Cambodia Is 2nd Asian Country To Rollout Long-Acting Injectable HIV Prevention Option – OpEd

Credit: Citizen News Service

 July 7, 2025 

By Shobha Shukla

After Thailand, Cambodia becomes the second Asian country to rollout long-acting and injectable options to protect oneself from getting infected with HIV. United Nations health agency (formally known as World Health Organization or WHO) had first issued its guidelines in 2022, asking countries to deliver long-acting injectable Pre-Exposure Prophylaxis (PrEP), using cabotegravir medicine, as part of comprehensive approach to HIV prevention.

PrEP is a medicine for HIV-negative people to reduce their risk of getting infected.

According to the WHO, long-acting injectable cabotegravir PrEP is a safe and highly effective prevention option for people at substantial risk of HIV infection.

In Cambodia, the first two long-acting and injectable cabotegravir PrEP doses were given to a female sex worker and a transgender person, said Patricia Ongpin, UNAIDS Country Director for Cambodia, Lao PDR and Malaysia.

Know more about long-acting injectable cabotegravir PrEP

Long-acting injectable cabotegravir PrEP is an intramuscular injectable, long-acting form of PrEP.

* First 2 injections are administered 4 weeks apart

* Followed thereafter by an injection once every 8 weeks.

This long-acting injectable PrEP with cabotegravir (CAB- LA) has shown in scientific studies to be safe and highly effective among cisgender women, cisgender men who have sex with men, and transgender women who have sex with men (studies include two randomised controlled trials, HPTN 083 and HPTN 084). These studies found that use of long-acting CAB-LA PrEP, resulted in a 79% relative reduction in HIV risk compared with oral PrEP, where adherence to taking daily oral medication was often a challenge.

WHO clearly states that both daily oral PrEP and long-acting injectable PrEP are highly effective.

Choice matters

Expanding the range of science- and evidence-based HIV prevention options, so that people can choose what works best for them, is very important if we are to empower people towards health seeking behaviour, as well as progress faster towards ending AIDS, she said.

“Evidence is very clear on what works in HIV prevention. But what we need to know is that one size does not fit all. So we really have to understand that a combination of HIV prevention options must be made available in the market for people to choose from – based on their daily life, personal choice, and what they are comfortable with,” said Patricia Ongpin, in an exclusive interview given to  CNS in the lead up to 13th International AIDS Society Conference on HIV Science (IAS 2025) – the largest global gathering on HIV science this year. She was also a speaker at IAS 2025 Affiliated Independent Event on the theme: “Strengthening competencies and capacities in Global South to end AIDS, end TB, and deliver on SDGs.”

“Cambodia is a leader in the HIV response for many reasons. It currently has an HIV prevalence among the general adult population of 0.5%. In 2024, it was estimated that there were 76,000 people living with HIV, 1200 new infections (which roughly translates to 3 new HIV infections a day) and 1000 AIDS related deaths that year in Cambodia,” said Patricia. “This represents roughly a 45% reduction in new HIV infections as compared to 2010.”

Nepal is the only country in Asia Pacific region (and among 4 in the world) to record a decline of over 75% in new HIV infections since 2010, said Eamonn Murphy, UNAIDS Director for Asia Pacific at the 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025).

Cambodia on track to achieve 95-95-95 targets for 2025

95-95-95 targets for 2025 refer to ensuring that at least 95% of people living with HIV know their HIV-positive status, 95% of those who know their status are receiving lifesaving antiretroviral therapy, and 95% of those on therapy are virally suppressed.

According to WHO, those people with HIV who remain virally suppressed have ZERO risk of transmitting HIV to anyone else. So, HIV treatment also works as prevention.

Not just rich nations like New Zealand, but also low- and middle-income countries like Nepal, Cambodia and Thailand in Asia and the Pacific region are meeting some of the 2025 HIV-related targets.

“Cambodia is on track to achieve the 95-95-95 HIV-related targets. In 2024, Cambodia had 92% of all people living with HIV who knew their status. Nearly 100% of all those who knew their HIV positive status were on lifesaving antiretroviral treatment, and 98% of those on treatment were virally suppressed. So, this is a fantastic achievement and we are really hoping that Cambodia can achieve the 95-95-95 targets on time for 2025,” said UNAIDS’ Patricia Ongpin to CNS (Citizen News Service).

She added: “This is a very strong health response in Cambodia. and it also reflects its strong political commitment, community-led response, and adoption of innovations. But it is not just a health response, it is essentially a multi-sectoral response from Cambodia. This includes provision of social protection for people living with HIV and female entertainment workers, to social protection schemes that allow them access to free healthcare and covers their other out-of-pocket expenses or reimbursements.”

Patricia was referring to Health Equity Funds in Cambodia – a social health protection government scheme designed to enable poor people to access free healthcare at public facilities. They aim to improve access to healthcare and reduce financial burdens, particularly for those most vulnerable.  

