The TB-HIV dilemma for migrants on the Thai-Burma border, writes Asia Sentinel’s Constanze Ruprecht

In late October, a large group of people living in and around the northern Thai border town of Mae Sot were closing in on a terrible milestone of sorts. All of them – more than 60 migrant children, women and men – were living with HIV and taking antiretroviral drugs, which they needed to stay alive. Some were also co-infected with tuberculosis, the most frequent opportunistic infection experienced by people living with HIV or the Aids virus itself.

Each group member’s daily regimen of drugs – a one-year ‘buffer’ provided by an international non-governmental organization that was now pulling its operations out of the country – was about to run out, with no new supplier in sight.

“We have been unable to secure a sustainable source of ARVs for our patients,” explained a staff member of the Mae Tao Clinic, a clinic providing health care services to migrants and displaced people near the Thai-Burma border. “If they stop taking their medication, we face a crisis.”

Drug Resistance
Adherence to a prescribed ARV drug regimen is essential. People living with HIV and/or TB who stop taking medication for whatever reason, and even only for a few days, can develop resistance to the medication. Drug resistance is irreversible and the new strains of the disease can be passed on to others.

Multi-drug and extensively drug-resistant tuberculosis is an even greater potential threat than HIV drug resistance in terms of impact, because unlike HIV – a blood-borne disease – TB is transmitted from person to person through the air. A rampant increase in drug resistance can thus indeed fuel a public health crisis.

The Mae Tao Clinic representative said that “from a public health perspective TB is more difficult to handle, mainly because of time-related compliance issues. People with TB have to take medication daily for six months. If they interrupt this treatment, which happens frequently with migrants who are on the move and may stop taking drugs when they feel better, then drug resistance can occur.” 

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