In typical 11-year-old style, Nak is squirming in his chair. He's itching to be away
from grown-ups and their questions and back playing with his friends. When pressed,
Nak confides that he likes chicken soup and mathematics. Then, glancing slyly at
Wayne Dale Matthysse, co-founder and project manager of Wat Opot, Nak slides off
his chair and adds a parting aside:
Eleven-year-old Nak is one of 63 children under the care of Wat Opot.
"A year ago I wasn't doing very well at school because I thought I was going
to die," said Nak, one of the 23 HIV-positive children living at Wat Opot. "But
now I am working harder. When I grow up I want to teach math to grade 3."
There are an estimated 123,100 people living with HIV in Cambodia, said Mean Chhi
Vun, director of the National Center for HIV/AIDS, Dermatology and STD (NCHADS).
"We do not currently have specific figures for children," said Chhi Vun
on April 10. "But I would estimate that there are about 6,000 children living
with HIV/AIDS and about 3,000 of those need anti-retroviral drugs."
Nak, who was born HIV-positive, arrived at Wat Opot when he was eight. He now receives
the medical treatment he needs and has settled in well.
"I have good friends here and I like playing with them," he said. "I
go to the crematorium every night to see the other children who have died."
Matthysse admits that everyone at Wat Opot is "well-attuned" to death.
The NGO was obliged to build its own crematorium when the local pagoda refused to
cremate the hospice's dead for fear of transmission.
Next to the crematorium's furnace is a "family room." Here, photographs
of late patients, from babies to elderly men, adorn the walls and neat urns of their
ashes stand in a cabinet in the center of the room.
According to a 2006 UNAIDS report, HIV prevalence among people age 15 to 49 has decreased
from 3 percent in 1997 to 1.9 percent in 2003. But one third of new infections are
"vertical" - meaning HIV positive mothers are passing the virus on to their
"The rates of HIV/AIDS transmission from mother to child remained the same [from
1997 to 2003]," said Mam Bunheng, secretary of state at the Ministry of Health
"[But] we hope it will decrease soon because now all people, both male and female,
are more aware about HIV/AIDS."
Currently, 1,787 HIV-positive children receive anti-retroviral treatment (ART) in
Cambodia. Overall, 2006 saw a rapid increase in the number of HIV-positive patients
able to access ART to approximately 80 percent of all in need of treatment, according
to the UNAIDS report. Now, reducing mother-to-child transmissions is the priority,
said Tony Lisle, country coordinator, UNAIDS.
"There is absolutely no reason why a child should be born HIV positive,"
he said. "This is a measure of the fact that women are not able to access good
ante-natal care packages."
At Wat Opot the results of Cambodia's lack of ante-natal care packages are only too
apparent. The project was established in 2002 as an AIDS hospice. Five years and
approximately 400 deaths later, the project has stopped accepting new adult patients
so it can focus on the 63 children - 23 of whom are HIV positive - left behind.
Six-year-old Tia's story is a common one at Wat Opot.
Late one night an ambulance arrived and asked if the wat would accept a patient with
HIV. The patient they accepted had Tia in tow.
"The patient was very badly beaten and the boy had his two front teeth missing,"
he said. "The lady died three days later and no one came to get the boy so we
kept him. Now, three years later, he has settled in and his front teeth have grown.
We asked him once if he wanted to go back to his home village but he said 'no' very
firmly, so we never asked again."
On March 28, Wat Opot staff were informed that a 2-month-old baby born to one of
the wat's HIV-positive adult patients had the virus. Matthysse said the mother had
not been able to make it to the provincial hospital for the birth.
"If a child is born in a place where it can have access to the algorithms of
treatment, you can halt the onwards transmission of AIDS," said Lisle.
Cambodia has approximately 461,000 live births per year, and it is estimated that
about 9,700 pregnant women are HIV positive. Without any intervention, approximately
3,000 infants may be infected with HIV annually through vertical transmission, according
to UNAIDS data.
"Children are the future of HIV in Cambodia," said Matthysse. "The
problem is that [HIV positive] kids think short term. For example, one HIV-positive
11 year old has never been to school as his family assumed there was no point. We
are trying to make them think long term."
Some of the children at Wat Opot are visibly ill. Other are indistinguishable from
their non-infected peers. All are treated equally, and all attend the local village
school, said Matthysse.
"There is some teasing at school," he said. "If a child who has HIV
is being cocky, they might get a 'at least I don't have AIDS' comment. But we are
trying to get them to the stage where they can retort with 'at least I don't have
a big nose.' We want them to understand that HIV is something they have, but other
kids have different problems too."
According to Choub Sok Chamreun, team leader at the Cambodian HIV/AIDS Alliance,
many HIV-positive patients face discrimination.
"We think we should put AIDS/HIV education on the school curriculum. Now people
just laugh about sexual health but this lack of information is dangerous," he
Challenging discrimination and reducing mother-to-child transmission will take time,
said Lisle, the UNAIDS country coordinator.
"The Ministry of Health has agreed to provinces initiating 'opt out' HIV testing,"
he said. "Before you had to ask so this could change the number of women who
are testing and who will then have access to services which could prevent onwards
In 2006, only 6.4 percent of the total annual number of pregnant women got an HIV
test and only 3.3 percent of HIV positive pregnant women received a complete course
of ARV prophylaxis to reduce mother to child transmission, according to UNAIDS data.