Editorial | Articles about Cambodia | Khmer

Wednesday, December 31, 2008

Cambodia no country for Islamist movements

Why Al Qaeda Isn't Gaining a Foothold in Cambodia

The post-Khmer Rouge nation is a portrait of tolerance for Muslims, but the US worries that this could change.


Village Elder: Yousuf Bin Abetalip, one of Cambodia's 400,000 Muslims.
David Montero

By David Montero | Correspondent of The Christian Science Monitor
from the December 30, 2008 edition

CHROYAMONTREY, Cambodia - In this village, and others like it throughout Cambodia, Muslims and non-Muslims live side by side in harmony, their existences unmarred by the toxic cocktail of government repression, separatist ambitions, and growing radicalism characteristic of many neighboring countries.

"I've been living with Muslim neighbors since I was young," says resident Ouk Ros. "When there's a marriage, we join together in the party."

Still, as money and influence from the Persian Gulf pours into Cambodia, many fear that pockets of the 400,000 strong Muslim community could fall into the orbit of a less-tolerant form of Islam.

"There are some organizations here from the Middle East that are very radical and that are very intolerant, and they are trying very hard to change the attitude and the atmosphere of the Muslim population here," the outgoing US Ambassador, Joseph Mussomeli warned in August.

A unique confluence of modern history, geography, and government initiative have combined to foster tolerance in Cambodia, many observers here say.

In Thailand and the Philippines, Muslim communities are concentrated in separate – and often disadvantaged – territories, which are byproducts of ancient kingdoms to which Muslims once belonged. Separatists in Thailand's south have been fighting for greater autonomy since 2004 and in the Mindanao area of the Philippines since the 1970s.

But Cambodia's Muslims, sometimes referred to as Chams – a reference to an ancient empire of warriors, the Kingdom of Champa – have always lived dispersed throughout the country.

"We don't have any separate lands, and we don't want any separate lands," says Osman Ysa, the author of two books on Cambodia's Cham population. "We consider this country as our own."

To date, Muslims here have also eschewed radical politics, although not without exception. In 2003, authorities arrested a Cambodian citizen, as well as an Egyptian and two Thai nationals, all suspected of ties to Jemaah Islamiyah, an Al-Qaeda affiliate based in South Asia.

Cambodia's unique and dark modern history helps explain why the dominant form of Islam remains both peaceful and accommodating, Muslim leaders say. When the ultra-Communist Khmer Rouge seized power in 1975, they outlawed religion and set about decimating the Muslim population. By 1979, when the Khmer Rouge fell, about 500,000 Muslims had been killed – nearly 70 percent – according to one of Mr. Ysa's studies.

As a result, the violence of Al Qaeda today reminds Muslim leaders of the Khmer Rouge of yesterday.

"When Cambodia was controlled by Pol Pot, the Khmer Rouge look liked Al Qaeda," says Sley Ry, the director of religious education at the Cambodian Islamic center, Cambodia's largest Islamic school, located near Phnom Penh.

"We've already suffered a lot.... We are very disappointed by Al Qaeda because God tells: 'Don't kill people,' " adds Yousuf Bin Abetalip, an elder of Choy Changua, a village just outside of Phnom Penh, where about 300 Muslim families live.

Buddhism is the state religion in this country of 14 million, but the country's constitution enshrines freedom of worship. Unlike in China, where the Communist government has been accused of limiting the freedom of Muslims to worship, the government of Prime Minister Hun Sen has built large mosques and provided free radio airtime for Muslim programming.

Beyond such overtures, Muslims enjoy real political power. About a dozen serve in top political offices. Mr. Sen even has his own advisor on Muslim affairs.

But there are fears that Cambodia's moderate form of Islam could be contested. In recent months, ties between Cambodia and the Persian Gulf have grown as the Gulf States look to Cambodia as a potential buyer of oil and supplier of food. In September, the government of Kuwait pledged $546 million in soft loans, while Qatar pledged $200 million. Kuwait has also earmarked $5 million to refurbish a mosque in Phnom Penh.

