Just days after the international emergency-relief group Doctors Without Borders/Médecins Sans Frontières (MSF) was awarded the Nobel Peace Prize in October, POZ sat down with Tido Von Schoen-Angerer, MD, a German volunteer with MSF’s HIV program in Bangkok, Thailand. Since 1971, MSF has hounded media to cover, and government officials to answer to, the atrocities its workers witness at ground zero. With a nearly $1 million purse, the Nobel is more than an honorific plaque—one MSF head said the group would likely apply the money to its operating budget. Despite the prize, Schoen-Angerer, 33, wasn’t exactly celebrating—he’s on a mission to make generic versions of patented drugs available to developing countries, as activists have done with some success in South Africa.

POZ: MSF’s project in Thailand is not only PWA home care, but also raising awareness about access to medications. Can you tell us about that?
TS: It’s outrageous that the antiretrovirals are so expensive, even though they’re developed mostly with U.S government funds. Nobody can afford them in Thailand. The U.S. trade rep, Charlene Barshefsky, threatened Thai officials with trade sanctions if changes weren’t made in the patent laws’ exclusive marketing rights. I think that’s crazy.

How does Barshefsky justify this?
It’s called “safety monitoring,” but essentially it’s just protecting marketing rights. We published a report about the situation in Thailand that was adopted by the Thai national AIDS committee, so hopefully their government will take those things on. But of course it’s difficult because they’ve been subject to so much pressure from the United States.

Trade law injustices must be a hard sell to the media.
It’s much harder to reach people with this issue than with a picture of Rwanda, where you see the problem directly and see how you could make a difference. It’s hard to go into all the complex legal details, but there are very long-term effects.

Is this what you went to med school for?
No, it’s not. A year ago I had no clue about these issues. It’s sometimes hard to deal with all this bureaucracy as a doctor, but since nobody was doing it, we had to. There are some NGOs [nongovernmental organizations] in Bangkok working with us now, which helps. Things are also starting to move with the help of U.S. activists. Without ACT UP and others, there wouldn’t have been any success in South Africa.

What does this work mean for the rest of the world?
All things connect internationally now—something happening positively in South Africa will help us in Thailand. Now we can do more without fearing that the U.S. trade representative will respond immediately. But Thailand and South Africa are just the tip of the iceberg. I’ve been looking at reports on other countries, and if you read between the lines, things there are exactly the same—or worse. There are just more NGOs in Thailand and South Africa, so there is a bigger awareness.

What exactly are you doing with the Thai government itself?
We’re planning a program to show that it’s practical and relatively simple to introduce antiretroviral therapy. The health care system is not so bad in Thailand—it’s not like here in the U.S., but it is a middle-income country. Bringing in affordable drugs could make a big change.

What about current access through clinical trials?
There are a lot of trials going on—often coordinated from the United States because it’s easier and cheaper—and a lot of patients who participate don’t get good care. Not a single patient in Thailand has been guaranteed continued antiretroviral treatment once they enter a trial. Maybe they get
antiretrovirals for one year, that’s it.

Any advice for would-be doctor do-gooders who want to get involved?
You’ll always fail—you can’t cope with all the problems—but it’s satisfying to do something. Instead of seeing the world’s problems on TV and saying, “Well, I can’t really do anything about it,” you can go there.


For more info about
MSF and trade-law issues, visit these websites:

Doctors Without Borders
This is a great overview of the group’s global efforts, with comprehensive info on each program (pictured). Cruise to the special report on access to essential medications, make a donation or order a benefit album.

International Gay and Lesbian Human Rights Commission
Sign a petition for “AIDS Drugs Now!” and gather
tips on organizing against restrictive trade laws.

Consumer Project on Technology
Recommended by MSF’s own doctors. This site’s name is as serious as its language and layout are clear. Click on the health section and check out the frequently asked questions (FAQs) on compulsory licensing and parallel imports.

Health GAP (Global Access Project) Coalition
This network of AIDS and public health groups has a no-frills introductory site updated daily with media articles about HIV drug trade goings-on. The group also maintains an e-mail list: Send a blank message to listproc@critpath.org with “subscribe healthgap” in the body of the e-mail.