건강할 권리와 치료의 정치: 태국 에이즈 감염인의 의약품 접근권 운동 = The Right to Health and Politics of Treatment: Access to Antiretroviral Drugs in Thailand

다국어 초록 (Multilingual Abstract)

This article presents an analysis of AIDS treatment activism formed by people living with HIV/AIDS (PLWHA); their demand is universal access to antiretroviral therapies (ARVS). When used successfully, ARVS prevent disease progression and improve the health of PLWHA. In Thailand, AIDS treatment activism mounted in the late 1990s to promote generic drug production and demand government support for AIDS treatment. This analysis draws from participant observations of AIDS-related NGO activities, especially focusing on the Thai Network for People Living with HIV/AIDS (TNP+). To secure PLWHA`s right to receive proper treatment in Thailand, the activists are pursuing a successive process to generate the institutional transformation of ARVS distribution. In the first stage, the breaking of multinational pharmaceutical company monopolies allows more extensive access to ARV. Thai AIDS activists brought lawsuits against the multinational drug company Bristol Myers-Squibb in 2001 to revoke a patent on didanosine, and the activists finally won the case in 2002. In the second stage of the process, the public healthcare system becomes a crucial channel for ARVS distribution. To make the implementation of AIDS treatment possible, two major factors are mainly considered by the activists and the state. One factor is the decrease in cost which occurred after the Government Pharmaceutical Organization started launching low-priced generic drugs. The other factor is the demonstration of cost-effectiveness of AIDS treatment. In addition, the representation of PLWHA as productive population is also accompanied. Since 2005, AIDS treatment has been freely dispensed via the universal health care scheme. In the third phase, to ensure the continuity of AIDS treatment, the state directly intervenes to adjust drug prices, and market intervention is aggressively supported by AIDS treatment activism. In 2007, the Thai government announced compulsory licensing for three drugs including 2nd line ARVS. Finally, AIDS treatment activism in Thailand transforms ARVS from a rare good into a public good. It illustrates that ARVS as a commodity should be governed not by ability to pay but by public interest. Corresponding to a processual resolution of the antagonism between private ownership and human rights, the transformative processes rearrange symbolic and legal hierarchy among rights. Furthermore, AIDS treatment activism in Thailand reveals how rights-based activist groups respond to demand distributional justice and provoke the state`s intervention over the market. It is a new form of social mobilization, which opens up a new line of inquiry into the study of struggles for public good in the globalizing world.

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