A local charity also supplements her income, bringing it to a total of 23 000 Bath a month. Still, over a third of the household budget is spent on ice. “My husband died of AIDS before ARVs where available in Thailand and I’m alone to provide for the whole family. Buying the ice is expensive and I could really spend this money on other things” she stresses.

But asked if she sometimes fails to buy the ice and a sparkle flickers in her eyes. She knows that properly storing the drug is critical to adherence to her treatment and if she or her son came to develop resistance to this treatment, there would be few other alternatives.

“I’ve always bought the ice!” she insists “But sometimes water gets in the bottle and the pills get damp” she worries.

Such licenses are fully compliant with the World Trade Organisation’s international trade rules and allow developing countries to import or produce generic versions of a drug otherwise unaffordable. This is a right that Thailand is ready to enforce in order to provide this life saving drug for free to the estimated 10,000 people who will need second line drugs in the coming years. 

At its original price, the ministry of health said it had only a budget for 2,000 patients. The move has infuriated Abbott which has since exerted constant pressure on Thailand to revoke its decision and has even made this a condition to the registration of Aluvia. 

Thailand’s commitment to make ARVs available for free to all, has received international praise. Around 100,000 people are currently given first line ARV treatment, thanks to generic copies produced by the state-owned Government Pharmaceutical Organisation (GPO). Yet, today the country finds itself embroiled in a bitter dispute with powerful pharmaceutical lobby groups ready to put patient’s lives at risk to protect their commercial interests. The Thai ministry of health has repeatedly been obliged to justify its lawful decision to provide access to lifesaving drugs to the poorest fringe of society. Abbott spends endless energy hampering and delaying efforts to produce affordable versions of this key AIDS drug to those who need it in Thailand. In the meantime, many are waiting for life saving drugs to be made available. Until then, they will continue to pay the price for the greed of some pharmaceutical companies.

Patient portraits

Somying, 33 year old – mother of two, on Kaletra for 3 months  

Somying realised she was HIV positive eleven years ago during a routine check up at her local clinic, while she was pregnant with her youngest child. “It was such a shock! ARVs were not available in Thailand at the time and the doctors told me my baby would have a 50% chance of being infected,” she remembers.

The baby was spared but her oldest child Amorn whose health had always been fragile was diagnosed with HIV. At the time, her husband a local painter, refused to get tested. He died of AIDS shortly after, leaving her alone to care for the whole family. Her health fluctuated until she became too sick to work. Scared that her prolonged absence would raise suspicion on her status Somying left the sausage factory where she had been working as a cleaner. 

In 2000 she became one of the first Médecins Sans Frontières’s patients to be put on ARVs. She was then switched to the national health scheme when the ministry started providing ARVs through its universal access programme. But seven years later she’s become resistant to first line drugs. She’s now, one of the few who receive Kaletra for free from the ministry of health. “I hope the government can soon afford to put many more people like me on this treatment,” she says “I know many people are waiting and need it to it to stay alive.”

Amorn, 13 year old – Somying’s son, on Kaletra for 4 months

Amorn is a lightly built, fragile looking boy. His emaciated face bears slight marks, remnants of the side effects he developed to his first line AIDS treatment. Amorn looks a bit too short and skinny for his age. You could easily feel there was something wrong with him and that’s precisely what drove him out of school for 7 years. “His teacher asked him about the marks on his arms, and when he said it was an allergy, the teacher said “you’re lying you’ve got AIDS, don’t get near me” remembers his mum “He simply refused to go back after that.”

But the shy teenager is back on the right track now. Thanks to Kaletra he’s started gaining weight again, and hopes to catch up on all the education he’s missed out on, and finally learn to read and write properly. Amorn became resistant to his first line treatment four months ago, just before his mother. They now both receive the drug for free through the national health scheme.

“I really thought he wouldn’t make it, but now he’s much better,” stresses his mother. Amorn’s blue and white school uniform is paid for by a local charity and so is the rent of the house they live in. The family is too poor to afford a refrigerator and has to spend a third of their monthly household budget on ice to make sure Kaletra is kept at the necessary cool temperature. “Buying the ice is expensive,” says Amorn who goes with his mother to the ice vendor every day. “it would be nice not to have to spend so much money on ice so we can buy other things.”

Somchai, 31 year old – receives Kaletra for free through Médecins Sans Frontières

When Somchai from Kalasin in northeast Thailand realised he was HIV positive he just couldn’t believe it. He was working in a factory in Bangkok at the time and felt strong and healthy. But then he developed herpes zoster, a painful skin condition, his girlfriend left him and his health further deteriorated until he was no longer able to work. He finally decided to go back to Kalasin where his mother could take care of him.

Only when he started ARVs did he regain hope of a better life. As he grew stronger he took on a new job. Five years went by before he relapsed and the doctor broke the terrible news. He was no longer responding to his drugs. “I felt totally devastated. I was so sick at the time I thought I wouldn’t make it. I couldn’t stand or even sleep.”

Somchai is not one of the few patients who receive the drug for free through the national health system. Médecins Sans Frontières provides him his monthly supply of Kaletra instead. Somchai hasn’t been able to get back to work yet. He goes fishing, and sells eggs from his mother’s ducks making an average of 120 baht a day to be split between his sister and his mother. “I’m too poor to pay for the drugs myself and even if it was 500 baht, I still wouldn’t be able to afford it”he says “I hope the government will soon be able to provide the drug for free to all those who need it, so that people like me can go back to work”