Marketing Research for HIV/AIDS Drug in Souteast Asia

Marketing Research For HIV/AIDS Drug in Souteast Asia

Myat Htay Kyi

Bioengineering and Environmental Health

Submitted To: Dr. Maria Kartalou

Submitted By : Myat Htay Kyi

July 19, 2000

Content

Page

I. Introduction3

II. Surveillance of HIV infection3

III. Mode of Transmission of HIV/AIDS 4-5

IV. Prevention Method in Southeast Asia5

V. Health Care System in Southeast Asia5-6

VII. Conclusion6

VIII. Recommendation6-7

IX. Reference8

X. Appendix9-13

I. Introduction:

Although , HIV came relatively late to Asia, virus is already present in all countries of Asia. Whether or not we want to admit it, there are people engaged in high risk behaviors everywhere. In this region, almost all countries have established the surveillance system., and without direct HIV data it was difficult to know how many people had already become infected.

Some countries (mainly industrialized countries) report more cases, while others report very few cases. Overall, the cumulative number is less than total estimated number of HIV/AIDS cases. This involves under-diagnosis, incomplete reporting and re-porting delay. In addition, unfortunately, HIV testing facilities are still far from adequate, especially in rural areas, even when counselling and testing are offered, people simply do not want to know if they are HIV-infected.

The purpose of this study is to find the market of HIV drug in Aisa. In order to achieve the target, this research can show how many people are living with the virus of HIV/AIDS and basic information of their status. It is because HIV drug and treatment system are relatively expensive and imported from westen countries. So that our production is based on intern

Because the aim of this research is to treat everyone who is infected, regardless of class, gender, race, age and culture.

II. Surveillance of HIV infection

To know the number of people living with HIV virus, prevalence estimates data is more reliable. Because it based directly on data collected through HIV sentinel surveillance. WHO and UNAIDS continue to work with national AIDS programmes and research institutions to refine knowledge and improve sentinel surveillance systems. These efforts should narrow current uncertainties and increase the future reliability of estimates of both HIV infection and death. Until the mid-1990s, HIV infections were estimated by calculating backwards from reported AIDS cases according to well-established patterns of disease progression.

In largely heterosexually driven epidemics where there is evidence that men and women

in the general population have become infected with HIV in significant numbers, HIV

surveillance is based mostly on tests performed among pregnant women attending

antenatal clinics that have been selected as sentinel surveillance sites.

In countries where the HIV epidemic is concentrated in a few groups with high-risk

behaviour – mostly drug injectors and men who have sex with men, as well as sex

workers and their clients – the methods for estimating HIV prevalence are different.

This is the case in most countries in Asia, because there are very few HIV infections in the general population, and because many of the infections are in groups largely or entirely made up of men, data from pregnant women are of very limited use. Rather, HIV estimates in such cases are based on information on HIV prevalence in each group of people with high-risk behaviour, together with estimates of the size of each of these populations. Since these behaviours are often socially unacceptable and sometimes illegal, information on both HIV prevalence levels and the size of the population affected can be much harder to come by. Consequently, uncertainties around these estimates may well be greater for countries where the epidemic is concentrated in specific groups.

Notes on specific indicators listed in the table 1,2, and 3. (Weeklyepidemiological record 1995; 70:353–360)

Without such personal information, other occupational and migrational information may be used as indicative of risk. (Table 4)

III. Mode of Transmission of HIV/AIDS

Globally, sex between men and women is by far the most common way of passing on

HIV. But a second epidemic drives the virus in many, if not most, it is the epidemic among men and women who inject drugs. Over half of all AIDS cases are attributed to injecting drug use in countries including Malaysia, and Vitenam which are in Southeast Asia region. (Table 5)

Figure 1. shows the proportion of HIV infections attributable to drug use in a number of countries. People who have been working in hotels, brothels and restaurants are also perceived to be at risk, especially where they may be involved in commercial sex work.

While precise figures may be hard to come by, it is clear that HIV can explode through

drug using populations with remarkable speed and can stabilize at very high rates.

Drug injection poses a threat of HIV infection not only to the individuals who engage in it but also to their sex partners. In Souteast Asia some places, including much of China and parts of India and Myanmar, more women are infected through sex with drug users than in any other way. Fully 83% of injecting drug users in Vietnam said they did not use condoms with their regular partners, and 63% never used them even with casual partners. Injecting drug use also contributes to mother-to-child transmission of HIV. Patients seeking health care for a sexually transmitted infection should be a primary

Target for renewed prevention efforts. This is especially true of people who are experiencing their first such infection.

