Statement by the Cambodia People Living with HIV/AIDS Network (CPN+)

To the Secretariat Committee
Of the 2nd Annual National AIDS Conference
Cambodia, October 1-2, 2002

Cambodia Declaration of Commitment at the United National General Assembly Special Session on HIV/AIDS (June 2001):

By 2003, ensure that national strategies, supported by regional and international strategies, are developed [...] to strengthen health-care systems and address factors affecting the provision of HIV-related drugs, including antiretroviral drugs, inter alia, affordability and pricing, including differential pricing, and technical and health-care system capacity [...] (paragraph 55).

In June 2001, Cambodia joined nations throughout the world in signing the Declaration of Commitment on HIV/AIDS. This declaration outlined important commitments that CPN+ supports and requests the Royal Government of Cambodia to take seriously in the fight against HIV/AIDS in our country.

With more than 169,000 infected with HIV and an additional 50 to 100 new infections every day, immediate action is necessary to provide services to People Living with AIDS (PWAs). About 20 Cambodians die each day from AIDS and PWAs can only live only up to 5 to 7 years in Cambodia due to the lack of adequate health care as compared to 10 to 20 years in neighboring countries. If the RGC takes action now, it can lead to a more healthy and productive nation tomorrow.

Cambodian PWAs welcome the RGC's AIDS Prevention and Control Law, which should promote the involvement of PWAs in Cambodia's response to the HIV/AIDS pandemic, and prohibits discrimination against PWAs and their families. We look forward to the implementation of this law, which states it will increase access to HIV/AIDS information, voluntary HIV counselling and testing, and provide primary health care to all PWAs.

This statement comes from more than 2,756 PWAs in Cambodia as represented by CPN+. The purpose of the statement is to highlight the request of PWAs and the need for rigorous and fast action on the part of all agencies working in the HIV/AIDS sector. We ask that the RGC, donors and the NGO community to take these recommendations seriously thereby reinforcing the rights of PWAs as equal members of Cambodia society.

Recommendations

CPN+ members have prioritized access to Antiretroviral (ARVs) and opportunistic infection treatment as some of the most important needs. Currently we are trying to estimate the number of PWAs enrolled in ARV treatment programs in our country. There are countless others who purchase ARVs illegally from private pharmacies at high prices that are beyond the reach of ordinary Cambodian citizens. This private use of ARVs without proper education and monitoring, threatens to increase drug resistance and further jeopardizes future medical options for PWAs. This statement outlines action that can be taken now to increase access to ARVs for PWAs.

Increased Access to ARVs

• Access donor funds - International donors are increasingly making funds available for programs in developing countries to pay for ARVs, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. We request that the RGC takes steps immediately to facilitate funding from international donor agencies to fund programs of ARV access for Cambodian PWAs.
• National expansion of ARV programs-Although seemingly expensive now, greater access to ARVs saves financial expenditure in the future through longer lives, decrease numbers of opportunistic infections, and less pressure on the health system. Increase in ARV programs should be considered with increasing the capacity of health staff to monitor and ensure dosage compliance. The RGC can take action to decrease the price and access to ARVs by securing agreements with ARV drug companies and either allowing for tax free imports of ARV pharmaceuticals or permission to produce generics within Cambodia as long as the production and potency follows WHO guidelines. Quality of ARV drugs must be ensured by the RCG to maintain standards that provide effective results for ARV users.
• Differential pricing of ARVs-For most PWAs, ARVs are either limited in access or too costly. The RGC should consider differential pricing of ARVs that could include regional purchasing of ARVs by several countries, thereby decreasing the price, and subsidized purchasing by poor clients.
• Long-term ARV programs-Agencies that currently have ARV programs need to provide life-long access of ARVs to current clients and expand their programs. Life-long commitments to ARV access coupled with proper education and monitoring will decrease future drug resistance risks.
• Role for networks like CPN+ in ARV compliance-Networks like CPN+ can play a strong role in education and monitoring of ARV use. As PWAs, we are willing to become more involved in expanding the use of ARVs and with increased capacity, our peer support can result in stronger ARV programs with dosage compliance.

  Policies that will increase access to ARVs

  • Guaranteed Access-Some developing countries like ours have passed laws and decrees that guarantee access to ARVs by PWAs. We encourage the RGC to consider such laws.
  • Modify the law on Parallel Importation-We request that the RGC modify the law on parallel importation of pharmaceutical drugs. Modification of Article 4 (Draft Law on Patents, Utility Model Certificates and Industrial Design Exempting Pharmaceutical Products) will make it easier for ARV imports and thus increase access and reduce the price for PWAs. Governments in the region have offered technical assistance in modifying national patent laws so that these laws permit access to lower cost ARVs, for example the commitment made at the Asia-Pacific Ministerial Meeting on HIV/AIDS and Development in October 2001 by the Australian Government. We request the RGC to take up international technical assistance, which has been offered, and to modify the Draft Law.
  • Regulating Private Pharmacies-CPN+ supports regulating private pharmacy selling of ARVs. Although private pharmacies do increase access to ARVs, CPN+ recognizes that the lack of proper use of ARVs threatens all PWAs. Regulations will help control the price, quality and compliance of ARV use. With proper education and enforcement of regulations, private pharmacies should be able to participate in ARV distribution.