There are fears that the money could open the door to private individuals and foundations who seek to influence the Muslim community here. Whether founded or not, in January, the Federal Bureau of Investigation (FBI) opened its first office in Cambodia, citing the potential for terrorism.

"Cambodia is an important country to us for the potential of persons transiting Cambodia – using Cambodia as a spot for utilizing terrorism," FBI director Robert Mueller said, inaugurating the new office.

In September, the prime minister announced a new law to more tightly control nongovernmental organizations. Sen's reasoning: "Terrorists might come to the Royal Government of Cambodia and hide themselves under the banners of nongovernment organizations."

Some critics contend the law is not aimed at terrorists, but nongovernmental organizations (NGOs) that routinely criticize Sen's administration.

"It's not only to control the terrorists groups, but also to control NGOs in general," says Thun Saray, the director of Adhoc, a human rights organization based in Phnom Penh.

As concern over terrorism grows, Muslims here, including Mr. Abetalip, say they will be the first to prevent it. "If there's any Cambodian people who want to follow Al Qaeda, we will straight away arrest them and bring them to the government."

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Monday, December 29, 2008

Supreme Court Tested by Labor Leader’s Murder Case

Cambodia: Supreme Court Tested by Labor Leader’s Murder Case

Lack of Justice Leaves Unionists in Fear for Their Lives

The Cambodian Supreme Court should rely on the evidence and not give in to government pressure when it reviews the case. Born Samang and Sok Sam Oeun have already spent five years behind bars for a crime they did not commit, and it is time for justice to be done in this case.
Sara Colm, senior researcher for Human Rights Watch

December 28, 2008

(New York, December 28, 2008) - Cambodian authorities should exonerate and free Born Samnang and Sok Sam Oeun, who were unfairly sentenced to 20 years in prison in 2005 for the murder of labor leader Chea Vichea, said three international human rights organizations and the world's largest trade union confederation in a joint statement released today.

The Cambodia Supreme Court will hear the case on appeal on December 31, 2008.

The joint statement was issued by Human Rights Watch, the International Trade Union Confederation, and the Observatory for the Protection of Human Rights Defenders (a joint program of the International Federation for Human Rights and the World Organization Against Torture), which have all closely followed the case since Vichea's murder.

"The Cambodian Supreme Court should rely on the evidence and not give in to government pressure when it reviews the case," said Sara Colm, senior researcher for Human Rights Watch. "Born Samang and Sok Sam Oeun have already spent five years behind bars for a crime they did not commit, and it is time for justice to be done in this case."

Chea Vichea, 36, was the founder and president of the Free Trade Union of Workers of the Kingdom of Cambodia (FTUWKC) and a vocal supporter of the opposition Sam Rainsy Party. He was shot and killed in broad daylight in front of a newsstand in Phnom Penh on January 22, 2004. Vichea was well known for his outspoken efforts to organize garment workers and to fight for improved working conditions in Cambodia, work he continued in spite of death threats.

The investigation into the high profile murder was marred by alleged police brutality and forced confession by one of the suspects, intimidation of witnesses, and political interference in the judicial process. The prosecution and conviction of Born Samnang and Sok Sam Oeun have drawn extensive criticism from Cambodian and international human rights activists, union advocates, lawyers, and United Nations officials.

The International Labour Organization (ILO), which sent a fact-finding mission to Cambodia in April 2008 to investigate the murders of trade unionists, has repeatedly expressed strong concerns about the convictions of the two men and called for a fresh investigation into Chea Vichea's murder.

"The lack of justice in this case leaves trade unionists in fear for their lives," said Guy Ryder, general secretary of the International Trade Union Confederation, whose 311 affiliates represent 168 million workers worldwide. "Even ILO leaders who were on an official ILO mission to Cambodia earlier this year were subject to intimidation."

