AMID the welter of statistics and findings of three recent surveys on Cambodian's
sexual attitudes and behavior, one fact stands out - ignorance makes the AIDS virus
Myths about cool-skinned people not being infected and toothpaste killing the virus
continue to flourish, despite barrages of awareness programs.
While nationwide information campaigns have achieved high levels of awareness of
HIV/AIDS, health workers and educators say that much misunderstanding remains, resulting
in risky sexual behavior, particularly by men, and discrimination against people
living with AIDS.
"They are aware of HIV/AIDS but they do not know and fully understand it,"
says Va Sopheak, a researcher and trainer at the Cambodian Red Cross (CRC).
According to a survey of sexual attitudes, knowledge and behavior released Feb 28
by the CRC, with the assistance of the Australian Red Cross, over 40 percent of men
visit sex workers at least "sometimes" and as many of half of those do
not "always" use condoms.
Added to another finding from the survey, that over 95 percent of men report "never"
using condoms with their wives. The result is obvious.
"This is a bad situation. If they go to a sex worker without using a condom
and they get the (HIV) virus and then come back and sleep with their wife or lover
then she can get the virus," says Sopheak.
The CRC researcher ascribes the persistence of dangerous practices by Cambodian men
to widespread misconceptions about both HIV and AIDS and confusion about how the
virus is transmitted.
To illustrate the point Sopheak tells the story of a military commander, who asked
the researcher to accompany him to a massage parlor and assured him that he would
"I gave him two condoms to use and after he came out they were still in his
pocket, so I asked him why he didn't use them."
"He told me not to worry, the girl was very pretty with smooth, white skin.
He touched her skin and it was cool enough. The commander said that if their skin
is hot it means they're infected with the virus."
Sok Long, another CRC researcher, explains that the belief continues among Cambodians
that "healthy looking" people are not infected with the HIV virus, even
though most Cambodians are aware that AIDS is incurable.
"For HIV/AIDS it takes a very long time for the signs and symptoms to appear,
so it's very difficult to make people believe it," says Long.
Coupled with this is an almost fatalistic attitude among some older Cambodian men
who, after years of war and hardship during the 1980's, want to enjoy the pleasures
they missed when they were younger - or believe that having survived so much they
are invulnerable to a "small thing" like HIV/AIDS.
"They think if they get AIDS it will take about ten years for then to die. So
if they are forty it will be time to die at fifty anyway. So that's okay for them,"
Much of the misunderstanding about HIV/AIDS is an unfortunate result of public campaigns
in Cambodia to date which have successfully raised people's concerns about HIV/AIDS,
but not sufficiently enlightened them to change their behavior, say researchers and
Information campaigns produced images of people living with AIDS as "ghoulish
monsters" left a trail of "fear and misunderstanding" in their wake,
argues Save the Children Fund UK (SCF) director Joan Anderson. The organization released
a survey on young people's attitudes towards sex on Mar 8.
"People want to see a picture - what does AIDS look like?," explains Anderson,
adding that not only misconceptions but discrimination has become an unwanted outcome
of the national information campaigns.
The SCF survey found that close to 60 percent of the 1,006 young Cambodians interviewed
in Phnom Penh, Kratie and Battambang said that they would stop contact with someone
who was HIV positive or living with AIDS.
The CRC survey reported even more widespread negative attitudes, finding that three
out of four Cambodians would not care for family members who had AIDS at home for
fear they would be infected.
Educating young people about safe sex is a topic that must be handled carefully in
Cambodia, for fear of provoking a backlash from parents, according to Anderson.
The task is made more difficult by conservative attitudes to gender relations which
see many Cambodian wives playing subservient roles to their husbands.
According to Anderson, the SCF survey found that only a quarter of girls gave answers
to safe sex questions that would "really protect them".
"Probably the best way to protect yourself is not to get married," says
Anderson ironically, arguing that education programs must look at encouraging more
communication between Cambodian spouses about sex.
Both the CRC and SCF surveys found that while awareness of HIV/AIDS is high - albeit
inaccurate - knowledge of other sexually transmitted diseases remains poor, reflecting
the high-profile campaigns concerning the more recent disease.
Infection with a sexually-transmitted disease (STD) increases the risk of contracting
HIV between five and twenty times, according to the CRC's Va Sopheak. The CRC survey
found that 16 percent of respondents in Phnom Penh reported having an STD in within
the last year and a 12 percent rate in rural areas.
In the absence of knowledge of STDs, many Cambodian have adopted alarming solutions
to cure themselves, says Dr Ouk Vong Vathiny, the director of the Reproductive Health
Association Of Cambodia (RHAC), commenting on the results of United States Agency
for International Development funded survey conducted by RHAC and the National Aids
Men who contract STDs usually attempt to cure them with a hodgepodge of often inappropriate
antibiotics bought at a local pharmacy. This may alleviate the symptoms in the short
term, but not cure the disease, says Dr Vathiny.
When husbands pass the STD on to their wives the result is a vicious cycle of re-infection,
explains the RHAC director.
"The wife doesn't know she's got the STD and gives it back to him," says
Misuse of antibiotics to treat STDs has led to resistant strains. The RHAC survey
found that gonorrhea samples taken from respondents tested resistant to five out
of eight commonly used antibiotics.
Even more alarming was the fact that over 40 percent of sex workers are often compelled
to seek treatment inside the brothel. Dr Vathiny said sex workers, particularly in
Battambang were being told by brothel owners to douche with toothpaste "because
it can kill the germs."
Health workers and educators are now looking at other ways to get the message about
HIV/AIDS across, and change people's behavior.
"We need a more effective way of campaigning to make people believe this is
a serious disease," says the CRC's Sok Long."They've already heard the
message, but it's not enough to listen."