Patricia Ongpin, UNAIDS country director to Cambodia, Lao PDR and Malaysia. Supplied
A person in Cambodia will contract HIV while you are at work today. Another will be infected while you are asleep. One of those people will be under age 25.
We need to keep this in mind even as Cambodia was celebrated for its world class HIV response during last week’s visit of UNAIDS executive director, Winnie Byanyima. Virtually everyone who tests positive is successfully treated. But there is still some work to do when it comes to prevention.
This nation has gotten something right that other countries are still figuring out. When someone learns they are living with HIV how do we make them feel safe and supported instead of scared and alone? The answer lies in ensuring health services are welcoming and that community and social support are available. That means not just treating them as patients, but as whole people with mental, emotional and practical needs.
But keeping people healthy is just part of the picture. To end AIDS as a public health threat we must also improve prevention. New HIV infections are like a leaking faucet. Every drop in the bucket is another individual requiring lifelong treatment. The only way to ensure that we have an affordable, effective, and sustainable HIV response in the future is to shut off the pipe by stopping new HIV infections.
The Kingdom has already made commendable progress toward this goal. Since 2010 new HIV infections have reduced by around half, 45%. That’s far faster than the average rate of decline in the Asia and Pacific region. It’s also better than the global average. But it still means 1200 people are newly infected every year, adding to the bucket drip by drip.
Who are these people? The vast majority, 88%, belong to key population communities who are at higher risk of HIV infection including men who have sex with men, people who inject drugs and transgender people. And 44% of new infections are among youth between ages 15 and 24. Four of every five new infections are among males. Taken as a whole, the most vulnerable group to HIV in Cambodia are young gay men.
But it is not the mere fact of belonging to a “risky” group or being young that puts a person in danger. We create the perfect storm for HIV infections when certain realities are allowed to continue. First, when people are not able to get sexual and reproductive health and harm reduction information that’s relevant for their lives. Second, when they are unable to access the prevention tools that should be available to them. And third, when they experience prejudice and rights violations that make them more likely to hide than to come forward for support.
Female entertainment workers prove that effective HIV prevention is possible for key population communities. This group has steeply declining HIV rates. That’s because they have benefited from a mix of innovative approaches. Peer-to-peer education has been critical. So too has been a landmark initiative of the Cambodian government to give them access to healthcare through the Health Equity Fund. The momentum is continuing. Cambodia will soon become the first country in the region to make the Dapivirine Vaginal Ring (DVR) available. This is the only antiretroviral tool to help stop HIV infections which is specifically for women.
UNAIDS coordinates the Indo-Pacific Partnership for HIV Prevention in Cambodia. This Australia-supported project aims to accelerate progress through proven approaches, including ensuring that HIV prevention options are widely known and accessible.
Non-medical approaches are key to the effort. Community-led monitoring is a method to help improve services based on feedback from clients. Virtual interventions aim to reach people online rather than through face-to-face interactions. Self-testing and community testing are strategies to reach the remaining eight per cent of people living with HIV in Cambodia who are unaware of their status. The work also includes political advocacy and community capacity building to create a more supportive context for people to access HIV services.
The project complements the excellent work Cambodia is already doing to increase access to pre-exposure prophylaxis or PrEP. This is where HIV-negative people take treatment to avoid contracting the virus if they are exposed. In 2024 more than 15,000 people were accessing PrEP. This month, for the first time, people will have the chance to use an injectable PrEP that protects them for two months rather than taking a daily pill. Choice goes to the heart of the prevention mission. People must be presented with options so they can select the ones that best fit their lives.
This work is part of a broader strategy for a sustainable response. Almost three-quarters of HIV prevention spending in Cambodia is from international sources. The government has increased domestic resources to prevent new infections. However, just 18% of total HIV funding goes to prevention with a mere seven per cent allocated to key populations. As Cambodia refines its approach, it should also ensure that the money goes where it is most needed. Ultimately, increased investments in community-led programmes and modern HIV prevention services specifically for young men who have sex with men will speed up progress to ending AIDS.
Patricia Ongpin is UNAIDS country director to Cambodia, Lao PDR and Malaysia. The views and opinions expressed are her own.
