, said there are at least 850 thousand living with the virus; Thailand, Vietnam, Indonesia these are countries struggling with the virus and Singapore is right in the middle. Clearly, this is knocking at the gate."

The current W-H-O HIV/AIDS initiative is snazzily known as the 3-by-5 campaign

It aims to supply medication to three million HIV-AIDS sufferers by 2005.

Most HIV-AIDS campaigns have been restricted to public education and prevention, but Dr Lee says this has to change.

"This is the world's worst public health threat that the world had faced. I believe Black Death in the 15th, 16th century in Europe was probably less significant problem than HIV-AIDS today. We believe, in WHO, that we have to focus very strongly on prevention to deal with this problem. But now we have to also introduce treatment. 'Without health, there is no development'. "

HIV is a virus that mutates very quickly to defend against any medication, so effective medications are almost always new and experimental.

This creates the single largest obstacle to treating HIV/AIDS in the public health sector -- the problem of expensive drugs.

Here's a Newsradio 938 listener's contribution to the station's World Aids Day radio forum last year.

"Dennis Yim [DY]: Let's take a caller right now. Victor good morning to you. Victor: Er Morning. DY: Yes what would you like to tell us? Victor: Those who catch AIDS is in a terrible state. The cocktail is very expensive you see. If they can't afford it don't know how they continue their treatment."

So how achievable is the W-H-O's 3-By-5 campaign, given the sheer costs of treatment?

Dr Lee says there's been outside help for public health planners.

"Today it will be about ten thousand dollars to treat one person per year because R&D costs are in the price. Many activist groups fought for many years to lower this drug price. Now after 20 years, generic drugs are offering the same combination of drugs at 300 dollars per year."

Generic or cheaper versions of HIV/AIDS medications are governed by strict intellectual property agreement endorsed by the World Trade Organization.

However, Dr Lee says there are abuses to this system.

"The TRIPPS agreement at the DOHA declaration there was some intellectual property exemptions for those drugs used for public health purpose. This will only work if rules are observed by everybody. Some European countries provided drugs to certain countries in Africa and in no time these drugs re-cycled back to their own market in Netherlands. And if this happen, it will be a great dis-incentive for anybody to provide drugs at reduced price."

But there is a reason why such black markets exist.

The lower-income HIV/AIDS sufferers in the developed countries can't afford the 10,000-US-dollar-medicine bill.

Vice-President for Singapore's HIV/AIDS activist group, Action for AIDS Brenton Wong, highlights the plight of sufferers in Singapore.

"More than half our patients cannot afford the triple drug therapy in Singapore. That is why many are going to Thailand for treatment. The 3-in-1 drug costs about 60 to 70 a month and in Singapore pay almost 900 to a thousand dollars for that."

The poor and the rich in Thailand gets help because they have access to generic drugs.

Singapore is a different case, as Minister of State for Health Balaji Sadasivan explained at a Newsradio's radio forum last year.

"We have strict patent laws and as a result only patented medicine is sold. And the costs of patented medicine is determined by the company that makes the medication. Generic drugs available in Thailand are very cheap and Singaporeans do go to Thailand to buy generic drugs as a result. But that's not because there's a big subsidy but because of patent laws."

Dr Lee agrees that the discrepancies in the pricing of HIV/AIDS medications are hard to fathom.

"Drug prices are a big mystery. The more you know, the more you don't know. One example, the price of polio vaccine which is manufactured in France and purchased by UNICEF and used for us in the field, is 11 US cents. The same vaccine, you have to pay maybe twenty or thirty dollars in a more advanced market. Exactly the same vaccine!"

But if you don't give the giant pharmaceutical companies their profits, they won't do the research.

On the other hand, when these companies recover their research costs through the retail price of their products, you deny the latest drugs to a sizable group of patients in developed economies.

How's that for a Catch-22 situation?

This is Chong Ching Liang for Newsradio 938.

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Related Links:

Newsradio 938 (now 938Live)
http://www.938live.sg/

UNAIDS
http://www.unaids.org/en/default.asp

Ministry of Health
http://www.moh.gov.sg/corp/about/newsroom/pressreleases/details.do?id=8519689

Action for AIDS
www.afa.org.sg