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(i)
Introduction
HIV
was first detected in Cambodia in 1991 and the first cases of AIDS were
diagnosed in 1993. Despite the recent decline in national HIV infection
rates, Cambodia’s national HIV infection rates remain the highest in
Asia.
Concerted
efforts in behavioral intervention among high-risk and bridging
populations, improved Sexually Transmitted Infection (STI) case
management, and national condom social marketing have contributed to the
decline of both HIV and other STIs in the country. The year 2000 was the
second year where surveillance records showed a decline in HIV prevalence
across all key high-risk groups, with estimated national prevalence at
2.8% for the general population, and 31% among direct commercial sex
workers (HSS 2000, NCHADS).
However,
the epidemic has reached the general population. The 2000 national HIV
sentinel surveillance estimates:
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169,000 Cambodian aged 15-49 years are infected with HIV. Many HIV
positive persons are unaware of their HIV status;
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The ratio of male to female infection is estimated at 1.5: 1. The
gap is now narrowing as more women become infected. Without strong
interventions in the prevention of parent to child transmission, new
infections among infants in Cambodia will continue to increase.
The
country has seen a considerable number of deaths in the past few years and
symptomatic AIDS cases are rising sharply, while the country’s health
systems need much strengthening. Increasing numbers of children are being
orphaned by AIDS. UNAIDS estimated that at the end of 1999, 13,000 Cambodian
children had become orphans due to AIDS.
Although
Cambodia has achieved some success in HIV prevention efforts reducing risk
behaviors, vigorous efforts, including continued funding assistance and
scaling-up of existing intervention programs nationwide, are needed to
sustain and accelerate the decline in HIV infections.
(ii)
Key Issues
The
government has responded to the HIV/AIDS epidemic with the establishment
of National AIDS program, the creation of important structures at national
and provincial levels, the adoption of a multi-sectoral approach, and the
promulgation of laws and policies related to HIV/AIDS. Many local,
national and international NGOs are engaged in HIV/AIDS world and these
are coordinated through the HIV/AIDS Coordinating Committee since 1993.
There is close cooperation between government and non-government
responses. Nonetheless, issues and priorities for 2002 include:
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Weak/poor implementation of law and policy — Laws relating
to sex work and trafficking exist but are not very effective. Current
efforts to improve the legal framework need to be supported, and
implementation improved. In particular, the legal status of sex workers is
unclear, leaving them vulnerable to exploitation and trafficking, and at
greater risk of contracting HIV. Some efforts to suppress the sex industry
drive sex work underground, further from the education and services that
reduce the spread of HIV. Many minors are victims of debt-bonded
prostitution and trafficking, and are particularly vulnerable to
contracting HIV
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Responding to increasing demand for care, treatment and support
for People Living with HIV/AIDS (PLHA) and families.
HIV positive people are in need of knowledge about self-care and
services in prevention and treatment of opportunistic diseases that
develop as their immune systems weaken. Medical services need to be
strengthened and made accessible at provincial and district levels and in
the Communities for patients too weak to travel. Psychosocial and economic
support are critical as many Cambodian families with chronic illnesses
have depleted their resources and assets in order to find a cure or to
take care of their loved ones. A number of local and international NGOs
have worked closely with the government in responding to the situation but
significantly greater efforts and resources are needed.
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Increase understanding, reducing stigma and discrimination -
despite past education and information campaigns, misconceptions about
HIV/AIDS persist among government health personnel and many Cambodians at
large. Reform and improvements to existing health care services continue,
but the number of PLHA able to access medical services remains a key
issue. In particular, the UN Charter on Rights of PLHA though adopted, is
yet to be fully implemented.
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Attention and resources for orphans and vulnerable children
including those affected by AIDS. Reducing stigma and segregation of
children orphaned due to AIDS in school and Communities continues to be a
challenge. This has been carried out successfully in some communities with
strong partnerships involving government, NGOs and religious sectors.
Again scaling up efforts, improving the quality of care, and reaching more
children with services remain the key issues.
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Involvement and roles of PLHA in policy and planning — After a
period of formation of local PLHA groups, a national network of PLHA has
been formed - the Cambodian Network of PLHA (CNP+). The network is young,
and requires much support and capacity building in order to have an active
role in voicing the needs of PLHA, influencing policies, and having a
stronger role in peer support. The network is looking into expanding to
the provinces.
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Developing a multi-sectoral response- Multisectoral
activities can be both sectoral and intersectoral. The sectoral
activities consist of those undertaken within each sector to address HIV/AIDS
issues relevant to that sector. For example the education sector can
include life skills and HIV/AIDS education into school curricula,
exemption of fees for orphans, promote integration and encourage peer
support among children. The initiative has started but needs much further
development.
(iii)
Recommendations
Progress
is being made on key aspects of HIV/AIDS programming. However, given the
continued spread of the virus and increasing numbers of people affected by
HIV/AIDS, NGOs impress upon the RGC and donors, the continuing and urgent
need for expanding and upgrading HIV/AIDS interventions. When formulating
and undertaking programs in the future, consideration should include the
need:
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For scaling up prevention and care responses that address the needs
of the most vulnerable populations including sex workers, other high-risk
populations, PLHA, and women and children affected by HIV/AIDS
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For
strengthening the government health care services to provide HIV/AIDS care
with improved accessibility for vulnerable and poor people
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For scaling up responses that extend coverage in rural areas
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For increased involvement of PLHA in advocacy, policy formulation
and programming
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For building on lessons learned about mobilizing community
responses to HIV/AIDS
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For intensive education and information campaigns to reduce stigma
and discrimination
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To continue the balance and integration of HIV/AIDS care services
with other chronic diseases, given the limited resources available for
health and the need to place the HIV/AIDS work in the overall context of
efforts to promote access and quality of health care for the poor
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To
continue to focus on effective monitoring systems to ensure that resources
are used efficiently and effectively to reduce the spread of HIV/AIDS and
mitigate the impact of the epidemic.
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