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Asian patients get treatment but many still dying

Lifesaving antiretroviral therapy (ART), a standard treatment in developed countries, was so scarce that in 2003 less than 5 percent of the one million people in Asia who needed ART received the drugs.

india Updated: Nov 29, 2005 18:58 IST
Mangai Balasegaram (AFP)
Mangai Balasegaram (AFP)

A few years ago, providing treatment for AIDS patients was a low priority for many Asian governments. Treatment was considered too costly and, amidst a rising tide of new HIV infections, the focus rested on prevention programmes.

Lifesaving antiretroviral therapy (ART), a standard treatment in developed countries, was so scarce that in 2003 less than 5 percent of the one million people in Asia who needed ART received the drugs.

A combination of a few potent drugs, ART can dramatically improve the immune systems of AIDS patients. After ART emerged in the late 1990s, death rates of AIDS patients fell spectacularly in industrialized nations. But the drugs were prohibitively expensive for developing countries and required sophisticated diagnostic tools.

Now though, following a drop in drug prices and a two-year treatment campaign led by the World Health Organization (WHO), the global picture of AIDS treatment is changing. In some affected Asian nations, about a third or more of patients in need are now on ART.

"There's been a rapid scale-up. More than 50 poor countries in the world have more than doubled (ART) in the last 18 months," says Jim Yong-Kim, director of the HIV/AIDS unit at the headquarters of the World Health Organization (WHO) in Geneva, Switzerland.

In Asia, the number of people on ART almost tripled in the 12 months between June 2004 and June 2005 from 55,000 to 155,000.

In India, death rates among AIDS patients have fallen as more patients go on ART, following a 20-fold drop in generic antiretroviral drug prices in the last five years, says N. Kumarasamy, chief medical officer of the YRG Centre for AIDS Research and Education.

One study found AIDS-related deaths fell by 80 percent between 1997 and 2003. "We have done studies using these drugs and found they are safe, effective and tolerable."

However, WHO's ambitious target to get three million people in developing nations on ART by the end of 2005 will not be met. In June, only one million were on ART.

In an interview Monday with the BBC, the WHO's Kim said sorry for failing to save as many lives as planned.

"All we can do is apologise," he said. "I think we have to just admit we've not done enough and we started way too late."

But Kim said despite missing the target, the programme had not been a failure, as hundreds of thousands more people had been given access to lifesaving therapy.

Some countries are nevertheless racing to meet their own treatment targets set for the year end.

"There is a movement now and things will eventually accelerate. We have shown that treatment is possible, even in low-resource settings," says Michel Tailhades, a medical officer working on AIDS treatment in WHO's Western Pacific regional office in Manila.

Cambodia, which has the highest HIV infection-rate in Asia, now has 10,000 people on ART. This represents nearly 40 percent of all AIDS patients in need of treatment.

Thailand now offers ART to more than half of all people in need. China has gone from just 200 patients on ART in 2001 to nearly 20,000 today, while India now has 50,000 people on the treatment.

Shortage of medics
The numbers may represent a huge increase, but are still a fraction of those infected -- or dying.

India, for example, has an estimated five million infected people, according to the National AIDS Control Organization. This year, some half a million people died of AIDS in Asia alone. And with another one million people newly infected with HIV, the epidemic is still expanding.

The treatment drive has been hampered by the people -- or lack of them -- delivering drugs. Many Asian nations lack medical staff trained in HIV/AIDS. They also do not have strong public health systems to deliver treatment or have a secure drug supply. Funding is another perennial problem.

In many countries, the numbers of doctors and nurses trained to deliver HIV/AIDS treatment has barely increased, despite a burgeoning epidemic. A study last year found there was only one trained physician for every 11,000 people in Vietnam while China has just 200 trained doctors in the country. Indonesia, which UNAIDS warned this week was on the cusp of an epidemic, now has funding but lacks trained health staff.

Training programmes are now underway in many countries. Yet that may not be enough. In some cases, health workers are simply reluctant to specialize on AIDS. "People are still afraid of HIV," says Tailhades.

Adeeba Kamarulzaman, the head of infectious diseases in Universiti Malaya Medical Centre in Petaling Jaya, Malaysia, says she is constantly trying to recruit new doctors to the field.

"It's not popular with junior doctors. I've had people interested but their families discourage them," she says. "The discrimination is still there, even among doctors and nurses. There is still a lot of ignorance."

She adds that the common perception among health workers was that HIV patients will die quickly.

As AIDS is largely linked to public health care in Asia, it also does not draw doctors in the private sector or health workers who charge patient fees.

"The public health system is more or less private in some countries. Health workers have to fund their own cost recovery, so they may not see the benefits of HIV treatment," explains Tailhades.

To address this, the WHO is holding a meeting next year on incentives for HIV/AIDS health care workers.

"Incentives and remuneration are critical. Carefully calculated incentives can solve the problem," Kim says.

WHO has called for 100,000 more people to be trained and for community workers to deliver treatment. "If you effectively train them, they can manage most cases. Doctors can get the complicated cases," Kim says.

One thorny issue to be resolved is the drugs themselves. Plenty of cheap generic drugs are available in Asia - yet still not enough to meet current needs. Currently, the only viable manufacturer of raw materials is China while the major producer is India.

"China needs to scale up, but it is worried about being called a patent violator. This makes no sense because research-based pharmaceutical countries won't be able to supply all the needs," Kim says.

By 2010, some nine to 14 million people will need ART. "We'll have to get low-cost manufacturers involved then, in which case India and China will have a role to play," says Kim. By then, Asia may have the largest numbers of people on antiretroviral drugs.

First Published: Nov 30, 2003 20:21 IST