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Thai hospitals turning away HIV patients, say activists

Low-income patients bear brunt of medication shortages

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  • Ivan Fernandes, Bangkok
  • Thailand
  • July 31, 2014
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Some government hospitals in Bangkok are refusing treatment for low income Thais with HIV, patients and activists say.

"I went to the hospital but they told me they have no medication because I'm a gold card holder. I don't know what I'm going to do," a person with HIV told ucanews.com.

Thailand's complex health care system breaks patients down into three separate categories: civil servants, employees of private companies and all other Thai citizens. Thais from low-income families receive a "gold card" that allows them access to health care in their home districts. People with HIV who are gold card holders attend a government hospital and pay 30 baht (about US$1) to receive clinical services.

A recurring issue is that hospitals often run out of drugs for gold card patients. When they do, the hospitals close their books to gold card holders, even those with life threatening tuberculosis or HIV, health workers said.

The HIV Foundation Thailand, an independent, nonprofit organization that serves people vulnerable to HIV, has confirmed that in late July multiple hospitals across Bangkok told HIV patients that the antiretroviral drug Efavirenz, considered an essential component of HIV treatment by the World Health Organization (WHO), is not available.

Nikorn Chimkong, the foundation's executive director, said that delaying the ingestion of HIV drugs allows the virus to develop resistance to the medications, eventually limiting available treatment options.

"The Thai government has a universal health policy to be proud of. But these problems at points of care across Thailand are undermining our good intentions," Chimkong said.

A nurse at a local government hospital who spoke on condition of anonymity said that denial of care is happening across multiple government hospitals which impoverished people attend for free HIV treatment.

The nurse explained that the problem was caused by hospital pharmacists underestimating the number of patients with HIV and stock requirements.

"The problem is less about budget and more about poor stock management," she said.

Scott Berry, the foundation's regional adviser, said that the Thai health system may be creating an environment for drug resistant HIV to become a serious public health issue.

"Drug-resistant HIV can be transmitted to others, creating a potentially a new public health crisis in which available HIV drugs are ineffective for newly HIV diagnosed people," said Berry.

The foundation also has received reports that some clinical practitioners are giving false information about HIV treatment to justify turning patients away.

One patient reported that the pharmacist told him not to worry, that Efavirenz stays in the blood for up to two months. "But we know that's not true," Berry said.

The WHO reports nearly 520,000 people with HIV/AIDS in Thailand, making it the country with the largest adult HIV prevalence in Southeast Asia.

This figure does not necessarily include migrant or undocumented workers from neighboring countries.

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