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HIV conference reveals successes, and rising worries

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Infection rates are down, but increasing high-risk behaviour and a drop in condom use by sex workers raise concerns 

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Cambodian actress Im Chanratha plays "Thida" in KMF's award-winning Aids awareness drama Facing the Truth. Officials have warned of a ressurgence in Aids in the Kingdom.

IF last week's Third National Aids Conference in Phnom Penh had presented authorities with a report card on how well they have responded to the disease, it might have read "Good, but must do better".

Delegates at the three-day conference reported satisfaction at falling infection rates and increasing access to treatment, but cautioned of a possible resurgence of HIV/Aids in the Kingdom.

Tony Lisle, UNAIDS Cambodia country coordinator, said the conference was useful in allowing authorities to reassess where they should use their resources.

"It focused around prevention ... and that the dynamic of the epidemic is changing," Lisle said.

Lisle told conference delegates, including Deputy Prime Minister Sok An, that with adult prevalence declining from a high of two percent in 1998 to 0.9 percent in 2006, Cambodia has achieved its Millennium Development Goal for Aids.

"This is no small achievement - a combination of many factors, not the least [being] exemplary leadership, compassion and a national response that has courageously done the right thing, the right way."

But Lisle noted that prevention strategies have not accounted for the disease's changing trends, including the emergence of groups engaging in double- and triple-risk behaviours, such as prostitution and intravenous drug use.

"HIV prevention coverage for all these populations remains unacceptably low," Lisle said.

The conference also addressed the decline in condom use among sex workers.

The percentage of prostitutes who consistently used condoms fell from 96 percent in 2003 to 94 percent in 2007, according to Cambodia's National Aids Authority, and some are concerned that new efforts to enforce human trafficking laws could lower condom use further.

Dr Teng Kunthy, National Aids Authority secretary general, likened the new law to an aspirin intended to cure a headache, but that upset the stomach in the process. He said he strongly supported the purpose of the legislation but believed its implementation needed to be amended.

Greater clarification on how anti-trafficking laws could be enforced without jeopardising condom use by sex workers is expected later this month, Teng Kunthy said.

Conference organisers faced some criticism from patient advocacy groups because individuals living with the disease were largely excluded from participating.

Heng Sambath, coordinator for the Cambodian Alliance for Combating HIV/Aids, said only 20 delegates, out of more than 900 in attendance, were HIV positive. Only one was allowed to present.

"[The Conference] did not show the difficulties that HIV-positive people, including men-who-have-sex-with-men and prostitutes, face."

Teng Kunthy said patient groups had been consulted since January under a sub-committee run by Cambodian People Living With HIV/Aids Network (CPN+). The number of agencies  wanting to participate would have made it too difficult to include everyone, he said.

The end of the conference coincided with news that a Cambodian film about  the importance of HIV testing for pregnant women had won an international "FREDDIE" award from the US-based International Health and Medical Media Agency.

Facing the Truth, a half-hour drama by Khmer Mekong Films that topped the "Prevention" category in this year's awards, follows the lives of two pregnant sisters and their husbands, who unexpectedly test positive for HIV.

 "This award is a wonderful achievement, not only for KMF, but also for Cambodia's National Maternal and Child Health Centre," said the film's writer and producer, Matthew Robinson.

The award will be given at a ceremony in Philadelphia on November 14, an event that organisers call "the medical world's equivalent of the Oscars".

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