In a report released in November 2008, the ILO sharply criticized the Cambodian government for not effectively stemming a series of violent and deadly attacks against trade unionists. At the core of the problem, the report said, is Cambodia's lack of an independent judiciary, which allows the real perpetrators of such attacks to evade justice. The atmosphere of impunity in Cambodia reinforces the climate of violence and insecurity, the report said, which in turn "is extremely damaging to the exercise of trade union rights."

The ILO report's findings, which could affect the future of Cambodia's important garment industry, noted that during the ILO mission in April, the government "demonstrated an unwillingness to engage in fully frank discussions" and "provided no concrete indications" that it would act upon any of the ILO's recommendations.

In addition to the murder of Chea Vichea, there has been an ongoing pattern of violence against trade union activists in Cambodia. This includes the murders of FTUWKC official Hy Vuthy in February 2007 and FTUWKC Steering Committee member Ros Sovannarith in 2004, and a series of threats and physical assaults against FTUWKC representatives and other trade unionists.

The four organizations urged the Cambodian government to launch a full and impartial investigation into Chea Vichea's murder, as well as an independent and public inquiry into the handling of the prosecution of Born Samnang and Sok Sam Oeun.

"If the Supreme Court fails to provide long-overdue justice by releasing these two innocent men, it will only further highlight the lack of progress toward rule of law in Cambodia," said Souhayr Belhassen, president of the International Federation for Human Rights.

The organizations also urged the Cambodian government to take prompt action to address the key issues highlighted by this case: Cambodia's endemic impunity and lack of rule of law, government interference in the judiciary, intimidation and violence faced by trade union members and leaders, and widespread torture by the police.

"It's time for the Cambodian authorities to finally deliver justice to Born Samnang and Sok Sam Oeun, and stop the widespread practice of torture by Cambodian police to force confessions out of criminal suspects," said Eric Sottas, secretary-general of the World Organisation Against Torture.

Background

The police and court investigations into Vichea's killing were marred by a series of procedural flaws and violations of international legal standards. The police allegedly tortured Born Samnang to obtain a confession. A judge who initially dropped the charges against the two men for lack of evidence was swiftly removed from his position, and the charges were reinstated. The subsequent trial of the two men was conducted in a manner that flagrantly violated Cambodian law and international fair trial standards. In April 2007, the country's Appeal Court upheld their convictions despite the state prosecutor acknowledging that there was insufficient evidence.

Chea Vichea's family members say they believe Born Samnang and Sok Sam Oeun are not responsible for the crime, as has Var Sothy, the newsstand proprietor who was the key eyewitness to the killing. She subsequently fled Cambodia in fear for her life.

As an example of the politicization of the Cambodian judiciary, the Chief Justice of the Supreme Court, Dith Munthy, is a member of the Standing Committee of the ruling Cambodian People's Party. The lack of judicial independence has been cited in successive UN human rights reports for the past 15 years and is a major concern in the ongoing attempts to bring Khmer Rouge leaders to justice. The Cambodian government has long acknowledged weaknesses in the judiciary and made commitments to address this, but has taken no meaningful steps to do so.

For background on Chea Vichea's murder and the prosecution of Born Samnang and Sok Sam Oeun, please see:



Further background documents, at: http://www.hrw.org/english/docs/2006/10/03/cambod14314.htm.

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http://www.hrw.org/en/news/2008/12/27/cambodia-supreme-court-tested-labor-leader-s-murder-case

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Wednesday, December 17, 2008

The Mekong's Hidden Treasures

The Mekong's Hidden Treasures

More than 1,000 has been discovered including 519 types of plants

This is spiny new species discovered in Thailand in 2007 (Copyright: Somsak Panha)


This is known as Cyrtodactylus phongnhakebangensis discovered in Vietnam in 2002
Cnemaaspis caudanivea discovered in Vietnam in 2007 (copyright: L. Lee Grismer)

This is flying frog, thhe blue-spotted tree frog known as Rhacophorus Cynaopunctatus discovered in Thailand in 1998 (Copyright: Chan Kin Onn)

