living overseas/obtaining meds overseas/keeping your USA doctor...

[ivorytickler]

Hello all,
 any expatriates out there? I need advice on obtaining meds overseas. If one spends a great deal of time overseas, even relocates to a european country, how does one obtain hiv meds while living there? Can one keep their USA doctor and have meds sent overseas, or does one have to abandon the USA doctor and start from scratch in a foreign country? All suggestions and/or answers welcomed. Thank you.
Bob

[natthai]

Hello all,
 any expatriates out there? I need advice on obtaining meds overseas. If one spends a great deal of time overseas, even relocates to a european country, how does one obtain hiv meds while living there? Can one keep their USA doctor and have meds sent overseas, or does one have to abandon the USA doctor and start from scratch in a foreign country? All suggestions and/or answers welcomed. Thank you.
Bob

I have been an expat for almost all of my professional career however my infection is recent so I can mention a few points to consider. My conclusions so far is that having HIV makes it considerably more difficult to work legally as an expat overseas despite your education, level of experience etc.

One potential benefit:
1. In some countries it is easier to get meds than in the states. In less regulated countries you could keep your doctor in the USA and simply buy the meds yourself. Also the prices maybe considerable less expensive in some countries that have invoked their "compulsory licensing" rights under the WTO (Thailand and India specifically).

Some potential problems:
2. If you are going to obtain a legal status to live and work in a foreign country that will involve obtaining a work permit/residency visa they will almost certainly ask for an HIV test. My doctor informs me that in the past  many sympathetic doctors have helped patients with this issue however the embassies are becoming increasingly more strict. For example, they will insist you go to a specific doctor that they already contract with. I can speak specifically for the Canadian, English, British Caribbean, American, German embassies. I have friend who have all gone through the process with these countries and they all had to be HIV free. I have heard that Australia allows HIV positive immigrants but I can't confirm it.

So if you show positive many places will not approve your work permit. Most countries have relaxed travel visa requirements but not residency requirements.

3. Some countries are VERY strict with generic meds. For example, if you plan on entering Singapore or Hong Kong and you have a generic version of a med, even if it was prescribed to you by a doctor it is not necessarily legal in that country. They will confiscate it, detain you at the border, charge you, etc. In Singapore you are actually looking at a serious prison sentence. I can speak from direct experience regarding Singapore. They take these matters VERY seriously in some countries so do your research first.

4. Most countries are very strict about importing/customs/duty fees. They might open all of your parcels entering the country so if you plan to have something shipped from another country you have to be careful about this issue as well.

Edit: You posted in off topic, normally I wouldn't have seen this post. You might want to consider moving this to the Living with Forum this is very ON topic.

[Ann]

I agree, Nat, and I've moved it to Living.

[joemutt]

3. Some countries are VERY strict with generic meds. For example, if you plan on entering Singapore or Hong Kong and you have a generic version of a med, even if it was prescribed to you by a doctor it is not necessarily legal in that country. They will confiscate it, detain you at the border, charge you, etc. In Singapore you are actually looking at a serious prison sentence. I can speak from direct experience regarding Singapore. They take these matters VERY seriously in some countries so do your research first.

That is not my experience. Can you back that up with any links? Did you receive a serious prison sentence in S'pore? (since 'you speak from direct experience'). I have been many times to S'pore over the last 10 years with my meds, some of which are generics, never encountered the problem you describe.

[natthai]

That is not my experience. Can you back that up with any links? Did you receive a serious prison sentence in S'pore? (since 'you speak from direct experience'). I have been many times to S'pore over the last 10 years with my meds, some of which are generics, never encountered the problem you describe.

Are you an expat living in Singapore? The issue I mention is based on direct experience from advice given to my by two HIV specialists (doctors who work for the red cross), a group of Singapore friends (one working for UNAids and formerly for a Singaporean NGO), my exboyfriend who is Singaporean and who did have legal trouble and discussions with my current boyfriend who is a pharmacist working for Merck.

