Treating HIV/AIDS in Cambodia – a snapshot from Takeo

Cambodia's level of poverty, ranking it in the bottom 20% on the UNDP human development index, along with its ever-present burden of an all too recent grief has had far-reaching effects on its public health system. It is a country that has endured a turbulent history and although it is developing quickly with a booming tourism industry and a rapid growth in infrastructure, the quality of the health system still falls by the wayside. The vast majority of Cambodians have little or no access to basic healthcare, a feeling which is even more palpable in the remote rural regions of the country where people must travel further to reach clinics, which are often dirty, overcrowded, poorly staffed and do not offer adequate care.

One of these rural regions is Takeo Province in south-western Cambodia. A thirty minute drive from Donkeo District Hospital, where Médecins Sans Frontières (MSF) is working in a chronic disease clinic, can be found clusters of small villages, where most of the inhabitants living in thatched or wooden huts on stilts. The majority of people here earn their living from subsistence agriculture.  Across rice fields, desolate and dried out following a scorching dry season, is a small, thatched house inhabited by Chantrea and her six year old daughter, Botum.

Chantrea first became sick in 2003, one year after her husband had died of HIV/AIDS. She spent all her money and sold everything she owned to be able to receive treatment. However, people in her small community associated HIV drugs with death and told her she shouldn't take them. Her husband had died from taking drugs, so to them it was clear that Chantrea would follow the same fate.

When she became even sicker, a relative encouraged her to seek proper treatment. Fortunately, this relative had heard of the antiretroviral (ARV) treatment that MSF was providing in the province and so Chantrea finally went to seek advice. She was immediately placed on ARV treatment and was counselled that her child should be tested. Sadly, Botum tested positive also.

"At first I was scared for both me and for my child. I was afraid of taking the drugs, of giving them to her. I thought we would both die. My husband started taking drugs just two months before he died, so we thought they caused his death. But the doctors and the counsellors at MSF were really encouraging and told me we would feel better if we took them. I’m so glad I listened to them."

The transmission of HIV from mother to child is a common issue in developing countries, especially with cases like Chantrea and Botum, where they did not seek medical treatment until it was too late. With limited access to diagnostic services and appropriate intervention treatments in countries like Cambodia, the problem remains widespread for many mothers and their children. Transmission of the virus can be avoided however through close monitoring and treatment of the mother throughout her pregnancy and during labour, delivery and breastfeeding. In Cambodia, MSF is currently working closely with the Ministry of Health to improve prevention of mother to child transmission programs and to ensure that more children are not infected with the virus.

At present, MSF is providing ARV treatment for approximately 450 children in Cambodia, the vast majority of whom have contracted their virus from their mother. With this treatment, patients such as Botum are able to lead a relatively normal life. Through a comprehensive program involving drugs and counselling, Botum has been able to successfully fight TB, a common co-infection of HIV, with drugs supplied by MSF. Chantrea has been astounded with her daughter's general progress: "At first it was difficult to give drugs to her, as I had to grind them before she would take them. It’s much easier now. I know we have to do it so it's no problem. She is so much happier and more confident now."

There are still between 25,000 and 30,000 people in urgent need of ARV treatment in Cambodia. Currently, teams are working to treat HIV/AIDS patients in five locations: Takeo, Siem Reap, Oddar Meanchay, Phnom Penh and Kompong Cham. In two of these sites, Takeo and Siem Reap, teams are also treating other chronic diseases such as diabetes and hypertension.

MSF has been working in Cambodia since 1989.

The patients' names in this article have been changed.