HEADLINES [click on headline to view story]:

Your Health & Happiness

The Doctor's Consultation 

Agony Column

Camera Class by Snapshot

Money Matters

Life in the Laugh Lane

Your Health & Happiness: AIDS drug access increasing in Asia and the Pacific

But future care needs daunting for region’s health systems

Recent progress in delivering antiretroviral (ARV) drugs to people living with HIV/AIDS in Asia and the Pacific has been impressive. But the 8.2 million people living with HIV in the region present a major future care need that national health systems are not ready to absorb in the coming years.

The ‘3 by 5’ target – to provide three million people in low- and middle-income countries with ARVs by the end of this year is providing an important impetus in the overall international efforts towards expanded access to care and treatment services.

The experiences reported during the recent 7th International Congress on AIDS in Asia and the Pacific, held in Kobe, Japan, provide further evidence that large-scale HIV treatment access is achievable, effective and increasingly affordable, even in the poorest and most challenging settings. At the same time, the challenges of expanding coverage beyond current levels and building sustainable systems to support it remain a significant challenge.

In Asia, the region with the second highest need for AIDS treatment, the number of people receiving ARVs has increased three-fold from 55,000 to 155,000 in the past 12 months. Despite this significant progress, the overall proportion of people in the region with advanced HIV infection receiving ARVs remains low, mirroring the global average of around 15%. That means that around one million Asians with HIV who would currently benefit from ARVs do not have access to them. The additional seven million people with HIV in the region – but who do not yet need ARV or other care options – will each inevitably reach the stage where they also require AIDS-related care services in the coming years.

“There is still a significant gap, and the three million target is likely not going to be achieved by the end of the year. But we have shown that the equation is still valid,” said Dr Jack Chow, assistant director general of the World Health Organization (WHO) and head of their HIV/AIDS, Tuberculosis and Malaria programme. “I think there is a profound opportunity to demonstrate in a creative way that if you introduce teams with educators, citizen leaders and journalists to educate the community in a variety of needs, the uptake will be high and rapid when the programme rolls in,” he added.

In India, the Asian country with the largest current and future AIDS care needs, around 65,000 people are taking ARVs. That leaves a further 700,000 for whom ARVs are out of reach. In Thailand, where the delivery of ARVs has been the most effective in the region, about 40% of those who would already need ARVs do not have them.

“We have given a promise to people that ARVs will be made available, and we are clearly not keeping up that promise,” said Dr NM Samuel, who runs the Department of Experimental Medicine and AIDS Research in Chennai, India. “If we are unable to provide ARVs on a regular basis to people who require them, can we then seriously think about alternatives, like ensuring prophylaxis and treatment for [HIV-related] opportunistic infections on a regular basis, or providing nutritional supplements. Or are we going to wait another three years for so many more people to die before these measures come into effect?”

The current gap in all kinds of HIV/AIDS care provision in the region represents a common failure to meet not just the 3 by 5 target, but the key goals agreed to by all governments in the Declaration of Commitment on HIV/AIDS during the UN General Assembly Special Session (UNGASS) in 2001. In that commitment, leaders from Asia and the Pacific promised, by 2005, to “…develop and make significant progress in implementing comprehensive [HIV/AIDS] care strategies … required to provide access to affordable medicines, including anti-retroviral drugs, diagnostics and related technologies, as well as quality medical, palliative and psychosocial care.” Once again, just one year ago, in July 2004, 38 governments from the region reiterated that commitment through a ministerial meeting and resulting statement titled Access for All: Political Accountability.

In the opening session of the ICAAP congress Dr Peter Piot, Executive director of the Joint United Nations Programme on HIV/AIDS drew attention to the lack of sufficient action to make these commitments a reality: “These figures show that the vast majority of countries are doing too little on AIDS overall and in particular on protecting and supporting those who are most at risk.”

In mid-2006 a comprehensive review of national performance against the specific targets of the UNGASS Declaration of Commitment on HIV/AIDS will be completed and the level of action on HIV/AIDS by all countries will be placed under a spotlight.

“The likely failure of 3 by 5 to reach its target is not just another missed target. It is an indictment of leaders in rich and poor countries that failed to back it and save the lives that needed saving,” said Leonard Okello, international HIV coordinator at ActionAid International, one of the African delegates attending the ICAAP congress. “The G8 meeting (had) the chance to correct this. They now need to give their backing to a target of universal access for all who need it by 2010 and make sure this happens,” he added.

