HIV treatment deteriorates in Cambodia

Cord is supporting a local Cambodian organisation helping women who report poor access to HIV and AIDS treatment from public health facilities.

Until 2010 MSF provided health support services and medical treatment to over 50% of HIV and Aids patients in Cambodia.  The treatment and support included HIV consultations and counselling, home-based care, ARVs, HIV, AIDS and TB diagnoses and care for opportunistic infections, free meals and hospital beds, and even mobile HIV and AIDS and TB treatment for patients in prisons.

According to MSF’s International Activity Reports 2005 and 2009, they provided increased numbers of HIV and AIDS patients with improved quality of free health support and medical treatment. 

Sadly, access to health support and medical treatment has been declining since 2010 when MSF fully handed over responsibility for this to local public medical facilities – two national hospitals in Phnom Penh and referral hospitals in various provinces. The quality of health services is low and the health system appears compromised by low capacity and poor management. HIV patients are increasingly overlooked by Cambodian institutions.

Cord Cambodia is supporting Positive Women’s Hope Organisation (PWHO), one of the organisations trying to bring some relief. They have many years of experience helping people living with HIV and AIDS by providing counselling, building their capacity to earn enough money, caring for people in their homes, accompanying people on medical visits and coordinating work between hospitals and communities.

Photo: Home based services provided by PWHO's staff

Ms. Em Ra, from PWHO explained why medical care is deteriorating. “The number of medical doctors and nurses in HIV and AIDS departments has decreased due to a lack of salary supplement which used to be financed by MSF and other NGOs, and some medical doctors and nurses departed from the hospitals for to work in the private health sector and health-based NGOs”, she said.

Two members of staff from PWHO, Ms. Keo Kamrong and Ms. Keo Pheakdey, currently receive HIV treatment and support at Preah Norodom Kosamak Hospital.   Although antiretroviral drugs and meals hospital beds are free at this hospital they have experienced difficulties such as expensive fees - medical checkups and blood tests costing 70$ USD a time - and long waiting times in accessing antiretroviral drugs. This compounds the other problems they face such as poor health, insufficient energy for work, inability to work, family issues, social stigma and discrimination. They have also experienced misconduct from medical staff.

Their colleague Ms. Em Ra reported that at the Khmer-Soviet Friendship hospital in Phom Penh “Although CD4 checkups carried out twice a year are free, patients must pay fees for other medical checks and blood tests, and are charged 200,000 Riels [$50 USD] for a hospital bed for five days.”

The income of PWHO’s staff is about $150 USD a month.

“Some doctors have not followed the Code of Conduct as service providers or government officials; they often use offensive language and display bad forms of behaviour to their HIV and AIDS patients.” Ms. Em Ra added.

Cord Cambodia has supported Positive Women’s Hope Organisation (who are a partner of one of Cord’s existing partners, American Jewish World Service) in a number of ways including strategic planning, governance and management, fundraising, sharing best practice, monitoring, reporting and evaluation.

Although Cord Cambodia has been instrumental in developing the work that PWHO carries out,  the future is not looking bright for those suffering with HIV in Cambodia. Services at provincial referral hospitals may by even more limited than the hospitals in Phnom Penh, and Handicap International’s recent report* would seem to confirm this. Similarly, UNDP reports Cambodia is not on track to achieve health Millennium Development Goals.

PWHO foresee that HIV and AIDS services may deteriorate further if hospitals cannot cope with increased patients, particularly those newly infected as it is reported that budget from the government to National HIV and AIDS Authority is to be cut by 15% from 2012, as well as the level of external support from donors also decreases. There is a danger the difficulties shared by PWHO staff may lead others to give up trying to access HIV medical support and treatment from the public health facilities - Cord and PWHO are determined not to see this happen.

*Handicap International (2010), Low Access to HIV and AIDS and Sexual Violence Protection Services among Women and Men with Hearing, Visual and Physical impairments of Battambang and Kampong Cham Provinces of Cambodia, Phnom Penh, Cambodia.