DISEASES IN CAMBODIA
Major infectious diseases found in Southeast Asia include bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis. Schistosomiasis (bilharziasis) is present in Thailand but the chances of getting it are relatively low. High risk areas include the southern parts of the Mekong River and lakes in northeastern Thailand.
U.S. health officials rate the risk of infectious disease in Cambodia as “very high,” notably from food or waterborne diseases (bacterial and protozoal diarrhea, hepatitis A and typhoid fever) and “vectorborne” diseases like dengue fever, Japanese encephalitis and malaria.
Dysentery, malaria, yaws, tuberculosis, trachoma, various skin diseases, and parasitic diseases were common. Inadequate nutrition, poor sanitary conditions, poor hygiene practices, and a general lack of adequate medical treatment combined to give the average Cambodian a life expectancy of about forty-six years by the late 1960s. This figure represented a significant increase from the thirty-year life expectancy reported a decade earlier.
It is estimated that one in three Cambodians has had tuberculosis." The disease is often difficult to treat because people who have it are also often infected with something else, sometimes AIDS.
An estimated 300,000 Cambodians are disabled, many of them by land minds.
In the spring of 2004, there were reports of mysterious disease in the town of Ping near the Vietnam border in northeast Cambodia. The symptoms, which included choking and severe coughing, were similar to SARS but unlike SARS the disease responded to antibiotics. At least seven were killed and 30 came down with the disease.
More than 100 people in Cambodia came down with swine flu in 2009, including Prime Minister Hun Sen and three cabinet ministers, and at least two died. The disease first appeared in June. The second victim—a 47-year-old man—died in October. Hun Sen required “urgent treatment” and recovered after several days of “receiving treatment from medical specialists.”
During the Mad Cow Disease crisis in Britain, a newspaper in Cambodia suggested that the cows be used to clear mine fields. Ireland set up border patrol to watch out for smuggled cattle.
Rural Cambodians often bath in and drink water that is also used by animals. Water-born diseases such as dysentery are relatively common. In one survey, 82 percent of the children in Kampot Province suffer from parasitic illnesses. Many have chronic diarrhea directly linked to drinking contaminated water.
Malaria in Cambodia
Malaria is a serious problem in Cambodia. Many people die from it every year. It is found everywhere in the country, particularly in rural areas, but generally visitors are not at risk if they stay close to the cities and the beach resorts. Be especially careful in swampy areas and during the monsoon season. Many of the antimalarial medicines sold in Southeast Asia are fake. A study by Lancet in 2001, found that a third of antimalarial drugs sold in Cambodia, Thailand, Vietnam, Laos and Burma contained no active ingredient.
Dangerous chloroquine- and Fansidar-resistant strains of malaria are common, especially near the borders of Thailand, Cambodia and Myanmar . Mefloquine-resistant strains have also been reported. Chloroquine, Fansidar and Mefloquine are the preventative anti-malaria medicines people usually take in malaria areas. Malaria has been “practically eliminated” from coastal areas of Thailand (it is still found on some islands near Cambodia).
Authorities discourage people form have standing water and distribute chemicals to fight malaria mosquitoes.
Dengue Fever in Cambodia
Dengue Fever occurs in Cambodia, especially if there is a lot of rain and lot of stagnant water for mosquitos that carry the disease to breed in.. There is often an annual outbreak in the Phnom Penh area early in the rainy season from May to July. Dengue fever is a nasty disease. Sufferers have a pounding headache, aching bones and joints and feel too sick to eat anything. There is no vaccine or cure. It can be treated though and it is important to get treatment right away.
Dengue fever is a viral disease transmitted by Aedes mosquitoes. The disease causes an acute illness of sudden onset that usually follows symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands, vomiting and rash. In Cambodia, the outbreak of dengue fever usually begins at the onset of the rainy season in May and lasts until October. In 2011, the country reported 15,980 dengue fever cases and 73 children were killed.
In 2011, Cambodia reported 15,980 dengue fever cases that killed 73 children.
aegypti mosquito Dengue fever is a nasty, viral disease transmitted by the Aedes mosquito, usually the Aedes aegypti , the same mosquito that often carries yellow fever. Sometimes called "breakbone fever" or "break-heart" because of the intense pain it can produce, the disease is characterized by sudden onset of fever; intense pounding, frontal headaches; aching bones and joints; nausea and vomiting; and a feeling of being too sick to eat anything. Other symptoms include severe sweats, symptoms: eye pain, rash, chills, and excruciating chest pains. Tests foe dengue rely on the presence of antibodies, which can take up to a week to develop.
