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Act now on 'time bomb'

The Editor,

I n the article "Grim AIDS forecast: 40,000 Dead", your reporter Huw

Watkin made reference to a study undertaken by the Cambodian AIDS Social Research

Project, for which I was the principal investigator. While I have no objection to

this study being cited, indeed the WHO when funding the study hoped that it would

be publicized, the report which you mention has yet to be released. It is undergoing

peer review by other researchers in the field, and while it has received favorable

reviews I have not made the report available to anyone.

What I did write in a paper given at the First International Conference on Khmer

Studies at the University of Phnom Penh (the conference was actually poorly covered

by your paper) in August this year, was the 30.5 per cent of young females interviewed

for this two year study and 80 per cent of males (not 90 per cent as your paper mentions)

placed themselves potentially at risk by their refusal, reluctance or inability to

practice safer forms of sexual activity. I went on to add that if this could be extrapolated

and applied to all young females and males in the age group 14 years to 26 years,

based on the Socioeconomic Survey of Cambodia, 1993/94, then more than 380,000 young

females and more than 870,000 young males would have exposed themselves to risk-related

forms of sexual activity.

However, I also argued, that this study was "not a quantitative study and it

would be well near impossible to extrapolate from this study and quantify the incidence

of risk-related sexual behavior among young people. Such an exercise, I argued, apart

from being methodologically unsound, makes little or no sense. I went on to argue

that clearly not every risk-related sexual behavior will ipso facto lead to young

people becoming HIV positive, acquiring other STDs, or in the case of young females,

becoming pregnant. This study only illustrates the quantitative dimensions among

the 281 young people who agreed to share their experiences with the study's young

researchers. What is more important, I argued, are the social and cultural contexts

of this risk-related behavior.

The report, which I hope to release in the next few months will look in considerable

detail at the varied social and cultural contexts of such behavior. I must admit

that when the young researchers were collecting this data I was very surprised. Being

a Cambodian woman brought up in the late 1960s and early 1970s, I did not think that

some of the things I was hearing were at all possible. Clearly Cambodian society

has changed more for young people than a person like myself was capable of grasping

at the outset of this study, or perhaps I lived a too sheltered life as a young woman.

But the study on which this report is based was never designed as a survey as your

reporter explicitly states. Rather the study was funded by the WHO in 1994 after

it was realized that large-scale population surveys on sexual behavior could offer

few insights into the personal and social contexts in which sexual activity takes

place. It was not that such surveys were not of use, they were in the context of

providing useful information regarding awareness of, and knowledge about HIV/AIDS,

beliefs regarding routes of transmission, attitudes towards people with HIV/AIDS

and sexual behavior patterns. What these surveys could not do was provide a more

nuanced understanding of sexual behavior, including the occurrence of risk-related

practices.

As this study will reveal, AIDs intervention strategies in Cambodia cannot simply

focus on female sex workers and their clients, but also on young females who for

reasons other than monetary factors have sex prior to marriage or young males who

find it sexually more exciting to have sex with other males than with females, to

give but two different contexts.

While I applaud the attempts by your paper to highlight the potential AIDS "time

bomb" that awaits all of us Cambodians, it would be helpful if your reporters

could understand the difference between this study and the large scale population

surveys on sexual behavior that have been undertaken in other societies. Dr Hor Bun

Leng of the National AIDS Program is correct when he argues that Cambodia needs to

act now.

Finally, I would like to add that as the National AIDS Program has little funding

for its programs, the Cambodian AIDS Social Research Project does not have the funding

to rewrite this study in Khmer so that it can be read and properly understood by

local Cambodians. Hopefully funding for this will materialize in the not too distant

future.

- Dr Chou Meng Tarr, Principal Investigator, Cambodian AIDS Social Research

Project.

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