HIV/AIDS in Cambodia re-visited

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It is a rare privilege for me to re-engage with HIV/AIDS work in Cambodia after 10 years and see progress that was a decade ago quite frankly unimaginable.

In Turning the Tide, a retrospective study of Cambodia’s national HIV/AIDS response published by UNAIDS in 2006, I came across a reference to an article of Andrew’s . Entitled ‘AIDS could be Cambodia’s next Pol Pot’, it captured how frightening the scenario was in 1997-98, when 30-40% of sex workers in some areas were testing positive for HIV, public health infrastructure was almost non-existent, the civil war was still raging, and agencies were struggling to get the HIV prevention message through to a largely illiterate population more concerned with short-term survival than a sexually tranmissible disease that might kill them in 5-10 years.

In fact, HIV adult prevalence in Cambodia peaked at 3% in 1998 and has since declined, reaching an estimated 0.9% by end-2007. This is an amazing achievement for any country, least of all one of the poorest in the world.

The most significant change, and Cambodia’s greatest achievement, is undoubtedly access to anti-retroviral therapy (ART). Despite extraordinary odds, something like 80% of people who need ART are receiving it.

In the course of my recent consultancy work, I met with a rural development worker who said that 10 years ago, people diagnosed with HIV ‘fell into depression, stopped eating and died quickly’. Now people have hope and live much longer.

But this brings a new set of challenges. Poverty is both a contributing factor to and a consequence of HIV infection. Many people living with HIV had jobs in residual markets like garbage collecting and manual labour before they became infected — jobs they can’t return to without jeopardising their health. They want to provide for their children to attend school so they have a chance of breaking out of the family’s poverty cycle. Yet although they have access to life-saving drugs, they often don’t have enough food to eat, let alone the means to earn a living.

There’s also the challenge of ‘positive prevention’: ensuring that living longer with HIV doesn’t result in the infection being passed on further, whilst respecting people’s rights to lead a full life.

Working as I was for two Catholic NGOs meant I met a number of ‘faith-based organisations’ in Cambodia, who started out with a mission to help destitute people with AIDS die with dignity and now find themselves rising to the challenge of caring for HIV-positive children-cum-teenagers, with all the normal teen issues, plus their HIV-status and experiences of grief and loss to deal with. These children (rightfully) envisage a future involving partnerships and possibly children of their own.

On May Day I visited several programs supported by the Maryknoll order in the outer suburbs of Phnom Penh: Little Folks (for HIV-affected children), Little Sprouts (for HIV-infected children) and a hospice that is part of the Seedlings of Hope program.

The Little Folks showered my colleague and I with gifts of stars they had decorated in their art class. The Little Sprouts competed for cuddles and treated us as if we were celebrities. And the Seedlings of Hope hospice was aptly named: a place of hope in the face of overwhelming odds.

Our host Fr Jim said he’d seen people come into the hospice with CD4 cell counts of between 10 and 50, yet still make a recovery (Cambodia’s protocols recommend starting ART when CD4 counts are at 200-250; the international standard is 350). We met a man who looked too thin to be alive and yet Jim said the smile on his face denoted real progress. There are people employed as carers at the hospice who were once patients themselves. Everyone, whatever their condition, is treated with respect and love.

Similarly, I was struck by how well cared for the Little Sprouts were in their group homes. Not all of them looked well. But they were clean, clothed, bright and engaging – no sign of the neglect I’ve seen in children on the streets and riverbank here.

In light of a current on-line debate amongst expatriate parents regarding the banning of a HIV-positive child from a foreign-run school here, it was heartening to see that one of the carers had her (HIV-negative) one-year-old living among the 15 or so kids with HIV aged 2-12 in her care.

The consensus is that Cambodia’s gains in terms of responding to HIV are tremendous but fragile. Major challenges remain. These days most new infections are in married women whose only ‘risk behaviour’ is to have unprotected sex with their husbands, and through them to their babies. And although ARV prophylaxis dramatically reduces the chances of HIV transmission to the newborn, only a woefully small percentage of HIV-positive pregnant women have access. Most have no formal antenatal care at all.

And in a timely reminder that access to ART is not the best-case scenario, I spoke with a man called Sopheak who, when asked about the main concerns for PLHIV in his area replied, ‘Our first need is to find a cure.’

That, and to prevent new infections.

Next up I hope to work for my old friends at Cambodian Red Cross, whose HIV/AIDS program I helped to establish all those years ago. It feels like I’ve come full circle.

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One Response to “HIV/AIDS in Cambodia re-visited”

  1. khim Says:

    Angela,

    Keep up the good work !

    khim

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