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Keeping an epidemic at bay

THE global AIDS epidemic is now being reversed, according to the 2010 Global Report of UNAIDS released on Tuesday, though challenges remain.

For the estimated 33.3 million who currently live with HIV, as well as those at risk of infection in the future, the fight is not yet over. The report acknowledged stigma, discrimination, a flat-lining of funding for the AIDS response and lack of access to treatment for an estimated 10 million who need it as serious obstacles. Nevertheless, “the world has turned a corner”, the report said.

Cambodia received a United Nations award this year for success in battling the epidemic. According to UNAIDS, the adult HIV prevalence declined to 0.5 percent in 2009, down from 1.2 percent in 2001.

But various factors recently reported – including alarming practices among at-risk youth and a potential loss of generic medicine from a looming India-EU trade pact –indicate the risk of resurgence lingers.

UNAIDS Country Director Tony Lisle spoke with The Post about the against fight against HIV/AIDS in Cambodia.

What’s the bottom line for Cambodia with regard to this report?
The bottom line is we’re certainly one of the 56 countries that have stabilised and declined in rates of new HIV infections.

The report strikes an optimistic tone, but there are some serious challenges ahead. How should we read this in Cambodia?
I think the report basically resonates well with the situation in Cambodia. As far as UNAIDS is concerned, I think we cannot be complacent, and that is also the position of the Royal Government, and in particular the National Aids Authority.

We’re also seeing saturated concentrated epidemics. For injecting drug users, for example, we have a prevalence rate of 24.4 percent, which is very worrying. In any key population with over 5 percent prevalence, that’s a source of concern, because a concentrated epidemic in that population [is an] opportunity for the epidemic to grow.

If we look at men who have sex with men, the latest data we have is a prevalence rate of 5.1 percent, and the most recent data on sex workers shows around 14.7 percent prevalence.

So we continue to have stubborn and concentrated epidemics, and if we don’t continue to see high rates – 80 percent plus – of consistent condom use amongst these populations, and if we don’t see continuing capacity to have full coverage for antiretroviral treatment for all those in need, we could see a new wave of infections, we could see another epidemic.

India and the EU are working on a trade pact that could restrict access to cheap generic medicines. What will be the impact on Cambodia?
This is a global issue. There are many countries that benefit enormously from generic drug production in India, not only for opportunistic infections but also anti-retroviral treatment. There are very specific exemptions under the TRIPS formula, [the WTO agreement on trade-related aspects of intellectual property rights], to ensure compulsory licensing, to ensure that countries will continue to enjoy the import of generics from India. Now we would hope that the [free trade agreement], if and when it is signed, will ensure that those exemptions will apply.

There is no doubt that if Cambodia does not have access to cheap antiretroviral therapy drugs, or to cheap generics for opportunistic infections, and also allied generics for example for TB treatment, then we’ll have some extremely significant challenges.

[In Cambodia,] there are 67,000 people living with HIV, 37,000 on treatment and 10,000 projected to be on treatment. Cambodia has done a remarkable job in getting over 95 percent of those in need on treatment.

We need to ensure that we continue to enjoy affordable treatment options.

The importance of human rights was stressed in this report. What would be the impact on the fight against HIV if the Cambodian government closed down the UN Office of the High Commissioner for Human Rights?
I couldn’t comment on the question. The OHCHR works closely with all the partners … and we continue to enjoy their contribution to the response to HIV and their technical expertise.

How about off the record?
I don’t comment off the record.

Is the fight against HIV improving the health system in Cambodia more generally? How so?
Hugely. I think the fact that the work we’re doing for linked response prevention of mother-to-child transmission of HIV is actually strengthening overall results for maternal and newborn health. It’s actually HIV dollars that have rekindled and regenerated paediatric health care in Cambodia.

Through paediatric AIDS care, we now have something like 20 operational district referral hospitals that now have comprehensive pediatric health care referral facilities.

We’re seeing a lot more women coming for HIV testing and being referred to other health services.

Is there anything else you would like to add?
When we think about Cambodia emerging from years of genocide and the years of challenges it has faced in building a stable, secure society, and facing the most serious epidemic in the region with 2 percent [infected with HIV], the achievements were and are remarkable. The important thing is to build on them.

interview by Thomas Miller

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