Hiv medication

[Johanne]

hi..I have a friend who has been hiv+ for 8 years. He has recently started medication on the 30 baht scheme. The medication he has been on appears to be ineffective and his doctor has told him he needs a different kind of ARV which he must purchase privately. His cd4 count has gone down from 100 to 85 and he is having problems with autoimmune hepatitis and a skin problem. He does not have the money to pay for private treatment and lives in Sam Phran. My question is are other ARV/ARTs available on the 30 baht scheme or just the basic one(s) and can he get all the tests like cd4, X-ray, liver function tests etc as part of the 30 baht scheme because they are very expensive.

I have tried to get him to contact the Thai Red Cross Anonymous Clinic for advice, but he is unwilling to do this because he is scared other people knowing he has hiv, and as I speak no Thai myself it is hard for me to understand how the system should work.

Many thanks in anticipation of some advice.

[Sheryl]

He can get all tests done and doctor visits coveted under 30 baht scheme. Re the meds I am not sure, it will depend on what drugs exactly. He should get the exact names of the drugs and contact an HIV advocacy group to find out whether these really require self pay. There may be dome listed on the pinned HIV thread, I am away from my computer presently.

Treatment at the TRC Anonymous Clinic is 100% confidentisl. He does not need to worry on that score.

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[Sheryl]

P.S. given his low count he should go ahead and pay for 1 month supply of new meds at TRC and start taking them -- can pursue the issue of long term payment later. Starting correct treatment now is rather urgent.

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[Johanne]

Hi Sheryl. Thank you for your prompt reply. Just so I understand correctly...should all the tests cost 30 baht because the bills I have seen from the hospital are more...an X-ray costs 1500 baht for example. The only thing that costs 30 baht is the actual medication.

I understand that the TRC is completely confidential, as does my friend, but he worries that he will ‘bump into’ a friend and will not be able to make an excuse for being there, unlike his local hospital. Unfortunately there is little I can do to allay these fears, or get him to understand there is no shame in having hiv. I have tried!

I have a list of his current drug regime, but he will not know what his new meds are until he gets them on Monday.

As you can see I am new here so I will check through the threads to find the advocacy sites as you suggest.

As you say, with such a low count and that fact it is falling he does need to get the medication urgently. As he only earns 500 baht per day I am worried that he will put off going back, which is why I am trying to help find out what he can do as he seems unable or unwilling to do this himself.

Thanks again for your help....it is much appreciated.

 

[orchis]

-starting meds 8 years into a known hiv infection with a CD as low as 100 is a risk.

-if he 'seems unwilling' to find out ( alternatives) that puts a lot of weight on your shoulders, but i am glad you do.
be prepared if you don't succeed. i speak from my own experience.
-i would get the name of his new meds and check with red cross-anonymous clinic about price;
also check with another doctor for alternatives if they prove to be too expensive.
 it's true that not all meds fall under the 30 thb scheme but many do, this is an improvement to the old situation.

-if his ID is registered at SamPran and he goes to his designated hospital in the same area, tests and xrays would also fall under the 30thb scheme.
 

[BritManToo]

1 hour ago, Johanne said:

should all the tests cost 30 baht because the bills I have seen from the hospital are more...an X-ray costs 1500 baht for example. The only thing that costs 30 baht is the actual medication.

 

Normally it's 30bht per illness, including everything.

Not so sure about chronic illness, they usually don't collect any money from chronic illness patients.

(Diabetes, cancer, blood pressure, etc.)

 

My local government hospital charges me 150bht for an x-ray (as a foreigner).

1500bht for an x-ray sounds like a private hospital bill.

Name of hospital?

 

Did you go to the hospital and see the bill being presented, or is it something he told you about?

Fake hospital fees is a popular scam for Thais to pull on foreigners.

Edited September 28, 2018 by BritManToo

[Sheryl]

It should all be free or 30 baht, Xray and all other tests included. PROVIDED he is being treated at the hospital where he is registered under the "30" baht scheme.

 

What often happens is that for confidentiality reasons patients go to a different hospital than they are registered at. Try to find out if this is what he is doing as it would explain the charges.

