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People queue for a HIV test after an outbreak of the virus was discovered in Battambang in 2014.
People queue for a HIV test after an outbreak of the virus was discovered in Battambang in 2014. Heng Chivoan

Ending AIDS in Cambodia

Thirty-five years have passed since the first official report identifying the disease that is now known as AIDS was published in the United States. In that time, 35 million people have died worldwide from AIDS-related illnesses, including an estimated 115,000 in Cambodia. Despite the toll that the virus has taken here, Cambodia has emerged as a leader in the global efforts to overcome the AIDS epidemic. Today, as the world marks World AIDS Day, we celebrate Cambodia’s success and look forward to the day when this country ends AIDS as a public health threat.

HIV – the virus that leads to AIDS – was slow to reach Cambodia, but after the first case was reported in 1991 the virus spread quickly, with an estimated 23,000 new infections in 1995 alone. Today, approximately 73,000 Cambodians are living with HIV.

Fortunately, the Cambodian government and civil society mobilised quickly to address this threat, showing bold leadership in mobilising key institutions, expertise, and resources to deliver quality services. Strong support of the international community, including the US government’s President’s Emergency Plan for AIDS Relief (PEPFAR) and the Joint United Nations Program on HIV/AIDS (UNAIDS), have added to the nation’s efforts to respond to HIV.

By 2015, Cambodia was able to reduce new infections to fewer than 1,000 per year – a decrease of 96 percent from its peak. Cambodia also has the highest antiretroviral treatment coverage of any country in Asia, and one of the highest in the world.

In 2013, Cambodia committed itself to achieving the global “90-90-90” targets by 2020 (that 90 percent of people living with HIV are diagnosed, that 90 percent of those diagnosed are on anti-retroviral treatment, and that 90 percent of those on treatment are virally suppressed).

Cambodia has pledged to go even further and reduce new HIV infections to fewer than 300 annually by 2025 and effectively end the AIDS epidemic as a public health threat, five years ahead of the global goal. If Cambodia achieves these targets – and the country is on track to do so – it would set an important precedent for the rest of the world.

Cambodia’s achievements in the HIV response have been founded in the timely adoption of international recommendations and best practices, as well as its innovations in delivering services to people in need. Reaching the ambitious national goals will require continued investments, and commitment to scale up what works, and to change course when alternative evidence-informed strategies would bring better results.

This week, Cambodia reached a new milestone by launching a policy to immediately treat everyone diagnosed with HIV with antiretroviral treatment, in line with the latest recommendations from the World Health Organization.

This is good for the sake of individuals, their loved ones and the country as it is a sound public health investment that will save lives and reduce future costs. By promptly and proactively treating everyone living with HIV, further transmission of the virus can be prevented, helping to eliminate new HIV infections. This is also an opportunity to encourage people at risk of HIV infection to get tested.

There is still much work to be done to meet these targets, however, particularly in the area of treatment. In the early years of the epidemic, an HIV diagnosis often led to an untimely death. Today, antiretroviral (ARV) therapy offers a person living with HIV a nearly normal lifespan if they are diagnosed and access ARV medicines promptly and adhere to their treatment and a healthy lifestyle.

At the end of 2015, 75 percent of people living with HIV in Cambodia were receiving ARVs. This is a huge accomplishment, but it means that there are still an estimated 15,000 Cambodians living with HIV who are not yet enrolled in treatment. We must work together to figure out why people are falling through the cracks and to ensure that everyone is able to receive treatment. Not only will this save the lives of these individuals, but it is also a critical step toward eliminating HIV transmission.

Experience shows that people will only consent to receiving HIV services if they are treated with dignity, feel safe and their human rights are respected. This is a particular problem for marginalised groups including entertainment workers, men who have sex with men, people who use drugs, people living with HIV, and transgender people, some of whom still face stigma, discrimination, arbitrary arrests and violence.

This inhibits their ability to both protect themselves from HIV and live full and productive lives once they are on anti-retroviral treatment. We encourage Cambodia to continue efforts to protect human rights, to ensure respect for all, to combat discrimination, and to enable legal and policy environments – without which stopping new HIV infections will remain an elusive dream.

Ensuring that everyone living with HIV is diagnosed, receives treatment, and is able to live a full and complete life free of stigma and discrimination is possible. It will not happen automatically or easily but the last 25 years have shown what is possible. Sustained leadership, commitment to implementing the right policies with focused investments, increasing national impact and a people-centred and human-right based approach can make it a reality within the next decade.

Cambodia is leading the world by example. Shaping a future free of the fear of AIDS depends on everyone‘s continuing commitmentBoth the US government, through PEPFAR, and UNAIDS are honoured to have collaborated with the Cambodian government, civil society organisations, communities and individuals impacted by HIV to achieve the amazing turn around in the Cambodia’s AIDS epidemic. We remain strongly committed, and will continue to invest our voices, our capacity, and our financial resources, to support Cambodia’s efforts to achieve its ambitious, yet achievable, goals.

William A Heidt is the US ambassador to Cambodia and Marie-Odile Emond is the UNAIDS country director.

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