Official Bank Sites Related Information August 16, 2006—Fifteen years ago, Thailand was on the verge of a major AIDS epidemic. A small number of annual HIV infections in the late ‘80s had grown to 143,000 by 1991. The disease was spreading rapidly from injecting drug users and commercial sex workers to their sex partners and families. Then, the Thai government made a crucial investment in the future. It launched a massive public health campaign, spending $434 million in the 1990s to enforce condom use in brothels and warn of the dangers of unprotected sex in schools, mass media, and the workplace. It was a move that probably prevented more than 6.7 million people from becoming infected with HIV by 2005 and will save as much as US$18.6 billion in treatment costs by 2012, says a new report by the World Bank and the Government of Thailand. Cause for Hope in Burkina Faso
Once fewer than 1,000 people in the country could get AIDS drugs. Today, thousands have access through a pilot program as infections start to decline in urban areas. Read more >> And these successful prevention efforts allowed Thailand to become one of the few developing countries giving life-prolonging antiretroviral therapy (ART) to people living with HIV, according to “The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand,” released August 16 at the International AIDS Conference in Toronto, Canada and co-authored by a team including Bank staff and Dr. Sombat Thanprasertsuk of the Thai ministry of health. Antiretroviral therapy consists of combinations of drugs that slow the growth of HIV in the body, even to the point of making a patient significantly less infectious. Antiretroviral (ARV) drugs are not a cure and must be taken life-long. But ART may prevent people from becoming ill for many years, allowing them to lead near-normal lives. In the past, ARV drugs were too expensive to be affordable in developing countries. But lower prices for some of the drugs are making treatment possible for a greater number of people. Still, though 6.8 million worldwide could immediately benefit from ART, only about a quarter of those who need it can get it, according to the World Health Organization (WHO). In low- and middle-income countries, just over 1.6 million persons were receiving antiretroviral therapy at the end of June 2006, WHO says. Thailand, with financial assistance from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, currently provides ART as standard treatment for 80,000 Thais--more than 90 percent of those who need it—“a remarkable achievement,” notes the report. The report credits in part the availability of a domestically produced triple drug combination, GPO-vir, a “first line” treatment that costs about US$30 per month per patient. First-line treatment currently works for most patients, and cheaper ART has opened the door for many people who could previously not afford ART or have access to it. But the report also notes that it would have been a lot more difficult for Thailand to offer ART had it not waged its successful prevention campaign in the 1990s. Without it, Thailand would have had 14 times the HIV and AIDS cases it has today. For every dollar Thailand spent on prevention in the ‘90s, it has saved US$43 in treatment cost over the next decade, estimates the report. “It is doubtful that any other Thai government investment achieved such a high benefit-cost ratio,” the report says. It adds that countries such as India and China, where the HIV/AIDS epidemic is at an earlier stage, “should be aware of the high return to HIV/AIDS prevention campaigns” when making allocations of their government budgets. The report estimates that without the prevention campaign 7.7 million Thais would now be infected with HIV, and 850,000 would have AIDS. Instead, the total number of HIV infections since Thailand’s first case in 1984 stands at about 1 million. In 2004, there were 572,500 HIV cases, with about 50,000 expected to develop serious AIDS-related illness over the next year. New HIV infections were expected to amount to 19,500, down from 143,000 in 1990. The report concludes that Thailand’s ART program, in its current form, “has good prospects” for remaining affordable in future, even as 10,000 to 20,000 new cases are added each year. But greater future needs for more expensive “second line” ART—used when first line treatment does not work or stops working—could pose challenges, the report says. And the report estimates that continuing to support existing ART patients for the rest of their lives and absorbing new ones while maintaining other health programs will require a 20 percent increase in the total health budget by 2013. But the biggest challenge for Thai health policy makers will be to “resist complacency.” “Although HIV prevalence rates have come down dramatically since the mid 1990s, the HIV/AIDS crisis in Thailand is far from over,” warns the report. “With a large number of people infected with HIV, the potential for the epidemic to spread if prevention efforts are relaxed is considerable.” |
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