New official figures indicate that about one out of every 70 Cambodians is HIV

positive. Stephen O'Connell and Bou Saroeun look at the epidemic

that local officals now say could be a threat to national security.

A young man in the final stages of his battle with AIDS,

showing skin lesions, probably Kaposi's sarcoma

DARA

(not his real name) is a 38-year-old former policeman from Sihanouk-ville. At

the end of 1997 he developed lesions. He thought it was a harmless skin problem

but by July 1998 was worried enough to have a blood test. It was

AIDS.

Dara used to frequent brothels. "Sometimes I used condoms,

sometimes I didn't," he said.

Out of work and with failing health, Dara

moved in with relatives in Phnom Penh and treated himself with local medicines.

As Dara's health deteriorated the relatives grew increasingly fearful

that they would catch the disease and demanded he leave their house.

In

June 1999 he was admitted to the AIDS ward at the Russian hospital where he

stayed for six months. There he met Father Jim Noonan of the Maryknolls who told

him that if his health stabilized, he could come and live at the Maryknoll's

Seedlings of Hope hospice on the outskirts of Phnom Penh.

He has lived at

the hospice since January.

 

The hospice has only 12 beds available for AIDS patients abandoned by their

families, so Dara is one of the lucky few to receive care and shelter

there.

"If I had a chance to talk to the Cambodian people, I really want

them to know HIV and AIDS are real," he says.

"Some people still don't

believe. I want all people who have sex in the brothels or who have lots of sex

partners to use a condom.

An orphan whose parents have both died from Aids and who was

born with HIV nears death

"And I want the Government to increase the

education of the people so they understand how HIV is transmitted," says

Dara.

Cambodia has the most serious HIV/AIDS problem in Asia and has the

potential to become one of the worst affected countries in the world.

The latest estimate from the HIV Sentinel Surveillance 1999 says some

170,000 Cambodians are now infected with HIV, the virus that causes

AIDS.

Dr Tia Phalla, Secretary General of the National AIDS Authority,

said although there has been a slight drop in HIV infection rates among sex

workers under 20 years, Cambodia is still facing a major health

crisis.

"Since HIV infects people who are in the labor force, and mobile

populations like soldiers and police, then when they are infected they will lose

their productivity for their families and the nation. A huge amount of money

will be lost for the country and that will definitely affect the security of our

country."

Phalla said he is greatly concerned about the increasing rates

of infection between men and their wives. "Our worry right now is the role

played by men as 'bridges' for HIV infection from sex workers to housewives," he

said.

The Government has few strategies to combat this trend, said

Phalla. "As experienced all over the world, intervention among couples is very

difficult. We can very easily reduce the epidemic from sex workers to men, but

it is hard to stop the epidemic from men to their wives."

Phalla said

these men should be made to feel responsible for their behavior. "If they are

not yet infected they can preserve the lives of their wife and child. If they

are infected then they can spare the life of their wife so she can take care of

the children," he said.

This 26-year-old woman was a beer-girl and part-time sex worker in the provinces.

When she developed AIDS, her family banished her, and now she is dying, homeless,

on the streets of Phnom Penh.

As more Cambodians become sick with AIDS, Phalla

believes home care for these people is the only practical solution because the

hospitals can't cope. "First we must fight discrimination, then we can use

families to take care of their infected relatives. But it will be very

challenging," he said.

At the end of May the National AIDS Authority will

have a conference with the Ministry of Cults and Religion to map out a strategy

on how to make the best use of Cambodia's 50,000 Buddhist monks in the areas of

HIV prevention and care for those sick with AIDS.

Another initiative

trialed in Sihanoukville, but set to expand nationwide, is the 100% Condom Use

program. "It showed very encouraging results that we can provide safety for sex

workers in sex establishments."

Dany, a 22-year-old prostitute from Prey

Veng, knew nothing of the dangers of HIV until she arrived in Phnom Penh and

learned from an Indradevi Association [a Cambodian NGO working in AIDS

prevention] health team about HIV and other STDs.

Dany is afraid of the

disease and knows there is no cure. Most of her clients are concerned as well,

but occasionally they refuse to use a condom.

Dany said she received

training from Indradevi on how to coax a client into using a condom."Sometimes I

use strong words, sometimes soft words."

She said she often explains to

the men about how HIV is transmitted, passing on the knowledge she gained from

Indradevi.

So the safe-sex message is getting out and the increased use

of condoms in brothels is perhaps slowing the spread of the disease, but Phalla

cautions there is no cause for complacency.

"The epidemic is not

stopping. We must not relax" he said.

Dr Jean-Bernard Castaing, with

Medecins Sans Frontieres, France Section, AIDS Project, treats patients with

AIDS at Phnom Penh's Preah Bat Norodom Sihanouk Hospital.

Every day at

least one patient dies from AIDS in the hospital's infectious diseases ward.

"Working with this disease is psychologically difficult for the staff," said

Castaing.

"This infectious disease ward [with 60 beds] is full, full,

full. Every day at the outpatient consultation [for HIV positive patients] we

see 20 to 30 people. In the ward we have two men for every woman, but in the

outpatient consultation there are the same numbers of men and women.

"We

only treat the opportunistic disease. We cannot treat AIDS with antiviral drugs

because it is very expensive - $200 per month," said Castaing.

Cambodia

has only 8,500 hospital beds. As the estimated 170,000 people already infected

with HIV become sick, they will easily overwhelm the country's hospital system.

Castaing said MSF is helping the Government with ideas to develop a home-based

care system to relieve the already overburdened hospitals.

One positive

trend, said Cas-taing, is that people in the community seem to understand a

little more about HIV/AIDS than they did a few years ago