Logo of Phnom Penh Post newspaper Phnom Penh Post - Look ‘beyond’ numbers for HIV/AIDS stats

Look ‘beyond’ numbers for HIV/AIDS stats

Look ‘beyond’ numbers for HIV/AIDS stats

Dear Editor,

In your article “Govt, NGOs note drop in HIV infections” (December 31), it was reported that there was a drop of about 1,000 in the number of people registered as living with HIV in the Kingdom compared with the previous year. While on the surface it seems like good news, it would have been more useful to look beyond the numbers, or even at what goes into those numbers.

For example, these are people who are “registered” – meaning there are probably many who are not, and who do not know their HIV status. The accuracy of a registration system is also important, given that HIV carries with it major stigma and people may not wish to be on the registry for various reasons.

Second, it would be good to know if there were more people who died from AIDS and opportunistic infections than those who got newly infected in the past year, because the number of deaths also affects the total number of people living with HIV. In other words, if people died because they were untreated (and this is likely given that in 2000-2002, when HIV prevalence rates were over 2 percent, the estimated numbers of people with HIV in the Kingdom was more than 100,000). Simply by doing nothing for treatment, people will die of AIDS, given the natural history of the illness.

That, too, results in a drop.
Third, the provision of antiretroviral treatment also increases life expectancy. Therefore, many people who would have died without receiving treatment are still living – and they also figure into the numbers.

Fourth, and most important, where are the new infections coming from? Is it from women or men? What age groups? Is it from sex workers, men who have sex with men, injecting drug users or partners of people with HIV? Is it from perinatal transmission? At what stage of illness are people diagnosed? This is where the focus of prevention should be. How well is the registration system able to capture this ?

The recent government decision to stop salary top-ups and incentives for health workers may also have an effect – if services are more difficult to access, or if there are more costs involved for clients, then these may also affect the numbers of people who are registered and who seek and receive treatment at the optimal stage. Others may wait to see a doctor only when they are in the very late stages of AIDS, where treatment is no longer effective and much more costly.

Finally, the January 4 issue of the Post headlined the expiry of Korsang’s licence and its non-renewal. Whatever the reasons for this, it does not look good for the future of HIV prevention in the Kingdom. While the NACD mentions that Korsang has not been stopped from doing its work, the lack of a valid licence means that Korsang staff may be vulnerable to sanctions or harrassment from authorities for not having the required permits.

If the NACD and the NAA are serious about stopping the spread of HIV (and Hepatitis B) through injecting drug users, then they should immediately scale up programmes that have been shown to have public health benefits – such as needle and syringe exchanges, opiate substitution, access to counselling and antiretrovial treatment, peer outreach and drop-ins, condoms, and longer-term detox and rehab services – rather than put their hopes in an unproven form of treatment such as Bong sen.

Vic Salas, MD, MPH
Consultant – HIV/AIDS, Health & Development
Phnom Penh

Send letters to: [email protected] or PO?Box 146, Phnom Penh, Cambodia. The Post reserves the right to edit letters to a shorter length.
The views expressed above are solely the author’s and do not reflect any positions taken by The Phnom Penh Post.

MOST VIEWED

  • Prince injured, wife dies after accident

    THE wife of former First Prime Minister Prince Norodom Ranariddh, Ouk Phalla, 39, died while the prince was “severely” injured following a road accident in Preah Sihanouk province’s Prey Nub district on Sunday morning, officials said. Rananriddh, who is also the president of the Funcinpec

  • Guards protest dismissals, reject claims of sharing naked photos of child

    Some 20 former security guards at the US Embassy in Phnom Penh protested on Tuesday against their dismissal. They accused their employers of falsely claiming they had viewed and shared child pornography from their mobile phones as grounds for their termination. In total, 32 personnel were dismissed

  • Bun Heang mocks US, threatens its citizens in scathing open letter

    After being hit with sanctions from the US Department of Treasury, Cambodian General Hing Bun Heang said he would retaliate against any US national who does not respect his country’s sovereignty, has ambitions to invade Cambodia or incites “traitors” in the Kingdom to do

  • Funcinpec urges probe into deadly Preah Sihanouk accident

    THE Funcinpec party has urged the government, especially the Ministry of Interior, to investigate the traffic accident in Preah Sihanouk province which left Prince Norodom Ranariddh badly injured and his wife Ouk Phalla dead. Funcinpec Vice President You Hokry told reporters at Botum Votey pagoda,