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ON THE ROAD TO BANGKOK: HIV IN THAILAND & ASIA—the latest information out today
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July 8, 2004
AIDS Drugs' Fast Rise in Asia Risks Resistant Strains
By LAWRENCE K. ALTMAN, NY Times
BANGKOK, July 7 - So many pharmaceutical companies in Asia are racing to produce anti-H.I.V. drugs, a leading AIDS organization is warning, that, on the continent, where the infection is rapidly spreading, widespread misuse could create epidemics from drug-resistant strains of the virus.
At least 27 Asian companies are manufacturing anti-H.I.V. drugs that are becoming increasingly available in Asia and elsewhere, the organization said. Yet anti-H.I.V. drugs from only three companies meet the World Health Organization's quality standards; those from the 24 other companies have not been reviewed by the organization or have not met its standards.
Most Asian countries have far too few doctors and health workers trained to properly prescribe the drugs and monitor their use for the continent's estimated 7.4 million infected people, the organization said.
The warning was in a report by Treat Asia, a network of clinics, hospitals and research institutions sponsored by the highly regarded American Foundation for AIDS Research in Manhattan.
A copy of the report was made available to The New York Times. The report is expected to be discussed in greater detail at the 15th International AIDS Conference, which begins here on Sunday.
Dr. Joep Lange, a Dutch scientist who is the president of the International AIDS Society and who read the report last week, said he was surprised by the findings.
"I didn't realize there were so many companies'' involved and that "the number of Asian doctors trained to treat AIDS is so frighteningly low," Dr. Lange said in an interview.
"We need to scale up training efforts quickly and develop a better mechanism for quality control of drugs," he said.
Advocates for AIDS patients and health officials have called for wider availability of lower cost generic anti-H.I.V. drugs to treat the world's 38 million infected people. Many Asian manufacturers are rushing to introduce generic drugs in advance of regulations that could affect the sale of those drugs, the report said.
But anti-H.I.V. drugs can vary in purity, potency and the way chemicals are combined. Without adequate quality control and careful supervision of care, the authorities say, the medications may be ineffective or create imbalances that pave the way for the virus to mutate, developing resistance. Two of the 27 manufacturers are in Thailand, where an estimated 84,000 people are not receiving antiretroviral treatment. But the Thai government has exported $3 million of H.I.V. drugs, the report said. Dr. Lange, the International AIDS Society president, said the percentage of infected Thai people receiving antiretroviral treatment was "strikingly low."
Thailand has one of Asia's most sophisticated health care systems, but only 100 doctors trained to treat AIDS, or about one doctor for every 6,700 H.I.V.-infected patients, the report said. Although Thailand has been a leader in preventing H.I.V., health officials fear that complacency is leading to a new wave of the epidemic.
"Our point is if there is proliferation of the generic drugs, as many are calling for, where is the infrastructure to deliver them?" said Kevin Robert Frost, a public health worker for Treat Asia in Bangkok and a co-author of the report.
"In Asia, the availability of drugs is far outstripping the capacity to deliver them," Mr. Frost said in an interview. Also, he said, "many questions linger about the relative safety and consistency of these drugs."
Treat Asia urged the creation of a regional database of generic manufacturers to help determine which drugs are available in each country.
China has fewer than 200 doctors trained to treat the estimated 840,000 people infected with H.I.V. Last year, China offered free treatment for 5,000 patients. But health workers handed patients pills without counseling. Within weeks, 20 percent to 40 percent of the patients stopped taking the drugs, Mr. Frost said. The combination of drugs used by the Chinese apparently led to a high rate of unwanted side effects, he said.
China "desperately needs to introduce a new combination of antiretroviral drugs," Mr. Frost said.
Elsewhere, "prescriptions from unqualified health care workers have left many people with little or no instruction on the safe and proper use of antiretroviral drugs" the report said, and "the consequences of widespread self-medication can be catastrophic."
"Wealthy Cambodians who know they are H.I.V. positive frequently self-medicate with antiretrovirals purchased over the counter," the report said.
