Date: October 11, 2007 (Thursday)
Time: 12:30 – 14:00 (sandwich lunch from 12:30 –12:45; seminar begins at 12:45)
Venue: Mrs Chen Yang Foo Oi Telemedicine Centre, 2/F, William MW Mong Block,
Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong

Abstract:
MSF is an international humanitarian organization providing medical assistance to vulnerable populations: those affected by natural or man-made disaster, and also those excluded from health care because of their status as refugees, migrant workers etc. Reporting on the reasons for such exclusion and advocating for change is a fundamental part of their work.

MSF treats more than 100,000 people with HIV/AIDS in 20 countries in Africa and Asia. While MSF is not a research organization, it is essential that they do operational research to adapt the provision of quality health care to the resource limited settings where they work.

In Thailand, there is universal access to antiretroviral treatment (ART) for Thai citizens through the public health sector. However groups such as prisoners, migrants, and injecting drug users are excluded. In 2003, health staff in two prisons asked MSF to support treatment for HIV infected prisoners. Treatment guidelines needed to be adapted for management by the under-resourced prison health care system. Other barriers to overcome included lack of trust between prison staff and prisoners – making prisoners reluctant to seek treatment – and ensuring continuity of treatment for prisoners following their release. Eighty-eight prisoners with HIV have been treated with ART, outcomes being comparable with other settings.

Provision of treatment led to the development of a close working relationship between MSF and prison staff and was followed by requests for them to work on HIV prevention. By far the most important risk factor for HIV transmission within the prisons is unprotected homosexual intercourse. Attempts to limit HIV transmission therefore involve working with prison guards on attitudes to provision of condoms within the prisons, as well as health education for the prisoners themselves.

There are few examples of HIV prevention and treatment programs in prisons in the developing world. The MSF had shown that satisfactory outcomes could be obtained in under-resourced prison settings and thought that their experience should be written up and submitted for publication. During the peer review process, ethical considerations arose: could any of the beneficiaries be harmed by publication of the paper? The conclusion of an independent review board was that the paper was descriptive and thus it was unnecessary to seek ethical approval beforehand. This has important implications for MSF as much of their work takes place in emergency settings, where it is not feasible to seek ethical approval before providing treatment.

Bio-sketch:
David Wilson qualified as a medical doctor in UK, where he used to be a General Practitioner. He has worked with MSF for 16 years in Hong Kong, Vietnam and Thailand, treating asylum seekers, migrant workers and people with HIV/AIDS. Apart from providing clinical care, his professional interests include advocacy for access to essential medicines, training community health care staff, and treatment education for people with HIV/AIDS. He has published articles in The Lancet and PloS Medicine.

Registration:
For registration and enquiries, please call Ms Maggie Cheuk at 2819-2841 or email mhrn@hkusua.hku.hk