Dengue fever is found in 100 countries and kills about 20,000 people annually. Nine out of 10 people who get dengue fever don’t even feel it or get a mild case in which they feel something akin to a slight flu. People who get full-blown dengue fever are sick for a week or more. Many patients have a rash, which appears 3 to 5 days after the onset of the disease, and experience severe emotional and mental depression during the recovery period. Most cases of the disease are benign and self-limiting although convalescence may take a long time.
A few people with dengue fever suffer gastrointestinal bleeding. Fewer still suffer brain hemorrhages. In about 1 percent of cases dengue fever can cause a severe and often fatal hemorrhagic disease called dengue hemorrhagic fever (DHF) that occurs when capillaries leak and the circulatory system collapses.. Those that die of dengue fever often get DHF hemorrhaging in the final stage of the sickness. Failing to realize they are infected, they go don’t get treatment soon enough and lose blood plasma and go into shock after the initial fever passes. Some victims die within 10 hours of developing serious symptoms if they don’t get appropriate treatment.
There are several strains of dengue fever (the four main one are immunologically related). Those who get the disease develop an immunity to the strain they were infected by but are more likely to get DHF and get seriously sick if they get infected with a second, different strain. Scientists are not sure why this happens but think it may be because the immune system reacts the second time as if the invader were the first strain, wasting precious energy and leaving the body vulnerable to an attack by the second strain. Many doctors believe that since so few people show symptoms the when get dengue those that do display symptoms probably have gotten the disease a second time from a second strain. Getting the disease twice for two different strains seems to provide immunity for life from all strains of dengue fever.
Dengue Ravages Cambodia in 2012
In September 2012, Radio Free Asia reported: “Dengue fever cases in Cambodia have reached an “alarming level” with deaths rising rapidly. The disease is striking Cambodia at a time when the two countries are contending with seasonal outbreaks of malaria and other infectious tropical illnesses, and as they struggle with weak health care infrastructure systems. Dengue fever is caused by a virus transmitted by mosquitoes and mostly affects younger children. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. The infection occasionally develops potentially lethal complications. [Source: Radio Free Asia, September 20, 2012]
In Cambodia, the Ministry of Health announced that an epidemic in the country had reached an “alarming level,” with Banteay Meanchey, Siem Reap, Oddor Meanchey, and Kandal provinces most severely affected. Senior health officials reported that in the first eight months of the year, the disease had killed 134 children, up from only 48 deaths last year, and sickened 32,000 others, compared to only 11,020 cases a year ago. Among the fatal cases, 70 percent died of gastrointestinal bleeding They said that the outbreak is the worst since 2007, when at least 400 children died and more than 36,000 children were sickened.
Director of the National Center for Parasitology, Entomology and Malaria Control Chor Meng Chour said the Ministry of Health is focusing on the provinces that have been affected by heavy rainfall, which creates conditions for mosquito breeding. “This year … the outbreak has lasted longer,” he said. “Right now, the epidemic has surpassed the national red line.”
In Cambodia, the outbreak of dengue fever usually begins at the onset of the rainy season in May and lasts until October. Meas Ly, a 70-year-old villager from Kompong Cham province, said the residents of his district don’t have enough larvicide to prevent mosquitoes from breeding in swamp areas and local waterways. “We don’t have Abate yet,” he said, referring to a larvicide product. “We want the government to distribute Abate to us.” Ministry of Health officials said they have reserved about 320 tons of Abate for distribution but so far have released only half of that. They said the ministry spends around U.S. $2.5 million annually to fight the disease.
In October 2012, Xinhua reported: “At least 34,483 dengue fever cases were reported in Cambodia in the first nine months of this year, a 166 percent increase compared with 12,972 cases in the same period in 2011, a report of the National Center for Parasitology, Entomology and Malaria Control showed. From January to September 2012, the disease had killed 146 Cambodian children, up 147 percent compared with 59 deaths during the same period in 2011. "The disease continues to kill between 3 and 5 children a week," said Dr. Char Meng Chuor, director of the center. He explained that there were more deaths this year because parents had sent their ill children to private clinics first, and when the treatment was ineffective and the disease became more severe, they would send them to public hospitals, but it was too late for them to be cured. Char Meng Chuor said to prevent the outbreak, the center has distributed some 270 tones of Abate (a chemical substance used to kill larvae in water pots) to households this year.[Source: Xinhua, October 3, 2012]
Ek Madra of Reuters wrote: “There is no vaccine for dengue but even if a treatment existed, the Health Ministry, which has an annual budget of $3 for each of Cambodia's 13 million people, would struggle to afford it. Instead, the Health Ministry focuses its efforts on prevention, telling people in towns and villages to use mosquito nets, keep an eye on their children, burn rubbish and not allow pools of stagnant water, where the insects breed, to collect. "We can change lots of things, but changing people's behavior is hardest of all," said Ngan Chantha, head of the ministry's anti-dengue program. "We tell them what to do, but as soon as we go away, they revert to their old habits." Many people disagree, saying it is impossible to keep an eye on children when so many mothers and fathers have to work to provide for their families in what remains one of the poorest countries in Asia. [Source: Ek Madra, Reuters, October 17 2007]
Dengue Fever Outbreak in Cambodia in 2007
A total of 407 people died of dengue fever and nearly 40,000 were infected with it in 2007, most them children, according to the Cambodian Health Ministry . This was the highest toll in nearly a decade. Major outbreaks began in May. In 1998, 424 people died from it and 16,000 were infected.