Mr. Frost said that he began the study in the spring after seeing a spurt in the availability of generic drugs that had escaped the attention of most AIDS authorities and health officials.
Mr. Frost, a former advocate for people with AIDS who worked on AIDS research at New York University, said his team based its report on consultations with top health care officials in 15 Asian countries and interviews with dozens of officials in government, pharmaceutical companies and AIDS organizations. He described the report as the first systematic study of its kind.
Treat Asia's warning follows by a day a report from the United Nations that said that the incidence of H.I.V. in Asia in 2003 rose to the point where the continent now accounted for one in four of the world's new H.I.V. infections.
The Treat Asia report, which will be published on the organization's Web site (www.treatasia.org) beginning on Sunday, also follows a decision in June by the World Health Organization to drop two generic H.I.V. drugs from its list of approved treatments.
How devastating the epidemic of H.I.V. in Asia could become is a subject of debate. A report by the National Intelligence Council, a government, academic and private sector group, issued in 2002 said Asia's epidemic could grow to affect as many as 40 million people by 2010. Others have been less pessimistic in their predictions.
10 MILLION MORE ASIANS HIV-INFECTED BY 2010 UNLESS URGENT ACTION TAKEN, WARNS NEW REPORT
Bangkok, 8 July 2004 -- Countries in Asia and the Pacific region must urgently adopt comprehensive responses to HIV in order to avert a catastrophic increase in infections and drastic economic consequences, according to a new report released today by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Asian Development Bank (ADB).
The report, entitled Asia Pacific's Opportunity: Investing to Avert an HIV/AIDS Crisis, suggests that if prompt action is not taken, by the end of the decade 10 million more people from Asia and the Pacific could be infected with HIV and the economic costs of the virus could have risen to US$17.5 billion annually. The result would be millions more people thrown into poverty.
More than 7 million people are already living with HIV in Asia and the Pacific, with hundreds of thousands of people dying each year. Economic losses totaled US$7.3 billion in 2001. "The AIDS menace threatens to take a massive human toll in the region and jeopardizes efforts to achieve the UN Millennium Development Goal of cutting extreme poverty by half by 2015," said ADB Vice-President Geert van der Linden.
Resource needs to fight the disease are expected to reach at least US$5.1 billion per year between 2007 and 2010, the report says. However, in 2003, when the region's countries required US$ 1.5 billion to finance a comprehensive response, only US$200 million was available from all public sector sources, governments and donors combined.
The report stresses that regional leaders must give top priority to ending the enormous -- and increasing -- shortfall in finances required to build comprehensive prevention and care responses. In all but a few countries, private households have to bear some of the highest proportion of out-of-pocket spending on health in the world.
"Governments in Asia and the Pacific can still avert a massive increase in infections and deaths, limit economic losses and save millions of people from poverty if they are willing to finance comprehensive AIDS programmes," said Dr Peter Piot, UNAIDS Executive Director. "The role of political leadership is more critical at this point than ever before."
According to the UNAIDS/ADB report, if Asia Pacific leaders implement comprehensive prevention and care programmes immediately they can dramatically reduce the number of new infections and the cost of the epidemic in the region. They are at a 'make-or-break' stage in the fight against AIDS.
"Even in Thailand, which has a relatively strong response to HIV/AIDS, analysis suggests that between 2003 and 2015, the pandemic may slow poverty reduction annually by 38%, unless appropriate measures are taken" says Robert England, UN Resident Coordinator and Chair of the Theme Group on HIV/AIDS in Thailand. During the same period, poverty reduction could also be slowed by up to 60% a year in Cambodia and by nearly a quarter in India.
The ADB is making a concrete contribution to addressing the need in the region and has already earmarked US$140 million from its Asian Development Fund as grant money for combating HIV in Asia and the Pacific.
The Asian Development Bank is dedicated to reducing poverty in the Asia and Pacific region through pro-poor, sustainable economic growth, social development, and good governance. Established in 1966, it is owned by 63 member states - 45 from the region. In 2003, it approved loans and technical assistance worth US$6.1 billion and US$177 million, respectively.