  Strengthen Institutional Care

  • Capacity of health staff-Government and non-government health care staff need education in ARV use. The health care staff could also use education on care for and the needs of PWAs. Some health care staff discriminate against PWAs. An anti-discrimination campaign needs to be integrated into health staff educational programs
  • Increase access to Opportunistic Infection (OI) medicine-PWAs die of opportunistic infections due to lack of access to appropriate medicine. Government infectious programs, like tuberculosis, need to be more rigorously linked with HIV/AIDS programs as is currently happening. Health staff needs education on identifying OIs and correctly prescribing drugs to remedy them.
  • Equity programs for poor PWAs-The RGC should consider instituting equity programs for poor PWAs that allow them subsidized or free medical care. The poor cannot afford drug costs from the public and private health providers. Some equity programs in Cambodia show promise and should be more widely replicated.
  • Voluntary Counseling and Testing (VCTs) Expansion-Most HIV+ people in Cambodia are not aware of it. One of the first strategies to protect PWAs against OIs after infection is simply knowing your HIV+ status. This allows you to react through lifestyle changes and demanding access to ARVs. Through the expansion of VCTs, PWAs will know sooner their status and take action earlier.

  Improving Linkages

  • Link and strengthen cooperation between hospitals, clinics and health centers, Home Based Care providers and hospice care-Improving these linkages will give PWAs greater access to better care options. Often health officials do not know the options available in our country. Better linkages and education about these linkages will provide access to a wider range of health service to PWAs than they currently understand as available.
  • Donors and government increase investments in care-Government, donors and NGOs should consider investing in care as well as prevention. The AIDS epidemic is entering a different stage in our country with more people symptomatic and needing care. Increasing access to ARVs will help Cambodia continue its mandate to increase economic growth and poverty alleviation by stemming life expectancy decreases and decreasing opportunistic infections. Investments in ARVs now will help stop a dramatic future increase in health and social expenditure from the health complications of PWAs and shorter life expectancies.

  CPN+ believes that this statement outlines some concrete actions that can be taken by the RGC, donors, and NGOs to help PWAs and the country. CPN+ does recognize that access to ARV programs have a short-term economic cost but through examples like Brazil and Thailand, investments now will lead to health savings, greater economic productivity, and social stability later. Other countries have demonstrated that ARV access pays for itself within 5 years by stemming future health expenditure. We urge agencies to consider the voice of those of us who are PWAs. Your support now will have a long lasting affect not only on our lives, but on the lives of our children and our country.

  About CPN+

  CPN+ was established in July 2001 as the first network for People living with HIV/AIDS (PWA) in Cambodia. This network has 24 AIDS service organizations members working in Phnom Penh, Kampong Cham, Takeo, Prey Veng, Banteay Meanchey, Battambang, Kampot, Kompongthom and Siem Reap provinces. These organizations provide assistance to more than 3,000 PWAs formed into support groups. The mission of CPN+ is to build a strong and united voice of PWAs that conveys the dire need to improve the quality of life of PWAs..

  About the process for writing this statement

  CPN+ collected information from 2,756 PWAs. PWAs identified many problems including stigma and discrimination, poor living conditions, malnutrition, lack of shelter, no access to free medical treatment such as ARVs and opportunistic infection, minimal access to information, restricted access to job opportunities including firing by managers once they know the staff is positive and limited care and support services. CPN+ expressed theses needs of PWAs to CNGOs, INGOs, government institutions and UN agencies to begin building strategic alliances. These recommendations incorporate the concerns of these other agencies as well.

  Strategic Alliance Member

  Impact/FHI, HIV/AIDS Coordinating Committee (HACC), World Vision International (WVI), Care, Save the Children Fund UK, PACT, Friends, Woman's Agenda for Change (WAC), RACHA, CHEC, Preah Bath Norodom Sihanouk hospital, Center of Hope (Sihanouk hospital), Medicines Sans Frontiers France (MSF/ France), Medicines Sans Frontiers Holland Belgique (MSF/H.B.CH), Pharmaciens Sans Frontiers (PSF), Phnom Penh Home Care Network, National AIDS Authority (NAA), National Center for HIV/AIDS, Dermatology and STI (NCHADS), Cambodian Red Cross, Join United Nation Program on HIV/AIDS, UNICEF, UNDP, WHO, Minister of Health Ministry, Council Ministry and Prime Minister.