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."