Rhacohorid frog known as Chiromantis samkosensis discovered in Cambodia in 2007 (copyright: L. Le Grismer)

This is smooth-skinned wart frog known as Theloderma discovered in Thailand in 2007 (Copyright: Daicus Blabut)

This is rock rat known as Laonastes aenigamus discovered in Laos in 2005 (Copyright: David Redfiled)

This is rat known as Tonkinomys daovantieni discovered in Vietnam in 2006 (Copyright: Darrin Lunde)

This is Naung Mung Scimitar babbler discovered in Myanmar in 2005 (Copyright: Christopher)

This is called, Lygosoma boehmei (Lizards) discovered in 2007 (Copyright: Thomas Ziegler)

This is Woollyy bat known as Kerivoula titania discovered in Cambodia's Seima Biodiversity Conservation Area in 2007 (Copyright: Gabor Csorba)

This is nocturnal spider known as Heteropoda dagmarae discovered in Laos in 2005 (Copyright: Peter Jager)

Ellopostoma mystax, which is inhabits Thailand's Tapi Basin (Photo: Kampol Udomrittiruj)

Palm-sized wolf snake known as Lycodon cardamomensis discovered in Cambodia, Cardamom Mountains, in 2002 (Photo: Jenny Daltry)
Vogel's green pitviper discovered in Thailand (Photo: Montri Sumontha)
Gumprecht's green pitviper known as Trimersurus gumprechti discovered (2002) in Thailand, Laos, Vietnam, China, and Myanmar (Photo: Rene Ries)

This is Gentiana khammousanensis discovered in Lao (Photo: Royal Botanic garden Edinburgh).

This is beautiful Aeschynanthus mendumiae flower was discovered in Laos, Khammouan province (Photo: Royal Botanic garden Edinburgh)

Source: MSNBC

A new report crowns Southeast Asia's Greater Mekong region as one of the world's hottest spots for biodiversity, with more than 1,000 previously undocumented species discovered over the past decade. But it’s also a hot spot for economic development, which sets up a race to protect what is clearly a biological bonanza.

In all, roughly 25,000 species call the Mekong River basin home. On a species-per-mile basis, the region's waterways are richer in biodiversity than the Amazon, according to "First Contact in the Greater Mekong," a report released today by WWF International.

"This region is like what I read about as a child in the stories of Charles Darwin," Thomas Ziegler, curator at the Cologne Zoo in Germany, said in a news release. "It is a great feeling being in an unexplored area and to document its biodiversity for the first time ... both enigmatic and beautiful."

Nicole Frisina, communications officer for WWF's Greater Mekong Program, told me that "the rate of species discovery is quite prolific as you compare it with other areas of the world." The average works out to two new species every week - and if anything, the pace is accelerating.

From war to wonder
The Greater Mekong Program's director, Stuart Chapman, told me there are a couple of reasons for that quickening pace.

The colored areas represent different parts of Southeast Asia's Greater Mekong region, draining into Cambodia's Mekong Delta.


First, the Greater Mekong region - which takes in areas of China's Yunnan Province as well as Cambodia, Laos, Myanmar, Thailand and Vietnam - includes some incredibly remote areas, such as the Annamite Mountains on the Lao-Vietnamese border.

Under the best of circumstances, traveling to these frontiers is difficult and expensive. And during the region's decades of conflict (including, of course, the Vietnam War and Cambodia's wars), scientific exploration was nearly unthinkable.

"In some regions, there haven't been a lot of scientific expeditions purely because there's been a lot of [unexploded] ordnance around," Chapman said.

That's all changing now: Many parts of Southeast Asia are undergoing intense economic development. Just to cite one example, more than 150 large hydroelectric dams are being planned in the region. And that raises a huge challenge for scientists scrambling to explore the Mekong's lost world.

The 'race against time'
"This poorly understood biodiversity is facing unprecedented pressure ... for scientists, this means that almost every field survey yields new diversity, but documenting it is a race against time," Raoul Bain, a biodiversity specialist from New York's American Museum of Natural History, said in today's news release.