 

If so, he can do either of the following:

 

1. Treat at the hospital where he is registered abd try to put aside his concerns about what others think.

 

2. Change his tabian ban listing to another location (wherever it is he prefers go be treated). To do this all he needs is an address and a friend or relative willing to add him to their tabian ban. That and a few visits to the respective ampurs. Once he does this, he needs to newly register at the hospital for his new tabian ban showing them his tabian ban listing so that they include him fully under the 30 baht scheme. Once he has done this he will have to use that hospital for everything so should make it one not too far from where he lives and works.

 

If you can get him into a support group for HIV positive people it may help him overcome some of his concerns. While there is unfortunarely still social stigma attachef to HIV there is also an element of self-stigmatization too. He can't change other people but he can change his own sense of shame and how he responds to other people's possible gossip.

 

Failing to do so may unnecessarily cost him his life.

 

2 points you might make to him:

 

1. If he gets seriously ill or dies there is no way at that point that everyone won't know. ... friends, family, coworkers, neighbors, evrryone. And not just after he is dead. They will know for weeks or months before he dies. The condition is glaringly obvious at that point. So skipping treatment to avoid stigma will both cost him his life AND completely fail to conceal his condition and save "face" in the long run.

 

2. Re TRC the only way someone who knows him can see him there is if they are also there. Which will be for same or similiar reason.

 

 

 

 

 

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[Sheryl]

P.S. re the meds it sounds like what has happened is that he is unable to take firstline meds due to liver impairment. It might be that the meds caused his hepatitis or it might be that he has a concurrent inectious hepatitis B or C, not unusual as same route of transmission as HIV.

I would be surprised if in such case the 30 baht scheme will not cover cost but to be sure please verify (1) what exactly the new meds are and (2) whether he was told this at a hospital other than the one is registered ubder a tabian ban.

Meanwhile do whatever it takes to get him started on the new meds ASAP. A delay will seriously affect his prognosis.


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[Johanne]

Hi Sheryl. Thank you for your prompt reply. Just so I understand correctly...should all the tests cost 30 baht because the bills I have seen from the hospital are more...an X-ray costs 1500 baht for example. The only thing that costs 30 baht is the actual medication.

I understand that the TRC is completely confidential, as does my friend, but he worries that he will ‘bump into’ a friend and will not be able to make an excuse for being there, unlike his local hospital. Unfortunately there is little I can do to allay these fears, or get him to understand there is no shame in having hiv. I have tried!

I have a list of his current drug regime, but he will not know what his new meds are until he gets them on Monday.

As you can see I am new here so I will check through the threads to find the advocacy sites as you suggest.

As you say, with such a low count and that fact it is falling he does need to get the medication urgently. As he only earns 500 baht per day I am worried that he will put off going back, which is why I am trying to help find out what he can do as he seems unable or unwilling to do this himself.

Thanks again for your help....it is much appreciated.

 

[Johanne]

Hi BritManToo,

Thank you for your input. I do understand about scamming, but as he has never asked me for money he must be playing for the long game if that is his ultimate goal. Also I have checked out the validity of what he says and the myriad of accompanying photos just in case. Also I have no money to give him! 

[Sheryl]

Hi Sheryl. Thank you for your prompt reply. Just so I understand correctly...should all the tests cost 30 baht because the bills I have seen from the hospital are more...an X-ray costs 1500 baht for example. The only thing that costs 30 baht is the actual medication.
I understand that the TRC is completely confidential, as does my friend, but he worries that he will ‘bump into’ a friend and will not be able to make an excuse for being there, unlike his local hospital. Unfortunately there is little I can do to allay these fears, or get him to understand there is no shame in having hiv. I have tried!
I have a list of his current drug regime, but he will not know what his new meds are until he gets them on Monday.
As you can see I am new here so I will check through the threads to find the advocacy sites as you suggest.
As you say, with such a low count and that fact it is falling he does need to get the medication urgently. As he only earns 500 baht per day I am worried that he will put off going back, which is why I am trying to help find out what he can do as he seems unable or unwilling to do this himself.
Thanks again for your help....it is much appreciated.
 

