A study to test a possible HIV prevention medicine is raising concerns among Cambodian
sex workers, who say the program poses risks to their health and offers no compensation.
The research, funded by Microsoft mogul Bill Gates, will test the drug tenofovir
as a potential protection against HIV. The possibility of finding a pill that can
safely prevent HIV infection is causing a ripple among the international community
as currently no HIV prevention medicine exists.
The Ministry of Health's National Centre for HIV/AIDS, Dermatology and STIs (NCHADS)
is recruiting 960 sex workers to take part in the one-year study. Researchers say
testing is due to begin in May.
Cambodia has the highest prevalence of HIV infection in Southeast Asia. Five out
of every 100 sex workers in Cambodia are infected with HIV annually, the center's
research revealed.
But the prostitutes' collective, Women's Network for Unity (WNU), is concerned there
is no protection for participants who may suffer side-effects from taking the medication.
WNU is demanding insurance to cover possible side-effects from the drug for up to
30 years after the study is completed. "If the drug manufacturer doesn't give
us insurance... we won't agree to take the drug," a WNU spokesperson said.
WNU is holding a conference on March 29 to discuss whether they should take part.
Over 1000 sex workers and representatives from women's rights NGOs are expected to
attend. "If they insure us for 20 to 30 years, we will be happy," the spokesperson
said.
NCHADS said there is no funding to provide insurance.
Tenofovir is already used around the world as an approved treatment for HIV. Known
rates of side-effects are comparatively low, and are mostly digestive complaints
- nausea, vomiting and diarrhea.
But the effectiveness and side-effects of taking the drug as a prophylaxis are unknown
and two similar studies are planned in Africa and in America to evaluate this.
NCHADS researcher Vonthanak Saphonn said Cambodia was selected as a location for
the research due to the prevalence of HIV infection. "We really need to get
this study done," he said. "Sex workers are the most vulnerable group."
Saphonn said although there was no health insurance available, participants would
be closely monitored and provided with free health care during the study. The compensation
package was based on models from international studies.
Saphonn emphasised that women had a choice whether or not to partcipate. "The
basic principle for this research is informed consent," he said.
He acknowledged that the side effects of taking the drug as a prevention, rather
than a treatment, were unknown, but said he hoped they would be similar. "We
don't expect to see any more [side effects] than what we have seen in HIV-infected
patients."
The Minister of Women's Affairs, Mu Sochua, supported the WNU's demands for insurance.
"It's totally fair. If there's a 0.0001 percent risk, it's still a risk. Whoever
takes part in this experiment has to be given a guarantee."
But a medical researcher working in Cambodia said it was not normal practice to provide
insurance in a clinical trial, as drugs are not insured until they are approved.
"That's the whole point of a clinical trial - to see if there's any side effects
or not," he said.
The WNU spokesperson is adamant that insurance be supplied and said if no resolution
was reached on March 29 the collective would encourage all sex workers not to take
part in the study. "Our network is strong. If we tell the sex workers not to
take part, they will not take the drug."
Unless an agreement is reached, Cambodian sex workers may soon have a message for
Bill Gates: "This program has performed an illegal operation and will be shut
down."
