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.
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.'