Ek Madra of Reuters wrote: “Dawn has not yet broken but already more than 1,000 sick children queue outside a hospital in Phnom Penh in a desperate wait to get treatment for dengue. Dengue has killed 389 people in Cambodia, nearly all of them children. "Please help my grandson. He has had a fever for three days now," pleads 50-year-old Loung Neang, tears rolling down her cheeks as she cradles the listless body of an 18-month-old child outside the hospital before dawn. She traveled 80 kilometers the previous day from the eastern province of Kampong Cham, where medical facilities are nearly non-existent. But she arrived at the overcrowded hospital too late to have the child admitted and must wait another 24 hours for a bed to open up when patients are discharged. Whether her grandson will live that long is another question. Outside the hospital, waiting children lie on reed mats on the ground, their arms hooked up to saline drips hanging from the trees. [Source: Ek Madra, Reuters, October 17 2007 )(]
“Dengue has infected more than 38,000 people in Cambodia so far this year, government figures show. "Every day, every ten minutes, a child is arriving in shock, without a pulse and with no blood pressure," said Beat Richner, a Swiss doctor and founder of four donor-funded hospitals in the war-scarred Southeast Asian nation. In all, his clinics can treat 900 infants, but it is not enough. "More will die as the dengue continues to spread," he said. )(
"I am poor and can't afford a private clinic. Where should I go now?" 43-year-old Pov Sokhom shouted at the policemen keeping order at the hospital gates as she covered her 7-month-old granddaughter with a wet cloth to keep her cool. The child's mother is working in one of the many garment factories around Phnom Penh, leaving parental duties to grandparents. )(
“Even though dengue has always been a rainy season threat in the tropical Southeast Asian nation, Richner said this year appeared to be the worst yet despite government and World Health Organization (WHO) campaigns. He blamed the domestic and international authorities, which are responding to higher-than-normal levels of dengue across the region, for being slow to act even when it became clear in May that 2007 was going to be a bad year. "That is very sad. It's a huge suffering for the children," he said. )(
“The WHO, United Nations Development Program, Asian Development Bank and International Red Cross have all chipped in to help provide pesticides to kill mosquito larvae. Richner's Kantha Bopha hospitals, which offer advanced medical facilities to Cambodians for free, need $7 million a year to keep themselves afloat, but the size of the dengue outbreak is already causing them to eat into next year's budget. Furthermore, raising cash is becoming harder because of Western preoccupation with diseases like bird flu, he said. "Bird flu is a threat to the Western world, so they pour money and commitment into that," he said. "But dengue? There's no threat to the United States or Europe so nobody's interested." )(
Bird Flu in Cambodia
See Southeast Asia
Mystery Illness Kills Cambodia’s Children
In July 2012, Mark McDonald of Al Jazeera wrote: “This is the grim track of a mysterious new illness that has already killed scores of children in Cambodia: First, there’s a severe fever. Then comes encephalitis, a swelling of the brain. Finally, the lungs go, and the child dies. All this happens within 24 hours. The disease is absolutely murderous in its efficiency — Dr. Beat Richner, the physician who first sounded the alarm about the outbreak, said that 64 of 66 his patients with the illness have died. All children. All under 7. Dr. Richner, a Swiss physician, is the founder of the Kantha Bopha children’s hospitals located in the capital Phnom Penh and in Siem Reap, home to the famed Angkor Wat temple complex. He first notified the Cambodian government about the appearance of the deadly new disease on June 20. [Source: Mark McDonald, Al Jazeera July 4, 2012 ==]
“Cambodian health officials called in the World Health Organization, and together they announced they were investigating the unknown illness. Also the agency issued a global alert. Early tests have ruled out simple pneumonia and other commonly known communicable diseases. Bird flu, which killed a young Cambodian mother and her 11-month-old son last year, also has been eliminated as a likely cause. “It is very early to find the cause. We are still trying to gather data,” said Nima Asgari, a W.H.O. public health specialist interviewed by The Phnom Penh Post. ==
“The new illness has apparently not spread to other wards in Dr. Richner’s hospitals, and he told The Post that “wrong treatment” could be the culprit in the new illness. “All these children had encephalitis and were hospitalized and treated at private clinics before coming to us,” Dr. Richner said. “I worry that a wrong treatment and drug intoxication at some private clinics has destroyed the lungs leading to a pneumonia we cannot treat.” Cases have now appeared in 14 Cambodian provinces, according to a local health hotline worker quoted by The Post. The U.S. Embassy in Phnom Penh has not issued any special warnings or health alerts on its Web site. ==
