Six-year-old Srey Nich, pictured with her mother, says she suffers pains throughout her body, but is one of at least 1,000 Cambodian children who do not receive life prolonging anti-retroviral treatments.
S REY Nich runs into the small room she calls home and plonks into her mother's lap.
She's mad that a neighbor has hit her for wandering around the rickety boards that link her stilt house to others above the luminous green slime of Boeung Kak lake.
As she frowns and a single tear falls down her cheek, Srey Nich's face looks older than her six years, although her body is small.
She is one of seven HIV-positive children in her community of rented rooms and shacks on the lake behind Phnom Penh's train station, and one of more than 1,000 Cambodian children who do not receive the anti-retroviral treatment (ART) that could help prolong their lives.
"I get stomach aches, headaches and pains in my entire body," mumbled Srey Nich shyly, after prompting from her mother, Srey Pheap, 38, who was infected by her husband. He died last year in hospital.
Life is tough for Srey Pheap and her daughter. She makes anywhere from 500 riel to 3,000 riel a day washing clothes - although sometimes thieves steal the garments as they dry and she has to repay the owners - and is three months behind in the rent of their one-room home that costs $15 a month. When her daughter gets seriously sick, Pheap takes her to Kantha Bopha hospital for free medical treatment, but this does not include ART.
It's difficult to say exactly how many children are in a similar situation to Srey Nich. The most recent government estimate of children living with HIV/AIDS was 6,000 in 2003.
Mean Chhi Vun, director at the National Center for HIV/AIDS, Dermatology and STDs (NCHADS), said between 2,000 and 3,000 of these HIV-positive children need ART drugs but, in early 2005, more than 1,000 children did not have access to the treatment.
The provision of ART to children with HIV/AIDS received a boost earlier this year, with the announcement of funding from the Clinton Foundation to the Ministry of Health that Chhi Vun said should result in 700 children receiving the treatment.
The funds amount to approximately $2 million over two years, and would be spent on providing ART, offering vocational training, and helping drug manufacturers lower the price of the drugs, he said.
Throughout the kingdom, there are 29 hospitals that offer the personalized combination of ART drugs that can help slow the reproduction and progression of HIV in the body, said Chhi Vun, noting the increase in the past two years.
Several NGOs also provide ART treatment and other support for children affected by HIV.
Richard Veerman, head of mission at Médecins Sans Frontières (MSF), said his organization helps 528 children living with HIV/AIDS in Siem Reap and Takeo provinces, and that 275 of those get ART.
Catholic NGO Maryknoll helps 372 HIV-positive children, including 234 who receive ART, said Sok Phalla, assistant program director for "Little Sprouts", a program for children with HIV.
Massimo Ghidinelli, HIV/AIDS adviser for the World Health Organization, said Cambodia has many health centers that offer blood tests, access to life-prolonging drugs and general health care.
"What we need today is the strong collaboration from the patient that means it is better for patients to go to hospital and meet with a doctor before they get seriously sick," Ghidinelli said.
But accessing treatments is a financial burden that is too much for some families on the knife-edge of poverty.
Living next door to Srey Nich and her mother on Boeung Kak is Sochenda, whose two daughters and 18-month-old granddaughter all have HIV. Sochenda has never tested her blood for HIV, but her husband died of the disease two years ago.
"Some days, when my 23-year-old [daughter] gets sick [and can't work as a beer promoter], the entire family has nothing to eat and we don't have even the money to take [her granddaughter] Marady to hospital," Sochenda said.
While the treatment available at Kantha Bopha hospital is free, sometimes the family doesn't have the few thousand riel it costs to travel by motodop to the hospital.
Ouk Mony, an HIV-positive volunteer for the Urban Sector Group who lives in the lakeside community, said at least 23 young women residing in the maze of stilt houses earn their living as sex workers, contributing to an HIV infection rate well above the national average of 1.9 percent.
Poverty drives people to desperate measures.
"Here, the girls lack money to rent a house and they become sex workers," Mony said. "They get only 3,000 riel from each customer [and] sometimes when they earn a little money and bring it home, drug-addicts rob them in the train station on the way."
Add to this risky behavior the devastating effects of philandering husbands who have unprotected sex and pass the virus on to their families, and this lakeside community has been particularly hard-hit by HIV/AIDS.
Seven children under the age of 8 are known to be HIV-positive, said Mony, but none of them receive ART.
While generic versions of ART drugs are available for as little as $140 a year, a 2004 UNAIDS report estimated that only 7 percent of the 5 million to 6 million people living in low- and middle-income countries receive the treatment.