Rising populations and greater economic development are putting wildlife habitat in danger. The World Conservation Union has already added 10 species from Vietnam to its extinction list, and another 900 species are considered threatened.

The WWF (fomerly known as the World Wildlife Fund) issued today's report as part of its effort to preserve the region's biological riches even as the 320 million people living there reach for new economic riches. "You don't have to have people choose between the two," Chapman said. "You can have both, with careful planning."

The organization called on the region's six governments to work together on a conservation and management plan for 230,000 square miles (600,000 square kilometers) of transboundary and freshwater habitats. Chapman said the governments already have identified corridors of land in need of cross-border conservation.

However, he said, "having them identified on the map hasn't resulted in transboundary planning. ... That kind of thinking hasn't really taken hold yet."

Coming attractions
The biological riches could eventually yield new medicines and sustainable food sources for the region's needy populations - or perhaps new attractions for the world's eco-tourists. And for scientists at least, there are plenty of attractions out there, hiding in plain sight.

For example, a new rat species was discovered as a delicacy in a Laotian food market - and scientists traced its evolutionary lineage back to a group of rodents that were thought to have gone totally extinct 11 million years ago. It turned out that the Laotian rock rat (listed as Kha-nyou on the menu) was the sole survivor of that ancient group.

Another previously unknown species of pit viper was first seen by scientists as it slithered through the rafters of a restaurant in Thailand's Khao Yai National Park.

"These are the kinds of surprises that illustrate the diversity of this region," Chapman said.

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Thursday, December 11, 2008

Hor Namhong Versus Sam Rainsy

Hor Namhong Versus Sam Rainsy:
Hearing at the French Court on December 9, 2008

December 11, 2008 (By Sam Rainsy Party Blog)

Deputy Prime Minister and Foreign Affairs Minister Hor Namhong has filed a defamation lawsuit against Sam Rainsy before the French Court following the publication this year in France of a book by the opposition leader titled "Des racines dans la pierre" (Rooted in Stone).

The hearing which took place at Le Palais de Justice in Paris started at 4:50 pm and ended at 8:30 pm.

Hor Namhong was there with five lawyers. They brought Raoul Jennar, a Belgian "expert on Cambodia", as a witness. Sam Rainsy was there too but with only one lawyer and no witness.

Hor Namhong's arguments

1- Former King Norodom Sihanouk was condemned by the French Court on January 23, 1991 after being quoted as saying in the French newspaper Le Journal du Dimanche dated July 23, 1989:

"L'équipe de Monsieur Hun Sen est composée d'anciens Khmers rouges archi-criminels. Par exemple, Hor Nam Hong, ex-commandant d'un camp de concentration Khmer rouge, est responsable de la mort après d'atroces tortures de beaucoup d'anciens membres de la résistance anti-américaine, tels mon cousin le prince Sisowath Méthavi et son épouse, sœur aînée de ma femme… "

"Mr. Hun Sen's team is made up of former arch-criminal Khmer Rouge officials. For instance, Hor Nam Hong, ex-commander of a Khmer Rouge concentration camp, is responsible for the death, after atrocious tortures, of many former members of the anti-American resistance, such as my cousin Prince Sisowath Methavy and his spouse, who was my wife's elder sister…"

According to Hor Namhong, Sam Rainsy in his book made against him the same allegations as the ones Norodom Sihanouk made nearly twenty years ago; Sam Rainsy should then be condemned in the same way as the former King was condemned by the same Court.

2- Hor Namhong lost many relatives under the Khmer Rouge regime. Therefore, he could not have cooperated in any way with the Khmer Rouge.

Sam Rainsy's arguments

1- In his book Sam Rainsy actually wrote:

"Hun Sen n'était pas seul dans son cas: la plupart des supplétifs du régime vietnamien avaient frayé avec les Khmers rouges. Quand Ranariddh et Hun Sen eurent définitivement scellé mon compte, ils ne trouvèrent pas mieux que de nommer à la tête de mon ministère Keat Chhon, celui qui, pendant tant d'années, fut le principal conseiller de Pol Pot. Et quelques années plus tard, le Ministre des Affaires Etrangères serait un ancien collaborateur du pouvoir khmer rouge soupçonné d'avoir causé la mort de nombreuses personnes dont des membres de la famille royale".

