Since the start of this month, a state-run pharmacy in northern Bangkok has been witnessing a two-fold increase in the number of patients seeking anti-HIV drugs.

Close to 20 patients with HIV are purchasing the drugs daily, according to sales clerks at this drug store. That is double the number of people with HIV who submitted doctors prescriptions for the anti-retroviral (ARV) drugs before.

Prior to April, this outlet that sells a range of drugs made by the Government Pharmaceutical Organisation (GPO) catered to about 10 HIV-positive persons every day. Even then, some patients would not buy the combination of three ARVs needed for the anti-Aids drugs cocktail.

Officials at the GPO are delighted at this increase in demand, since they view it as a healthy response to their initial effort to supply the countrys HIV/Aids patients with the worlds cheapest anti-Aids drug.

It means that more people can afford to buy the drugs than before, Wanchai Subhachaturus, deputy managing director at the GPO, says in an interview.

We had the poor HIV/Aids sufferers in mind. As a government body, it is our duty to help them without trying to make profits from patients.

The oval-shaped pill that the state drug-maker is marketing, called GPO-VIR, is sold for 20 baht (about US 45 cents) per tablet. According to the GPOs calculations, a monthly dosage for a patient afflicted with the deadly disease will amount to 1,200 baht (US$27)

In contrast, a monthly dosage of Aids drugs produced by the pharmaceutical giants in the industrialised world and sold in Thailand amount to 20,000 baht (US$450).

Anti-Aids drugs cocktail

Besides the price, what makes this new pill unique is that the GPO-VIR tablet is made of three drugs  Nevirapine, Lamviudine and Stavudine  that until now had to be consumed as part of the anti-Aids drugs cocktail.

Such drugs are the best available medicines to slow the production of HIV, which causes Aids.

For Wanchai, the GPO-VIR dosage will be easier for the patients, since it means they can now consume one tablet twice a day instead of following the dosage of three tablets in a drug cocktail twice a day.

The patients will find some convenience in this, he explains. Now they only have to do with two pills a day rather than six.

The GPO drug, now available in six of its outlets in this initial phase, is already winning applause from non-governmental quarters.

This is another victory for those fighting to make healthcare more affordable for HIV/Aids patients, says Dr Jiraporn Limpananont of the Drug Study Group, an independent research body in Bangkok.

The GPO deserves praise for providing such cheap drugs for Aids patients, she adds. The sick will be relieved, particularly the poor.

Worst in Thailand

When Aids was first detected in Asia in the 1980s, Thailand was among the worst affected countries. Close to one million people of the countys 60 million people are positive for HIV, and over 300,000 have died from the pandemic.

We have over 50,000 new HIV cases on an average every year, but some years it can be higher, says Dr Taweesap Sirapratasiri, director of the Aids division at Thailands Communicable Disease Control Department (CDC).

Until March, the CDC had a budget to help some 3,000 HIV patients go through a carefully monitored drug regimen. But Dr Taweesap expects the CDC to triple the number of patients in its AIDS care programme due to the advent of the GPOs latest drug.

CDC should be able to help about 9,000 patients a year, he confirms. According to our estimates at least 100,000 patients need the ARVs urgently.

The GPO, according to Wanchai, produced 120,000 tablets in its initial batch of GPO-VIR and added a further 200,000 by the second week of April. A further 600,000 will be to be available at outlets by late May.

Very soon we will have the capacity to produce 100,000 tablets aday, Wanchai explains. We have also begun working on another combination of three drugs.

For the GPO, which was set up over 60 years ago by the Thai government in order to produce cheap, reliable generic drugs for the countrys sick, the success with GPO-VIR is a high point in a 10-year journey.

In 1992, the GPO began research to develop a cheap generic drug for Thailands HIV sufferers. By 1995, the GPO was selling three-drug, anti-Aids cocktails for amounts ranging from 4,800 baht (US$107) to 6,000 baht (US$136) per patient for a month.

By the beginning of this year, each patient was paying around 2,500 baht (US$57) to buy a months dosage of the GPOs anti-Aids generics.

Recommended by doctors

Likewise, during the last decade, the GPO has succeeded in producing generic versions of 16 types of ARVs recommended by doctors to inhibit the spread of HIV in the body.

For health activists working for cheaper anti-Aids drugs in the developing world, particularly in Africa, where over 25 million people have HIV, the GPO has been an ally in the battle against the powerful pharmaceutical industry, which holds the patents for the drugs.

During the last 14 months, health activists and medical aid agencies have succeeded in forcing down the price of anti-Aids drugs for the worlds poor.

One breakthrough was in February last year, when Cipla, an Indian pharmaceutical company, agreed to sell generic anti-Aids drugs to African countries through the Paris-based medical aid agency Medecins Sans Frontieres (Doctors Without Borders).

Ciplas offer ranged from US$350 to US$600 for a years dosage for a patient. In contrast, the same combination of drugs sold in the United States by pharmaceutical firms that hold the patents to HIV/Aids drugs cost between US$10,000 to US$15,000 per year.

An equally significant moment in the push for cheaper drugs took place at the World Trade Organisations ministerial meeting in Doha, Qatar, in November. There, trade negotiators agreed that developing nations have the licence to produce or buy cheaper generic drugs to cope with pandemic, like Aids, devastating a country.

However, despite such pledges, there are lingering doubts on whether people living with HIV in the developing world will stand to gain from Thailands production of the worlds cheapest anti-Aids drugs.

The drug companies concerned have said they will challenge any attempt (by Thailand) to supply (GPO-VIR) to other afflicted countries, states a document by the Southeast Asia office of the British development agency Oxfam.