“Mr. Asgari, who worked on the bird flu cases last year, said the new illness was probably not related to dengue fever or a new outbreak of Chikungunya, also known as CHIKV, an untreatable alphavirus similar to dengue fever that is transmitted by mosquitoes. CHIKV has not been seen in Cambodia for nearly 10 years, health officials say, and its re-emergence might have caused a dramatic spike in dengue fever, with more than 9,000 reported cases so far this year. There have been at least 38 dengue deaths, including 14 children. ==
“Dr. Char Meng Chuor, director of the National Center for Parasitology, Entomology and Malaria Control, told the news agency Xinhua that the infection rate had increased by 369 percent compared to 2011. He said people were being reminded to use mosquito nets and to fill in any puddles around their homes. He said the government was distributing Abate, a larvae-killing chemical. ==
Use of Steroids Linked to Hand-foot-mouth Disease Deaths
Clothilde Le Coz of Asian Correspondent wrote: Since April, 2012, “78 cases of the so called “hand-foot-mouth” disease (HFMD) have been reported in Cambodia according to WHO and the Cambodian Ministry of Health (MoH). It is the first time the disease has been reported in the country, causing the death of 64 children between 3 and 11 years old and sparking debate in medical circles.[Source: Clothilde Le Coz, Asian Correspondent, July 16, 2012 ~~]
“According to data released by the World Health Organization (WHO) and the Cambodian Ministry of Health (MoH), 79 percent of the children who died from HFMD syndrom were treated with steroids. This could be seen as the cause for aggravation of the disease, leading to death. Asked about this possibility, Dr. Nima Asgari, in charge of the investigation for the WHO, told Asian Correspondent that “patients who have this syndrome should not be treated with steroïds, in any case. Since fatal cases were observed in China and Vietnam, it is known that steroïds can be “fatal” when used to treat the disease. ~~
“The virus causing the HFMD disease in Cambodia is the Enterovirus 71 (EV 71), also known in Thailand, China and Vietnam to have caused millions of cases of the HFMD in the past few years. The Pasteur Institute based in Phnom Penh just started to research if the EV 71 observed in Cambodia has the same strain observed elsewhere in the region. ~~
“According to Dr. Philippe Buchy director of the Virology unit at the Pasteur Institute, “a few days ago, the disease was somewhat mysterious”, although the proper term would be “borne illness to be determined”. In a CNN report published on July 11, the Pasteur Institute seems to declare that the virulence of the disease was caused by a slight alteration of EV71, as well as the fact that the Cambodian population has not been exposed to the disease for years, and the use of steroïds, which weakened the body condition of the children. In conclusion, Dr. Buchy states that “the case is closed”. Two days later, these information was confirmed by the WHO and the MoH in a press briefing. Dr. Asgari said that the steroids treatments ”aggravated” the disease, which led to the death of the children. ~~
“The first death occured on April 20. Twenty-three deaths were reported a month later and there were 44 dead by June 20. The WHO and the MoH published a press release on July 4 to qualify the disease as “mysterious”. According to Dr. Philippe Buchy director of the Virology unit at the Pasteur Institute, “what is a mystery is in fact that EV 71 has been detected in fatal cases, which should have been only rare and unusual complications of the EV 71 infection”. Dr. Laurent added that the July 4 WHO’s alarming tone was “stupid” and created panic. According to the Bangkok Post, Thailand is now seeing a real exodus from Cambodian parents willing to have their children treated in Thailand. ~~
Thousands of children have suffered and still suffer from the same disease in Vietnam, China and Thaïland. In 2011, Vietnam has recorded 169 deaths from a virulent form of the disease Hand, foot and mouth over 110,000 reported cases. Yang Jiechi, Chinese foreign minister, confirmed to the Cambodia Daily and Phnom Penh Post that Chinese specialists will come to Cambodia to help identify the disease more precisely. The Thai Public Health ministry also said specialists will be sent to Cambodia to help prevent the spread of the disease. In 2011, China has reported more than one and a half million cases, killing 500 of them. Thailand is now starting to see fatal cases. ~~
AIDS in Cambodia
Cambodia used to have the highest AIDS rate in Asia. In the late 1990s the adult AIDS rate in Cambodia was 3 percent, compared to 0.5 and 2 percent in India, Bhutan and Malaysia, 2.3 percent in Thailand, 0.5 percent in the United States, and 26 percent in Zimbabwe (the highest rate in the world). In some hospitals the majority of patients were AIDS sufferers. At some Phnom Penh hospitals there were so many that patients were placed in corridors and courtyards. In some villages you could see proportionally large numbers of young, abnormally skinny people. Most Cambodians knew someone who had the disease.
