An Interview with Dr. Adeeba Kamarulzaman—The Current State of Asia’s Fight Against AIDS

July 2006—Recently named as chair of TREAT Asia’s Steering Committee, Dr. Adeeba Kamarulzaman is engaged in the fight against HIV/AIDS on multiple fronts. As a physician and chief of infectious diseases at the University of Malaya Medical Center in Kuala Lumpur, she provides care and treatment to people living with HIV/AIDS. Last year she was appointed president of the Malaysian AIDS Council, a role that allows her to advocate on a national level for progressive HIV/AIDS policies, including the successful introduction of harm reduction programs. In addition, her work with TREAT Asia provides her with the opportunity to help shape anti-AIDS programs across Asia. Dr. Adeeba discussed her work and her perspectives on the epidemic with the TREAT Asia Report.

TREAT Asia Report: How did you become involved with HIV/AIDS?

Dr. Adeeba: In the early 1990s I was training as a physician in Melbourne, Australia. In the internal medicine program I was exposed to infectious diseases and HIV/AIDS, and I realized that I liked that discipline. As part of the training I worked at the Fairfield Infectious Diseases Hospital (since closed), where around 70 percent of the patients had HIV/AIDS. That was in the days when there was no effective treatment available, but it was an extremely stimulating environment because the physicians were very caring and inspiring, and so were the patients and their caregivers. So I got involved in this area and went on to specialize in AIDS and infectious diseases.

TA Report: You’ve been widely recognized for your work on harm reduction in Malaysia, and you’ve also spoken eloquently about the responsibility of Islam in relation to harm reduction efforts. How have things changed in this regard over the last few years?

Dr. Adeeba: I can only speak for Malaysia, and luckily things have changed there to some degree. I don’t take credit for it at all, but it is very fortunate that our leaders have finally recognized that drug use is driving the HIV/AIDS problem. A number of things came together to make that happen. One was that many of us were advocating for harm reduction, and another involved the Millennium Development Goals. For Malaysia, reducing HIV/AIDS is the only one of those goals that has not been reached, and for our leaders that is very significant; it has made them stand up and listen.

The government was also willing to consider harm reduction efforts because of what I call “failure fatigue.” We’ve had a drug use problem for years and years in Malaysia, and despite laws that make the death penalty mandatory for trafficking in a number of drugs, things had gone from bad to worse.  We have these treatment rehabilitation centers on which the government is spending a lot of money to little effect, and the public was starting to get agitated and asking questions. So we were also looking for an alternative. There’s substitution therapy such as methadone maintenance, which has been shown to work, and specifically in terms of HIV/AIDS there’s syringe exchange. Because of these two epidemics, AIDS and drug use, there’s been a turnaround in terms of policy.

TA Report: Can you tell us about some of the most innovative or successful strategies you’ve seen employed in the region to combat the epidemic?

Dr. Adeeba: I think it’s been work by the grass-roots organizations in countries like Thailand, Indonesia, and Cambodia that has been so impressive and creative. And they have done this with very limited financial resources. You hear of the Buddhist monks, for instance, who have little but compassion to care for HIV/AIDS patients. Those sorts of things always touch me. And now you see harm reduction plans, not just in Malaysia, but also in Indonesia. Actually, in Indonesia they introduced harm reduction earlier than we did and they are moving forward even faster.

TA Report: You’ve been involved with the TREAT Asia network since its inception five years ago. What were the participants’ hopes for the network when it was first created, and how far has it come toward achieving those initial goals?

Dr. Adeeba: I think we’ve progressed in leaps and bounds, and it makes me proud. When I got involved with TREAT Asia I was looking for regional cooperation; I felt pretty isolated. The whole world’s attention was on Africa, but I could feel and I could see that there was this looming epidemic in Asia, and yet no one was noticing. TREAT Asia has done pretty well at focusing attention on Asia, especially through reports and publications. The network has brought together a large group of physicians who are key opinion leaders in their own countries, and we’ve benefited from that interaction.

From the start we wanted to drive good treatment policies in Asia and good research and good training programs, but obviously we’re far from achieving all those things. Still, we’ve made significant steps.

TA Report: TREAT Asia’s regional network model was initially met with skepticism by some—the idea of bridging cultural and political differences over such a huge geographic area seemed daunting. Has the model worked? What have been the biggest challenges?

Dr. Adeeba: I don’t think the cultural or the language differences have made a difference—actually, I don’t think anyone’s noticed them! Basically English is the common language for most of us, with the exception of one or two countries. There are more commonalties than there are differences in terms of the level of the epidemic, awareness, stigma and discrimination, the training that’s required, human resources, research—all those things are more than enough to bind us together.

We want to do so many things, but all of us in our own countries are so busy with our own national issues that we can’t take on as much with the network as we would like. That’s the single biggest challenge. And then there’s funding, but I think with our gradual success we’ve begun to attract more and more funders.

TA Report: What do you regard as TREAT Asia’s greatest success so far in fighting HIV/AIDS in Asia?

Dr. Adeeba: The TREAT Asia HIV/AIDS Observational Database [TAHOD] has been our most meaningful contribution. The information that has come from TAHOD has generated several publications and we’ve done many presentations at major conferences. That research not only attracts attention to HIV in Asia but it tries to answer questions  questions—and that’s its aim, really—it tries to answer questions about treatment-related issues in Asia, which can be vastly different from the U.S. Also the TREAT Asia Special Report in 2004 on the shortage of doctors trained to treat HIV/AIDS brought a lot of good attention to human resources issues.

Our new drug resistance surveillance work is going to be significant, too. Without TREAT Asia, many countries would not be able to begin the sort of surveillance that’s required, so this new initiative is very important from a scientific, technical point of view.

TA Report: TREAT Asia has recently received several important grants to support its work. What direction do you think the network should take over the next five years? Are there specific research issues that TREAT Asia participants are anxious to address as a group?

Dr. Adeeba: I think we need to expand on TAHOD; there are still many questions about treatment that need to be answered and those answers could be learned from an observational database. And from there, hopefully we will move on to doing clinical trials that are relevant to Asia. For example, we need to figure out what would constitute a better second-line treatment because the limited number of drugs that we have around the region hampers us. In addition, we hope to look at how much monitoring is required for effective disease management—those sorts of issues are important.