Towards Sustainable ARV Service in ASEAN: "Countries Are Not Powerless"
Jakarta, June 28, 2005

Over fifty participants of a closed meeting titled "Towards Sustainable
ARV Service in ASEAN" agreed on Tuesday that ASEAN countries need to
collaborate and maintain the sustainable generic ARV and OI treatment in
response to the increasing needs of such services. They also recognized
the need for all stakeholders (MOH, National Drug Regulatory Body,
Global Fund, NGOs, PLWHA, Pharmaceutical Industries, etc) to coordinate
and join hands in realizing those goals.

The meeting was held on June 28, 2005 in Dharmais National Cancer
Hospital, Jakarta, Indonesia. Speakers from Thailand, Vietnam and
Indonesia share their experiences in implementing 3 by 5 program and
identify the obstacles. The meeting is attended by government officers,
national legislators, pharmaceutical representatives, health care
providers, People Living With HIV/AIDS, WHO representative,
international and local NGO activists as well as journalists who
actively participated in the discussion.

During the meeting, all participants discussed issues such as each
country's estimation of ARV use, the capacity of generic ARV production
in each country, procurement system, funding and possibility of
collaboration in ASEAN. The participants also discussed the impacts of
WTO regulations and Indian Patent Act to the sustainable ARV and OI
services in the region.

"Countries are not powerless," said Dr. Olaf Valverde Mordt of MSF
Belgium for Indonesia, referring to the patent-related situation.
Efforts made by countries like Thailand, Indonesia, Brazil and South
Africa have proven that they still can serve their people in need of ARV
with their local productions. He added that there was possibility for
Indonesia, Thailand and Vietnam as ARV generic producers to fulfill the
needs of ASEAN countries by exporting their products. At the same time,
the countries should also pay attention to the drug's quality, price and
intellectual property protection.

Dr. Rosmini Day, Director DTDC, CDC of Indonesian Ministry of Health
said that 3 by 5 program in Indonesia has targeted 10,000 PLWHA to have
access to ARV by end of 2005. She, however, said that government only
estimates 5,500 people will need ARV in 2005 and estimate 6,500 people
next year. She admitted that poor recording and reporting system has
caused government cannot calculate the real needs.

Prof. Zubairi Djoerban, Chairman of the Working Group on HIV/AIDS
Faculty of Medicine, University of Indonesia (Pokdisus FKUI-RSCM), said
that currently around 3,500 people receiving ARV in Indonesia.
"Actually, there are still many people in small cities who need the
drugs."

Dharmais President Director Prof. Samsuridjal Djauzi suggested
government to provide ARV exceeding the need estimation to avoid
miscalculation due to poor reporting system. "It is better for us to
provide sufficient ARV than to face shortages. Because it is to no avail
if we ask the patients to keep adherence while the drugs are not
available."

Samsuridjal, who is also the head of Access to Therapy in Pokdisus, said
that the country would face immediate increase of ARV needs, especially
from international organizations that provide ARV schemes and people who
prefer to pay their treatment by their own money.

Starting from 2004, state-own pharmaceutical company PT Kimia Farma has
produced generic ARV only for government use. Its quality of ARV
products has been approved by comparative study of dissolution rate and
bioequivalent. "We still have 90% of idle capacity since we just used 10
% of production capacity as of 2004," said Gunawan Pranoto, Director of

Kimia Farma. The company's production capacity could serve ARV for
31,250 patients.

Ong Van Dung of Vietnam pharmaceutical company Stada VN, said in his
written paper that the company has supplied ARV to more than 50 medical
facilities in local as well as central levels. It also supplies ARV to
more than 2,500 patients every month. The treatment protocol with the
fixed-dose combination would decrease the treatment cost with 3 ARVs
approximately US$ 220 per year from 2005. Vietnam has 80,000 cases of
HIV/AIDS and 30,000 of them are in need of treatment.

In Thailand, the target of 3 by 5 in March 2005 is around 100,000 people
in need of ARV. A report from the Ministry of Public Health in April
this year revealed that cumulative clients who use ARV in Thailand was
around 98,000. Government Pharmaceutical Organization (GPO) said that
the number of people who need ARV in Thailand based on WHO estimation
was 98,000 while Thai expert said the figure could be 200,000.

Lawan Sarovat of MSF-Belgium for Thailand said that the goal of 3 by 5
program is not only access for all but sustainable access for all. "If
we don't have drugs in our country, we cannot access that." She also
emphasized the need for all stakeholders to take actions to meet the
needs of people for treatment. Besides getting ARV from national program
by the Ministry of Public Health, there are some people who get ARV from
other schemes, such as social security scheme, civil servant medical
scheme and those who pay by their own pocket.

Since 1995, GPO has produced ARV for the local needs and 90 percent of
GPO's ARV market is for government, 8 percent for private sector and 2
percent for export. Mr. Itsaraet Gosriwatana, the International Sales
Manager of GPO said that ARV export is for humanitarian purpose and it
is mostly distributed to NGOs and private sector in Cambodia, Myanmar,
etc. For quality, safety and efficacy of ARV products, the GPO has
conducted bioequivalent study, WHO GMP - standard of production and
clinical study.

He, however, showed his concerned over Free Trade Agreement (FTA)
between Thailand and the US, especially about the Intellectual Property
Right. "FTA may restrict or limit the use of public health safeguards in
the TRIPS Agreement." He also said that there are some risks of local
productions such as the effects of the use of compulsory licensing and
Indian Patent Law.

One participant proposed that limited resources in ASEAN countries
should be use efficiently and national policy must fulfilled people's
needs (ARV).

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-Debbie & Samsu-

The Indonesian Perspective's