The information came to me in the context of a conflict between regional ASEAN trade agreements and WTO trade agreements.

Firstly I am living in Thailand where they have invoked "compulsory licensing" for some HIV drugs under terms they have with the WTO treaties. I think India is the only other country to have done this. Anyways even though they have legal right to do it, it made the US Pharmaceutical industry VERY upset. They immediately put Thailand on a "black" list, a "watch list" and threaten them with trade sanctions constantly. It is a very contentious issue here and in the newspapers every month. "Compulsory Licensing" is also the number one issue at the pharmacy schools.

Basically Thailand invoked their right to produce generic copies of some meds that are still patented under a clause in the WTO treaty that  specifies that a country may produce generic copies of lifesaving medicines if the citizens cannot afford them, which clearly in Thailand that cannot. Although they have the legal right it angered the Pharmaceutical Manufactures that operate in the region. In response, Merck for example GREATLY lowered some of its ARVs prices to complete with the GPOs.

So the specific issue is that about 5 years ago many people living in Hong Kong, mainland China, Korea (somewhat) and Singapore would fly to Thailand, get their generic meds (for their own personal use) and then fly back. This is technically illegal. I have a close group of S'pore friends and my ex is Singaporean. He did face charges over this issue had to hire an attorney and had to go to court and yes the penalties he faces were VERY harsh. As you may know S'pore has a very idiosyncratic relationship with 'drugs'. Read the arrival card they put in your passport when you enter the country, you know the one that says in 100 point font that "Drug trafficking is punishable by death under Singaporean law..." Of course they are specifically mentioning narcotics but patentable medicines (in Singapore) that are generically produced (in Thailand) are illegal in Singapore and could be considered smuggling if not declared.

The next experience comes from a close S'pore friend was volunteering for an NGO in S'pore that was buying medicines in Thailand and bringing them to S'pore. The NGO would then give them to people who could not afford them. He could only do that for a very short time because he described the work as extremely hazardous and the customs were starting to clamp down hard. One of his collegues (an unpaid volunteer) did go to jail over this issue. Again, there is some conflict in the ASEAN versus WTO trade agreements regarding this issue and that is what allowed the NGOs to operate. He eventually had to stop it and instead got involved in UNAids advocating for more fair prices for meds in Singapore.

This story was also confirmed by my personal doctor who is a Director of the Thai Red Cross AIDS research center. She told me very specifically NEVER disclose you have generic meds in S'pore and lately Hong Kong too. Several of her patients ran into serious legal trouble. As you know the Red Cross is an international organization and they know the international rules and regulations very well. She was very stern and clear in her warning. She is also a principle investigator of the international START study--a very reputable doctor.

This information was confirmed to me just last weekend by a warning given to my friend from his doctor about a patient who recently ran into trouble in Singapore over this issue.

My advice to you is to do your research and be careful. To the OP I would say that you have to be very careful. International law, patents and "Intellectual Property" in particular the high pricing of HIV Anti-Retrovirals which makes them unavailable to most of the infected world population are a very contentious issue right now, especially in Asia. There maybe specific cases like the one I described that you may not be aware of and yet you might get caught up in it unintentionally.

There is an even bigger issue at state going on right now and that is called ACTA. The US is pushing for the prohibition of all generics. This particular agreement supersedes the WTO treaties as well as national laws. This issue will definitely get bigger in the next year or so and it is of particular concern for expats such as ourselves.

http://en.wikipedia.org/wiki/Anti-Counterfeiting_Trade_Agreement

[leese43]

Some potential problems:
2. If you are going to obtain a legal status to live and work in a foreign country that will involve obtaining a work permit/residency visa they will almost certainly ask for an HIV test. My doctor informs me that in the past  many sympathetic doctors have helped patients with this issue however the embassies are becoming increasingly more strict. For example, they will insist you go to a specific doctor that they already contract with. I can speak specifically for the Canadian, English, British Caribbean, American, German embassies. I have friend who have all gone through the process with these countries and they all had to be HIV free. I have heard that Australia allows HIV positive immigrants but I can't confirm it.

