Despite the Kingdom’s success in reducing HIV infection rates among the general population, mother-to-child transmission remains high as new approaches to prevention evolve

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SOVANN PHILONG

A young orphan receives medical treatment for Aids at Takhmao Hospital.

WHEN TO TREAT?

The decision to administer drug treatments to HIV-positive children is based on the number of T-cells (white blood cells that protect the body from infection) present in the blood of patients with HIV, NCHADS director Mean Chhi Vun said.

CHILDREN are the new face of Cambodia's HIV/Aids prevention efforts as rates of antiretroviral treatment for the young rise - driven by unchecked mother-to-child transmission - new statistics for 2008 show.  

"From January to September last year, about 2,913 children received antiretroviral drugs," said Dr Mean Chhi Vun, director of the National Center for HIV/Aids, Dermatology and STDs (NCHADS), up from just 1,800 children in 2007.

Nationwide infection rates are determined by the number of children receiving antiretroviral drug treatments in clinics throughout Cambodia, he told the Post Sunday, adding that the figures were not comprehensive and did not include an estimated 600 children infected with HIV who have not yet received any treatment - or those who have not been identified as HIV-positive. Data for the last three months of the year is not yet available, he said.

Exactly how many children in Cambodia are living with HIV or Aids is not known. But other experts support the proposition that infection rates are rising fast.

"In 2007, 300 children with HIV were treated in our hospital," said Chan Ry, deputy director of the National Pediatric Hospital. "Now, we are treating 1,155 children."

Mother-to-child transmission

According to a 2006 UNAIDS report, HIV prevalence among people aged 15 to 49 has decreased from 3 percent in 1997 to 1.9 percent in 2003. But one-third of new infections are "vertical" - meaning HIV-positive mothers are passing the virus on to their babies.

The most recent Ministry of Health data available shows that the rates of mother-to-child transmission remained the same from 1997 to 2003. But NCHADS's new data on infection rates - though far from comprehensive - indicates this may be changing. According to Mean Chhi Vun, it is due to unchecked mother-to-child transmission.

This [child HIV] is a problem that we still have to commit to

solving.

In theory, there is no reason why a child should be born HIV-positive. Experts say Cambodia's rising rates of such tranmission testify to the fact that women are not able to access good ante-natal care packages. They say that if a child is born in a place where it can have access to the algorithms of treatment, you can halt the onwards transmission of AIDS.

Cambodia has approximately 461,000 live births per year - the majority of which occur outside of hospitals and health centres - and it is estimated that about 9,700 pregnant women are HIV-positive. Without any intervention, approximately 3,000 infants may be infected with HIV annually through vertical transmission, according to UNAIDS data.

Breaking the cycle

In a bid to prevent pregnant women unaware of their HIV-positive status, and unwittingly passing on the disease to their unborn children, the government has been rolling out a program of HIV testing.

"We provided HIV testing for 6,745 pregnant women [this year] in 68 health centres across five of our operational districts," Mean Chhi Vun said.

Some 35 of the 6,745 women tested positive for HIV and received followup care and medicine from the centre, Mean Chhi Vun said.

Unfortunately, this relies on pregnant women visiting health centres and much more remains to be done.

"If we want to reduce the number of children with HIV/Aids, we should provide better education and more medicine to stop transmission between mothers and children," said Seng Chhunleng, coordinator for the Orphans and Vulnerable Children program at World Vision, which specialises in HIV care for children.

He urged the government to work more closely with community-based initiatives, not just with government organisations and international aid agencies, because grassroots groups know more about the problems on the ground.

"This is a problem that we still have to commit to solving. If we don't do something now to stop the spread of HIV between mothers and children, we will continue to see infection rates rise," he said.

Tan Vouch Chheng, an undersecretary of state at the Ministry of Health, said there are currently 26 locations from which anti-retroviral drugs are dispensed, with another 212 facilities offering HIV testing.

"We have to expand our programs for prevention and the spread of HIV/Aids from mothers to children," she said.

The spread of HIV among adult men and women was the focus in past years of prevention and treatment programs, but now the government is focusing its efforts on a national registration program for children with HIV to help coordinate treatment, said Teng Kunthy, general secretary of the National Aids Authority of Cambodia.

"The registration program has been running smoothly so far and has encouraged more children to seek treatment," Teng Kunthy told the Post Tuesday.

Nuon Chantho, 33, has been HIV-positive since 2002, along with her husband and eight-year-old son.

"The government and NGOs need to provide more education about how to prevent the spread of the disease. That is why I volunteer to teach others about ways to prevent infection and how to get treatment," she said.