By Robert Horn, Fortune
May 21 2007: 6:03 AM EDT
(Fortune Magazine) -- When Narisara Panya's husband died of AIDS seven years ago after returning to Thailand from a construction job abroad, it was devastating. With only a small plot of land that didn't always yield enough food for their two children, 44-year-old Narisara - who became HIV positive herself - needed an income. But because she was stigmatized in her community, even after starting antiretroviral therapy, no one would hire her. And no banks, or even loan sharks, would lend her money to start a business. "They were afraid of the illness and thought I would die before being able to pay them back," she says.
An experiment in microcredit came to her rescue. With a 24,000 baht ($685) loan from a program called Positive Partnership, Narisara was able to set up a small business selling ginseng tonic and herbal supplements in roughly 100 neighboring villages. Now she and her business partner earn 8,000 baht ($228) a month each, more than twice the average income in their village in northeastern Thailand. "My customers know I'm HIV positive," Narisara says, but they don't care. "They are surprised at how healthy I look."
Banking on third-world small businesses
Microcredit is hardly new. Several programs, including ones for the HIV positive, have been modeled after Bangladesh's Grameen Bank, founded by Nobel laureate Muhammad Yunus. The innovation here is partnership: To get a loan, a person with HIV must find an uninfected partner. Instead of being a burden, people with HIV now bring money into the community.
Narisara found a neighbor, Pojana Soengern, whose niece had died of AIDS. "People see from our example that someone like me who does not have HIV can work with someone like Narisara who does, and I am perfectly safe," Pojana, 55, says. "This project has improved my life too."
The program is the work of Thailand's famous AIDS campaigner, Mechai Viravaidya. He earned the nickname "Mr. Condom" when, as a cabinet minister in the 1990s, he was largely responsible for Thailand's HIV-prevention program that the World Bank credits with sparing 7.7 million Thais. In recent years, Mechai says, government efforts have slackened. So in 2004, as head of the nonprofit Population Development Association, he reached out to the private sector. U.S. pharmaceutical giant Pfizer (Charts, Fortune 500) has donated $300,000 and employee expertise; it recently pledged $100,000 more. Other funders include Bangkok Bank and Novartis (Charts). "This isn't charity," Mechai says. "The program works because it uses a business approach."
Ironically, the program is gaining recognition just as a battle has erupted between Thailand and Big Pharma over the country's decision to produce generic versions of HIV drugs made by Abbott Laboratories (Charts, Fortune 500). Abbott accuses Thailand of violating its patent and refuses to introduce new medicines there. Thailand claims its actions are legal under a World Trade Organization agreement.
Pfizer, watching from the sidelines, makes few HIV drugs and doesn't market them in Thailand. Its new HIV drug approved in the U.S. in April won't be available in Thailand until 2011 because of a lengthy approval process. By then, Pfizer expects Thailand and Big Pharma will have ironed out their differences.
Meantime, the payoff for Pfizer is goodwill. "Our philosophy is to take a more holistic approach to public health," says Pfizer spokesman Anutra Sinchaipanich. "Improving the lives of people with HIV is part of that."
Breaking down the stigma of HIV has advantages for the industry. Fear of discrimination keeps people from getting tested, so they stay out of the health-care system or seek care too late. Pariah status can cause depression and nonadherence to drug regimens. Resistance builds, creating the need to develop new drugs faster.
From microcredit to microcapitalism
Although Africa remains the continent most severely affected, according to the United Nations, HIV is spreading faster in Asia, primarily China, Indonesia and Vietnam, with one million new infections every year. An effective response would cost just 4 percent of most national health budgets, says Swarup Sarkar, a UN epidemiologist. HIV is most devastating to those on the borderline of poverty. More than five million people are impoverished each year in Thailand, Cambodia, India and Vietnam alone, according to the Asian Development Bank. "HIV pushes people into destitution," Sarkar says.
Positive Partnership pulls them out, having funded more than 600 businesses so far: Kanchana Tunpu, who is almost blind, started cattle breeding in partnership with a cousin; in a nearby village, Supinya Lekyumadan turned to a lifelong friend as a business partner to buy tools and equipment to expand her stone-carving business.
With a repayment rate of 91 percent, the program is drawing attention. The U.S. Agency for International Development and the Population Council have recommended scaling up the project. The UN Development Program recently shepherded fact-finding delegations from China, India, and Cambodia with the goal of starting similar ones.
"Before we had the project, people were just afraid," says Narisara, who appears well and is healthy. Without Positive Partnership, "I would be dead. But now I want to live. Now I can stand on my own feet."
From the May 28, 2007 issue
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