The Doctor's Consultation: Averting bloodshed by groups

by Dr. Iain Corness

I received a very interesting email the other day, with threats of blood being let in the beer bars, so here is the (shortened) email, and my thoughts on it.

“Dear Dr. Iain, Is there a blood shortage for falangs? Is there a difference in falang blood and Thai blood? In the July 8th issue of the Bangkok Post Letters to the Editor section, under the headline of ‘Donating blood for a good cause,’ a falang tourist ‘Visited the Red Cross Thailand National Blood Centre and donated blood, primarily resulting from the urgent need, and public media call, to farangs to donate.’ He wrote that he became aware that there exists a constant short supply of specific blood groups in Thailand especially those which are carried by us Europeans/Westerners. After I read the letter to the editor, I cut it out and went to my favourite beer bar and talked about it with my friends. Well, Dr. Iain, you would never guess the huge fight the question ‘Is there a difference between falang blood and Thai blood?’ caused at the bar. Suddenly they were punching and scratching each other and rolling on the street outside the beer bar. It was something to see. John.”

I must admit that initially I thought this was a letter for Ms. Hillary, but on re-reading, I felt there were a few questions raised, which should be answered. This article will, I hope, answer all your questions, John.

Every time there is a disaster involving human life, a call goes out for donations. In Thailand, this usually means a call for Rhesus Negative blood group types.

Why is this so? Surely the blood collection agencies could just stock up in this type of blood? Unfortunately the answer is no. In fact it is impossible for Thai blood stocks to have enough Rhesus Negative blood for any disaster, major or minor.

The reason is simple. Blood groups, which are generally classified by the ABO system (so we are all either A, B, O or AB) differ in their distribution in the world. There are many reasons for this, including susceptibility to disease of various blood groups, population drifts, inter-marriage and others; however, the end result is that simplistically the Asian population has a different distribution of ABO groups from the Caucasian population; for example, Blood group B is far more predominant in the East than in the West.

When you look at one of the other blood typing systems, the Rhesus grouping into Positive or Negative, even greater disparities become apparent. The Asian population has very little Rhesus Negative (0.3 percent), compared to the Caucasians (15 percent). For interest, 50 percent of Basques are Rhesus Negative, one of the highest in the world.

Consequently, when there is a need for blood for a number of injured Caucasians in an Asian country, the chances of there being sufficient blood stocks are virtually nil. Taken to disaster proportions, when 30 percent of injured in the tsunami were visiting Caucasians, then you can understand the urgent need for Rhesus Negative donations.

If you are a farang resident in Thailand, please have your blood grouped and if you are Rhesus Negative, go on a register at the local Red Cross, or even the nearest large hospital, so that you can be called upon in emergencies. The Central Blood Register can be contacted at 02 259 7305.

Currently, post disaster (or ‘between disasters’) there is no shortage, but since blood does not keep ‘forever’ there will be times in the future when we will need Rhesus Negative blood, so don’t spill it in the streets, spill it at the Red Cross!

Agony Column

Camera Class: A fancy black shoebox - Is that all it is?

by Harry Flashman

The world is now ‘instant’ and electronic. We do not have to do anything other than push a button. Unfortunately, there is a tendency to think this about photography as well. All you have to do is find your subject and pop the shutter. Hey presto! The world’s best photograph is yours. Unfortunately, the blurb sheet that came with your camera will also give this impression, no matter how incorrect it is! After all, they wanted you to buy it, didn’t they?

You see, any camera, irrespective of how clever it is claimed to be, how advanced its electronics are, or even with its auto-programmed multi-phasic metering, it is still in the end, just a machine that lets light fall on unexposed film. A fancy black shoe box with a lens at the front and film at the back.

There are always times when the camera will get it all wrong, and this is more often than you would imagine. This is because it is a machine, so it can’t think. Even more, it cannot mind-read so it has absolutely no idea what is the most important subject in the clutter of objects in the shot you are taking. In fact, in the interim it is worthwhile, if you have an SLR, taking more frames with what you think to be the correct exposure, rather than just relying on the camera’s inbuilt electronic gizmos.

