Underground gays, drugs before sex in brothels, and doctors lacking knowledge about

using antiretrovirals are emerging as new challenges in the battle to control the

spread of HIV/AIDS in Cambodia.

Dr Ma Suon Sopheak, home-based-care team leader in Koh Kong province, who exhibited

his program at the 15th International AIDS Conference in Bangkok, said Cambodian

local doctors lack knowledge about using anti-retrovirals for treatment.

"I think we came here to share experiences and to learn new strategies against

HIV/AIDS," said Sopheak. "There are many things we don't know."

Tun Samphy, from the Urban Sector Group, who manages the sex worker education program

for AIDS reduction, presented her exhibition about gays/MSM (Men who have Sex with

Men) which she said were the new risk group for Cambodia. Because they were in hiding,

this group would continue the epidemic of HIV/AIDS.

She estimated that in Phnom Penh there were about 200 gays, both men and women, providing

sex services.

Seng Chantha, program manager of Men's Health Cambodia (MHC) said MSM were just the

starting point of the problem in Cambodia and would become a high risk group if they

were not exposed to education about HIV/AIDS.

"I think these gays have not received awareness about the epidemic because they

are in hiding," said Chantha.

Heng Bunthak, program coordinator of Khmer Women's Cooperation for Development (KWCD)

said Cambodia was experiencing widespread drug use such as yama (methamphetamine,

or speed) which is being used in conjunction with sex in the brothels and guest houses,

and was a probable major cause of not using a condom.

"I think five out of 10 prostitutes are using yama and it is high risk for epidemic

diseases because people on drugs are less likely to use protection," said Bunthak.

He said it was estimated that as many as 30 to 60 percent of brothel women might

be using methamphetamine and were often forced to by brothel owners, powerful clients

and youth gangs.

He said the sex workers could make more money than usual if they encouraged their

clients to have drugs before sex. "Normally they pay the prostitute 5,000 riel

per time, but if they have drugs with the client, the client pays more and the prostitute

gets paid more."

Cambodia has the highest HIV/AIDS prevalence in Southeast Asia, with one third of

new infections as result of mother-to-child transmission.

Carol Bellamy, the United Nations Children's Fund executive director, has warned

that the number of children orphaned by AIDS will increase unless steps are taken

to stop the HIV/AIDS epidemic.

Mean Chhi Vun, director of the National Center for HIV/AIDS said the Cambodian government

plans to provide antiretroviral treatment (ART) to 6,000 of the estimated 157,000

people living with HIV/AIDS by the end of 2004, rising to 20,000 in 2009. The Ministry

of Health had allocated $36.5 million for the consumer care program and $22 million

to buy antiretrovirals. The Global Fund to fight AIDS, Malaria and TB would sustain

the program until 2010.

"But first we have to strengthen the health system through sub-health centers

in each province," said Vun. "We need to support them [HIV/AIDS patients]

for at least 10 to 20 years."

Some locals involved in the consumer care program were still lacking proper skills

on antiretrovirals, therefore more training on using the appropriate drugs was needed.

Tia Phalla, Secretary General at the National Aids Authority (NAA) said more than

3,000 or about 15 percent of people living with HIV/AIDS had received free ART drugs

in Takeo, Kampong Cham, Phnom Penh, Siem Reap, Battambang, and Svay Rieng provinces.

He said patients from Banteay Meanchey could access the ART from Siem Reap or Battambang.

However, Neang Sarin, 38, who has been living with HIV/AIDS for three years in Banteay

Meanchey, said he had not received any ART. "My disease now is much more serious;

I cannot do heavy work." His wife and two children are also infected with the

virus.

He said people with some money could go to Siem Reap, 170 km from Banteay Meanchey,

to get the ART, but the poor could not go because they had no money to pay for travel

and at least one week's stay.