We understand that the government is about to begin negotiations with the US for a Free trade Agreement (FTA). As a group representing people living with HIV/Aids (PLWHAs) in our country, we are very concerned that the life-saving medicines we need may become even more unaffordable if a FTA is signed with the US.

Excessive, high prices of antiretroviral drugs (ARVs) due to patents in the hands of some big global drug companies have led to worldwide outcry in recent years. When there was competition from generic ARVs used to treat Aids, the prices of patented drugs fell from US$11,000 (about RM40,000) per patient per year to US$150 (about RM600) per patient per year. Even then, this is too expensive for those who are poor and in need of treatment. That is why generic drugs are so very important.

No generic drugs means no access to affordable life-saving Aids drugs. This will translate to more deaths to PLWHAs. In Malaysia, figures in June 2005 show that there are 63,438 reported cases of HIV infection, and 10,044 Aids cases in Malaysia. Between 1986 and June 2005, we have already lost 7,673 lives.

At the same time, we understand that the Ministry of Health (MOH) is looking at reaching out to 1,200 intravenous drug users as a target for their Harm Reduction programme. With this programme, MOH is also establishing a strong referrals system to hospitals, rehabilitation centres, substitution therapy, etc.

This programme is an entry point towards encouraging more voluntary testing and counseling.

Epidemic at our doorstep

Therefore, there are more likely cases of HIV/Aids to be detected amongst this invisible population. This in turn will lead to a bigger number of detected HIV/Aids cases in Malaysia. The impact of the FTA will also be on this invisible population. The World Health Organisation in June 2005 has already warned that an HIV epidemic is knocking on Malaysia's door.

We were very encouraged when the government issued a special compulsory licence in 2003 to import some generic ARVs from India for use by MOH. The monthly treatment cost by government hospitals and clinics fell by 81% from US$315 (about RM1,200) to US$58 (about RM200). MOH has targetted 4,000 people to be on ARVs therapy. But this is still below the more than 10,000 Aids cases that need urgent treatment.

The import licence has also come to an end. So we hope and trust that the government has plans to ensure continuing access to affordable ARVs. Without ARVs, more PLWHAs will die.

That is why we are very worried about news reports on FTA negotiations with the US. We do not know what is being proposed in the Malaysia-US FTA, but based on previous US FTAs and the US proposals in the controversial Thai-US FTA negotiations, there are a number of common provisions which are very alarming.

We believe the US will demand that Malaysia also agree to similar provisions, and these will make all medicines more expensive.

For example, US FTAs usually force more medicines to be patented and the patents have to continue for more than 20 years, which is the length of time for patents to run. When a medicine is patented, it means there is a monopoly and so no other manufacturers can make that medicine.

That means that the patent owner can charge as much as it likes because there is no competition.

We have learnt that US FTAs also impose monopolies for at least five years even when there is no patent, by blocking the use of test information by health authorities to register generic versions of the

patented drugs.

Human right

We make a strong plea to the prime minister and the Malaysian government to reassure us that public health will always be a top priority and that FTAs with Malaysia will not contain anything that goes against access to affordable medicines. We urge the premier to hold consultations so that we, the PLWHAs, and all Malaysians can learn more about FTAs that will be negotiated and how they will have an impact on public health and access to affordable medicines.

We also urge the premier to continue with the government's promise of transparency by making public suggestions and proposals in the FTAs.

For PLWHAs, the treatment that we need is a life long treatment. For us, it is a matter of life and death. So we strongly appeal to you, prime minister, to safeguard our human right to affordable medicines and treatment. Please do not allow an FTA with the US or any country that will harm the health of Malaysians.

EDWARD LOW is director of the Positive Malaysian Treatment Access & Advocacy Group (MTAAG+) and the Positive Living Group both which provide support for People Living with HIV/Aids.