It works like this - taking a shot of your favourite girlfriend on the beach, for example (or your wife if the girlfriend is indisposed) - in working out the exposure settings, the camera takes a reading from the blue sky, the blue sea, the yellow sand, the red beach umbrella and finally from your subject’s face. It puts all of this information together, adds them up and divides by the number of readings and gets the average and applies that figure to the f stop (aperture) and shutter speed. Even blind Freddie can see that if the background is exceptionally bright, the camera will be influenced by this when averaging, and come up with the wrong exposure for the subject’s face - the reason for taking the shot in the first place. Remember once more, it cannot read your mind.

In these types of situations (and in Thailand with the bright sun, these situations often occur) the trick is to take the meter reading from the subject and ignore the rest of the items in the shot. In this example of the girl on the beach, walk in close and take the exposure reading directly from her face. With some cameras you can “lock” that exposure in - you should look for the AE-L facility, or just twiddle your dials manually till you get the correct aperture and shutter speed. Now go back and compose the shot, leaving the same aperture and shutter speed settings. Do not be alarmed that the camera will try and tell you that the exposure levels are wrong. It is “averaging” everything out, remember, and your picture is hopefully not “average”. You now also know what the correct settings are for your subject - you did it yourself!

For an interesting experiment this weekend, try taking the above shot on any beach or lakeside anywhere. Set the camera on Auto or Programme or whatever your model and make calls it. Take the shots. Now go and do it the ‘manual’ way I have described and see what differences you get. Setting things up the way you want will produce a better exposed photograph (for the important subject) than just relying on the camera manufacturer’s ideas on what you should have.

With the increasing complexity of modern cameras there is a tendency not to read through the instruction manuals properly. How many of you can honestly say you’ve read yours all the way through? Recently? Perhaps as another interesting experiment, you should first go to find the instruction book, and secondly, spend some time reading it and understanding the camera’s functions (and limitations). I still carry a very dog-eared manual for my Nikon in the camera bag. There’s always a time when you just might need it.

Money Matters: False profits?

Part 1

Alan Hall
MBMG International Ltd.

There are plenty of reasons to feel nervous right now about the global economy. There are even more reasons to distrust all those folks out there telling you not to worry, it’s all under control and although booms are normally followed by busts, this time will be different.

A few weeks back, we attended a presentation excellently organised by AustCham, featuring Saul Eslake, chief economist of ANZ Bank. Saul was extremely well-informed about the Aus economy (as you’d expect from a chief economist), extremely witty (as you might not expect from a chief economist) and eminently approachable. We particularly enjoyed his description of Asia funding US consumers’ purchases of imports as the greatest vendor financing scheme of all time (vendor financing is generally where manufacturers/distributors lend to their clients - who otherwise wouldn’t be able to secure sufficient credit - to allow the clients to buy their products or services in order to generate the profits to repay the loans. The vendors are happy to lend the money knowing full well that the profit margin on their goods and services ensures that, as long as the rate of default isn’t too extreme, the additional revenue generated will be sufficiently profitable to justify the whole process). Going forwards, Saul made the following assumptions:

- Oil and other commodities have peaked and will fall in price slightly over the next 2 years
- World economic growth will hold up at 4% per year for the next 2 years
- The Fed will continue to raise rates by 0.25% at frequent intervals, reaching 5% by mid 2006.
- The US$ will strengthen due to reduced interest rate differentials
- Asian central banks will resist revaluation of their currencies

He also believes that the Australian economy will avoid recession this time, mainly because he feels that every recession in Australia since WW II has been caused by politicians interfering in the sphere of economics and now that the Reserve Bank is not subject to political control, the bankers will avoid the mistakes made previously by the politicians. It would appear that Saul believes in Goldilocks, but no bears!

We have our own views on the Australian economy, which are available in a recently commissioned document, and these are rather more complicated than “The bankers are running the country so it’s ok this time.” We also feel that the global assumptions, including the existence of Goldilocks, are a very limited possibility (we do empirically know that bears exist) and probability indicates a much messier situation.

In a recent article on debt, we highlighted why we think that the US consumer simply can’t keep spending at current rates. Saul believes that while the US can keep borrowing, it can keep spending. His assumptions don’t allow for a significantly increased borrowing requirement, so with greater debt outstanding and higher interest rates, the sums just don’t add up. He does see a risk of US recession, but not until 2007 which he thinks would be the result of a downturn in China dampening global growth. At MBMG we’re usually drawn to outside the box thinking but this is more cart-in-front-of horse-thinking and the other way round is a far likelier scenario.

Meanwhile, Optimal Fund Management’s technical whiz, Cobus Kellerman, came up with a fairly startling piece of research last month (it’s taken us this long to fully get to grips with it, which is why it’s only appearing in a column now) and it’s probably way beyond the talking heads of CNBC, which is perhaps just one reason why they haven’t covered this at all.

Cobus analysed various statistical information from the S&P 500 since 1946 (the data from 1972-1997 and 1997-date were separated to ensure that current trends remain valid within historical precedents). He’d found himself becoming focused on the Dividend yield relative to 3 month and 10 year T-bills (generally pretty uninteresting stuff that has been raked over innumerable times). This time, however, he noticed something that hadn’t previously stood out. By categorising dividend yield payments into 4 types of categories, certain investment return characteristics became apparent. Cobus realized that one of 4 situations can happen:

- Dividend Yields can be above the net mean and can actually still be increasing
- They can be above the mean, but be falling
- They can be below the mean but rising
- They can be below the mean but falling

Grouped this way performance data for these periods is very consistent: as you’d probably expect below average and rising or above average and falling are the most common scenarios (just under 60% of the time since 1946 and just over that since 1972). Also, as you’d expect, when the yield starts to fall (whether from above average or below average) returns are negative, volatility is high and the Sharpe ratio (risk/reward co-efficient) turns very ugly.

Is this coincidence? Find out next week in part 2.

The above data and research was compiled from sources believed to be reliable. However, neither MBMG International Ltd nor its officers can accept any liability for any errors or omissions in the above article nor bear any responsibility for any losses achieved as a result of any actions taken or not taken as a consequence of reading the above article. For more information please contact Alan Hall on alan@mbmg-international.com

Life in the Laugh Lane: Match dot comedy (Chapter Two)

by Scott Jones

Last week we covered my dead end relationships in Hong Kong and Vietnam with women I met at Match dot com, an international online dating site. Those gentle experiences did not prepare me for the fervor of Thailand, where they love you before you arrive and are ready to devote their lives to you and their other boyfriends in several countries.

Match dot Thai Candidate Number One looks rosy on the website but the English in her emails is remedial. She definitely knows the words “can’t wait to see you, my love” though they are never in the right order. She and a friend meet me at the airport in Bangkok which, after two months in Vietnam, seems like I’ve come from the moon to the capital of the Earth. She still knows only seven English words, but her friend knows at least twice that many. My Thai consists of hello, goodbye, where’s the bathroom and a few numbers, probably never in the right order.

I am just trying to survive the day but they both seem ready to spend their lives with me. After three hours of dinner, passing my Thai-English dictionary back and forth to talk about nothing, and a tour of the Night Bizarre area where you can see women doing unnatural things with ping pong balls, I only want a solitary trip to Scottyland.

Suddenly they know more words like “no money, no taxi home, support my entire family, will you marry me tomorrow?” 500 baht sends the tour guides somewhere else, wherever. I remember the experience fondly as a Pair o’ Sites with Parasites.

The next day I arrive in Chiang Mai with great expectations of Match dot Beautiful Woman who speaks several languages and has an impressive marketing position. I am ready to devote my life to her. As she approaches me at the designated rendezvous, I am puzzled. The face doesn’t match the photos. I learn that the web shots were taken with her slim nose job that she has since been reversed. I respect her for returning to her original proboscis. (I’m trying to get back down to my original weight ... 6 pounds, 11 ounces.) But how many other reversals might there be in the future? (I imagine she’ll come home with a small arm fastened to her forehead, several ears, perhaps as a man once again.) Who knows? Whose nose?

I venture again to Bangkok for Match dot TryTryAgain who is very energetic, speaks great English and looks good in pictures. In person she never stops speaking, somehow eats vast amounts of food while orating and wears enough make-up for all the parasites in Bangkok. Her head looks like the soft clay bust I made in elementary school. Flying leaves and scraps of paper stick to her face as we approach an All-You-Can-Eat Buffet. (I imagine kissing her and leaving the deep impression of my nose in her cheek.) I am astonished at her mastodon appetite, though she’s still very thin. It must take immense energy to fuel her aerobic vocal ramblings. (I can’t get this limerick out of my mind: A bulimic sweetheart of mine, Was asked at what time she would dine, She replied at 11 .. .at 3, 5 and 7 ... at 8 and a quarter to 9.) I leave, but she’s probably still there today, masticating and chattering, as her face rubs off on the napkin.

Next week, the final chapter: Speechless in Chiang Mai.

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