Drug treatment programs are being cut back even as rates of abuse rise—with one organization describing the situation as a “crisis”—because most funding is tied to HIV prevention and the prevalence of the virus is decreasing, health experts said.
“Virtually all civil society funding related to working with people who use drugs is linked to HIV prevention,” said David Harding, an independent consultant who has worked with NGOs on drug abuse prevention and treatment programs in Cambodia.
“Less organizations are providing direct services to drug users than there were 10 years ago,” he said.
The decline in services comes as Cambodia is wracked by rising methamphetamine abuse, the substance of choice for the largest number of drug users, according to a U.N. report.
Meth use is especially prone to being overlooked by the country’s available health service providers because it is most commonly smoked, and many drug treatment programs—focused on the spread of HIV—target injected drugs, such as heroin.
Donors generally prefer to fund treatment programs for intravenous rather than non-intravenous drug users because they “often do not recognize non-injecting drug use…as a vector for HIV transmission,” Mr. Harding said.
From 2005 to last year, the percentage of the population aged 15 to 49 living with HIV nearly halved. The trend follows a steady decline in HIV prevalence since its peak in 1998, according to UNAIDS data.
Declining HIV rates have resulted in donors readjusting their funding.
From 2010 to 2012, total HIV spending declined by 12 percent, from about $58 million to $50 million.
Expenditure per person living with HIV also decreased by 10 percent, from $764 to $683, according to the National AIDS Spending Assessment in Cambodia for 2011 to 2012.
“Preliminary data indicates overall expenditure including external funding has further been on the decline in 2014 and 2015,” said Marie-Odile Emond, UNAIDS Cambodia’s country director, in an email.
Ms. Emond attributed the decline to donors “prioritizing funding for countries with…higher or still emerging epidemics.”
In 2014, major funders, USAID and The Global Fund to Fight AIDS, Tuberculosis and Malaria, decided to scale back their funding for HIV prevention and treatment.
Asked about declines in funding to Cambodia, Ibon Villelabeitia, a Global Fund communications specialist, said in an email: “The Global Fund’s funding allocation formula is based on disease burden and the country’s income level.”
The drop in aid for HIV/AIDS programs is having a ripple effect on drug treatment programs.
“The funding is continuing to decrease as it’s HIV funding,” said Sou Sochenda, a manager at NGO Khana, which supports HIV treatment and prevention programs, including those serving drug users.
Khana’s HIV/AIDS flagship project, which is solely funded by USAID, offers technical assistance to HIV service providers, works only with people who inject drugs and focuses on new HIV case detection, Ms. Sochenda said in an email.
Similarly, its partner organization Korsang, which works directly with drug users to reduce health risks, has only one donor, Khana, “and the funding ends in 2017,” Ms. Sochenda said. “This is the crisis.”
Drug prevention and treatment programs—from counseling, rehabilitation and medical treatment to needle-exchange programs—are rarely funded without having a dual objective, like lowering rates of HIV infection.
Ms. Sochenda said programs funded by her NGO have become smaller and less comprehensive due to the foreign aid pinch.
“We used to provide other basic health services (including overdose prevention and management) and other primary health care,” Ms. Sochenda said.