The Ministry of Health has warned pharmacies and private clinics not to sell antiretrovirals (ARVs) – medication distributed free by the government to thousands of patients to slow the progression of HIV – after the meds were recently available for purchase at pharmacies.

Officials don’t know how the pharmacies got the medication, said Dr Ly Penh Sun, director of the National Center for HIV/AIDS, Dermatology and STDs, noting that it could have been resold by patients or come from the Central Medical Stores (CMS) – a warehouse where the Health Ministry stores the medication.

“It’s not known how it got to the pharmacies,” he said. “We are not sure that it’s from the Central Medical Stores. We don’t have to speculate before the investigation.”

The CMS and the department of drugs and food were doing an inventory, Penh Sun said. He said he didn’t know whether any medication was missing.

The CMS imports the drugs, which are then distributed to provincial health departments and then to local hospitals, where patients come to get a refill every two months, he added. There are 57,000 patients on treatment.

“The drugs can be coming even from the patients,” Penh Sun said. “It is possible that they resell it.”

A warning letter was issued on June 13 to pharmacies and private clinics banning the selling and buying of the medication. In the letter, the ministry vowed to take strict legal action against those who don’t follow the directive.

CMS manager Thorn Thaily insisted yesterday that there was no problem at the warehouse.

“At my place, there is a software system to even manage the people,” he said, declining to comment on whether he had conducted an inventory after the issue was discovered and whether any medication was missing.

A spokesman for the Global Fund, which supports programs in Cambodia that include ARVs, said yesterday that if the medication did come directly from state-run warehouses, they would be “extremely concerned”.

During the last three-year allocation, Cambodia received $35 million for an HIV grant for the period between October 2015 and December 2017, said spokesman Seth Faison.

“The Global Fund has zero tolerance for corruption, and could discontinue funding at any time if grants are abused,” he said. “Any confirmed cases of misuse of Global Fund grants will be reported and addressed.”

However, if the drugs are coming from patients reselling their medication, it can lead to a failure in treatment, NCHADS’ Penh Sun said.

It’s also unsafe for patients who might be buying the medication from the pharmacies, said Dr Laurent Ferrandini of WHO Cambodia. In the long term it can lead to resistance to the drugs.

“It needs to be prescribed by a doctor for the right dosage,” Ferrandini said. “It’s extremely important.”