Around 40 million people were estimated to be living with HIV/AIDS worldwide at the
end of 2001. Almost 22 million others have already died of the disease, and many
of those deaths have contributed to the world's 13.2 million AIDS orphans.
These are some of the figures that make World AIDS Day, which is on December 1, a
date that is hard to ignore. It is a day that will also be marked in Cambodia, which
currently has the highest HIV rate in Asia.
The latest country figures reveal a small drop in the number of Cambodian adults
infected with HIV, from 2.8 percent to 2.6 percent, which is around 157,000 adults.
A lack of both adequate health care and anti-retroviral drugs (ARVs), has combined
with the stigma surrounding those with the virus, a growing number of AIDS orphans,
and many other related problems to force HIV/AIDS high up the agenda of government
and NGOs.
The HIV/AIDS Coordinating Committee (HACC), an umbrella group of interested NGOs,
will coordinate with the National AIDS Authority (NAA) to mark World AIDS Day.
On the cards is a day-time ceremony and concert at Wat Phnom. Also more than 1,500
volunteers will fan out on six national highways leading out of the capital. While
loudspeakers on their buses broadcast awareness messages and music, the volunteers
will also distribute condoms, materials, and educate people about HIV.
Seng Sopheap, HACC's coordinator, said the aim was to "find crowds of people
and provide HIV awareness to sellers and moto taxi drivers and others".
"The message for World Aids Day is we want to reduce discrimination because
as Nelson Mandela said, most people die from discrimination and stigma, not from
HIV," Sopheap said.
Sopheap's view matches the theme for World AIDS Day: Live and Let Live. Pratin Dharmarak,
program manager at NGO Family Health International/Impact (FHI), agreed the theme
was relevant to Cambodia, because of the large numbers of people who are sick and
dying and need support.
"In the past there was so much campaigning against HIV-positive people globally,
and this has resulted in fear and discrimination," said Dharmarak. "So
the focus should be on understanding and promotion of positive living. If you have
HIV you can live many years of valuable life, but the [HIV-positive] person and society
needs to understand this."
Dr Tia Phalla, secretary general of the National Aids Authority, said there was a
need to take care of those already infected, but insisted the government's main concern
remained prevention. He said a joint effort between the government, civil society
and the United Nations had contributed to the success in cutting the HIV rate.
"We have made progress in terms of curbing the epidemic," said Dr Phalla.
"In 1994 we found the daily new infection rate was 110 per day. Now in 2002
there are only 20 new infections a day."
However Pok Panhavichetr, executive director of the Khmer HIV/AIDS NGO Alliance (KHANA),
said the vulnerability of those living with the virus was increasing, despite the
reduced prevalence rate.
"Even though the numbers are decreasing, their vulnerability is increasing because
people are dying and they don't have access to ARVs," she said. "[That
is] because they are poor and the government does not have the capacity to provide
[the drugs]."
The government's own figures show that the virus has already killed 80,000 Cambodians,
and predicts that will rise to 230,000 by 2010 unless there is improved access to
ARVs.
At the second national HIV/AIDS conference in early October, Prime Minister Hun Sen
publicly stated his support for increased supply of ARVs. Yet fewer than 500 people
have access to free ARVs in the country's hospitals, and the issue of funding remains
unresolved.
In September Cambodia submitted a proposal to the Global Fund for AIDS for $16 million
to provide ARVs for 3,000 people over five years, and to train doctors to supply
treatment.
Another NGO, the Cambodian People Living with HIV/AIDS Network (CPN+), has run a
strong campaign for increased and affordable access to ARVs.
CPN+ coordinator Heng Sokrithy said he wanted "the government and all Cambodians
to implement their rights that were agreed in the National Assembly, and to support
[people living with AIDS] to have access to free ARV drugs and treatment for opportunistic
infection."
Sokrithy referred to the HIV/AIDS law passed by the National Assembly in June, which
makes it illegal to discriminate against people who are HIV-positive. It is now also
illegal to knowingly infect another person, and people with the disease must tell
their spouse or sexual partner.
The focus on ARVs is necessary, but much more needs to be done, said Geeta Sethi,
country program advisor at UNAIDS.
"When we look at ARVs I hear people talk about it as the solution, but clearly
it is not the only thing that is required," Sethi said. "Whether you have
ARVs or not you can still pass on the virus. You can't just let up on prevention
because you have the drugs."
Sethi said the major challenges would prove to be treatment, care, looking after
orphans, and reducing the vulnerability of women. She said the latest surveillance
survey showed the highest number of new infections were passed from husbands to their
wives. Currently 75,446 women are HIV positive, and infections among women are increasing.
"We also need to reduce rates among men who have sex with men (MSM), which is
an area that hasn't been really explored at all," Sethi said.
According to a recently-released FHI study, 14.4 percent of MSM were found to be
HIV-positive. This would place them in a 'high risk' category along with direct and
indirect sex workers and the military.
The final word before World AIDS Day came from the government, with the NAA's Dr
Phalla urging "every member of society" to pull together to help "cope
with this very serious and severe man-made disaster".
"We are calling for strong involvement from everybody including decision makers
to ensure consistent condom use is maintained at the highest level," Dr Phalla
said. "We know it is hard to ask people not to have sex. The most important
point is to ask them to reduce the risk by using condoms with sex workers, and their
boyfriends and girlfriends."
