International Gay and Lesbian Human Rights Commission

SUMMARY

On November 30, the day before World AIDS Day, about one thousand Thai people living with HIV/AIDS and their allies will descend on the Parliament House in Bangkok to demand equal treatment under the new universal health care plan, which currently provides coverage for treatment of every disease --except chronic renal failure and HIV/AIDS.

The Ministry of Public Health (MOPH) promised to include AIDS drugs if the monthly cost of production were below 2,500 Thai Baht (THB) per regimen. (US$55). Even though the Government Pharmaceutical Organization (GPO) announced last month it could produce regimens for 2,310 Baht/month, the MOPH has resisted inclusion of anti-retroviral drugs in the universal health coverage plan. Activists intend to stay at the Parliament until an outcome that respects their dignity, right to life and health, and equality is achieved.

ACTION

The International Gay and Lesbian Human Rights Commission (IGLHRC), together with the Thai Network of People Living with HIV/AIDS (TNP+) and the Thai NGO Coalition On AIDS (TNCA), asks for urgent letters to the Prime Minister and Minister of Public Health. We demand that the Thai government fulfill its promise to include AIDS drugs under the universalized health care plan and immediately increase the AIDS treatment budget and step up provision of domestically produced generic anti-retrovirals.

Please write to:

Prime Minister Thaksin Shinawatra
Office of the Prime Minister
Government House
Thanon Nakhon Pathom
Bangkok 10300
THAILAND
Phone: +66-2-280-3777, 280-8874
Fax: +66-2-280-1443

Ms. Sudarat Keyuraphan
Minister of Public Health
Ministry of Public Health
Tiwanond Road, Nonthaburi 11000
Thailand
Phone: +66-2-590-2057
Fax: +66-2-590-2028

Please send a copy of your letters to:

Paisan Tan-Ud, Chairman, TNP+
C/o Alden House
1051 Soi Charan 46
Charansanitwong Rd.
Khwangbangyeekhan
Bangplad, Bangkok 10700
THAILAND
Phone: +66-2-883-0226
Fax: +66-2-434-7578 (call first)
E-mail: ott1@ksc.th.com

Mr. Promboon, Thai National Coalition on HIV/AIDS
801/21 Ngamwon Rd.
Nonthaburi 11000
THAILAND
Phone: +66-2-953-5355, 5356
Fax: +66-2-952-5180
E-mail: tnca@ksc.th.com

Medecins Sans Frontieres - Belgium
311 Ratchapongsa, Ladphrao 101
Wangtonglang, Bangkok 10240
THAILAND
Phone: +66-2-375-6491, +66-1-838-4233 (mobile)
Fax: +66-2-374-9835
E-mail: msfdrugs@asianet.co.th

Note: If you have no time or have difficulty sending faxes/letters to the authorities themselves, please send them to TNP+ or MSF and they will forward them.

SAMPLE LETTER

Dear Honorable (Prime) Minister,

We congratulate you on your commitment to expand access to essential health care to all people living in Thailand through the new 30-Baht Health Care Plan. We are outraged, however, that people living with HIV/AIDS are being singled out as a group that cannot benefit from this plan, although AIDS is the leading cause of death in Thailand. We request that you demonstrate your commitment to protecting and promoting the health and lives of people living with HIV/AIDS by immediately taking steps to increase the AIDS budget and include anti-retroviral therapy under the 30-Baht Health Care Plan.

Access to essential drugs is a part of the human right to health. Article 25 of the Universal Declaration of Human Rights (UDHR) affirms that "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family," and stipulates the right to medical care as an aspect of this right. In 1999, Thailand ratified the International Covenant on Economic, Social, and Cultural Rights (ICESCR), and in doing so acknowledged its obligation to uphold the principles enshrined in it. Article 12 of the ICESCR recognizes "the right of everyone to the enjoyment of the highest available standard of mental and physical health." It mandates States, among other steps, to take necessary measures for the "prevention, treatment, and control of epidemic, endemic, occupational and other diseases," as well as to create "conditions which would assure to all medical service and medical attention in the event of sickness."

Science and practice show that anti-retroviral medications greatly reduce the incidence of opportunistic infections and subsequent hospital admissions, and death. HIV/AIDS therapy can reinvigorate prevention efforts, lessen stigma, and improve the demand for HIV testing. In Brazil, Europe, and the United States anti-retrovirals have turned HIV/AIDS into a manageable chronic infection, providing confirmation of their cost-effectiveness. Treatment keeps people alive and productive longer, including prolonging parents' lives so that they can raise their own children. Most of all, as South African AIDS activists have noted, a lack of HIV/AIDS treatment undermines one's aspirations to freedom, equality and dignity.

Denying access to life-saving AIDS medications to the hundreds of thousands of people who need them now is an abrogation of both domestic and international law. International human rights law guarantees freedom from discrimination on any ground, including health status. According to the Thai Constitution, there shall be no unjust discrimination against a person on the grounds of the difference in health condition. The Constitution also provides that "a person shall enjoy an equal right" to receive health services. Thailand's National Plan for Prevention and Alleviation of HIV/AIDS also prohibits all forms of discrimination against HIV infected people. Thailand's Eighth National Economic and Social Development Plan calls on the government to "promote more comprehensive delivery of health care and health services for people living with HIV/AIDS."

The UN International Guidelines on HIV/AIDS and Human Rights call on governments and communities to confront difficult issues with a sense of urgency, underlining the universality and indivisibility of human rights. On treatment, they say "the human rights obligations of States to prevent discrimination and to assure medical service and medical attention for everyone in the event of sickness require States to ensure that no one is discriminated against in the health-care setting on the basis of their HIV status."

