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Logo of Phnom Penh Post newspaper Phnom Penh Post - AIDS scythes through faithful wives

AIDS scythes through faithful wives

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When 30-year-old Srey Neang first tested positive for HIV in 2004 her immediate

impulse was to kill herself.

Say Sreymao, 24, and her son have moved from Pursat to Phnom Penh to be nearer health services. Her husband, who she said had a taste for massage parlors, developed HIV a few years ago. Now he is dead - and she fears she will be next.

"I didn't want to live because one of my

brothers already had it and I was scared," she told the Post. "My friend - who

was very healthy and big - found out she had HIV/AIDS and took poisonous

medicine that made her die. She left a three-year-old child."

Divorced

from her husband, a policeman, Neang said it was her young son who gave her the

strength to continue.

Today Neang, who lives in Phnom Penh, does not

know how she caught the disease. She was a faithful wife, but did not keep tabs

on her husband's extra-marital affairs.

"I don't know for sure whether my

husband went out for sex or not, because he is a policeman and worked from

morning until late at night," she said.

Soon after she was diagnosed,

Neang stopped working as a hairdresser, an essential part of her family's

income.

"I stopped working because I got sick, but also because I was

afraid of infecting other people," she said.

Now she stays home and works

in her mother's street-side sugar-cane juicing business. She generally earns

less than 7,000 riel a day.

"It is not enough for my family," she

said.

Neang resents not having had the power or knowledge to protect

herself from HIV. For her son's sake, she hopes she lives "a very long time" -

but the statistics on the fatal virus are against her.

Say Sreymao, 24,

was diagnosed with HIV in late 2003, while pregnant with her son. "I never got

information about HIV because I lived in the provinces," she said.

A

month ago, Sreymao and her son, who is clear of the disease, moved from Pursat

province to Phnom Penh to live with her elder sister and be closer to health

services. A health check later this month will reveal just how far the disease

has progressed. "But I have a fever so I know it is serious," she

said.

Her husband, who she said had a taste for massage parlors,

developed HIV a few years ago. Now he is dead - and she fears she will be next.

According to the Ministry of Health, Cambodia has the highest HIV

prevalence in Asia. Currently, 1.9 percent of adults aged between 15 and 49

carry the disease, down from 3 percent in 1997.

But in a frightening new

trend, monogamous married women like Srey Neang and Say Sreymao have emerged as

one of the groups most at risk of HIV infection in Cambodia. They represent 40

percent of new HIV infections in the country, said UNAIDS Cambodia coordinator

Tony Lisle.

"Much attention has been paid to drug users and sex workers

and that's appropriate," Lisle said. "But the trend of sexual networking is

changing... to be a married women is now to be at risk for HIV/AIDS.

"And

with an increase in infection among women, we're also seeing a higher rate of

transmission from mothers to children."

Lisle estimated that, based on

2003 figures, around 57,000 women are living with HIV/AIDS in

Cambodia.

Gender-based inequities

The

Director-General for Social Development at the Ministry of Women's Affairs, Chou

Bun Eng, maintains that women are physiologically more vulnerable to infection,

and gender-based inequities compound their risks. Research shows they are more

likely to be poor and powerless in their relationships and have less education,

and access to social services, then men.

Married women are largely closed

off from prevention programs, which has frustrated attempts to reduce infection

rates.

"We did not have any specific programs for women in households

because for a long time the focus was on high risk groups, like sex workers,"

Bun Eng said. They have traditionally been slotted into larger, community-based

campaigns, she said.

The social isolation of married women has also been

an impediment for treatment programs, especially for those in the rural areas.

Many live far from health centers, and lack the transport and opportunities to

be away from their family.

"If they escape an appointment once or twice,

their [antiretroviral] treatment is over because they need to go regularly for

it to work," Bun Eng said.

Cambodian Red Cross HIV/AIDS program director

Va Sopheak said poor economic conditions force many rural men to seek work in

the city, which increases their risk of frequenting brothels and having multiple

sex partners.

