Out of Luck Youth Turning to Blood Donation for Survival

Selling blood has become an increasingly popular attempt at getting-rich-quicker among homeless drug users at the Friends Youth Center in Phnom Penh, where 35 percent of clients trade blood for money, and 10 percent are HIV positive, said a Friends’ representative Thursday. Officials speculate that as much as 20 percent of nearly 2,000 kids may be HIV positive, with potentially double that number for drug users. “It looks quiet serious if you put the levels of blood selling against drug use,” said David Harding, social and medical technical adviser. “If the [blood] screening process is not efficient, the Cambodian drug supply is pretty contaminated.”

A Friends’ one-day snap-shot survey taken in October of 1,857 kids between the ages of 8 and 21 showed that 69 percent used drugs. Among 16 to 18 year-olds, 10.75 percent sold blood and six percent used injected substances, principally heroin.

Blood selling was even more prevalent within the 19-21 age group, where 24.38 percent exchanged blood for money. Of this group, 13.3 percent used intravenous drugs.

The majority of drug users were between the ages of 19 and 21 years old, and were principally male. Just 8 percent were female.

“Among the 19 to 21-year age group, there is a serious correlation between injected drug use and selling blood,” Harding said. Older youths dominate the survey, but “numbers have started to drip down the age range for both blood selling and drug use,” he added.

Although drug use and blood selling is common to Phnom Penh’s poverty stricken residents, Friends notes a dramatic increase in the phenomena among its approximately 1,800 clients since last year. There has been an 11.6 percent increase in drug use since June 2001, and an increased affinity for blood selling to match.

Harding could not provide definitive data on how many blood sellers have HIV/AIDS across the city, but considering the correlation between intravenous drug use and HIV, he said “We could be talking about as much as 40 to 45 percent, double our target group” being infected with the virus.

Many of the blood sellers use drugs, favoring solvents, amphetamines and intravenous heroin, Harding said. He added, though, that drug users in closed communities-insulated by power and money-could further increase the numbers of addicts with HIV/AIDS.

“If we’re talking about 69 percent of our population using substances, who’s to say what the percentage is in colleges and in rich families where the kids have a lot of money in their pockets and nothing to do,” he said.

The Ministry of Health is making strides to counteract the rise of unsafe blood selling. It has spent close to $1 million a year since 1997 on blood transfusion projects, according to Dr Oscar Barreneche, blood safety officer at the World Health Organization. Six new laboratories have been built across the country for safe collection, testing and distribution, raising to 23 the total number of centers.

Plans are in place to build blood transfusion laboratories in every province to ensure the safe screening of public sector blood, Barreneche said.

The financial burden will primarily be borne by the Ministry of Health, while Unicef, the Japan International Cooperation Agency, the US Center for Disease Control, the World Health Organization and the Pasteur Institute have donated equipment to facilitate the development.

A five-year Blood Donor Recruitment Project also was initiated in 1999 by the WHO and the Cambodian Red Cross to educate and recruit potential blood donors. The project targets a section of the population considered to be “low-risk”: primarily students, youth and monks.

Public awareness campaigns do little to alleviate the effects of poverty, however. Cambodians facing homelessness, drug addiction and destitution disregard the hazards careless donations may represent since repeated donations can earn a day’s wages in a matter of minutes.

Seventeen year-old Chan Sokhom has sold blood since 1993, going to the Preah Ang Duong Hospital in Phnom Penh as often as three times a month. He can earn up to 20,000 riel (about $5) for one pint of blood. “I’m an honest person. Instead of stealing car mirrors, I sell blood,” Chan Sokhom said.

Chan Sokhom, a resident at the Friends’ shelter, did not know it is unhealthy to give blood more than once a month-a fact that is often ignored, given the demand for donors. Doctors and donors seeking extra cash have created an after-hours culture of informal blood selling.

Professional donors were a bittersweet solution to the great blood drought that hit Cambodia in years past. In 1999, the supply of Cambodian blood did not meet the demand, with as little as only six units of blood stored at the National Transfusion Center, Barreneche said. As a result, professional donors lined up outside of public health clinics donning clean clothes and coifed hair to mask their bruised arms.

Families in need of blood, but scared of giving it themselves, often pay a third party to donate the fluid crucial to a sick relative’s recovery. Doctors pay a small amount of money to donors then charge families an inflated price.

Clinics are obligated to screen blood for HIV/AIDS and other diseases transmitted by sexual intercourse or intravenous drug use, but the tests are pricey and the need for blood is even higher. Even Barreneche admitted that he could only hope clinics were performing the appropriate testing, and said that some clinics probably only tested for HIV/AIDS.

Still, Barreneche insisted that the public should not fear the quality of Cambodia’s blood supply, as the National Blood Transfusion Center conducts stringent testing and distribution methods. He said most private clinics receive their blood from the NBTC, which pays $20 per blood unit to test for HIV/AIDS, Hepatitis B, Hepatitis C and syphilis. Of all the blood collected in 2002, 17 percent was discarded for possible infection.

“There is no causality relationship between the HIV positive kids and the quality of blood,” Barreneche said, saying that the Ministry of Health should be applauded for its efforts to clean up the blood supply. Cambodia, he said, is one of the few countries that has adopted strict blood screening facilities. “We cannot provide the wrong idea,” he said.

In addition, Barreneche added, clinics perform crucial tests to weed out unsafe professional donors. Hemoglobin levels are tested before blood is withdrawn. Repeated donors often have substandard hemoglobin levels and are consequently turned away. Screening is less stringent after hours, as is the case for Chan Sokhom and over 650 other Friends’ clients.

Both the government and NGOS are working to eradicate the unsafe trade of professional donors. Increased public awareness campaigns and an aggressive recruitment of low-risk donors has raised the permanent blood supply to 200 blood units, Barreneche said.

In June, the Cambodian Red Cross steered the takeoff of a Blood Recruitment pilot program, with support from the South Korean Red Cross. Aiming to allay myths attached to blood giving, officials are teaching target donors in Battambang and Phnom Penh that donating blood yields life, not death.

“We hope to change the attitude of the people, because normally the people believe giving blood is a risk to their life,” said Men Neary Sopheak, director of communications for the Cambodian Red Cross.

Efforts to clean up the blood supply are complicated, since even members of the targeted “low-risk” groups, specifically upper-class youth and students, may be contaminating current stores. As a result, Cambodia’s fight for a safer reserve continues to be an arduous battle of blood-letting.

(Additional reporting by Nou Sophors)

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