The New Straits Times, May 21, 2000
By Prof Dzulkifli Abdul Razak
At the turn of the millennium, AIDS has firmly entrenched itself as one of the global killers. Since late 1970s, the total number of deaths due to the epidemic is estimated to be more than 16 million. Just over a million came from the Asia-Pacific region.
Today, May 21, is the day to honour the memory of those who lost their lives to AIDS. It is the International AIDS Memorial Day 2000 which is themed "Break the Silence: Honour Every Death, Value Every Life".
On this day too, we should show support for those living with HIV/AIDS and raise community awareness of HIV/AIDS. It is time to dispel myths about the much misunderstood disease so that those affected could continue to lead a life without having to wear a badge of shame.
AIDS is like an iceberg, with a small visible tip and a huge invisible base affecting millions. Thus, the number of cases of HIV infection worldwide will continue to rise above 50 million mark, as it stands to today.
Some 15 years ago, most of those who were sick with AIDS had no more than a couple of years to live. This is in part due to the lack of understanding of the disease, and thus the absence of an effective treatment. Since suffers are left with defective immune systems, they remain vulnerable to one serious health problem after another. Tuberculosis (TB) being one of them.
While many of such problems could be treated, and even cured, there are still no sufficiently effective treatment to beat the killer virus, HIV. The virus with its myriad of different strains and possible mutations, can develop resistance to drugs very quickly.
Many people who initially responded to drug combinations may stop responding because the virus has grown resistant to the drugs they are using.
AZT is one of the earlier drug used on HIV/AIDS patients giving slight impact. It was only in the last four years, when a set of powerful drugs called "protease inhibitors" was released that the picture of AIDS began to change somewhat significantly. The death rate began to decline at least in the US. New drug combinations are also being used to reduce the rate of new AIDS cases.
Of concern too are the side-effects and toxicities of current anti-HIV therapies. So the search for a better and safer treatment continues.
The success in developing countries are still far from impressive. Too many people with HIV/AIDS are not receiving proper treatment. Typically new anti-HIV treatments are far too expensive for use in the impoverished countries of the Third World. Ironically these are the places where the vast majority of the world's HIV infected people live. About two-thirds of all the HIV-positive people in the world are said to live in sub-Saharan Africa, but few of them have ever had an AIDS test.
Even among people who acknowledge having the disease, some governments have health budgets as little as US$10 (RM38) per person per year, and treatment programmes are impossible to carry out. Even in the US there are still people who cannot get the drugs they need because the price is prohibitive, according to Daniel Zingale, former executive director of AIDS Action. Most commonly, the triple-therapy "cocktails" used to suppress the replication of HIV, cost about US$15,000 or more a year.
Of late there seems to be a ray of hope. Just this week five drug companies have expressed interest in working with five international agencies, such as the World Health Organization (WHO), the World Bank, UNAIDS, the United Nations Children's Fund (UNICEF) and the United Nations Population Fund. They are supposed to negotiate cuts in the price of AIDS drugs for poor countries.
Gro Harlem Brundtland, the WHO director general, was quoted as saying, "The reality of poverty and the affordability of medical technology has led companies to think about their policies and postures".
Athough the joint negotiation is welcomed by many, generally it is met with caution by those who have long cried foul of the domineering tactics used by the pharmaceutical industry and some governments who have supported them.
Drug companies stand accused of ignoring dire suffering in places like Africa, which buys only 1 percent of the world's drugs. The companies seems to concentrate on drugs to cure less life-threatening problems like obesity, baldness and impotence among rich countries, who make up 80 percent of the world drug market.
So far only a British company has reduce the price of its HIV combination therapy by 85 per cent. The other four companies are yet to show their commitment. But cheaper drugs may not necessarily provide a quick fix for the epidemic.
In addition, distributing the drugs, showing people how to take them and monitoring levels of virus, T-cells and drug residues in the blood can be a daunting task.
For AIDS activists, the likes of those who protested at world trade conferences such as those in Seattle and Washington, they alleged that the move is a great public relations exercise which will have little effect on their profits. The Africans who could not afford their drugs before, would help to increase the drug sales volume and jack up profits.
Others argued that drug companies are lowering prices simply to forestall the seizure of their patents by Third World nations in dire need for the drugs. Thailand and South Africa have recently passed laws allowing such seizure; some such as India, Bangladesh and Brazil have drug industries that ignore patent treaties.
In Thailand, where there are nearly one million people who are HIV-positive, the Thai Law Society is helping people infected with the virus to prosecute their case against the US firm holding a patent for a new drug, didanosine (ddI). The lawyers argue that the product is not a "new innovation" as per the 1992 Patent Law, pointing to the availability of ddI in Thailand long before the US firm asked for the register of the patent in 1992 (Poison Control, NST, Dec 5, 1999).
They are contemplating to file the case in Intellectual Property Court in order to improve access to the new HIV/AIDS drug - by revoking the patent on the drug. The price for ddI is between 46 to 49 baht per 100-milligram tablet,and patients spend about 200 baht per day for the medicine. The daily minimum wage for workers in Bangkok is Bt162. The cost of drugs to treat AIDS currently exceeds 300,000 baht annually per person.
It is apparent therefore that AIDS as a global problem is still far away from being solved even though there are cures available. The complexity is attributed not only by the nature of the disease itself, but more so by the global economic imbalances between and among nations and the industries.
As we observed the International Memorial AIDS Day, many more will have to die, not so much there are no worthwhile treatments but more because they are still not accessible to those in need of them. Thus as advocated by this year's theme we need to "break the silence" in order to "value every life". We must reassert the fundamental rights of the global citizens in face with life-threatening situations such as that of HIV/AIDS.
Hopefully, in this way will we "honour every death".
Recommended AIDS sites: http://4aids.4anything.com/4/0,1001,169,00.html