The International AIDS-HIV charity Avert reports: Cambodia’s HIV epidemic can be traced back to 1991. After an initial rapid increase, HIV infection levels declined after the late 1990s and by 2003 HIV prevalence was estimated at 1.2 percent. Results published in 2009 from the first national population-based survey estimated HIV prevalence at 0.6 percent. It’s believed that interventions with sex workers, carried out by the government and non-governmental organisations (NGOs), played a role in this decline. The adoption of a ‘100 percent condom’ policy that enforced condom use in brothels led to a substantial rise in condom use among sex workers and their clients and a drop in HIV infection levels among brothel-based sex workers. The use of condoms rose from 40 percent in 1997 to 90 percent in 2010 and new infections dropped to 2,000 per year. UNAIDS estimate that without the prevention efforts, this figure would have been more than 50,000. However, ongoing concerns include low levels of condom use among MSM, an increase in sex work occurring outside of brothels (making it harder to reach sex workers with interventions), and mother-to-child transmission of HIV – around one third of new infections occur through this route. HIV is mostly transmitted through heterosexual sex in Cambodia, and concerns are growing about the number of married women who are infected through their husband. [Source: Avert, International AIDS-HIV charity website]
In 2011 Xinhua reported” Cambodia's Vice-Chair of National AIDS Authority Tia Phalla said Tuesday that it's estimated that some 2,500 HIV/AIDS patients died this year and the deaths would decline to about 2,300 in 2012. "Cambodia has seen success in fighting HIV/AIDS -- the prevalence rate among adults aged 15 to 49 has dropped to 0.8 percent in 2010 from 2.5 percent in 1998," he said. "However, the deaths, new infections and discrimination against people living with HIV/AIDS still persist in this country. "
Spread of AIDS in Cambodia
AIDS and HIV developed into problems later but spread faster in Cambodia than in Thailand. The number of blood donors in Phnom Penh with HIV leapt from 0.1 percent in 1991 to 10 percent in 1995. The number of AIDS-HIV infect people rose from 121, 000 in 1997 to 170,000 in 2000 to 220,000 in 2003. As of 2003, about 80,000 people had died of the disease.
The spread of AIDS-HIV in Cambodia was blamed mainly in widespread prostitution, sex without condoms and a generally relaxed attitude about sex. Bu some estimates half the prostitutes in some areas were HIV positive and there was no pressures for them to wear condoms. Many men got the disease from prostitutes and then passed it on their wives who then passed it on to their newly born children. Initially the disease was spread mainly through intravenous drug use. In rural areas it is thought the disease was spread mainly by unfaithful husbands who pass it on to their wives.
As of late 1987, the government in Phnom Penh had disseminated no information on the spread of the Acquired Immuno-Deficiency Syndrome (AIDS or HIV virus) in Cambodia. In addition, the list of common illnesses in Cambodia, as reported by international organizations, does not mention Karposi's sarcoma and pneumo-cystic pneumonia (PCP), the most common complications resulting from infection by the HIV virus. The risk to the Cambodian population of contamination by carriers of the HIV virus carriers comes from two sources. The more likely of the two consists of infected, illegal border-crossers, including insurgents, from Thailand, where authorities identified a hundred cases of AIDS in 1987 (triple the number in 1986). Less likely is the risk of infection from legal travelers. Cambodia remains a closed country, and access by foreigners (except for Vietnamese, Soviet, and East European visitors) is limited to a few scholars and to members of international and private aid organizations. [Source: Library of Congress, 1987]
Despite an extensive AIDS prevention campaign in the early 2000s, there are about 20 new infections every day. At that time there were a few rays of hop. Young people were using condoms more and the AIDS-HIV infection rate was declining among sex workers.
