A World Health Organization (WHO) specialist visited Phnom Penh recently to lay the
groundwork for a comprehensive national plan for the control and prevention of both
AIDS and sexually transmitted diseases (STDs).
Dr. Rabin M Sadra said WHO, the Ministry of Health and various concerned agencies
were in the process of drawing up the three to five year plan which will follow on
from the short term plan implemented in 1991.
"We have assessed the needs for HIV prevention and control but we need to also
evaluate the resources available to us-the various non-governmental agencies-in order
to minimize duplication and maximize efforts in priority areas," Sadra said.
Commercial sex workers and the care and management of sexually transmitted diseases
were seen as the key issues of concern, he stated.
"We want to provide commercial sex workers with better education and information
so they can negotiate safer sex practices with clients. We also want to help provide
them with general health services as well," Sadra said.
The cause of concern with STDs, the doctor noted, was an alarmingly low level of
awareness compounded by insufficient health services.
Knowing about STDs and taking protective measures was seen as crucial because this
also granted protection from the AIDS virus. "If you are able to control STDs
you are able to control HIV," Sadra said.
Condoms therefore are of vital importance. In a survey conducted by WHO in late 1991,
a general population sample of 417 people was questioned on their basic knowledge
of AIDS, STDs and condoms.
Seventy percent said they had heard of condoms. Sixty-one percent said they knew
of the use of condoms as a means of protection against STDs. But only 25 percent
said they were aware that condoms could also help prevent AIDS transmission. However,
despite all this, condoms were rarely used.
In response to the question why the interviewee did not use condoms, 33 percent stated
they diminish pleasure and another 36 percent answered they didn't know why.
One question ignored by the survey was whether people could afford to use condoms.
Sadra, however, recognized this as an important factor but he saw it as tangential
to a greater problem. "Condom promotion is a big thing. But availability alone
is not enough. What we really have to do is make them attractive," he said.
Another particular cause of concern for Cambodia was the country's proximity to Thailand,
which has one of the biggest and fastest growing AIDS problems outside of Africa.
If efforts are not made now to combat the spread of AIDS, Cambodia in 10 years will
be facing a problem on the same scale that Thailand is facing today, Sadra stated.
"It's early in the game for Cambodia. It's not a very big country and although
the infrastructure has been terribly disrupted, there should be improvements in a
short time. I'm quite optimistic that HIV can be minimized and the trends that have
happened in other countries can be reversed here," the doctor said.
The Ministry of Health has been very co-operative in assisting in AIDS awareness
programs which have involved the briefing of community and political leaders and
the devising of educational materials for both schools and the general public.
These programs, which commenced in 1991, are currently continuing and will be expanded
as more interested agencies come on board, Sadra said.
Despite the efforts so far, there was still a pressing need to raise awareness, the
WHO doctor stated.
He pointed to the results of the 1991 survey that showed poor knowledge of how one
Eighty percent of the interviewees had heard of the killer disease and 77 knew
that it was transmitted by sexual activity, yet when asked 'who can get AIDS?' Only
18 percent gave what was perceived as the correct answer - 'anyone can'.
The doctor said the best ways to prevent AIDS, bar celibacy, were strict one partner
fidelity, use of clean hypodermic needles and avoiding blood transfusions in the
provinces where blood screening is not yet being conducted.
Sixty nine percent of the interviewees knew about the dangers of sharing needles
but large percentages believed the disease could also be contracted by touching (40),
sharing food (36) or toilets (28) with infected people and by being bitten by mosquitoes
(24). These figures highlighted the need for further education.
In 1992, 91 people were identified as HIV positive and three others in 1991 when
testing started, according to WHO figures. As no figures have been made available
for 1993, the total stands at 94. WHO recently conducted small surveys amongst sex
workers. In one survey HIV prevalence was 9.6 percent. In another conducted with
people infected with STDs it was roughly 4 percent.
"These are not representative of these groups or of the general population.
They are only indicators that there is something going on, the magnitude of which
we don't know," the WHO doctor hastened to point out.
Contrary to the speculation of a number of people, Sadra stated that the United Nations'
personnel were not responsible for bringing AIDS to Cambodia.
"AIDS was here before UNTAC. It's similar to Thailand where a lot of Thais blame
foreigners for the problem," he said.
WHO conducted a survey several years ago in the Thai northern city of Chiang Mai.
The survey showed that the HIV rate amongst prostitutes working in brothels charging
between one and two U.S. dollars with an almost exclusively local clientele was roughly
three times higher than their counterparts catering primarily for tourists and charging
U.S. $20 and upwards.
The Ministry of Health is aware of the scale of the problem they are facing.
"They are providing space for an AIDS unit staffed by four Khmer professionals
and two expatriate technical advisors," the doctor said.
He went on to say that they are "concerned to the point that they are criticized
for ignoring greater present dangers."
Some critics argue that, given the relatively low incidence of HIV infection, the
ministry should be more concerned with preventable or treatable diseases that still
claim the lives of Cambodians everyday.
Sadra, however, feels that this criticism is shortsighted. "The difference with
AIDS is that if you don't do anything now, you are looking at a decimation of your
economically productive work-force in 10 to 15 years time. So it's not just a health
problem, although that's a major component, but a social, economic and political
one," he said.
"Plus in the early stage you are in a position to prevent an epidemic,"
Dr. Sadra added.