For more information, please contact Dominique De Santis, UNAIDS, Geneva, mobile (+41 79) 254 6803 or (+661) 2500 882, or Graham Dwyer, ADB, (+63) 916 237 7328, email: gdwyer@adb.org. You may also visit the UNAIDS website, www.unaids.org, for more information about the programme.
Thailand Turning AIDS Crisis Around
By DENIS D. GRAY The Associated Press
BANGKOK, Thailand (AP) - When 15,000 delegates fly in for next week's international AIDS conference, they will be handed condoms at Bangkok's airport and highway toll booths. They will be offered drinks by prostitutes and mingle with children infected by the virus.
The man behind this work is Mechai Viravaidya, whose spicy promotional flare, grass-roots tactics and innovative thinking have proved critical in turning Thailand from an AIDS basket case into a success story.
In the 1980s, the nation of 63 million was judged on the verge of an AIDS explosion because of its vast sex industry. Four million people, it was then projected, would die by 2002.
The death toll so far is 400,000, and new cases have plummeted from a high of 142,000 in 1991 to about 19,000 per year now.
``There's been a huge change,'' says Mechai, ``But we still have to do more.''
But AIDS remains Thailand's top killer, with living victims numbering 600,000. And discrimination against the infected persists, he says.
And a United Nations report released Thursday said the country's improved track record is at risk because the government isn't confronting the high HIV infection rate among high risk groups such young people, gay men and injecting drug users.
``It is far too early to claim an emphatic victory against HIV/AIDS in Thailand,'' said the report by the United Nations Development Program, released ahead of the 15th International AIDS Conference beginning Sunday.
``Current prevention efforts do not measure up to the new realities of a shifting epidemic,'' it said.
Yet Mechai, who will co-chair the weeklong 160-nation International AIDS Conference starting Sunday, is positive, bubbling over with ideas. One of his latest: small loans to village business partnerships of AIDS sufferers and healthy Thais, in which the latter undertake to change attitudes toward AIDS in their communities.
``We believe HIV-positive people are bankable people,'' Mechai says. ``Loan repayment is higher than that of the fat cats who borrow in Bangkok.''
In the mid-1980s, after Thailand's first AIDS case was discovered, ``We did not allow any public information on government radio, television, no public education,'' Mechai recalls. ``It was terrible denial.''
Mechai was ready, having built up a countrywide network of dedicated workers and some 16,000 volunteers who were emerging victorious from another war - against a population explosion.
Using humor and vivid imagery to convey serious messages, Mechai and his Population and Community Development Association broke age-old taboos to promote family planning. They flooded the country with contraceptives and slogans such as ``too many children make you poor'' and ``only a dirty mind sees a condom as something dirty.''
Mechai soon had Buddhist monks blessing IUDs, teenagers competing in condom-blowing contests to the tune of the William Tell overture, and his clinics offering free vasectomies on national holidays. ``Mechai'' became a euphemism for ``condom.''
Annual population growth tumbled from 3.3 percent in the early 1970s to 1.8 percent in 1982, with the World Bank praising Thailand for one of the world's most successful birth control programs.
Mechai tackled AIDS with the same zeal and innovation, this time backed by political clout. In 1991, he was named to the Cabinet of Prime Minister Anand Panyarachun, and charged with coordinating AIDS prevention.
The effort got big funding, and every major institution was mobilized. Schoolchildren aged 9 and up were given AIDS education. Half a minute of every hour on national TV and radio stations was devoted to the issue.
Mechai's association pitched in, having built up a business arm which funds 70 percent of its spending. The ventures include grocery stores, for-profit medical clinics and a popular restaurant chain, Cabbages and Condoms, where diners are given after-dinner condoms.
``The Thai government was way ahead of other Asian governments, probably by about 10 years,'' he says. ``It shows that if you are serious about it you can win over AIDS. Not every individual, but society as a whole can win.''