In the late early 2000s, the kind of treatments that Western AIDS sufferers received was out of the question in Cambodia because it is was too expensive, As of 2003, only 1,600 AIDS-HIV sufferers were receiving modern antiretroviral (ARV) drugs. Even with a $16.6 million grant from the Global Fund to Fight AIDS, only 6,000 people received ARV drugs in 2005. Most people with HIV-AIDS sought help from kru, local healers, or slowly deteriorated. Some sold their homes, motorcycles and all their family’s possession for quack cures.
One kru who developed a reputation for producing an effective herbal concoction established the village of Chamkar Bey in southern Cambodia. AIDS-HIV sufferers from all Cambodia came to village to seek him out. One woman told AFP, “A old woman in Phnom Penh told me a kru was living here and had healed one of her relatives. I don’t think twice (about coming).”
The kru charges 1,000 riel (25 cents) for his brew or 500 riel “if people can’t afford it,” “The recipe,” he told AFP, is “based on herbs, leaves and bark” that “was dictated to me in my dreams.” The AIDS-HIV sufferers in the village were thin and had skin diseases but they seemed relatively energetic and spirited. “The fact is that 8 percent of the sick are in better shape after some time here,” a local doctor said.
One woman who arrived in a critical stage of the disease said he had gained 10 kilograms since being in the town and felt well enough to return home. Many Western medical observers attributed the success to the community in which AIDS-HIV sufferers could live and work together without being ostracized.
AIDS Victims and Prostitutes in Cambodia
In the early 2000s there were many AIDS orphans and many AIDS sufferers who were ostracized by their communities. It was not unusual for AIDS-HIV sufferers to be forced by their families to live outside the home, cook on different fires and not touch anything used uninfected members of the family. One 33-year-old AIDS sufferer who got the disease from her husband gave away her three children and then was told by her family, “Go somewhere else and die.” Another who was sold into prostitution by her brother said she wanted most to see her mother but her mother refused to see her.
Reporting from Phnom Penh, Mariane Pearl wrote in Glamour: “An estimated 29 percent of sex workers here have the disease. That night I head out with the social workers to learn about another harsh reality of Cambodia’s sex trade—HIV. In a nearby building, Chantha, the social worker, is teaching HIV prevention. She has forgotten to bring her wooden penis model, so she uses a pencil instead. The condom hangs ridiculously on the tiny pretend phallus, but no one laughs. Too many of the girls have lost friends to HIV. [Source: Mariane Pearl, Glamour, August 1, 2006]
An aid worker with Doctors Without Frontiers told the Washington Post about one prostitute with AIDS who continued to service customers from her hospital bed until she died because she need the money to pay her hospital bills.
Condoms Cut AIDS Rate and Save Lives in Cambodia
Reporting from Poipet, Nicholas D. Kristof wrote in the New York Times, “Cambodia has become one of the world’s few success stories in the struggle against AIDS, and it has achieved that success partly by vigorously promoting condoms. This strategy has saved thousands of lives. Cambodia has cut the prevalence of H.I.V. in adults from 3 percent in 1997 to about 1.8 percent today. In rural Cambodian towns like this one, billboards and posters promote condoms, and clinics and brothels have buckets of them. Health centers don’t have X-ray machines or oxygen tanks, but they have phalluses to show visitors how to put on condoms. [Source: Nicholas D. Kristof, New York Times, December 19, 2006]
Here in Poipet, I met a 27-year-old woman with AIDS, Tem Phok. She had been a prostitute in a brothel, so I assumed that that was how she contracted AIDS. “Oh, no,” she said. “I got AIDS later, from my husband,” who has already died. “In the brothel, I always used condoms,” she said. “But when I was married, I didn’t use a condom. ... A woman with a husband is in much more danger than a girl in a brothel.” That’s an exaggeration, but she has a point: It doesn’t do much good for American officials to preach abstinence and fidelity in places where the big risk of contracting H.I.V. comes with marriage. In countries with a high prevalence of AIDS, just about the most dangerous thing a woman can do is to marry.
