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Progress against HIV at risk

Progress against HIV at risk

091116_06
An orphaned child with HIV/AIDS is cared for by nurses at Takhmao Hospital earlier this year.

The government’s continuing disregard for human rights could prevent Cambodia from reaching its HIV goals

COMMENT
Joe Amon

CAMBODIA is considered one of the few success stories in the global fight against AIDS. HIV is on the decline: More than 2 percent of adults were affected in 1997; a decade later, HIV prevalence is 0.8 percent.

According to UNAIDS, “Cambodia provides evidence that well-focused and sustained prevention efforts can help reverse an HIV epidemic.”
Antiretroviral therapy is currently provided to around two-thirds of those who need it, up from 14 percent in 2004. Cambodia is also praised – and rightly so – for its progressive AIDS law protecting people living with HIV from discrimination. Those are impressive accomplishments.

Yet, human rights abuses against populations particularly vulnerable to HIV infection threaten the government’s success. The positive achievements of government health authorities and their partners have been outmatched in the past year by the negative actions of the police, Ministry of Social Affairs and municipal authorities; so far, health is losing. The real casualties have been among the most marginalised of Cambodians: those caught up in street sweeps, detained or forcibly evicted from Phnom Penh.

People considered “undesirable” – the homeless, sex workers, drug users, street children – are regularly arrested and detained by police and Social Affairs staff in advance of national holidays or visits by foreign dignitaries. Many people living with HIV are caught up in these campaigns. In May, Human Rights Watch talked to one homeless woman who was detained by Daun Penh district police during the ASEAN-EU foreign
ministers meeting. When she asked a police officer to return her confiscated HIV medicine, he replied: “You complain a lot! Jump into the truck!”

In the leadup to Phnom Penh’s annual water festival earlier this month, similar detentions took place. The deputy governor of Daun Penh district claimed that sex workers were arrested for HIV-prevention purposes, explaining: “We don’t want to see the boat racers bringing diseases such as HIV/AIDS back to their wives.”

People who use drugs, and particularly those who inject, are another group at risk – both for HIV infection and police abuse. The number of people who use drugs in Cambodia is hard to determine, but it is thought to be between 10,000 and 20,000; at least one in four people who inject drugs are estimated to be HIV-positive. Instead of addressing either the issue of drug use or HIV with evidence-based measures, however, the mainstay of the government’s strategy has been detention.

Cambodia has established 11 drug detention “rehabilitation” centres around the country. The “treatment” they provide? Forced physical exercises, military drills and hard labour. People in detention are recognised by UNAIDS as being at a heightened risk of HIV infection, but in addition to failing to provide effective drug dependency treatment, the centres provide neither HIV prevention nor treatment. These centres should be shut down and voluntary, in-community drug-dependency treatment developed in their place.

Another example of government policies undermining health goals and violating the HIV law was the forced eviction of some 40 families from Borei Keila in June to a de facto AIDS colony on the outskirts of Phnom Penh.

Protests by Cambodian and international HIV and human rights groups generated scrambled visits by UNAIDS and the national AIDS authority, but the basic situation is unchanged: Those who were forced to move remain far from jobs and isolated from medical facilities and support services. Although local nongovernmental organisations have a long-term plan to improve housing conditions and begin income-generating activities, the situation for these families remains precarious.

In June 2006, the Cambodian government committed itself to achieving ambitious national targets for providing universal access to HIV prevention, treatment, care and support by 2010. Now, three years later, a UN delegation has come to Phnom Penh to review what progress has been made. The delegation should pay close attention to the Cambodian government’s failure to respect, protect and fulfil the human rights of those at highest risk of HIV. The actions of the police, Ministry of Social Affairs and municipal authorities should be particularly scrutinised.

Joe Amon is director of the Health and Human Rights division at Human Rights Watch.

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