Questions Arise Over Demand for AIDS Drugs

Late last year, a fire swept through Krin Vang’s house in Tonle Bassac, and she was forced to relocate to the Anlong Kgnan squatter village, about 15 km from Phnom Penh. A few months later, her husband, who was HIV-positive, died. A few months after that, her infant son died.

Krin Vang is also HIV-positive and has lived with that knowledge for at least two years. It was bad, she said, when she was living at Tonle Bassac, but it is even worse at Anlong Kgnan since there is no access to fresh water for the 3,631 residents living there. She said she is too ill to travel the 30 to 45 minutes to work inside the city.

She is just one of about 50 HIV-positive people living at Anlong Kgnan and, like many poor HIV-positive people across the country, wants access to the HIV/AIDS medications that could prolong her life.

“I want the medicines, but how can I get them?” she asked.

But increasingly, experts are asking whether or not people like Krin Vang should have access to the drugs without the services—like clean water—that are necessary for the medicine’s proper administration but are out of reach for many of Cambodia’s poor.

The medicines, called anti-retrovirals, can essentially reduce HIV/AIDS to a chronic medical condition that can be treated at a yearly cost of $10,000 to $15,000 per patient in developed countries, or $350 per patient for generic versions of the drugs in developing countries.

Anti-retrovirals are perceived by many as the cure-all for the life-threatening virus, yet experts have cautioned recently that their use, without the proper supervision, could have disastrous effects and further inflame the country’s AIDS crisis.

When AIDS patients in developing countries like Cambodia use the anti-retroviral drugs and do not follow the rigid time schedules for taking the drugs; if they don’t have follow-up consultations; or do not have access to clean drinking water or food, the medication could become useless, or worse.

“If the anti-retroviral drugs are not taken on the schedule, it gives the virus an opportunity to become immune to the drugs,” said Geeta Sethi, UNAIDS country program adviser. “People would need to take stronger and stronger medicines, and that could be devastating for the country if people are provided drugs that do not work for the strain of HIV.”

For cases like Krin Vandy, HIV/AIDS drug therapies—like clean drinking water, employment or any basic support services—are out of reach.

“Even if the cure for AIDS was just a glass of clean water, how many people in the world could have access to that?” Sethi asked.

Although Cambodia has been praised for stabilizing its HIV/AIDS infection rate, it still has the highest rate of HIV/AIDS prevalence in the world, with an estimated 157,000 people infected with HIV or AIDS.

Currently, there is no estimate for the number of people who are taking the anti-retroviral drugs in Cambodia. Some NGOs, such as Medicins Sans Frontiers Holland/Belgium, say that at least 400 people currently receive free anti-retrovirals through various local and international NGOs.

“For the most part, these people take the anti-retroviral drugs, and there is no problem because they have home care and support services,” said Dr Kheang Soy Ty, deputy medical coordinator for MSF Holland/Belgium. “But there is a danger for those people who go to private clinics to get their medicines.”

People who buy HIV/AIDS drugs from private clinics or pharmacies often use over-the-counter drugs for as long as they can afford to, but do not go to NGOS for follow-up support programs or monitoring because “they do not want people to know their business,” Kheang Soy Ty said. They often end up going to MSF, Medicins Du Monde or a number of other local NGOs that provide anti-retrovirals for free after they run out of money, he said.

By this point, however, these patients will not respond to the basic two-pills-a-day doses, and are forced to take 20 per day. This means patients must take the medications with cleaner drinking water and are subject to a wider variety of side effects, he said.

And if that more complex regimen isn’t followed, the virus will have the opportunity to mutate once again into a strain that could potentially be resistant to any drug therapies, he said.

There are other troubling trends with taking the medications as well, Sethi said.

“If we feel better, there is a tendency to stop taking the anti-retroviral drugs, or to reduce the dosage, and this is one of the worst things people on the drug treatments can do,” Sethi said.

(Additional reporting by Kuch Naren)


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