Careful studies of “abstinence only” programs in the U.S. suggest that they do delay sexual intercourse, but that young people are then less likely to use condoms afterward. The evidence indicates that a balanced approach — encouraging abstinence but also promoting condoms — is far more effective at protecting young people in America or abroad from sexually transmitted infections, including H.I.V. In the past, social conservatives routinely cited Uganda as proof that it’s best to focus just on abstinence. It’s true that Uganda cut H.I.V. rates significantly, partly by promoting abstinence and fidelity — but also by promoting condoms. More recently, Uganda has been backing away from condoms, with U.S. support, and its H.I.V. prevalence is rising again.
For all the fears that condoms lead to promiscuity, the opposite has been true in Cambodia. Growing condom use has been accompanied by a drop in casual sex (probably because of increased nervousness about AIDS).
Drug Maker Tests AIDS Drug on Cambodian Prostitutes
Paul Elias of Associated Press wrote: “A biotech company that is using prostitutes in its AIDS drug experiments is being accused of exploiting the women and giving them poor education to further its research. Researchers in Africa and Cambodia are experimenting with Gilead Sciences Inc.'s popular drug Viread to see if it can be used as a sort of AIDS "prevention pill." At least some of the prostitutes involved will take pills with no medicinal value to see if they contract HIV, the virus that causes AIDS, more readily than prostitutes who take the drug. [Source: Paul Elias, Associated Press, July 14, 2004 #]
“Protesters, led by the AIDS activist group Act Up, accused the researchers of purposely providing insufficient prevention education to the volunteers because it needs infection data to analyze Viread's potential to protect against the virus. The protesters also demanded that the company take care of the lifetime medical needs of any volunteers who contract AIDS during the experiment. Gilead's research chief Norbert Bischofberger said all the overseas experiments were approved by the U.S. Food and Drug Administration, even though U.S. approval wasn't needed, and that all participants receive "extensive counseling." Bischofberger also said the company isn't compelled to provide lifetime health coverage to the studies' participants because researchers are giving them education on condom use and other areas that will make them less likely to contract HIV. "Many more of these women would have become positive without the study," Bischofberger said. #
“Viread is already approved in the United States for use by people already infected with HIV. Earlier studies in monkeys suggested the drug was effective in protecting monkeys from getting the simian version of AIDS when injected with the virus. Now Foster City-based Gilead and outside researchers hope those results will translate to humans. Armed with a combined $12 million in grants given by two U.S. government agencies and the Bill and Melinda Gates Foundation, researchers have launched ethically complex human experiments among HIV-negative prostitutes at high risk of contracting the disease in Cameroon, Ghana, Nigeria and Cambodia. Gilead is providing the drugs for free. #
“In Cambodia, for instance, some 960 women ultimately will be enrolled in an experiment bankrolled by a $2.1 million grant from the National Institutes of Health. Half those volunteers in the Cambodia experiment will be given Viread, known generically as tenofovir, and the others will take a dummy pill with no medicinal value. A year later, researchers will compare the two groups to determine if significantly fewer volunteers taking Viread were infected with HIV than those receiving the dummy pill. Viread accounted for $193 million in sales for the first three months of the year, helping make Gilead one of the few profitable biotechnology companies in the world. #
Protests by Prostitutes End Testing of AIDS Drug in Cambodia
Reporting from Phnom Penh, Ariana Eunjung Cha wrote in the Washington Post, “Yunang Soma stood shoulder-to-shoulder with other prostitutes on a makeshift stage in a park and shouted to the crowd: "The U.S. says it wants to help poor people, but it is killing the poor people!" Soma was protesting a trial of the drug tenofovir, which scientists think may one day serve as an effective "chemical vaccine" against the human immunodeficiency virus, which causes AIDS. Unlike true vaccines, which give a person lasting immunity to a disease but have proved difficult to develop for HIV, tenofovir is a daily pill. Scientists hope it will protect against infection for a few hours or maybe even days. The trial, funded by the Bill & Melinda Gates Foundation, was designed to see if it can stop people from becoming infected with HIV even if the virus enters their bodies. [Source: Ariana Eunjung Cha, Washington Post, May 23, 2006::]
“But researchers have run into a highly organized opposition that they say was engineered by foreign activists. The demonstrators have succeeded in shutting down the trial in Cambodia, but the protests continue there. Soma and her colleagues are intent on halting all trials of tenofovir, worldwide. Objections have focused on the study's subjects: prostitutes, usually poor, who critics say are being taken advantage of. They cite low payments, lack of information about side effects and no health insurance should something go wrong. In trying to get a better deal for those women, they have managed to slow the testing of what many scientists consider the best hope to stop AIDS in the underdeveloped world. ::
