Feature story |

A bitter pill to swallow

As the morning temperature rises over the sprawling slum of On Nuch, one of Bangkok’s eastern suburbs, 33 year-old Somying and her teenage son are standing on the canal’s bank. For the last three months, waiting for the iceboat in the simmering heat has become part of their daily routine. The small bags of ice they purchase every day are extremely precious to them, as precious as the life-saving AIDS drugs they have to take every day. “When I saw my doctor, after a series of tests, he told me I was sick because I had become resistant to my anti-retroviral treatment,” remembers Somying, who’s been on ARV for seven years. “I was desperate, I thought there wouldn’t be any medicines working on me anymore.” But Somying and her son were among the lucky few to get hold of the expensive second-line drug, lopinavir/ritonavir, marketed as Kaletra by the American pharmaceutical company, Abbott. Under Thailand’s universal health care programme, Somying and her son receive the drugs free of charge - she would never otherwise have been able to afford them.

But there’s a big problem with these drugs for Somying: they need to be stored at temperatures between 2 – 8 degrees C. This is enormously difficult for people in tropical countries who may not be able to afford a fridge. In the corner of the two-room shack, where Somying and her two children live, is a blue icebox given by Médecins Sans Frontières.  Everyday she removes the melted ice and places three new ice bags along with a plastic bottle containing her monthly supply of Kaletra. Although she doesn’t have to pay for the medicines, buying the ice remains a substantial financial burden – over a third of her household budget is spent on ice.

“My husband died of AIDS before ARVs were 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. Even so, this system doesn’t work perfectly. “I’ve always bought the ice!” she insists. “But sometimes water gets in the bottle and the pills get damp.”

Somying also needs to take her drugs at a regular time each day. “I live far from the hospital and when I have an appointment. I have to leave home at four in the morning.” That means a long journey on several buses through Bangkok’s notorious traffic jams. “I have to take the icebox with me wherever I go so I can take my drugs on time,” she explains. “It would be so much easier if there was a drug that didn’t need to be refrigerated.”

In fact there is a heat-stable formulation of Abbott’s lopinavir/ritonavir product was launched on the US market in October 2005. But it is still not available to Somying and other patients in urgent need of the drugs in Thailand. Abbott promised to register the newer formulation at a reduced price in more than 150 developing countries in April of this year, but excluded Thailand from that list. Abbott said that it would not market the drugs in Thailand following the Thai government’s decision to issue a compulsory licence on Kaletra.