If you mean by English the UK that isn't actually correct. There are no restrictions and no testing requirements either. Having said that though I did find this information: -

Problems getting into the UK
Visitors `suspected of having AIDS’ have been refused entry by individual
immigration officers on questionable legal grounds.

The Home Office claims that the policy is only to exclude people if it is
suspected that the person needs extensive medical treatment without being
able to pay for it. For further information on UK immigration law and HIV see
Immigration and asylum and HIV.

http://kernowps.co.uk/travr.pdf

From personal experience of helping my ex get permanent residency I can tell you that there were no questions regarding HIV status.

[mecch]

I dont know anything about getting treatment funded by the USA, as an American overseas.

Here's my two cents: I got a residence permit in Switzerland years ago. All residents must buy health insurance. All health insurance companies must offer a basic plan (that pretty much covers everything but dental) and they all must accept ANYONE who applies to their company for a basic plan.
So when I serocoverted two years ago - all my treatment is covered.  Works out to about 5000 swiss francs a year for my insurance, deductible, and medicine cap.  

[Cliff]

Hello all,
 any expatriates out there? I need advice on obtaining meds overseas. If one spends a great deal of time overseas, even relocates to a european country, how does one obtain hiv meds while living there? Can one keep their USA doctor and have meds sent overseas, or does one have to abandon the USA doctor and start from scratch in a foreign country? All suggestions and/or answers welcomed. Thank you.
Bob

It probably helps if you specify the country(ies) involved and the length of time you plan on staying outside of the US.  The advice is likely to differ greatly depending on where you plan on living and for how long!

[Cliff]

BTW, I'm an expat in the UK.  I kept my US insurance for a period of time (maybe 1-2 years).  For most of that time, I was required to keep it by my (US) employer, but truth is I never used it after leaving the country as the local healthcare was fine (and cheaper in terms of out-of-pocket expenses).  Plus it's a hassel trying to keep a doctor and refilling meds when you live abroad (i.e., the trips home, ensuring you have an uninterrupted supply, urgent healthcare attention that may be requied, etc.).

[Inchlingblue]

BTW, I'm an expat in the UK.  I kept my US insurance for a period of time (maybe 1-2 years).  For most of that time, I was required to keep it by my (US) employer, but truth is I never used it after leaving the country as the local healthcare was fine (and cheaper in terms of out-of-pocket expenses).  Plus it's a hassel trying to keep a doctor and refilling meds when you live abroad (i.e., the trips home, ensuring you have an uninterrupted supply, urgent healthcare attention that may be requied, etc.).

Are you now covered by the NHS the way UK citizens are? Do you have to pay premiums?

[Ann]

Are you now covered by the NHS the way UK citizens are? Do you have to pay premiums?

I'm also an American ex-pat. When we moved here in 1991, I was entitled to NHS health care right away (the ex is British so there were no issues with him). You don't pay premiums, you just pay into the system (National Insurance Contribution) when you work.

[Inchlingblue]

I'm also an American ex-pat. When we moved here in 1991, I was entitled to NHS health care right away (the ex is British so there were no issues with him). You don't pay premiums, you just pay into the system (National Insurance Contribution) when you work.

I know that UK citizens and legal permanent residents don't pay premiums, I was just wondering how it works for an expat, such as Cliff. I'm not familiar with his situation and I don't mean to pry but I thought, as mentioned by others that if someone already has HIV they can't just go live in the UK or other countries that offer subsidized health care (which makes sense, otherwise everyone with chronic conditions would be flocking there).

Maybe Cliff also has a partner from the UK but it sounds as if he just decided to stay as an expat? Can it be that easy to access NHS care for someone who is living there as an expat?