The Thai government, as signatory to the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) Declaration of Commitment (2001), recognizes that "access to medication in the context of pandemics such as HIV/AIDS is one of the fundamental elements to achieve progressively the full realization of the right of everyone to enjoyment of the highest attainable standard of physical and mental health."

Governments play a vital role in achieving universal access to essential drugs. The Thai government has shown in the past that political will is a key to successfully addressing the epidemic. We therefore encourage you to work with the key stakeholders in this treatment access movement, Thai people living with HIV/AIDS themselves. Thai AIDS activists have taken initiative to express their commitment to working with the government to improve its capacity to treat. We stand in solidarity with Paisan Tan-Ud, chairman of the Thai Network of People Living with HIV/AIDS (TNP+), when he says that all people should be treated equally, regardless of the type of illness they suffer, and that there should be no exemption for any disease under the universal health plan nor should cost be the deciding factor.

You have the power and authority to immediately expand your public health and AIDS budget and the availability of quality life-saving generic AIDS drugs. We hope that your government will choose to fulfill its human rights obligations by creating the conditions in which people with HIV/AIDS in Thailand can exercise all their rights, freely, fully, and equally.

Yours Sincerely,

BACKGROUND

In Thailand, 1 in 60 people, or approximately 1 million people are infected with HIV. It has the 15th largest number of HIV-infected people in the world, and there are approximately 30,000 new infections every year; 4,200 are children.

In October 2001, the Thai Government Pharmaceutical Organization (GPO), which produces generic versions of essential anti-retrovirals including AZT, ddI, d4T, 3TC and Nevirapine, announced it would reduce the monthly cost of its anti-retroviral medications from 5,000 Baht (US$112) to 2,500 Baht (US$ 55) by December 2001. Earlier this year, the Minister of Public Health had announced that, according to government policy, once the cost of producing anti-retroviral medication prices dropped below 2,500 Baht the new universalized health care scheme would provide coverage for these drugs. Activists, however, are dissatisfied with the reticence of the government to enact this policy since the price reduction was announced.

The Thai government currently provides AIDS medications to approximately 3,000 people. Recently, Thongchai Tavichachart, director of the GPO, said he expected to have the capacity to serve the needs of 50,000 patients by the end of 2001 and next year could supply at least 100,000. Yet the government has until now made no definite move to expand access.

The Thai national budget for 2002 is 100,000 million Baht, with 1,000 million devoted to HIV/AIDS-related programs. In 2001, HIV/AIDS-related programs received 1,500 million Baht; this year's reduction is attributed to the fact that the new universal health coverage policy includes prophylaxis and treatment for opportunistic infections. In 2002, 250 million Baht will be spent on anti-retroviral treatment; this past year, the budget was 240 million Baht.

The Thai Network of People Living with HIV/AIDS (TNP+) is one of the strongest HIV/AIDS support and advocacy bodies in the Asia/Pacific Islands region, with membership comprising over 460 groups across the country. Working in coalition with non-government AIDS organizations and other allies, TNP+ has been advocating for universal treatment access for people living with HIV/AIDS since the current administration, led by the Thai Rak Thai party, came into power in 1997.

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Thailand to include AIDS treatment in subsidized state health care plan By UAMDAO NOIKORN Associated Press Writer

11/30/2001 Associated Press Newswires Copyright 2001. The Associated Press. All Rights Reserved.

BANGKOK, Thailand (AP) - Thailand's government on Friday bowed to AIDS patients' demands to provide them treatment under a government program that offers medicare for 30 baht (70 U.S. cents) per hospital visit.

Addressing about 300 HIV patients protesting in front of the government headquarters, Public Health Minister Sudarat Keyurapan said the government has decided in principle to put AIDS treatment in the medicare program next year.

The announcement is a triumph for 1 million Thais suffering from HIV or AIDS, who have campaigned for government medical help since the 30-baht program was launched April 1. The program will initially cover those showing symptoms of the disease.

The plan, one of Prime Minister Thaksin Shinawatra's nine populist promises that won him a landslide victory in January elections, began April 1 as a pilot project in six provinces and went nationwide in October.

It aims to cover 46.6 million of Thailand's 62 million people who have no private health insurance. The program's beneficiaries pay 30 baht (70 cents) every time they visit a hospital to be eligible for consultation, treatment and medicines for almost every disease except AIDS and kidney dialysis.

"We're very happy that the government finally looked at our plight," said Paisal Tan-Utra, president of Thai Network for People Living with HIV and AIDS.

A working committee comprising all parties concerned would be set up to oversee the progress. The first talks are expected to start next month or in January, Paisal said.

His group is staging an all-day rally with activities in front of Government House to mark World AIDS Day on Saturday.

Paisal said the government bowed to the demand after talks between the representatives of the protesters and minister Sudarat, who was accompanied by the heads of the Communicable Disease Control Department and the Government Pharmaceutical Organization.

Sudarat said the ministry would double the anti-AIDS budget to 500 million baht (dlrs 11 million) next year. Under the deal, each patient would receive the locally made AIDS cocktail drug worth 2,310 baht (dlrs 52) every month.

"The budget could cover about 6,000 to 7,000 AIDS patients and the rest would join soon," said Sudarat.

At present, most HIV-positive people are left untreated as they cannot afford the drugs despite the government's effort to cut costs by producing some of the cheapest ones locally.

Thailand is credited with bringing down the rate of HIV/AIDS infection by 80 percent after a massive awareness and condom distribution campaign in the early 1990s. ientation, gender identity, or HIV status.