Cambodian sex workers and health officials on Monday expressed skepticism over the ethics of a $1 million HIV study, funded by the US National Institute of Health and computer tycoon Bill Gate’s charity foundation.
During a news conference at the offices of the NGO Oxfam Hong Kong, a panel of sex workers said they would refuse to participate in the study—designed to test whether the anti-retroviral drug tenofovir can prevent contraction of HIV—if they didn’t receive some health guarantees.
“If you guarantee the impact for a long time, we will participate,” said Sou Sothea Vy, 64, representative of the Women’s Network for Unity, a sex worker union that has demanded health insurance for participants for up to 20 to 30 years after the study ends. “If you do not, we oppose. We absolutely oppose,” Sou Sothea Vy said.
The study, which is expected to begin within the next two months, aims to recruit 960 sex workers in Phnom Penh.
Though researchers said the sex workers would receive counseling and a full explanation of the study, some argue that Cambodians are being exploited.
“They look for the vulnerable country to do the study in,” Dr Sin Somuny, executive director of Medicam, a consortium of health organizations, said last week. “The structure of the system is weak…” he said. “It’s easy for them to…conduct this kind of study.”
He cited the lack of long-term insurance for the participants as an example of exploitation.
“They risk their life…and the company in the future gets a huge benefit,” he said, calling on the country’s leaders to look more closely at the study. “Why do you risk your people’s lives without maximizing the benefit for the people in the future?”
Medical researchers who participated in the news conference said long-term insurance should be provided, but they could offer no assurance that it would.
“I don’t know how feasible it is for 20 or 30 years.” said Margery Lazarus, a medical anthropologist conducting preparatory research for the sex worker study.
Tenofovir—manufactured by the US pharmaceutical Gilead Sciences Inc—has not been clinically tested on HIV-negative patients yet, said Kimberly Page Shafer, the study’s principal investigator from the University of California in San Francisco.
The drug has been known to produce gas, nausea, vomiting and some kidney and liver dysfunction in HIV-positive patients—but little is known about its effect on HIV-negative patients, Page Shafer said at the news conference.
Similar studies are being conducted in Ghana, Nigeria and Cameroon, she said.
In Phnom Penh, the National Center for HIV/AIDS, Dermatology and Sexually Transmitted Infections will provide participants with medical care during the one-year trial and a checkup one month after the study is over, Page Shafer said. If the study is successful, participants will be given tenofovir for the following two years.
“What good is that to me?” sex worker Chuon Neth, 26, said at the conference, adding she could jeopardize her health by participating.
Despite 100 percent condom-use campaigns, 20 Cambodian women still contract HIV everyday, according to a National Aids Authority study released last year.
Though participants will be counseled to use condoms at all times during sex, people don’t use condoms properly all the time, Page Shafer conceded.
That has led some observers to wonder if the study will endanger the participants, who—as vendors of sex—are already at a high risk for contracting the disease.
Eng Veng Eang, project manager for HIV/AIDS at the Reproductive Health Association of Cambodia, said last week that many sex workers believe they only need one method of contraception to prevent HIV contraction—and many do not use condoms with their “sweethearts.”
“They believe: If they use drugs, they think the drugs can prevent HIV,” she said.
And even if the risks are properly explained, sex workers will struggle to understand it fully, said Chhu Bun Eng, director of the NGO Cambodian Women for Peace and Development, which runs peer-education programs for sex workers.
“The sex workers, if they do not understand, they will not know how to ask,” she said last week. “They don’t know about their rights.”
Lazarus, however, dismissed the argument.
“Making blanket statements that [sex workers] cannot possibly understand is patronizing,” she said.
Mu Sochua, minister of Women’s Affairs, said Thursday that the study jabs at an easily exploitable subgroup by focusing on sex workers, when an AIDS census revealed housewives were the fastest growing group of people contracting HIV in 2002.
“Maybe it is easier for the commercial sex workers to participate in the study,” she said, adding the sex workers do not have to get permission from their husbands to take part.
But Page Shafer rejected the criticism and said such studies concentrate on countries in Africa and Asia because the HIV contraction is more frequent.
“Do I think Cambodian women are more exploitable? No,” she said. “I’m doing this because I care.”