In your case, Ann, back in 1991, presumably you were HIV-negative at the time, you just moved there and got coverage on your own or was it because your husband at the time was a UK national? If you had had HIV would it have been that easy?

[Ann]

Yes, I was negative when I moved here. However, if you read Leese's post, you'd see that it wouldn't have been a problem if I were poz.

I believe Cliff moved to the UK on a work visa, so he would have been entitled to the NHS right away. AND he was poz when he moved.

Also, I'm not a British citizen, but I am a permanent resident of the Isle of Man and that grants me the same access to both the UK and IOM NHS as any other Manx citizen or resident.

It's all so civilized here.

[komnaes]

3. Some countries are VERY strict with generic meds. For example, if you plan on entering Singapore or Hong Kong and you have a generic version of a med, even if it was prescribed to you by a doctor it is not necessarily legal in that country. They will confiscate it, detain you at the border, charge you, etc. In Singapore you are actually looking at a serious prison sentence. I can speak from direct experience regarding Singapore. They take these matters VERY seriously in some countries so do your research first.

I cannot say for sure for Singapore, but this is not true in Hong Kong. Generic pharmaceutical products and medicines imported in the personal baggage for personal use are exempted. The emphases of course are "personal use" and "reasonable". The proper advises I would give are, first, to make sure that the meds are not sent by post as they have to be "accompanied" and in personal baggage. Second, while going through the Customs, if searched and inquired, show the Customs with the written prescription with your name on it. It's OK to show that one is HIV+ as Hong Kong has no travel restriction. And finally, of course avoid bringing in large quantity. What will be considered "reasonable" will depend on the duration of one's stay (say, if one is only visiting for a week, it will be very suspicious if one brings in like a month supply).

[komnaes]

PS - just want to also add that I am sure there are not as many people in Hong Kong as in Singapore are being treated in Thailand.

In Hong Kong, as long as one is permitted to live, even one is not a permanent citizen, one is entitled to universal health care. The average HIVers like myself probably pay no more than USD200 for all their tests and meds annually. While the stigma is strong here it's definitely not the case with the HIV clinics and the medical professional in general. So we're being treated very nicely here.

So the only reasons I can see one would go to Thailand for treatment and meds are probably because the person is living in Hong Kong mostly but only as a "traveler" (I know a few that are working in the city of Shenzhen, e.g., just across the border in Mainland China but decide to "live" in Hong Kong) and/or a citizen, permanent or otherwise, not wanting to be seen in a HIV clinic.

[Inchlingblue]

Ann, not to beat a dead horse but what I am trying to know is: can anyone just go live in the UK if they want to, regardless of HIV status, and qualify for NHS?

Say if one goes on a work visa, as you say Cliff did,  they can just decide they want to live there and get NHS benefits and voila, they can? I don't get it.

[Ann]

Well Inch, dead horses get beat all over these forums, so why not in this thread as well?

I'm pretty sure you have to have a legitimate reason, like work. In my case, it was marriage to a British citizen. However, I had to submit all sorts of proof that I wouldn't be a burden. My ex inherited the house we were moving to, so that was very much in our (my) favour. This proof had to be submitted to the Home Office in London and approved there first, then approved by the Department of Immigration on the Rock. There were reams and reams of forms and a real pain in the ass to fill out. Heh. I said ream.

We also had enough money in the bank to see us through about six months or so while my ex found work. (it only took him a few weeks) I didn't work until my daughter started school, but that was only five months being a full-time, stay-at-home mum. In addition, we also brought a car over (at the time it was far cheaper to ship the one we had than to buy a new/used one here) so that was a major expense avoided.

As long as you can show that you can be a productive citizen and have reason to be here, then yes, you can access the NHS. Additionally, if you can show that you are a legitimate asylum seeker, you can also gain access to the NHS.

[Inchlingblue]

That's interesting, thank you.