In his letter to these columns of June 24, Dr Joe Thomas criticised the limited access of HIV/AIDS patients to treatment. While his analysis on a global scale may be correct, its direct inference to Hong Kong could be less relevant. The Advisory Council has been, through the work of the Scientific Committee and the AIDS Services Development Committee, monitoring local AIDS services provision in the last few years. I agree with Dr Thomas that it is timely to look at the subject, but my concerns are of a different nature. Firstly, the care of people living with HIV/AIDS, like any other chronic illnesses, encompasses activities more than just the prescription of medicines. At this point in time, I am more concerned about their access to such services as hospital admissions, dental care, home help, hospice care, community nursing, to name a few. Designated services have been set up by the Department of Health, Hospital Authority and some non-governmental organisations. Our ultimate goal should be, however, to integrate AIDS patients into society. I am upset that there are still health and welfare services in the public and private sectors in Hong Kong which hesitate to accept AIDS patients. There is no quick solution. We need the concerted effort of all sectors to build up a comprehensive programme on both the prevention of the infection and the care for those infected. Secondly, it is unfair to say that access to antiretroviral treatment (with, for example, AZT) is 'limited to a few among the 800 or so people known to be living with HIV in Hong Kong'. Knowing that such treatment is not yet medically indicated at all stages of the infection, its provision to some but not all patients is understandable. There is still a big knowledge gap as to the when, which and how combination antiretroviral treatment should be prescribed. I must salute the few dedicated clinicians in Hong Kong in their endeavour to provide the best possible treatment option, given manpower and resource constraints. The number of patients given or under treatment is certainly more than 'a few'. The complexity of issues involved in treatment provision is straining the capacity of our frontline doctors and nurses. I am concerned about staff training and the planning of treatment services to uphold the standard of care in Hong Kong. Thirdly, new treatment recently reported in the press should be viewed in perspective. We know that 'triple therapy' is expensive and is not flawless. Treatment programmes need to be supported by such expensive investigations as viral load testing and CD4 lymphocyte monitoring. Our Scientific Committee has started developing management protocol in the local context. As the treatment cost rises, I am becoming acutely concerned about how the Government is going to ensure that quality treatment services are properly funded. Fourthly, Dr Thomas mentioned the 'distribution, production and pricing policy' of the pharmaceutical industry. I wish to expand his policy concern to all service providers on AIDS - within the Government, the Hospital Authority, and non-governmental organisations. The problem faced by Hong Kong is getting unique. While the HIV epidemic grows, the actual number of infected persons in Hong Kong has remained small. As the subject of AIDS tends to draw a lot of media attention, this has led to a general misconception that there are unlimited resources to deal with the problem. Our frontliners in Hong Kong tell us that this is not the case. To lend support to our fight against AIDS, we shall be addressing the issues of efficiency of the system, mechanism of co-ordination, policy planning and cost-effectiveness. Unfortunately I still have not seen a good deal of research conducted to answer these questions. Under the current optimistic atmosphere generated by new treatment, the importance of prevention should not be overlooked. We cannot afford to lose the pace gained by our forerunners in the last decade. The provision of funding for HIV treatment should, therefore, never be made at the expense of the local preventive efforts. Dr CONRAD LAM KUI-SHING Chairman Advisory Council on AIDS