In many countries, the opportunity of using such clinics to deliver HIV prevention services to populations at high risk for HIV transmission is being lost, in part because health systems emphasize curative services over prevention, and in part because the clients are thought of as "prevention failures". Clearly, people with a sexually transmitted infection have by definition engaged in unprotected sex with someone who also has other high-risk partners. But a past failure can be translated into a future success. These patients stand to gain more from prevention counselling than people with no risk behaviour.

As Figure 2. Shows, men are now far more likely to report using a condom when they

buy sex. The same is true of brothel-based prostitutes. While only two-fifths reported

consistent condom use by men who paid them for sex, from close to 10% in 1997 to

almost 40% in 1999.

Figure 3. Showing that in Thailand, the impressive success in reducing heterosexual transmission of HIV has exposed a failure to focus on other important groups, including men who have sex with men. In a study of military conscripts in an area of northern Thailand with a high prevalence of HIV infection, 134 of over 2000 young men said they had sex with men and all but three of these men also had sex with women. The men reporting male–male sex were nearly three times as likely to be infected with HIV as the men who had sex only with women, even after taking into account other factors such as sexually transmitted infections.

For many years, not enough was known about transmission from mother to child to take steps to help HIV-infected women have uninfected babies. In the absence of any intervention, around a third of HIV-positive mothers pass the virus to their newborns.

IV. Prevention Method in Southeast Asia

Asia can learn from the Asian experience. The success of Thailand, and others such as India, teaches us that concentrated epidemics can be contained, that one can slow down the spread of HIV, by enabling those with the greatest risk to protect themselves and others. It is important to take fully into account in national development and AIDS prevention plans.

Cambodia, one of South-East Asia’s poorest countries and the one with the highest rate

of HIV infection among adults. The surveillance system, which covers Cambodia’s five main urban centres, showed that visiting sex workers was the norm among men in some occupational groups, including soldiers, policemen and motorcycle taxi drivers, all of whom are relatively mobile and have ready cash, and many of whom are married. Yet condom use was relatively low.

New information highlights the challenges raised by these interlinked infections as well

as the opportunities for their joint prevention. On the other hand, recent data point to the enormous potential of using improved health care for sexually transmitted infections as an entry-point for prevention services that could help reduce the rates of both HIV and other sexually transmitted infections.

Standard guidelines for the management of such patients do call for counselling patients about prevention, including the use of condoms and the referral of sex partners for treatment. But service providers regularly score very poorly on this part of patient management. Referral for HIV testing has rarely if ever been assessed, but anecdotal evidence suggests that it is rare.

In the late 1990s, it was found that around half of all these infections occur during breastfeeding. In recent years, much has been learnt about how to prevent transmission of HIV from infected mothers to their babies. Studies in Thailand in early 1998 showed that a relatively simple drug regimen – a short one-month course of the antiretroviral drug zidovudine (AZT) – given to HIV-infected mothers late in pregnancy could halve the rate of HIV transmission to their infants so long as the women also avoided breastfeeding.

V. Health Care System in Southeast Asia

Using the 1991 guidance published by the World Health Organization (WHO), many countries did draw up clinical management guidelines for handling AIDS in children and adults by the mid-1990s.

Even before the epidemic, the health care system did not get a fair share of the national

budget. Typically, health centres and hospitals were short-staffed, facilities for diagnosis

were inadequate and drug supplies erratic, and training for health care providers was

uneven and often poor.

In the poorer developing countries, local health centres and small hospitals lack adequate facilities to diagnose the opportunistic diseases of people with HIV. They repeatedly run out of supplies of essential drugs, including the ones needed to alleviate distressing

symptoms and to manage opportunistic infections. For example, oral thrush – a fungal

disease which causes pain on swallowing – could be treated relatively easily, but

millions of patients continue to suffer for lack of a simple anti-fungal drug. Tuberculosis,

which can be cured, often goes untreated for the same reason.

The hospitals surveyed had suitable diagnostic facilities and the right drugs to treat three conditions – pneumonia, pulmonary tuberculosis and oral thrush. These are the only HIV-related conditions that are easy to diagnose and inexpensive to treat. For any other HIV-related illness, diagnostic capacity (X-ray and laboratory facilities) and drug supplies were so inadequate that a patient would have less than a 50% chance of being correctly diagnosed and treated. This was true, for instance, of Kaposi sarcoma (a frequent HIV-related cancer), serious fungal infections such as cryptococcal meningitis, and viral infections affecting the brain. Relief for difficulty in breathing was unavailable in half the hospitals. Strong painkillers were available in only two-fifths, despite the fact that most people with advanced HIV infection require pain control at some point.

