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Cambodia’s AIDS strategy could fail without sustainable financing

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c7301 (Published 21 December 2010) Cite this as: BMJ 2010;341:c7301
  1. Peter Moszynski
  1. 1London

Despite Cambodia’s success in driving down numbers of HIV infections, a new report on the future of the disease in the country argues that further success is not guaranteed and that the government needs to focus on prevention and assume more of the financing of its AIDS programme.

Written by Cambodian experts working with the Results for Development Institute, a non-profit organisation in Washington, DC, that aims to help accelerate social and economic progress in low and middle income countries, the report finds that in a best case scenario Cambodia could reduce the incidence of HIV to 1000 people a year in 2031—down from an estimated 2100 infections in 2009 and a peak of 15 000 a decade ago.

But the report’s authors also say that if efforts on HIV and AIDS stall and the current coverage of key services shrinks, the number of infections could climb to 3800 a year in 2031. It concludes that the government’s successful track record will not continue unless it scales up prevention services for the groups of people most at risk, such as sex workers, men who have sex with men, and injecting drug users.

Cambodia’s minister of health, Mam Bunheng, said, “We welcome this in-depth and forward looking report for our country. Cambodia has a long history of fighting HIV and AIDS head on, with effective prevention strategies, and we believe that this report will help us sharpen our strategies.”

Between 1998 and last year Cambodia dramatically reduced the number of new infections and made antiretrovirals widely available. By 2009 an estimated 93% of those eligible for HIV treatments were receiving them. The cost of the HIV and AIDS programme grew from $21m (£14m; €16m) in 2003 to $52m in 2008, with 90% of funding coming from outside donors.

Still, Cambodia’s AIDS epidemic, fuelled largely by unprotected heterosexual sex between men and female sex workers, “remains volatile and could spread rapidly without targeted prevention efforts.”

Vonthanak Saphonn, deputy director of the National Institute of Public Health and the lead Cambodian author of the report, said, “Cambodia has many choices in front of it. Our recommendation is that Cambodia needs to focus investments on HIV and AIDS in those areas that are most cost effective. This may mean that the country has to evaluate each intervention and focus on those that are contributing the most to the national programme in a cost effective manner.”

Robert Hecht, a managing director at the Results for Development Institute, said that the Cambodian study has particular significance for countries in Asia, Latin America, and eastern Europe that are fighting epidemics that are largely confined to specific at-risk groups.

“Cambodia is an important example of a country that was facing a possible catastrophe a decade ago and has averted that thanks to bold actions,” said Dr Hecht. “But there’s no room for complacency. This is the moment for Cambodia to strike a bargain with its outside funders such as the Global Fund [to Fight AIDS, Tuberculosis and Malaria], Australia, and the United States. If these funders maintain a modest level of financial support to help preserve Cambodia’s gains to date, the government can gradually step in to assume fuller and more sustainable funding of its AIDS programme.”

Notes

Cite this as: BMJ 2010;341:c7301

Footnotes