Cambodia: Fighting a growing AIDS epidemic

To fight the disease, MSF provides antiretroviral (ARV) treatment in a number of projects including one in the capital Phnom Penh (July 2001), in the northwestern province of Siem Reap (October 2002), in the city of Kompong Cham within Kompong Cham province (May 2003), in the operational district of Sotnikum (July 2003) located in Siem Reap province and in Takeo province (August 2003) in the south of the country. The programs aim to prove the feasibility of such treatment in resource-poor countries like this one. MSF's end goal is for the country's Ministry of Health to take over the ARV programs at a certain point and make these drugs available to all of the patients who need them. MSF also treats people with malaria, a large public health problem in this country. In addition, it provides care for chronic health problems and has started a number of financial programs to improve the quality of care and civilians' access to it. MSF is currently providing ARV treatment for AIDS patients in the capital Phnom Penh and in the city of Kompong Cham. At the start of 2004, MSF was providing ARV treatment for 1,075 adults and 41 children living with AIDS in the infectious diseases department of Phnom Penh's Norodom Sihanouk Hospital. At the same time, MSF staff working at the hospital located in Kompong Cham provided ARVs to 94 adults and five children. In the provinces of Takeo and Siem Reap as well as Sotnikum district, MSF also treats people living with AIDS using ARVs within Chronic Disease Clinics (CDCs). MSF's CDC in Takeo Provincial Hospital treats some 900 people with chronic diseases, primarily HIV/AIDS, diabetes and hypertension. Between 20-25 people living with HIV/AIDS begin ARV treatment every month. By the end of 2004, MSF expects to have 600 patients enrolled in its ARV program here. MSF also plans to start treating HIV-positive children in 2004 at these locations. In Siem Reap Provincial Hospital, MSF runs a CDC that provides ARV treatment and counselling for AIDS patients. The prevalence of AIDS in this province is 6.6 percent. An estimated 2,000 people living with HIV/AIDS are in need of ARVs from the provincial hospital. As of February 2004, 280 patients had been started on them. MSF plans to increase this number to 700 by the end of 2004. In addition to HIV/AIDS, other chronic diseases - mainly hypertension and diabetes - are treated at the Siem Reap CDC. At the start of 2004, MSF was caring for 750 HIV/AIDS patients, 300 people with hypertension and 450 diabetics. The Sotnikum CDC located in a poor rural area in the northwest of the country with approximately 240,000 inhabitants, provides care for patients with chronic diseases, including HIV/AIDS. HIV/AIDS patients receive counseling and ARV treatment when needed. An estimated 500 people in the local population need ARV treatment. At the start of 2004, 46 patients were using ARVs. This number is expected to increase to 170-190 by the end of 2004. In 1999, MSF initiated a financing scheme in Sotnikum district called the "New Deal", devised to motivate health care staff to provide higher quality care through better pay incentives. And in an effort to increase access to health care for the very poor (30-40 percent of the population living in Sotnikum Operational District), MSF set up a health equity fund which reimburses the health expenses of those who cannot afford to pay for health care. MSF also supports 17 health centers, the referral hospital and the Operational District office in an effort to improve the quality of care. In the town of Pailin, located in the western part of Cambodia near the Thai border, MSF is providing early diagnosis and treatment of malaria, which represents a large threat to public health in the region. This is due to a number of factors including: multiple drug resistance, geographic isolation and heavy forestation, a poor public health system, and an uncontrolled private sector that often deals in fake drugs. The population most at risk includes the estimated 40,000 people living outside the town. MSF's malaria project plans to prove that artemisinin-based combination therapy (ACT) can be effective in combating the disease in remote areas. The project uses a new combination therapy called Artekin and Malarine as first-line treatments and monitors the effectiveness of both drugs. In addition to its medical interventions, MSF has also started an NGO support project aimed at strengthening the capacity of Cambodian civil society to provide social support to HIV/AIDS patients and reduce the stigma surrounding the disease. The action also hopes to promote a more effective way to scale-up AIDS treatment. MSF also supplies drugs to certain partner groups, and facilitates training and coaching to them on an ad-hoc basis.