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

babies.

"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

said.

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

transmission."

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.