Global Movements, Local Concerns: Medicine and Health in Southeast Asia

Chapter 9: HIV/AIDS Epidemic and the Politics of Access to Medicines in Thailand: A Study of the Health Impact of Globalization

HIV/AIDS Epidemic and the Politics of Access to Medicines in Thailand 171 CHAPTER 9 HIV/AIDS Epidemic and the Politics of Access to Medicines in Thailand: A Study of the Health Impact of Globalization Yu-Ling Huang Introduction The devastating HIV/AIDS epidemic is the most serious public health crisis of the 21st century.1 Following its catastrophic spread in sub-Saharan Africa, the infected population in South and Southeast Asia has rapidly increased since the late 1980s. It is estimated that there were 7.8 million people living with HIV/AIDS in this region in 2006, compared to 24.7 million in subSaharan Africa. Thailand is one of the most ravaged countries in Southeast Asia: in a nation with a population of 63 million, more than one million people are infected with HIV and, of those, more than 400,000 have died. Despite these horrifying numbers, Thailand is known for its successful prevention and treatment program, which has achieved impressive outcomes. Hundreds of journal articles and reports about HIV/AIDS in Thailand have been published in the past two decades, in an effort to depict and understand the emergence and processes of this epidemic. Researchers have followed the virus from Bangkok to northernmost Thailand, from urban areas to rural settings, from brothel to household. They have investigated the possible routes of HIV transmission: needles shared by those injecting drugs, homosexual and heterosexual sex, blood donation, childbirth and breastfeeding. They have also interviewed the higher-up decision-makers, public health officials, AIDS activists, owners of sex establishments, sex 171 172 Yu-Ling Huang workers and their clients, clients’ partners, injecting drug users, young men in the army, and even pregnant women. The scale and scope of the research suggests the complexity of this disease in Thailand. This chapter is one of the endeavors to explore the impact of HIV/AIDS on Thailand, a developing country in Southeast Asia, and how Thailand has responded to this life-threatening challenge. As a student of macrosociology , I bring the perspective of global political economy into the picture of HIV/AIDS in Thailand. This perspective complements the existing epidemiological, behavioral, and socio-cultural literature by shifting the focus from prevention to treatment, in particular to the availability and accessibility of HIV/AIDS drugs. The issue of access to lifesaving medicines is critical for at least two reasons. First, although antiretroviral (ARV) drugs are not a cure for people living with HIV/AIDS, they reduce the mortality and morbidity due to the illness and extend the length and quality of life, even helping people to return to their daily work and family life. As demonstrated by what has happened in North America and Western Europe, the introduction of ARV treatments has transformed the HIV/AIDS epidemic — the plague of the 20th century — from a death sentence into a chronic disease of the 21st century. Second, the accessibility of AIDS medicines reminds us of an important lesson from the history of medicine: biomedical advances do not evenly benefit everyone. Scholars have criticized the lack of access to medical innovations for AIDS patients with poor resources as an indication of the increasing gulf between two epidemics, one for the rich and one for the poor. In a low-and-middle-income country like Thailand, the cost of brandnew ARV medicines can eat up a large portion of household income. Before 2000, less than five percent of AIDS patients received ARV treatments from the public program. The Thai government and civil society have been struggling to ensure that more HIV-seropositive people receive these essential drugs. The campaign to increase access to ARV medicines demonstrates that the unavailability of lifesaving drugs should be understood beyond a national scope and be contextualized in the setting of the global political economy. It involves not only the Thai government and its people, but also many transnational actors, those involved in international trade policy, multinational pharmaceutical companies, transnational non-governmental organizations, and AIDS activists. As I argue in this chapter, the politics of access to HIV/AIDS medicines in Thailand is an illustration of the health impact of globalization. To understand such an issue at a global level is important because “how we conceptualise the epidemic will determine what sort of response we apply.”2 HIV/AIDS Epidemic and the Politics of Access to Medicines in Thailand 173 Because my research focuses on a contemporary phenomenon, my primary materials...