"Mobile groups like the police act as a bridge, moving

HIV/AIDS from high-risk groups like sex workers to married women and children,"

Sopheak said.

He said this produces a more generalized epidemic, which

the organization has sought to address with its programs for policemen in

Kampong Cham, Prey Veng and Svay Rieng provinces.

And while 2005

research from the National Center for HIV/AIDS (NCHADS) suggests Cambodian men

are patronizing fewer brothel-based sex workers - where reported condom use is

above 90 percent - it has also found that sex-seeking behavior is

changing.

"Clients are now going to beer gardens, massage parlors and

guest houses where targeted interventions don't work," Lisle said. "There is an

increase in risk behavior and therefore an increase in the vulnerability of

their partner."

According to UNAIDS, more than 16,091 indirect sex

workers were operating in 2004, up from 7,400 in 2000.

The deputy

director for the National Centre for HIV/AIDS, Ly Pemhsun, says the government's

closure of many hard-line brothels was necessary because of their links to

illegal activities like trafficking.

"But I think every closure makes

sex workers harder to reach with education programs because they go underground.

They no longer have a stable base," he said.

These "closed environments"

make it very difficult to target indirect female sex workers, who may not

identify themselves as prostitutes, but who negotiate sex as part of their

hospitality services, he said.

According to the Reproductive Health

Association of Cambodia, which counsels women on the sex trade's dangers,

indirect sex workers are better paid and can be more discerning about their

sexual partners, but are less likely to ask partners to use condoms.

"In

a brothel, we know that condoms are now available and will be used. But with

this other type of sex work, we don't have a target or captive audience," Lisle

said.

Only about one percent of married couples use condoms, according to

a study by the UN Development Fund for Women and the Ministry of Women's

Affairs. Condom use is low because people do not perceive risk in those

circumstances, Lisle said. But the power dynamics in Cambodian relationships,

which are heavily tilted towards men, may also explain low condom

usage.

"Clearly, the issue of condom use in marriage is very difficult

and remains a point of conflict. Surveys say it is difficult because it breaks

down trust and encourages suspicion," he said. "In rural areas, women feel very

responsible if they contract HIV/AIDS. The implications for disclosing their

status to their partner or husband are serious: it could be a point for domestic

violence, even if they have received it from their husband."

Paally Hor,

executive director of the Cambodian Women's Development Agency's domestic

violence project, agrees. Women's economic dependence on their husbands prevents

them refusing unwanted sex or negotiating safe sex.

"In Khmer culture,

women are scared to negotiate with their husbands on condom use because most

women are dependent on their husband economically," Hor said. "She goes to the

medical doctor, but is too scared to inform her husband to go also. A woman is

not meant to negotiate with her husband, but she is the one taking the

risk."

Empowerment issues

Such cultural attitudes prompted officials

at "The Women's Face of AIDS" conference, which was held in Phnom Penh from

March 14 until 18, and attended by representatives from Cambodia, Laos, Myanmar,

Vietnam and China, to call for women to be given greater importance in society.

If they feel valued, women will feel more comfortable negotiating with their

husbands and protecting themselves and their children from infection, Bun Eng

said.

"But protecting yourself by using a condom is not enough," she

said. "In the workshop, we found that condom use is one option, but men must

also be faithful and respectful and think about their family's safety."

Lisle believes one solution is to target males early and, through a

range of interpersonal relationships, get them to question their

behavior.

"More work needs to be done on changing male conceptions of

responsibility and masculinity," he said. "There needs to be more health

services and forums for young males to talk about HIV/AIDS well before they are

married."

Taboos surrounding speaking about sex and using condoms need to

be overcome to create a culture of dialogue between couples, he

said.

"Whether people get couple-counselling is terribly important. To

build a tradition of social work and couple counselling is helpful so people

feel free to talk about HIV/ AIDS more frankly."

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