For the past 33 years, Hong Kong has been actively combating the AIDS epidemic with support from local community and the government.
Three decades of health advocacy has led to strong public awareness for the spread of HIV (human immunodeficiency virus) among the population. However, a majority of the discussion surrounding HIV has been centred around how to avoid contracting it, while little is mentioned about what a person should do after being infected by the virus.
What is the situation in Hong Kong?
Since 1984, over 8,000 people had reported being HIV-positive in Hong Kong, according to the Virtual AIDS Office. Although this number accounts for approximately 0.1 per cent of the city’s entire population, it is still a significant demographic to be catered by the public health system.
In addition, the number of people reporting being HIV-positive each year has been steadily increasing since the government began collecting data about the epidemic. In 2015, a total of 725 people had reported being HIV-positive in Hong Kong, which was the highest annual record in history. That number dropped to 692 in 2016 and remained as the second highest annual record today.
Government statistics also suggest that gay men who are ethnically Chinese remain to be the most vulnerable group to contracting HIV in 2017, as they make up a majority of the reported cases compared to other groups such as bisexual people, heterosexual people and injecting drug users.
What treatment is there for HIV?
People who are HIV-positive may live regular and healthy life when receiving treatment known as ART (antiretroviral therapy).
The ART treatment involves prescribing patients antiretroviral drugs to suppress the virus. Without the treatment, the virus will be allowed to progress and render the host’s’ immune system extremely defenceless against even the smallest infection, leading to AIDS (acquired immunodeficiency syndrome).
“[World Health Organisation] recommends ART for all people with HIV as soon as possible after diagnosis,” said the World Health Organisation (WHO) under the United Nations.
The WHO estimates that there were approximately 36.7 million people living with HIV by the end of 2015, and 18.2 million of these people were receiving ART treatment as of mid-2016.
The ART treatment is sometimes called HAART (highly active antiretroviral therapy) when more than one type of antiretroviral drugs are combined to suppress the virus.
While HIV thrives on attacking cells that are central to humans’ immune system and using it as host for replication, the ART treatment suppresses particular stages of this process and stops the virus from replicating itself.
The ART treatment may involve any combinations of the following six types of antiretroviral drugs:
- Fusion inhibitor (Stops HIV from binding and entering cell)
- CCR5 antagonist (Stops HIV from binding and entering cell)
- Nucleoside reverse transcriptase inhibitor (Stops HIV from making copies of its own genetic information)
- Non-nucleoside reverse transcriptase inhibitor (Stops HIV from making copies of its own genetic information)
- Integrase inhibitor (Stops HIV from taking its genetic information and integrating it into human DNA)
- Protease inhibitor (Stops replicated HIV genes from leaving the cell and become new virus)
The HAART treatment is effective because when the HIV virus becomes resistant to one of the antiretroviral drugs given to the patient, the other drug within the combined prescription can still ensure that the virus’ replication process does not happen.
How much does HIV treatment cost in Hong Kong?
The Hong Kong public health system has a long-established program to provide ART treatment to those who live with HIV.
The most well known HIV treatment provider is the Kowloon Bay Integrated Treatment Center, followed by Princess Margaret Hospital and Queen Elizabeth Hospital. All three centres provide ART and HAART as principal treatments for patients.
The cost for HIV-positive patients to receive treatment is the same as any other specialist outpatient clinic, according to Dr. Alfred Sit, medical and health officer from the Special Preventive Program in Department of Health.
Dr. Sit said the first consultation fee would cost the patient HK$100, while all subsequent consultations will cost HK$60 per attendance. Meanwhile, the patients will be given 16 weeks worth of drug item after each consultation, which costs around HK$10.
According to the spokesperson from Hong Kong AIDS Foundation, it is unlikely for the drug’s price to increase after each subsequent consultations.
“Treatment and care for HIV/AIDS, however, is complex and vary among patients and the stage of disease,” said Dr. Sit. “Components such as psychological counselling and health education are integrated into patient care and the cost incurred cannot be separately identified,” he added.
The doctor also said that the annual drug cost for HIV patients cannot be readily computed because it varies greatly with the regimen used which will be adjusted with time and patient profile.
The Hong Kong AIDS Foundation added that while accessing HIV drug is a non-issue for Hong Kong citizens living with HIV, the most difficult part of living with the virus remains to be facing the stigmatisation that society puts on them as well as the stigmatisation patients put upon themselves.
The data from Virtual AIDS Office showed that despite HIV infection rate in Hong Kong is steadily increasing, the rate at which people develop AIDS has remained consistently low over the past three decades.
This is significant as it takes years for symptoms of HIV to emerge after initial contraction. The fact that the number of people who developed AIDS each year has remained stable in spite of increasing HIV infection rate shows the virus is somewhat contained in the population.
The main focus of HIV advocacy today, therefore, is to prevent more people from contracting the virus in the first place.
While Hong Kong’s public health system already subsidises condom as means of prevention, the local group AIDS Concern said the government has been interested in introducing a new drug known as pre-exposure prophylaxis to the public. The drug allows an uninfected user to develop resistance against HIV when exposed to high-risk situations such as sex, which means significant protection for the vulnerable group, namely men-who-have-sex-with-men.