By Constanze Ruprecht
In late October 2010, a large group of people living in and around Mae Sot, Tak province were closing in on a terrible ‘milestone’ of sorts. All of 60 migrant children, women and men are living with HIV. They are taking antiretroviral (ARV) drugs which they needed to stay alive. Some were also co-infected with tuberculosis (TB). It is the most frequent opportunistic infection (OI) experienced by people living with HIV/AIDS (PLHIV).
Each group member’s daily regimen of drugs include one year ‘buffer’ provided by an international non-governmental organization (INGO) which is pulling its operations out of the country. It is about to run out with no new supplier in sight.
“We have been unable to secure a sustainable source of ARVs for our patients,” explains a staff of the Mae Tao Clinic, a clinic providing health care services to migrants and displaced people near the Thai-Burma border. “If they stop taking their medication, we face a crisis.”
Adherence to a prescribed ARV drug regimen is essential. People living with HIV and/or TB who stop taking medication for whatever reason, and even only for a few days, can develop a resistance. Drug-resistance is dangerous because it is irreversible and the new strains of the disease can be passed on to others.
Another often under-estimated problem accompanying drug resistance is the subsequent need for different drugs to replace the first regimen. These second- or third-line drugs are much more expensive and difficult to procure here in Thailand.
Thais living with HIV have the right to and usually receive free ARVs through the National Access to Antiretroviral Program for People living with HIV/AIDS, or NAPHA. People without a Thai ID can buy ARVs for a minimum of 1,350 baht per month.
Access is inevitably restricted for individuals or families already subject to the most dire of circumstances. Many migrants and displaced people along the Thai-Burma border live a day-to-day existence that may include a lack of food security and reliable shelter.
Given the existing obstacles to accessing adequate and appropriate treatment, it is not surprising that migrants may start with the TB six-month short course. But then despite doctor’s instructions, they stop taking the drugs once they feel better.
In a country that currently receives generous funding from the Global Fun to fight HIV/AIDS, TB and Malaria (GFATM), how is it possible we cannot manage to take care of our most vulnerable fellow humans?
Services and Gaps
A representative of the Thai Northern Network of People Living with HIV stated that “local hospitals do provide ARVs to migrants and displaced people as part of NAPHA’s extension programme, but they are bound by a quota system which always favours Thai citizens over unregistered migrants.”
Mae Tao Clinic already offers a number of relevant services for PLHIV, including voluntary counseling and testing (VCT), home-based care and peer educators. Relatively simple preventive approaches can also be applied in the context of TB-related services, such as face-masks and better ventilation in places where people go to get tested.
It seems that drug resistance is here to stay at least for now. The best response would include not only addressing the most immediate needs to mitigate impact but also introducing some longer-term measures.
In addition to the interventions mentioned above, anti-stigma and discrimination campaigns targeting Thai society would help PLHIV at all levels access existing ARV providers without fear of being socially outcast.
Also, “there seems to be little real interest among TB service providers to collaborate more with the HIV/AIDS sector,” an independent consultant supporting HIV/AIDS-related work at national and local levels in Thailand noted. “Because TB has for so long been considered ‘solved’ as a public health issue here, they do not have a sense of urgency.”
Well, it can’t get any more urgent for those people living with HIV/AIDS and TB here. They may soon become drug resistant due to apathy and ineffective programme design and interventions. Acknowledging and fully understanding the reality of this is acting decisively and comprehensively.(CNS)