Now 63, this Australian-educated son of Thai-Scottish parents is a member of the Thai senate and is approaching the AIDS conference in his city with characteristic showmanship. There will be a Miss Condom Universe contest, and lectures from prostitutes about AIDS prevention in their profession. ``They're a lot more worthy than a lot of MPs,'' says Mechai.
Asked how long he'll keep working for his causes, he replies with a laugh: ``I hope that at my funeral they offer free vasectomies.''
U.S. HIV/AIDS Official to Visit Vietnam
The Associated Press
HANOI, Vietnam (AP) - The U.S. government's point man on HIV/AIDS will examine how Vietnam is tackling the disease as it spreads from high-risk groups to the general population during a three-day trip to Hanoi, the Foreign Ministry said Thursday.
Global AIDS Coordinator Randall Tobias will meet with government officials and visit HIV/AIDS hospital wards, ministry spokesman Le Dung said.
The visit was arranged following President Bush's decision last month to include Vietnam on a list of 15 nations eligible for funding from America's $15 billion global AIDS plan, he said.
Tobias, who was scheduled to arrive late Thursday, will travel to Bangkok on Saturday for the 15th International AIDS Conference that begins the next day.
Bush announced last month that Vietnam would be the first country outside Africa and the Caribbean to be included in the five-year anti-AIDS plan unveiled last year. The decision was a surprise to some, given that India and China have much higher numbers of infected patients. It has not been determined how much funding Vietnam will receive.
Washington defended its decision to include Vietnam, saying it felt the money could make a difference in a nation where AIDS is on the brink of becoming an epidemic and where it predicts the number of cases will rise to 1 million by 2010.
Tobias will meet with Minister of Health Tran Thi Trung Chien and Deputy Prime Minister Pham Gia Khiem during his visit.
Vietnam has recorded a total of 81,206 HIV-positive cases, of which 12,684 have developed full-blown AIDS and 7,208 have died of the disease, according to the Ministry of Health.
However, health officials admit the actual number of HIV carriers is probably closer to 200,000.
Most of Vietnam's HIV/AIDS cases have been among intravenous drug users and sex workers, but the United Nations says new infections have started to appear in the general population.
Vietnam Braces for 2nd Wave of Bird Flu
The Associated Press
HANOI, Vietnam (AP) - As China and Thailand grapple with fresh bird flu outbreaks, Vietnam is bracing for the possible resurgence of the disease that killed 16 people here earlier this year, an official said Thursday.
China and Thailand undertook massive poultry culls this week after both countries confirmed fresh bird flu outbreaks.
Small, sporadic outbreaks have been reported in six Vietnamese provinces over the past three months, forcing the cull of 10,000 birds. But lab tests have yet to confirm the strain of the virus.
Vietnam on Thursday stood by its decision to declare itself bird-flu free in March when it received criticism from United Nations' health and agriculture officials who warned the announcement was premature and that the virus would likely return.
``I think our decision was correct,'' said Foreign Ministry spokesman Le Dung.
Also on Thursday, Hoang Van Nam of the Veterinary Department said 1,356 poultry samples have tested positive for avian flu out of 13,048 samples analyzed since April.
Farmers in Bac Lieu province, where more than 5,000 chickens from three farms died in an outbreak last month, were warned by provincial health officials not to travel outside their villages for 10 days after the cull.
In China, officials suspect that waterfowl or migrating birds visiting a lake in Anhui province might be spreading the disease, China's Xinhua News Agency reported.
No human cases have surfaced so far in the latest wave of cases in Vietnam, Thursday's Thanh Nien (Young People) newspaper quoted Trinh Quan Huan, director of the Department for Preventative Medicine and HIV/AIDS Control and Prevention as saying.
The Health Ministry, however, has instructed local governments to apply measures to protect people who come in contact with poultry and maintain environmental hygiene, he said.
Huan said hospitals designated to treat bird flu victims in February when the disease jumped from birds to people, killing 16, were also ready to receive and treat new victims.
Local governments in the Mekong Delta have been ordered to inspect poultry farms twice a week to monitor for any new outbreak of the disease.
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