An analysis presented at a WHO/UNAIDS workshop concluded that, in most developing

countries, antiretroviral treatment programmes aiming at universal coverage would not

be affordable. For example, based on 1997 prices, the provision of triple combination

therapy to all people with HIV could consume between 9% and 67% of total GDP.

VI. Marketing Systems of HIV/AIDS

A major change in the law took place a few years ago which permitted drug companies to engage in "direct-to-consumer" marketing, resulting in aggressive campaigns in televised and print media. Pharmaceutical industry also has a history of meeting with AIDS activists to review medical data and get input on drug development and patient assistance strategies.

There is several donor agancies as NGO and UN organization support directly to the government. When well managed, such a relationships between the companies influence and those donor agencies are more affective program for the marketing systems in Asia. Due to the financial situation of patient most companies and pharmaceutical offer a variety of support and grant programs to help AIDS donor agencies. ( Figure 4)

VII. Conclusion

To focus on this region, conclusion came from the two points as follow:

• There is generally good access to antiretroviral drugs, which combat the virus directly

and improve health and survival.

• People with HIV or AIDS and their organizations have played a role in health care, for instance by putting pressure on the pharmaceutical industry to reduce the prices of drugs.

VIII. Recommendation

This research can be part of the solution. But, it must be Asia's own solution, to protect our society, economy, proud nationhood -- all that we have, It has to be Asia's own commitment, starting at the top political leadership and throughout the civil society everywhere.

It must be Asia's own will to act, with governments and non-government organizations united as true partners under one common cause.

IX. Reference

1. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR 1997; 46(No. RR-10):1-55.

1. Centres for Disease Control and Prevention. Recommendations for public health surveillance of Chlamydia trachomatis and Neisseria gonorrhoeae infections (MMWR, in press).

1. Holmes, K.K. World Health Organization Working Paper 5. Priority areas for national STI surveillance: issues concerning co-ordination of surveillance of HIV and other STI. Geneva: World Health Organization, 1990.

1. Levine, W,C. Improving Measurement of STI Incidence and Prevalence in the Americas. Working paper for Informal Technical Working Group Meeting on STI Surveillance in the Americas. Washington, D.C., Pan American Health Organization, 1995.

1. Pan American Health Organization. Annual Surveillance Report for AIDS, HIV, and STI for the Region of the Americas, 1992. Washington: Pan American Health Organization, 1994.

1. Schwartländer, B., Van den Hoek, A., Heymann, D., Gerbase, A. Chapter 15: Surveillance. In: Dallabetta, G., Laga, M., Lamptey, P., (eds.). Control of Sexually Transmitted Diseases: A Manual for

the Design and Management of Programmes. Arlington, VA: AIDSCAP/Family Health International,

1997.

1. World Bank. Confronting AIDS: Public Priorities in a Global Epidemic. A World Bank Policy Research Report. New York: Oxford University Press, 1997.

1. World Health Organization. Control of Sexually Transmitted Diseases. Geneva: World Health Organization, 1985.

1. World Health Organization. Practical guide for the development of surveillance systems for sexually transmitted diseases. WHO/VDT/90.451 (Version 6.3.91). Geneva: World Health Organization, 1991.

1. World Health Organization. Protocol for the evaluation of epidemiological surveillance systems. WHO/EMC/DIS/97.2. Geneva: World Health Organization, 1997.

1. Annexes 141k Download the free Adobe(R) Acrobat(R) Reader to view these files

X. Appendix

Table 1. AIDS Death Cases in Southeast Asia

Estimated AIDS deaths / Population 1999
Adults and children, 1999 / Adults and children, cumulative / Total (thousands) / Adults 15-49 (thousands) / Low Estimate / High Estimate
Brunei Darussalam / … / … / 321 / 178 / <100
Cambodia / 14,000 / 42,000 / 10,931 / 5,253 / 170,000
Indonesia / 3,100 / 9,100 / 209,178 / 113,960 / 42,000
Lao People's Dem. Rep / 130 / 450 / 5,301 / 2,402 / 1,000 / <100
Malaysia / 1,900 / 5,600 / 21,817 / 11,449 / 39,000 / 260,000
Myanmar / 48,000 / 190,000 / 45,064 / 25,768 / 420,000 / 63,000
Philippines / 1,200 / 3,400 / 74,444 / 38,428 / 22,000 / 1,800
Singapore / 210 / 850 / 3,518 / 2,027 / 3,200 / 59,000
Thailand / 66,000 / 360,000 / 60,841 / 35,166 / 620,000 / 630,000
Viet Nam / 2,500 / 7,400 / 78,639 / 42,009 / 81,000 / 33,000