"Hun Sen was not alone in his case: most of the Vietnamese regime's auxiliary staff had cooperated in one way or another with the Khmer Rouge. When Ranariddh and Hun Sen had definitively decided on my fate, they did not find anything better than appointing at the head of my ministry Keat Chhon, the man who, for so many years had been the main adviser to Pol Pot. And several years later, the Foreign Affairs Minister could be a former collaborator of the Khmer Rouge regime suspected of having caused the death of many people including members of the royal family."

Sam Rainsy points to the fact that what he wrote is not exactly the same, in the content and in the form, as what former King Norodom Sihanouk had reportedly said.

2- There have been new developments and new evidence against Hor Namhong since 1991 when the former King lost the first lawsuit filed by Hor Namhong before the French Court. Sam Rainsy refers to The Cambodia Daily report "Clouded History" published on July 1-2, 2000, the interview of Senator Keo Bunthouk (Mrs. Ieng Kounsaky) titled "A camp called Boeng Trabek" published in The Phnom Penh Post dated January 19 - February 1, 2001 and the book by Ong Thong Hoeung "J'ai cru aux Khmers Rouges" (I believed in the Khmer Rouge) published in Europe in 2003. Related documents at http://tinyurl.com/56czqh

Hor Namhong said that he had filed a defamation lawsuit in Phnom Penh against The Cambodia Daily for the above-mentioned report and that he won the case. Out of the two authors of the report, only the Cambodian reporter [Thet Sambath] was condemned by the Cambodian Court because the other one, who is an American national [Kelly McEvers], "ran away." He said that all the defamation cases initiated by him in Cambodia have been closed because all the concerned journalists [including Dam Sith, the editor of Moneaksekar Khmer (Khmer Conscience) who was jailed for one week this summer], have apologized to him.

Raoul Jennar said that he has been hired by the Khmer Rouge Tribunal in Phnom Penh (ECCC) as an "independent expert." To defend Hor Namhong he said that the genocide perpetrated by the Khmer Rouge was "centralized" in such a way that "only six persons in the Khmer Rouge top leadership could make the decision to kill any person." He also said that the Cambodian government is in no way responsible for any delay in the judicial proceedings at the ECCC.

The French Court will decide on the case on January 27, 2009.

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Monday, December 01, 2008

Can HIV Infection Be Prevented?

Can HIV Infection Be Prevented with a Once-Daily Pill?

Once the bane of global activists and politicians in developing nations, pre-exposure HIV preventatives are being tested in AIDS-stricken Africa

By Nicole Itano
Scientific American

JOHANNESBURG, SOUTH AFRICA—Nearly four years after political pressure shut down two trials that would have tested whether a once-a-day pill could prevent high-risk HIV-negative people from catching the AIDS-causing virus, there’s a surge of renewed interest in the concept, known as Pre-Exposure Prophylaxis, or PrEP.

Western doctors and organizations that funded the halted trials of the anti-HIV drug tenofovir in Cameroon and Cambodia say they've learned their lesson from the debacle in 2004 and 2005, when activist groups questioned the quality of medical care impoverished study participants would receive if they suffered side effects or the became infected by HIV. Today, with at least seven U.S.-funded PrEP trials underway at a cost of $39.5 million, researchers are working with local advocates, who have traditionally been distrustful of Big Pharma, to push the studies forward.

"The whole prevention community really had a wake-up call," says Linda-Gail Bekker, an infectious disease researcher at the University of Cape Town’s Desmond Tutu HIV Center, who is running the South African study site for a new PrEP trial that will eventually involve at least 3,000 gay men in South Africa, Asia, South America and the U.S. The study, which is enrolling trial participants now, is being funded by the U.S. National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation. Its first results are expected in 2010.

