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Cambodia's HIV toll: 150,000 and rising

Cambodia's HIV toll: 150,000 and rising

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With the highest infection rate of any country in Southeast Asia, Cambodia is

now facing an Aids epidemic. Sarah Stephens talked to health care professionals

about new directions for AIDS programs in 1999: Tackling the Nation's No. 1 social

health challenge.

NO CONDOM - NO SEX, PLEASE

Geoff Manthey is an agitated man: "There are 100 new cases of HIV a day. That's

700 per week. That means in the seven weeks that I've been here, 4,900 people have

become infected and I haven't been able to do anything about it. "The UNAIDS

Country Program Advisor may be new to Cambodia, but already his determination to

have a lasting effect on the AIDS epidemic is evident.

"In most countries the epidemic takes place in stages - you have the ëluxury'

of being able to focus on solely preventative measures for the first stage."

But, Manthey believes, Cambodia, because of its recent social history, is in a unique

situation which calls for a unique response. "Already you're starting to see

many cases of full-blown AIDS, much earlier than we did in other countries, and what

we need to do now is focus on the care and support aspect. There needs to be a mix

of facility-based care in hospitals and hospices, but the burden of support will

fall on the community."

This is a sentiment which other health care professionals echo. Since the first cases

of HIV began appearing in 1991, most HIV/AIDS projects have concentrated on preventative

measures - promoting effective condom use, disseminating information to commercial

sex workers and trying to educate both men and women about the various ways the virus

can be transmitted. But at the end of 1998, with recent government statistics showing

a frightening increase in rate of infection (150,000 Cambodians are now thought to

be HIV positive), many professional health workers are beginning to review their

strategies for the future.

"I think there has not been enough (focus) on support and care," said Dr.

Oum Sopheap, Project Manager for World Vision's AIDS Prevention and Care Project.

In response to the rapid spread of the virus to the general population, "we

have to reconsider our target groups, strategies and monitoring systems... this year

we started a new initiative in response to the need of our patients, which is home

care services."

According to Sopheap, over 50% of AIDS patients his project deals with are ëneedy'

people - that is, poorer people who cannot care for themselves or who have limited

family help available to them. The World Vision pilot project, which started in February

1998, sends out teams comprised of NGO workers and Government Health Center workers

to provide support for a number of Phnom Penh's AIDS sufferers.

The carers, who offer counseling, social work, nursing and health education, visit

the patients regularly, sometimes even continuing to visit families after the AIDS

patient has died.

"Some they will visit every day, or even twice a day, depending on (how advanced)

the illness" said Sopheap. Although the pilot project ends in February, Sopheap

explained that there were plans to expand the operation to the provinces next year,

if the results prove encouraging.

Caroline Francis, Project Manager for CARE's border HIV/AIDS project, agreed that

there were likely to be policy shifts in approaches to AIDS. "The new trend

for the future will be an emphasis on care and counseling," simply because there

will be more and more fully developed AIDS cases in Cambodia," she said. "CARE

in general will be moving in that direction."

The need for a more care-based approach is only too clear to one Phnom Penh-based

volunteer, who works with one of the most vulnerable sections of the community, HIV-positive

children. Despite the obvious sympathy that such children elicit, there are simply

not enough projects or resources available to take care of the AIDS orphans that

have been flooding into Phnom Penh over the last year.

"I call them my throwaway children," said the volunteer, who declined to

be named. "There's not enough money in Cambodia for the healthy kids - what

are you going to do with kids that are going to die?" She estimated that in

certain orphanages in the city, the infection rate stands at around 50-60%, with

more children arriving each day. "Some staff are taking them home at night because

there's just no room (in the orphanage)."

In addition to the issues of care and counseling, according to Manthey, in 1999 Cambodia

will need to look hard at the lessons learnt by other countries, and to start modeling

its own prevention programs on those successfully adopted elsewhere. One example

is the recent ë100% condom' policy being implemented in Kampong Som, which is modeled

on a similar program in Thailand.

"This kind of operation takes an immense amount of cooperation from the local

authorities," Man-they said of the program, which aims to persuade all brothels,

nightclubs, karaoke rooms and massage parlors to pursue a strict ëno condom, no sex'

policy. Despite Dr. Sopheap's optimism that preliminary findings showed STDs had

dropped by 10% in the area, Manthey was more cautious.

"The devastation that AIDS causes is still not getting through to many Cambodians,"

he said. "What we need is for the highest-level authorities in the government

to stand up and say we must have 100% condom policies across the country ."

Perhaps the most important issue for AIDS care next year in Cambodia, at least at

a national level, will be effective coordination of the myriad of AIDS programs and

projects by a centralized coordinating committee. According to Dr. Sopheap, in several

of the projects supported by World Vision, "we saw many NGOs doing the same

thing in the same area."

Manthey agreed that an effective collaborative effort was vital: "There's a

great need for effective policy development and strategic planning in this area,"

he said. "From this will flow the resources we need. I've been impressed by

what I've seen so far - over the last 12 months there seems to have been a much improved

collaborative response (between NGOs and coordinating bodies)".

Indeed, the Prime Minister himself has already pledged that AIDS will be a priority

in health care, with the new government ready to respond in a much stronger fashion

and at a much higher level.

Yet despite these promises, there is still a mood of despondency that it's clear

the AIDS workers find hard to shake. "It will get worse before it gets better,"

said Francis.

"People here haven't really seen the face of AIDS yet. Many are HIV-positive,

but the cases of full-blown AIDS are relatively low. Until Cambodians see what the

disease can really do, it just won't hit home."

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