“So, a holistic approach in Cambodia’s HIV response has helped the country to become a leader in achieving the 95-95-95 HIV-related targets for 2025, in the hope that it can indeed end AIDS soon after,” said Patricia.

1st ever rollout of long-acting injectable PrEP in Cambodia

Patricia shared that long-acting injectable cabotegravir PrEP was launched in the second half of June 2025 in Cambodia. “A feasibility and acceptability research study was done last year in consultations with communities, so that we can know how will it be perceived by the people who are intended to use it. The government is working hand-in-hand with civil society organisations and communities so that there is more demand generation for long-acting injectable cabotegravir PrEP, and also to stem other challenges like hesitancy etc.”

She had a meeting with Cambodian Director of HIV programmes and learnt that the uptake of long-acting injectable cabotegravir PrEP is “pretty good right now, where we have both: people who are switching from oral PrEP to long-acting injectable PrEP, and also new initiation of PrEP in general.”

One dose of long-acting injectable cabotegravir PrEP costs US$36

Thanks to the Global Fund to fight AIDS, TB and Malaria (The Global Fund), long-acting injectable cabotegravir has become possible for eligible people in Cambodia.

Treatment for people living with HIV is lifesaving and revolutionary as it has made HIV akin to any other chronic disease. It has been proven that those who are on treatment and remain virally suppressed, live healthy and normal lifespans – comparable to those without the virus – and there is zero risk of any further HIV transmission from them. But oral HIV treatment has to be taken daily without fail. This could be challenging given the fact that HIV treatment is lifelong.

Long-acting injectable cabotegravir along with Rilpivirine (CAB/RPV LA) is also available as treatment for people living with HIV who have suppressed viral load (once every two months). But it is not yet rolled out in Cambodia yet.

Dapivirine vaginal rings in Cambodia: next breaking news?

“Right now, we have cabotegravir as a PrEP (HIV prevention option), injected once every two months. However, it is likely that soon Cambodia may rollout dapivirine vaginal rings for HIV prevention,” said Patricia of UNAIDS.

Dapivirine vaginal ring (developed by International Partnership for Microbicides and acquired by Population Council), is the world’s first female-controlled, long-acting, non-systemic, microbicide product that substantially reduces the risk of getting infected with HIV. Thus, it is also referred to as a PrEP ring.

The dapivirine vaginal ring is a flexible silicon ring that slowly releases the HIV prevention drug dapivirine into the target cells and substantially reduces the risk of her getting infected with HIV. Any HIV-negative woman, who is at risk of acquiring the infection, can herself put the ring in her vagina, leave it in place for a specified period and then replace it by herself.

Patricia informs that Cambodian government began considering dapivirine vaginal rings and long-acting injectable cabotegravir, roughly at the same time. “So, Cambodia is in the final process of settling down the standard operating procedures (SOPs) and training. We are hoping that in the next month or two,  dapivirine vaginal ring will also be added to the range of combination HIV prevention options people can choose from. We hope this would reduce the number of new HIV infections in Cambodia.”

Public health warrants infection prevention but would we sustain it?

UNAIDS’ Patricia Ongpin puts the spotlight on sustainability of HIV prevention as well as global AIDS response in context of competing priorities. “It is a real issue,” she rightly points out.

She calls on governments to have optimal political commitment which should match the services, legal reforms and policy harmonisation, policy framework, health and development financing, and systematic integration which are critical if we are to end AIDS by 2030. “Multi-sectoral approach towards ending AIDS is key,” she said.

Health financing varies between countries. For example, Malaysia has almost all (99%) of its HIV response domestically-funded, whereas Cambodia has roughly 36%, informs Patricia.

IAS 2025 message of UNAIDS’ Patricia Ongpin

“HIV is not over and we need to stand together in solidarity to support governments, communities, and development partners in making sure that HIV responses stay alive,” said Patricia. She called for ensuring effective collaboration between different partners, such as governments, communities and development partners – so that not only innovative financing can be fully harnessed, but we are also able to rollout all combination HIV prevention options along with other critical cog-in-the-wheels to end AIDS by 2030.

Shobha Shukla

Shobha Shukla co-leads the editorial content of CNS (Citizen News Service) and is on the governing board of Global Antimicrobial Resistance Media Alliance (GAMA) and Asia Pacific Media Alliance for Health and Development (APCAT Media).

WAIT,WHAT?!

Planned Hydrogen Refuelling Stations May Lead To Millions Of Euros In Yearly Losses

Joel Löfving, doctoral student, Department of Mechanics and Maritime Sciences, Chalmers University of Technology, Swede

 July 7, 2025  

By Eurasia Review

As hydrogen infrastructure is rolled out in the EU, refuelling stations must be distributed according to the same principle in all countries. But now a study from Chalmers University of Technology in Sweden points to shortcomings in EU regulations. Using an advanced model, the researchers show that the distribution of refuelling stations may both be incorrectly dimensioned and lead to losses of tens of millions of euros a year in some countries.