You made this same post earlier and I made 2 replies, see above

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[Johanne]

Hi Sheryl,

I think you may be right about the hospital thing, he originally signed up at San Pram for the government scheme for ARTs. Previous treatment was at another hospital near Chaing Mai, but not as an hiv patient. He only started the meds 4 months ago, and that was only because I told him I knew what was wrong with him and that he needed to get help fast...I do not think he would have admitted to it otherwise. 

I have known people who have died from AIDS related illnesses in the 80s..my best friend among that number, so I am aware what he has to look forward too if he doesn’t comply.

The hepatitis is due to the meds...he does not have any other kind of hepatitis...he has only ever had one sexual partner and does not use intravenous drugs...at least that is what he tells me and I have no reason to doubt this. He is only 27 it is so unfair. He is what I would call a very “proper” person...and leads what I think of as a very dull life. 

He is registered under the tabian ban in San Pram, but they have told him he needs to change to the hospital at Nakhon Pathom and that he will be charged 3500 for first appointment, after that he will be back on the 30baht scheme.

I have never been to Thailand so I have little idea of how things work, but the system seems to be pay up front. 

I have told him that I need to know what the new drugs are, and what will happen if he ignores the doctors advice. He has never seen anyone with aids related conditions and apart from his partner I am the only person who knows about the hiv and as you point out he is at serious risk of developing aids with such a low cd4 count. 

I am sorry to hear that you speak from experience, but I fear you may be right and that he is his own worst enemy. He will not even talk to his partner about what is going on with his health in case it makes him feel guilty about being the one who infected him, so I am the only person who is on his case, and as I am the one who made him go and get help in the first place I feel kind of responsible now.

Many thanks again for your time, it is really appreciated.

Jo

[Johanne]

Sorry about that...I am not the best with IT...I got a message about it being edited and reinstated if that helps

[orchis]

Helpline in THAI language

HIV-PHONE 02-253-2666 
If you have any questions about or need advice on the HIV virus or any information about how to live with people with HIV/AIDS, contact us at(+66) 2-253-2666. Our staff are available to help you on weekdays from 9.00-16.00 hours.

[Johanne]

Thanks Orchis...i will pass this on.

[orchis]

14 minutes ago, Johanne said:

Thanks Orchis...i will pass this on.

I forgot to mention it is a service of anonymous clinic-red cross, bangkok.

[Sheryl]

On the 30 baht scheme people do not have to pay up front. The total charge should be only 30 baht or else free (some hospitals do not bother to collect the 30 baht) except for a few services not included in the government scheme.

 

Som Phran Hospital is a very small community hospital and the next level up from them - which they refer cases they cannot handle to - is the Nakorn Phatom provincial hospital. As long as referred there by Som Phran Hospital (written referral letter) everything should be 30 baht or fee. I do not understand why the charges for Xray and for first visit (Re Xray are you sure there is not an extra 0 there? No way is the cost of an Xray at govt hospital 1,500 baht. Usually around 150 - 200 baht.)

 

He may have been referred from Sam Phran because they do not have the facilities to handle HIV clients needing other than sdt line treatment / with complications due to treatment.

 

it is not unknown for hospitals to try to charge for things they should not. There is a help line for people  covered under the 30 baht scheme, call center is 1330  and it is under utilized because most Thais do not know about it and others are afraid to speak up.  They can be very helpful in quickly resolving problems  https://www.nhso.go.th/FrontEnd/index.aspx 

Tell your friend to call them anytime he is asked to pay something. If the charge is legit they will tell him, if not they will speak to the hospital and put a stop to it.

[Johanne]

Hi Sheryl, 

I have passed on the information with a very stiff lecture. I may have put an extra 0 on the price...but he did have more than one X-ray....and the total price for a first time visit was 6,500. It was definitely a government hospital and all follow up treatment was charged at the 30 baht rate.

I am hoping that he will use these services...but ultimately it is up to him. I have also threatened to tell his partner what is going on which may be the most effective method. His partner is being treated privately, but has a much higher cd4 count and is doing rather better than my friend.

You have been so very helpful, thank you so much. Trying to research this stuff has been a nightmare. Now I can rest easy that I have given it my best shot. He is an adult after all, allegedly!

My very best wishes to you.

Jo