In August 2004, Cambodian Prime Minister Hun Sen stopped a trial of PrEP on prostitutes in his country under pressure from activists who said the study was exploiting vulnerable trial participants. Cameroon, which was to be part of a larger, three-country western Africa PrEP trial, shut the trial there down in early 2005 after questions were raised about the trial’s health care provisions for participants.

PrEP researchers now acknowledge they made a mistake by not involving local advocates from the start. After years of being told that antiretroviral drugs were toxic, the idea of using them in uninfected people seemed reckless to many. Local activists, along with their international supporters, believed the trials were being run by profit-hungry pharmaceutical companies who were coming to poor countries to do dangerous research that would later pad their own pockets and only end up benefiting people in the developed world.

In fact, the trials were being conducted by university and nonprofit researchers, and funded by the U.S. government and the Bill & Melinda Gates Foundation. Gilead Sciences, Inc., tenofovir's maker, provided the drugs for free but was otherwise not involved in the trial. And the drug's safety had already been proved in previous HIV treatment trials—many of them conducted in the U.S.

“I don’t think there was some wild, unethical conduct,” said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, which has helped facilitate dialogue on PrEP issues. “But there was a little defensiveness and a lot that got lost in translation.”

ACT UP/Paris, which is part of the international AIDS awareness activist coalition and was involved in the Cameroon controversy, and the Treatment Action Campaign (TAC), South Africa's largest organization of people with AIDS, have been involved in new trials from their earliest stages. New guidelines have also been written setting standards for community involvement in prevention trials, which recommend, for example, that researchers hold meetings with communities prior to the beginning of new trials to address what health care will be provided to participants.

The renewed interest in PrEP comes after two high-profile trials of a vaccine candidate produced by Merck were stopped early in 2007. At least 2.7 million people around the world are HIV-positive, according to the United Nations. Public health experts believe an arsenal of effective prevention tools against HIV is needed to curb its spread, because not everyone will practice existing methods known to work, such as condom use, monogamy between uninfected partners, and abstinence. Trials of potential microbicides, a woman-controlled prevention method that would work similarly to spermicides and other topical birth control methods by blocking or killing HIV during sex, have also been disappointing so far and may not be practical for all women to use. PrEP would offer an alternative.

The trials are investigating whether a daily dose of one of two antiretroviral drugs—either tenofovir disoproxil fumarate (TDF), commercially known as Viread, or Truvada (TDF combined with emtricitabine) can protect people at high risk of HIV from becoming infected.

Antiretroviral drugs, which stop retroviruses like HIV from replicating, are used to treat HIV-positive people. In certain cases they are also employed as a prophylactic to prevent the transmission of the virus from a mother to her newborn or to reduce the chance that someone who has been exposed to the virus, such as through rape or a needle prick, becomes infected.

TDF and emtricitabine are being tested for use as PrEP because they are known to cause low levels of resistance and fewer side effects, and because they remain in the bloodstream for a long time.

Results from studies in gay American men and injecting drug users in Thailand may be available next year. But the first full study testing whether PrEP stops the transmission of HIV through heterosexual sex (the main driver of the epidemic in Africa), which is being carried out in Botswana with plans to expand into South Africa, is not expected to yield results until 2011. And the three biggest trials, involving a total of 12,000 people across Africa, will not be complete until at least 2012.

Researchers are already looking forward to the potential issues that will arise if PrEP is found to be effective, such as whether the use of antiretroviral drugs as preventives will lead to increased resistance or how it could affect the future treatment options of people who later become infected.

If it does work, the public health community will also have to grapple with the tough question of when and how to use PrEP as well as how to balance the need to keep drug-resistant strains of HIV from thriving in the population while saving lives in the short term.

"PrEP has to be implemented as part of a formal program with guidelines and a funding stream. We have to start planning for that," says Lynn Paxton, a PrEP researcher at the U.S. Centers for Disease Control and Prevention.

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