By 2030, EU countries must have built hydrogen refuelling stations at least every 200 kilometres on major roads and one in every urban node. The aim is to facilitate the introduction of hydrogen-powered transport. This is governed by the Alternative Fuels Infrastructure Regulation (AFIR), which entered into force in 2023.

However, a study from Chalmers, based on data from 600,000 freight routes across Europe, shows that in many cases the requirements do not reflect actual demand. By modelling how hydrogen-powered long-haul trucks might operate in 2050, the researchers show not only where demand for hydrogen infrastructure will be highest, but also how current EU rules risk leading to large losses in some countries.

“EU law is based on distance, but traffic volumes differ in other ways between countries. According to our model, capacity in France needs to be seven times higher in 2050 than what the EU requires by 2030. Consequently, the rollout under AFIR works as a first step on the way, but will need to be supplemented,” says Joel Löfving, doctoral student at the Department of Mechanics and Maritime Sciences at Chalmers.

However, countries such as Bulgaria, Romania and Greece do not have the same traffic flows and they are being forced to build infrastructure that is unlikely to be used to the same extent. This may amount to tens of millions of euros a year in investment and operating costs for unused capacity.

Accurate simulation reflects demand

In addition to taking into account traffic volumes and distances, the Chalmers study includes topographical data from the European Space Agency. One important insight is that geographical terrain plays a greater role in energy demand than was previously assumed.

“Many models use an average energy demand per kilometre for trucks. But the demand profile changes markedly when parameters such as gradient and speed are included. This gives you a more accurate basis for where the infrastructure may actually be needed,” says Joel Löfving.

The study focused on long-haul traffic, i.e. distances of more than 360 kilometres, as shorter distances are likely to be covered by battery-powered goods vehicles in the future.

“We considered the direction of technology development for trucks. Much of the current research shows that batteries will be able to cover the shorter distances, while alternatives such as hydrogen may be needed as a supplement for long distances,” says Joel Löfving.

Political interest in demand-based rollout

The researchers’ model looks further than the 2030 requirements and analyses how investments in hydrogen infrastructure can be sustainable in the long term. The study has already been used to inform political discussions in both Sweden and the EU on how to plan the rollout of hydrogen infrastructure.

“At EU level, we have been able to provide feedback for the evaluation of AFIR that will take place in 2026, and my hope is to influence the development of the law in a way that takes into account each country’s specific circumstances. For Sweden, AFIR is a good start, but investing in expensive new technology is always risky. Because the study has a longer time frame, we have been able to contribute to the discussion on how to build an economically sustainable refuelling station network that will eventually make it easier to create a market for heavy hydrogen vehicles,” says Löfving.

Eurasia Review

Eurasia Review is an independent Journal that provides a venue for analysts and experts to disseminate content on a wide-range of subjects that are often overlooked or under-represented by Western dominated media.

 

Cities At The Climate Crossroads: Can Growth Be Sustainable?

 July 7, 2025 By Eurasia Review

Can cities continue to grow without destroying the planet? A new study from the Institute of Environmental Science and Technology at the Universitat Autònoma de Barcelona (ICTA-UAB), Spain, offers insight into this complex issue.

While there is no general answer to the question of whether sustainable urban growth is possible, as it depends on local physical conditions and development levels, what is clear is that continued urban growth is not desirable everywhere. More sustainability will require rigorous planning, effective governance, and a critical reassessment of dominant development narratives.

Although cities are key players in the fight against climate change, their economic, demographic, and spatial growth continues to generate severe environmental impacts that are difficult to control. Amid the rise of economic approaches such as green growth, degrowth, and post-growth, this new study warns of the lack of clear empirical evidence on their real effectiveness in urban contexts.

Published recently in Nature Cities, the research provides the first overview of the debate on economic growth and the environment in cities. To this end, it draws on empirical evidence from disciplines including urban economics, environmental governance, urban planning, and climate and sustainability science.

The article comparatively reviews three contemporary approaches to urban growth: green growth, which relies on technology and efficiency to reduce impacts; degrowth, which advocates reducing production and consumption to preserve ecosystems; and post-growth, which proposes deprioritizing GDP in favor of well-being and sustainability.

These approaches are analyzed across four dimensions of urban growth—economic, demographic, spatial, and environmental—considering both their impacts and political feasibility.

“The main contribution of the study is a comparative conceptual framework that helps understand how different forms of urban growth interact and what implications they have for the future of cities,” says Charlotte Liotta, researcher at ICTA-UAB and lead author of the study. Through this framework, researchers examined real-world examples of cities experimenting with alternative approaches, such as Barcelona’s superblocks and Amsterdam’s doughnut strategy.