Sources:Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Diseases

Table 2. Estimates of the distribution of HIV/AIDS in the countries of Southeast Asia, end 1997

Country / Estimated number of carriers / Estimated number of AIDS cases / Estimated number of AIDS deaths / Reported cases of AIDS
Brunei Darussalam / 300 / .. / .. / ..
Cambodia / 130 000 / 18 000 / 15 000 / 978
China / 400 000 / 9 000 / 6 400 / 281
Indonesia / 52 000 / 4 800 / 3 900 / 153
Lao PDR / 1 100 / 240 / 210 / 77
Malaysia / 68 000 / 6 900 / 5 700 / 1 386
Myanmar / 440 000 / 100 000 / 86 000 / 1 822
Philippines / 24 000 / 1 600 / 1 300 / 321
Singapore / 3 100 / 290 / <500 / 359
Thailand / 780 000 / 260 000 / 230 000 / 70 013
Viet Nam / 88 000 / 8 700 / 7 200 / 1 202

Sources:Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Diseases, Geneva, UNAIDS and WHO, June 1998.

Table 3. Estimated People living with HIV/AIDS , end 1999

Adults and children / Adults (15-49) / Orphans / Orphans cumulative
Brunei Darussalam / 0.2* / … / …
Cambodia / 4.04 / 71,000 / 13,000 / 39000
Indonesia / 0.05 / 13,000 / 2,000 / 9800
Lao People's Dem. Rep / 0.05 / 650 / 280 / 220
Malaysia / 0.42 / 4,800 / 680 / 8500
Myanmar / 1.99 / 180,000 / 43,000 / 65000
Philippines / 0.07 / 11,000 / 1,500 / 4400
Singapore / 0.19 / 790 / 120 / 500
Thailand / 2.15 / 305,000 / 75,000 / 51000
Viet Nam / 0.24 / 20,000 / 3,200 / 18000

Sources:Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Diseases, Geneva, UNAIDS and WHO, June 1998.

Table 4. Population Data in Southeast Asia

Country / Total Population (millions)(1999) / GNP per capita pp$(1995) / % Illiterae (>15 years) M/F / Per capita central govt.expenditure (ppp$) Health
Brunei Darussalam / 0.3 / - / - / -
Cambodia / 10.9 / 1,290 / - / -
Indonesia / 209.3 / 3,390 / 10/22 / 20.0
Lao PDR / 5.3 / 1,300 / - / 15.0
Malaysia / 21.8 / 7,730 / 11/21 / 150.4
Myanmar / 45.1 / - / 6/6 / -
Philippines / 74.5 / 3,670 / 5/14 / 37.7
Singapore / 3.5 / 29,230 / 4/8 / 364.4
Thailand / 60.9 / 6,490 / 5/12 / 116.9
Vietnam / 78.7 / 1,590 / - / 13.7

Sources:Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Diseases, Geneva, UNAIDS and WHO, June 1998.

Table 5. Modes of Transmission of HIV/AIDS in the countries of Southeast Asia, end 1999 ( Percentages and absolute totals)

Country / Hetero-sexual / Homo sexual/ bisexual / IDU / Blood / Peri-natal / Other unknown / Total
Brunei Darussalam / .. / .. / .. / .. / .. / .. / ..
Cambodia / 36 / 1 / 0 / 0 / 20 / 44 / 978
China / 19 / 3 / 50 / 9 / 0 / 19 / 281
Indonesia / 48 / 39 / 2 / 2 / 1 / 9 / 153
Lao PDR / 96 / 0 / 0 / 0 / 4 / 0 / 77
Malaysia / 22 / 3 / 55 / 1 / 1 / 19 / 1 386
Myanmar / .. / .. / .. / .. / .. / .. / ..
Philippine / 53 / 35 / 1 / 3 / 2 / 7 / 321
Singapore / 66 / 28 / 2 / 1 / 1 / 3 / 359
Thailand / 80 / 1 / 6 / 0 / 5 / 7 / 70 013
Viet Nam / 18 / 0 / 66 / 0 / 0 / 16 / 1 202

Sources:Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Diseases, Geneva, UNAIDS and WHO, June 1998.

Figure 1: