CAMBODIA's health authorities are bracing themselves for an "unavoidable tragedy"
which they say could claim as many as 40,000 lives by the year 2000 and severely
retard the country's economic and social development.
Dr. Hor Bun Leng, Director of the National AIDS Program, said Cambodia's HIV epidemic
- described by many experts as the most severe in south-east Asia - would begin to
claim large numbers of lives in 1988 as the immune systems of people carrying the
"Cambodia is facing a problem which could be as big as [that] seen in African
countries like Uganda [where a quarter of the population is HIV positive],"
Bun Leng said.
"In Uganda HIV has exploded like a bomb and we have that bomb here. The bomb
has not yet exploded in Cambodia, but even if it does not explode we are looking
at a tragedy in 1988 or 1989 - we cannot avoid it.
"Already we have somewhere between 70,000 and 120,000 people who are HIV positive
and these people will become sick and die in the coming years."
Using internationally recognized methodologies, a report prepared for the Ministry
of Health by Dr. James Chin of the University of California paints a grim picture
of Cambodia as the epidemic takes hold.
Chin's report prepared a series of scenarios to help authorities here understand
what they were facing.
The best case scenario - which assumed a complete halt in transmission of the disease
after 1995 - calculates cumulative deaths of 15,000 by the year 2000 during which
4,000 people will die as a direct result of AIDS related disease.
His worse case scenario - which the report concludes may likely prove most accurate
- predicts cumulative deaths to have reached 40,000 by the turn of the century with
an annual death rate of more than 12,000 by then.
In addition to the strain on health resources as a result of treating a large number
of AIDS patients, those monitoring the disease point to other less obvious - but
equally significant - economic implications.
Dr. Chin's report concludes that by the turn of the century, AIDS could create as
many as 4,000 maternal orphans each year and, as 90 percent of people infected with
HIV are 15 to 35 years old, AIDS is likely to rob the nation of many of the skills
and the talent required for its continued reconstruction.
Studies commissioned by the Ministry of Health conclude HIV entered Cambodia's population
in the early 1990's.
The first diagnosed case of AIDS was recorded in 1993 and increased to 240 reported
cases by Sept 1996.
However the fatality rate may already be much higher. Chin's report claims current
figures are unlikely to reflect the real situation and suggests the number of deaths
is likely much higher.
"There is a general agreement that the reporting of AIDS cases is very incomplete
and inaccurate and that there may well be at least ten to 20 times or more AIDS cases
that have not been diagnosed and/or reported in Cambodia...," the report reads.
According to HIV/AIDS specialists working in the country, Cambodia suffers predominately
from the HIV 1 strain of the virus - a strain which flourishes through heterosexual
transmission and destroys the body's immune system within seven to ten years.
No one survives infection. Those contracting the disease are condemned to die from
a myriad of infections which eventually invade and overwhelm the body.
AIDS Program director Bun Leng said at current rates of infection 200,000 Cambodians
would be HIV-positive by the year 2000, and he appealed for more international help
to slow the spread of the disease.
"The spread of [HIV] is very fast and is increasing, but this does not mean
we don't know how to deal with the problem. We have a good strategy, but our means
of responding is very limited.
"To reduce the spread of the disease effectively, the World Health Organization
has calculated that you must spend one dollar per head of population per year [for
detection and education]. But we are spending only a fraction of that," he said.
"We are spending just $500,000 for a population of about ten million people."
Bun Leng said Cambodia needed to conduct a much more aggressive education campaign
and Cambodians had to acknowledge social and attitudinal changes which favor the
spread of the disease.
A two year report recently completed by the Cambodian Aids Social Research Project
questioned the traditional image of Cambodian women as chaste and found that around
one-third of young women are sexually active.
In addition, it found nearly 90 percent of young men have sex with prostitutes, their
girlfriends and - in the case of one in ten young men - other males.
Conducted by high school and university students trained as researchers, the survey
also found that nearly half of sexually active young men never use a condom.
"In Cambodia, HIV is spread overwhelmingly by heterosexual sex. HIV has spread
into the family - we are very concerned about married women because it is very hard
to reach them with education campaigns," according to Bun Leng.
"Poverty means many more people are prepared to have sex for money.
"Right now we are seeing an increase in sexual activity outside brothels. We
see beer girls, cigarette girls, massage parlors [not classified as commercial sex
workers] . All these are high risk groups that we need to reach [with] education,
but we have no budget to this."
"There are places where cyclo drivers can go to buy sex for 500 riels. When
sex costs less than a beer, we've got real problems," added a foreign AIDS specialist.
According to tests carried out by the National AIDS Program, the past year has seen
infection rates among police and military - both considered key reference groups
- decrease from around eight to five and a half per cent and eight to six percent
Infection in pregnant women also seems to have dropped slightly to just under two
percent, but HIV infection in commercial sex workers (CSW's) now averages about 41
percent, up from 38 percent in 1995 and nine percent in 1992. In most provinces bordering
Thailand, the infection rate among sex workers averages 60 percent.
Local and foreign experts agree that in the near future the increasing numbers of
people developing AIDS will soon overwhelm Cambodia's rudimentary health care system.
"To understand the magnitude of the problem, look at how the health care system
copes with land mine victims," said one foreign specialist who requested anonymity.
"There is an estimated one hundred to three hundred land mine casualties each
month, and the health care system is severely strained. Within just a few years we
are talking about anything up to 12,000 patients with AIDS related disease each year."