HIV medication now subsidised in Singapore
As of 1st December 2008, also World AIDS Day, HIV infected patients in Singapore can look forward to more affordable medication.
HIV medication had previously not been subsidised unlike medication to treat other chronic diseases and Health Minister Khaw Boon Wan emphasised that it is time for a change.
With the Singapore Ministry of Health now subsidising HIV medication, patients may be more prepared to undergo screening for the infection. The subsidy lends a much needed boost in retaining patients on treatment with medication and complements an opt-out HIV testing scheme instituted at all public hospitals in the country. Over the next three years, the Ministry of Health is set to spend close to 4 million dollars to subsidise the screening of patients at public hospitals.
The World Health Organization identified the criticality of patient retention in HIV treatment programmes in it's 'Towards Universal Aid' 2008 progress report . Required drugs are only effective when consistently taken daily for life and this is often important not just for the individual patient but also for public health at large in preventing the spread of the disease. Yet many patients often do not adhere to required regimes. While side effects are a significant concern, the major issue is often the cost of medication.
In Singapore, the first diagnosis of a patient with HIV infection occurred more than 20 years ago. Every year since then, the number of newly diagnosed cases has been rising. From less than 200 new cases in the late 1990's, the figure had reached close to 500 by last year and continues to climb. All in, close to 4000 people in Singapore have been diagnosed with HIV infection since 1985 and currently 2000 patients with the infection are living in the country today. Among a population of close to 4.6 million, this figure may seem small but could rapidly rise if patients do not adhere to medication regimes and appropriate measures are not put in place to control the spread.
Adhering to the right medication regime can lead to a 90% reduction in transmissibility of the virus and can result in young patients leading an extra 40 years of a normal life with contribution to society. Recent advances in medication have also resulted in the average patient on treatment living about 13 years longer than would have been possible a decade ago.
The problem for many patients here however has been that medication alone can cost them around SGD$1500 per month not including consultations and other care situations and only one in four affected individuals can afford the medication. Worse yet, if they have infected family members and stigmatization results in unemployment, medication costs alone can very quickly wipe out their savings and medical insurance accounts.
Prior to the subsidy, the benefit for many has been the availability of such medication in neighbouring countries at a fraction of the cost in Singapore. Many travel to Malaysia and Thailand where their medicines can be purchased for SGD$100 to SGD$200 per month. The quality of such medication can nevertheless be doubtful as recent drug busts in the region have uncovered fake HIV medication that could very well be putting many such patient's lives at risk.
Dr Leo Yee Sin, head of the Communicable Diseases Centre, highlighted that HIV medication will go the way of generics in line with national policy to further reduce costs for patients. Generic HIV medication is effective in the majority of HIV infected patients although some will require non-generics.
In Singapore, the public health system subsidises identified drugs into 2 classes, one that has patients paying SGD$1.40 per week for their medication and another that involves a 50% subsidy of the patient's medication.
With the prospect of cheaper treatment, more people could come forward and there could be earlier detection of the condition, a point echoed by Dr Roy Chan, president of the Action for AIDS society in Singapore.
As for which HIV medicines will be subsidised and at what rate, this is yet to be determined. According to Dr Balaji Sadasivan, Senior Minister of State for Foreign Affairs, it is forthcoming and will be determined by an expert panel of doctors.
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