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
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
The Doctor's Consultation: Averting bloodshed
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
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!
You’re always telling us guys that we should be looking for nice Thai
girls and stay away from the bars, but you don’t say what to do when you
actually find one of these women. I have found a really nice lady in one
of the shopping centers working in the glasses shop and she is really
sweet. I had been in a few times because of problems with my eye glasses
and she always fixed them up for me for no charge. So how do I get fixed
up with her? She seems interested, speaks English, but where from here?
What are you males coming to? Just what do you want me to do, my Petal? Am
I supposed to take you down to the glasses shop and ask her for her hand
in betrothal for you? What would you do in your own country? You would
pluck up the courage and ask her if she would like to go to a party, or
the movies, or for dinner or whatever. She would then consider her options
and say yes or no. Don’t be such a wimp, Goggles. Faint heart ne’er
won a fair lady, goes the old proverb. Right now you appear to be Sir
Chickenheart, rather than Sir Galahad. Go ahead and just do it, as the
sportswear manufacturer suggests. Just don’t offer to buy her a house,
five baht of gold, a motorcycle and a new buffalo for Poppa on the first
date, that’s a good little Goggles.
I have an embarrassing little problem that maybe you can help me with. It
is in the old man downstairs, if you know what I mean, who seems to have
become lazy over the last few months. I don’t want to go to see a doctor
in one of the clinics near here, because I know the reception lady knows a
lot of my friends, but the problem seems to be getting worse. Can I just
get something from the pharmacy to get the lead back in the pencil?
Before you try the pencil sharpener, there is much you can do to get
yourself over this pencil problem. You are heading in the right direction
when you mention local doctors, but if you are too shy or worried that the
receptionist will go running to all your friends, then what about one of
the large hospital clinics? You can be anonymous there very easily. If you
have a medical problem, then go to the doctor. If you have a champagne and
chocolate problem, then you come to Hillary. It’s that easy, Petal.
You seem to have a regular ‘client’ using the name of Mighty Mouse who
writes in every couple of weeks. He seems to fall in love with someone new
all the time. Have you met him? Is he for real? Surely there aren’t
people that easily won over these days? Be interested to know what your
take is, Hillary.
Felix the Cat
Do I detect just a touch of envy, Felix? Do you have green eyes too?
Felix, like the woman reporter in America who went to jail because she
would not name her confidential sources of information, Hillary also
cannot divulge the kind of information you are looking for, though I doubt
if I’d go to jail for Mighty Mouse, unless I was promised unlimited
Veuve Clicquot (vintage, Petal, vintage) champagne and Belgian chocolates.
Even then, I don’t think I’d last too long. The local monkey house is
not known for its five star accommodation. No Felix, just accept the fact
that Mighty Mouse does exist, is real, does write in and maybe, just
maybe, does fall in love with anything in a skirt, or if I am to believe
everything he says, anything without a skirt is even better.
I have an estate in the UK, where I live for six months every year. My
children are all grown up and are self supporting, and my wife is well
covered in my will. The problem I am looking at now is the fact that I
have invested in real estate in this country, and have a Thai friend who
looks after my investment for me, collects rents and the like. I would
like to make sure that he is looked after if I should die, and would want
that my Thai real estate holdings go to him, and not my UK family which
will be well off when I go, which I hope will not be too soon. How do I go
about this, Hillary?
Really it is not too difficult at all, but you have to follow Thai law in
this situation. Hillary cannot give you all the details, but a good Thai
lawyer can. Ask around your ex-pat friends for names of recommended
lawyers, and if needs be get advice from more than one. I would try to
keep your two sets of beneficiaries as separate as possible. There’s
nothing like a death to bring a family together - to fight about who gets
what! Add in another set of beneficiaries and you have a real cat-fight.
Camera Class: A fancy black shoebox - Is that all it is?
by Harry Flashman
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
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?
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
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
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.
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.