“Prompted by the protests, Cambodia's prime minister in 2004 canceled the trial before a single pill was taken and threw the researchers out of the country. Trials in Cameroon and Nigeria were closed in 2005. Researchers did not expect protests because tenofovir is so widely used in the United States already. It is a licensed medication, tested and approved, and used as part of a cocktail of drugs to treat people infected with HIV. The question is whether it can work as a prophylactic drug in uninfected people. ::
“Given the difficulties researchers have encountered in developing a real vaccine, many see tenofovir as the next best thing. Some U.S. doctors are so optimistic that they have begun prescribing it to people who engage in risky behavior such as unprotected sex. So it seemed logical to conduct a large trial in a place like Cambodia, where 4 to 10 percent of prostitutes are infected with HIV each year. ::
“Soma and her supporters say she is part of a grass-roots movement fighting imperialists who would use the developing world as a testing lab. But the rally that day, one of several held throughout Asia, was organized mostly by outside activists who coordinated with each other via e-mail. They even produced the T-shirt that Soma was wearing, which read in part: "People over profit." ::
“Over the past few decades, poor countries with high HIV infection rates have struck a delicate bargain with the West, opening their populations to researchers from wealthier nations. Most of the money for the tenofovir trials, for example, comes from the United States. In return, the foreign governments seek access to the latest information about AIDS -- and a lower price for the drugs should they turn out to be effective. ::
“Soma's friend Pich Sochea, 38, who with Soma is a leader of a prostitutes' union, was among the first to hear about the trial, at an HIV prevention workshop in the spring of 2004. Sochea thought it sounded pretty good. The women would get paid $3 a month to take some pills -- either 300 milligrams of tenofovir or a placebo -- daily for a year.Sochea took some informational papers, which were in English, to Rosanna Barbero, an Australian who ran Womyn's Agenda for Change, a group that provides office space and funding to the prostitutes. They asked Barbero to translate the papers and explain the study to them. ::
“Barbero typed "tenofovir" into an Internet search engine and started reading. She learned that tenofovir has been long used as a therapy for people already infected with HIV. By preventing HIV from reproducing, it slows the progression of the disease. In experiments on healthy rhesus monkeys, all remained uninfected when they were deliberately exposed to the simian equivalent of HIV. But some Web sites listed serious potential side effects, such as kidney problems and osteoporosis. Barbero pointed that out to the prostitutes. Soma, 38, said she and her friends wondered: "If the trial is so good, why don't they get sex workers from their own country? Why are they coming to a poor country?" The prostitutes demanded meetings with the scientists. Working with Barbero and her staff, they came up with a wish list: more pay, more information and a promise of health insurance for 40 years. ::
“Kimberly Page Shafer, an AIDS researcher from the University of California at San Francisco and one of the lead investigators on the study, said a vaccine has to be tested in a population in which the rate of infection is high enough to provide an answer in a reasonable amount of time. A trial in the United States, where infection rates are much lower, would take decades. Page Shafer said that some of the prostitutes' concerns were being addressed: Scientists planned to set up a clinic in parallel with the trial for anyone who became infected with HIV. Long-term insurance, Page Shafer said, is not something that is typically provided in studies and would be prohibitively expensive. ::
“Although the researchers said they were willing to negotiate, they did not move fast enough. The anger and allegations spilled over to Hong Kong and Bangkok, where protesters threw red paint all over the booth used by Gilead Sciences Inc., the California-based manufacturer of tenofovir, at the International AIDS Conference that summer. In the fall of 2004, Cambodian Prime Minister Hun Sen ordered the scientists to stop the trial, citing concern for "human values and rights." ::
“The negative reaction to the study was further fueled by rumors. People said that the drug was so dangerous, it wasn't being tested in the United States (Tenofovir is being tested on a small scale in uninfected gay men in San Francisco and Atlanta); that the pills used in the study contained HIV (they contain only chemicals); and that the researchers were encouraging participants not to use condoms while they were taking the medication because they wanted the subjects taking the placebo to have a higher incidence of AIDS (the study protocol calls for researchers to encourage safe sex, including the use of condoms). ::
“As the trials were halted, AIDS activists began turning against each other. Angry that the protesters were slowing research, some attacked Womyn's Agenda for Change. "They found an opponent they could blame, which was me, the white woman Westerner who heads some organization," Barbero said. Others characterized Act Up Paris as the prime villain. Mark Harrington, a prominent AIDS activist, said that by demanding U.S.-level benefits for penniless Cambodian sex workers, Act Up was practicing "ethical imperialism." ::
Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Tourism of Cambodia, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.
© 2008 Jeffrey Hays
Last updated May 2014