No One-Size-Fits-All Solutions

The study does not advocate a single vision of growth but neutrally and evenly analyses the strengths and weaknesses of each approach. “One of the main conclusions is that empirical evidence on the decoupling of economic growth and environmental harm in cities remains limited, which calls for caution regarding the promises of green urban growth,” notes Jeroen van den Bergh, ICTA-UAB researcher and co-author of the study.

At the same time, the research questions certain degrowth proposals that advocate reducing the size of urban centres, arguing that large cities are not intrinsically unsustainable: their density and scale can offer real environmental benefits—such as improved public transport and more efficient housing—if properly planned.

Regarding population growth and urban expansion, the article warns of their environmental consequences if not strictly managed, including increased consumption and emissions, biodiversity loss, and soil sealing.

Against simplified views of urban development, the authors advocate for a more critical, integrated, and evidence-based perspective. The study does not aim to close the debate but rather to provide tools to better understand it—recognizing that sustainable solutions will always depend on the political, social, and environmental context of each city.

Peak Flows In India’s Ganges River Basin Plummeting

A river flowing through Mana - considered the last village in north India. A new study has indicated significant drops in water volume across India’s rivers. Copyright: Nithin Ajayan, Pexels.

 July 7, 2025

By Madhukara Putty

Peak water flows in parts of India’s largest river basin have been falling by over a sixth every decade, according to a study which highlighted a similar trend across the country, impacting on irrigation domestic water and hydropower in the world’s most populous nation.

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In the western and central Ganges River basin, peak outflows have declined by 17 per cent per decade, the study showed, which the researchers blamed on falling rainfall and drier soil.

“Our study provides updated insights into how flood behavior is changing across India — both in terms of intensity and timing,” said Sai Kiran Kuntla at the Indian Institute of Technology in Delhi, one of the study’s authors.

“Such findings help bridge the gap between scientific knowledge and actionable planning, particularly as climate change alters flood risks.”

The study analysed river discharge data from 173 gauging stations across major Indian river basins from 1970 to 2010. It found that about 74 per cent of the stations saw a significant decrease in peak flows. Researchers also noted shifts in the timing of these peaks across all basins.

Peak flow is a measure of water being carried by a river at its fullest. Understanding trends in peak flows can help estimate the flood risks and water availability in the region.

Urbanisation

The magnitude and timing of peak river flows are shaped by a combination of natural and human-made factors. Climate change can alter rainfall patterns and soil moisture, while seismic activity like earthquakes and landslides may reshape river courses. At the same time, human interventions — such as urbanisation, deforestation and the construction of large and small dams — can significantly modify a river’s flow.

“In many Indian basins, high-flow events, including moderate floods, are critical for replenishing reservoirs, especially during the monsoon season,” said Sharad Jain, a professor in the civil engineering department at the Indian Institute of Technology in Roorkee.

“These inflows are essential for meeting irrigation, domestic water supply, and hydropower needs.”

“A decline in … peak flows could therefore have implications, as it may reduce the volume of water captured during peak flow periods, especially in basins highly dependent on monsoonal runoff,” added Jain, who participated in the study.

In the Narmada basin, in central India, the decline is linked to dam construction during the same period. Meanwhile, in the drought-prone Deccan plateau in the southern part of the country, monsoon season peak flows dropped by eight per cent per decade and pre-monsoon peaks fell by a striking 31 per cent per decade.

“Peak outflows are a function of rainfall and soil moisture prior to rain,” explained Ashish Sharma, a professor of civil and environmental engineering at the University of New South Wales, Australia, who didn’t participate in the study.

“With temperatures on the rise, soil moisture is decreasing because of higher evaporation, and dry soil absorbs more water.”

Studies have shown a clear shift in the monsoon rainfall patterns in India, where several regions are currently witnessing flash floods.

“Instead of steady, moderate rainfall across the season, we now see longer dry spells broken by short, intense downpours”, said M K Roxy, climate scientist at the Indian Institute of Tropical Meteorology, Pune, who did not participate in the study.

“With unchecked urbanisation, even a short spell of rain turns into a flood”

The study also found that the timing of peak flows has shifted. In many basins, earlier rainfall is leading to earlier flood peaks. Such changes can have major consequences for reservoir operations, irrigation planning and early warning systems.

“Our results signal a hydrologic regime that is becoming more erratic,” said Manabendra Saharia, an associate professor of civil engineering at the Indian Institute of Technology in Delhi, and co-author of the study.

“Translating these insights into updated reservoir rules, urban drainage designs, and drought-relief plans is now urgent if we want India’s water infrastructure to stay one step ahead of a changing climate.”

This piece was produced by SciDev.Net’s Asia & Pacific desk.

Madhukara Putty writes for SciDev.Net.