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Orphans and victims of AIDS timebomb

Orphans and victims of AIDS timebomb

Rasmey was just a few days old when he was found by Nuth Dara on the steps of the

post office in downtown Phnom Penh. Dara could have left the abandoned, bawling bundle

where he found it, but instead took Rasmey home where he soon became a well-loved

member of the family.

To the delight of everyone he quickly grew into an energetic and mischievous toddler.

He learned to walk and speak, but then he fell ill with chronic diarrhoea.

"I try to feed him up, but he just keeps getting weaker. The doctors say he

has HIV and they can't cure him," Dara said.

"He's a lovely child and I wish more than anything he could live to become a

man. But I know that he will soon die."

Rasmey is just one of thousands of Cambodian children who have fallen victim to the

country's HIV/AIDS epidemic, an epidemic which the Cambodian Ministry of Health estimates

will kill 4,000 children and leave a further 6,000 orphaned within two years.

But Pawana Wienrawee of the United Nations AIDS Program, UNAIDS, said that figure

may be understated.

"We have a fairly good idea of the situation in Phnom Penh, but out in the provinces

we just don't really know how many people are HIV positive. Nor do we know how many

people are dying from AIDS because illness is often misdiagnosed and the cause of

death is usually unrecorded," she said.

But the limited knowledge that health professionals do have reveals that the HIV

rate is spreading faster in Cambodia than in any other Southeast Asian country and

has prompted warnings the epidemic may be spinning out of control.

According to the World Health Organization's Dr Annie Macarry, authorities have less

than two years to act. "The HIV/AIDS problem in Cambodia is dramatic - the population

is facing a situation which, in terms of deaths, will rival Pol Pot's regime.

"If the government is unable to take effective measures soon, the epidemic will

run away and never be controlled - it will destroy this country," Dr Macarry


Limited Ministry of Health testing suggests at least 100,000 Cambodians are already

HIV positive and that the spread of the disease is startling. The United Nations

Development Program forecasts that 500,000 people - close to one in 20 of the population

- will likely be infected by the year 2006.

FEAR, ignorance and a virtually non-existent public health care system means that

many AIDS victims are ostracized, the lack of access to care and compassion leading

to painful and lonely deaths.

And, according to Sao Sira, a Cambodian doctor working with HIV/AIDS patients at

the Sihanouk Hospital/Center of Hope, the fight against the disease is being hampered

by indifference and mistrust.

"We will not be able to cope with the problem, we just don't have the resources

and so the only hope is for community-based care. Before Pol Pot there was strong

sense of community in Cambodia, but that disappeared during the Khmer Rouge time,"

she said.

"Of course people are scared of catching the disease, but most of all people

don't care for themselves or each other now," Dr Sira said.

"Many people are aware of the risks or know they have the disease, but they

say they don't care whether they live or die.

"But what is worse is the myths associated with the disease," she said.

"Many people think HIV can be cured and some men even think the best way to

get rid of the virus is to have as much sex as possible."

Extra-marital sex with prostitutes is a popular and cheap form of recreation for

Cambodian men. Even the poorest have access to sex for as little as 500 riel - about

15 US cents - cheaper than either a can of beer or a packet of condoms.

But the nation's estimated 60,000 commercial sex workers suffer an HIV infection

rate of close to 50%.

The Ministry of Health asserts that only four in ten clients who seek pleasure in

the nation's vibrant sex industry choose to wear condoms and testing of police and

soldiers - many of whom are married - reveals an infection rate of between 5% to


FOUR-year-old Srey Lek is too young to understand why her father abandoned her after

her mother died last year.

She doesn't understand why she keeps getting sick, nor does she comprehend she is

unlikely to survive long enough to celebrate her fifth birthday.

It's probable that Lek's father is now dead, but she has been lucky to be "adopted"

by the staff at Sihanouk Hospital/Center for Hope who last year managed to save her

from a near-fatal infection.

But, her friends at the hospital sadly agree, the next time she gets sick may be

the last time - and there's little doubt that staff at the center will soon see many

more children like Lek.

The Ministry of Health's National AIDS Program manager Dr. Tia Phalla said infection

rates in most vulnerable groups appear to have peaked, but that authorities are now

bracing for a surge of infections among married women and their new-born babies.

"In our culture women do not have the power to insist on condoms. Men will go

to brothels [and have unprotected sex], then sleep with their wives," Phalla


"Now the ratio of infection is three men to every woman, but that will soon

be one to one," he said.

NAP monitoring of pregnant women has revealed that prevalence of HIV infection in

that group has nearly doubled from 1.7% to 3.2% in just 12 months and, according

to UNAIDS' Pawana Wienrawee, traditional Cambodian birthing techniques expose close

to one in three children to infection during birth.

"Both mothers and children in Cambodia will suffer a surge in infections in

the near future," she said.

"But in Cambodia, like most developing nations, it is women who care for the

family and do most of the work.

"A sick woman cannot work and she cannot care for her family. The health care

and social welfare systems are virtually non-existent and the few government orphanages

are already full. The situation is all very depressing," she said.

Like many health professionals working on Cambodia's HIV/AIDS epidemic, Pawana Wienrawee

has become frustrated at the apparent lack of political commitment to containing

the spread of the disease.

"Most of the people working on HIV/AIDS are working very hard because they know

how bad things will get. But we are only just starting to see large numbers of people

die and so the problem is not yet really visible," she said.

"But soon we will be swamped with AIDS cases and we will start seeing very large

numbers of deaths. But by then it will be too late."

Pawana said the problem has been amplified by Cambodia's recent political meltdown

and the subsequent reluctance of donors to commit money and expertise.

"Donors want to see stability before they commit themselves, but the longer

we take to really get on top of this problem, the bigger the human tragedy will be,"

she said.


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