CAMBODIA: When It Comes to HIV, Trust Can be a Weakness

By IPS Correspondents Reprint | | Print |

Rosario Liquicia

SIEM REAP, Cambodia, Sep 27 2002 (IPS) - Muny has been fretting for weeks, but is too scared to go back to the hospital where he had his blood tested for HIV months ago.

“My girlfriend is okay. She has no HIV, so maybe I’m okay too,” he said, referring to the results of his partner’s blood tests. “But I’m afraid to know if I have HIV,” said the 23-year-old guesthouse worker who had grudgingly gone for blood testing on his girlfriend’s urgings.

Muny is sexually active and has multiple sex partners. He says he uses a condom whenever he has sex with girls from night clubs or karaoke bars, but never with his girlfriend.

“When I do it with my girlfriend, I don’t use a condom because I know my girlfriend does not have sex with another man, just with me,” he explains.

His buddy, Art, also engages in sex with different partners, is aware of HIV, and uses a condom — except when he sleeps with his girlfriend.

“With other girls I use condom because I am afraid of HIV,” said the 20-year-old Vietnamese-Cambodian who drives tourists around temples and other tourist spots in his motorbike.

Muny and Art are among thousands of men in this northern province of Siem Reap, and tens of thousands more in other parts of Cambodia, who, well aware of the risk of HIV, use condoms to protect themselves from sexually transmitted infections.

The problem lies in the fact that they use it only when having sex with sex workers.

In other words, while this may address HIV and STDs within the sex industry, it may well continue to fuel the spread of the pandemic to the male clients’ girlfriends, wives and partners.

This, health experts say, may undercut Cambodia’s recent successes in its anti-HIV/AIDS campaign.

So far, the Cambodian government’s campaign to promote 100 percent condom use in brothels and other entertainment places — following neighbour Thailand’s example — has been instrumental in stemming the rise of HIV cases in this country of 12.3 million people.

According to the Joint U.N. Programme on HIV/AIDS (UNAIDS), HIV prevalence in Cambodia has dropped from over four percent at the end of 1999 to 2.7 percent at the end of 2001 largely as a result of a broad national response to the pandemic.

At the end of 2001, 160,000 Cambodians between 15 and 49 had HIV, down from 210,000 in 1997, it said.

In July, the United Nations Development Programme said in a report that Cambodia’s efforts in its war against the epidemic may see it achieving the goal of “halting and beginning to reverse the spread of HIV/AIDS by 2015”.

But health workers are concerned that the trend of low condom use in non-commercial, affectionate relationships could threaten the success of Cambodia’s fight against HIV/AIDS.

Reports of low condom use among couples are affirmed in a qualitative research study conducted in Phnom Penh by Population Services International (PSI)/Cambodia, which markets condoms and birth control pills.

As in other parts of the world, people cite trust as the major reason for not using condoms with regular partners, said PSI/Cambodia in a report called ‘Love, Sex and Condoms in the Time of HIV’, launched in the capital in mid-September.

“The higher the degree of affection that a relationship term implied, the less likely that condoms were used with that partner,” said the report by PSI, which held focus group discussions with female and male students, female garment workers, male motorbike and cyclo drivers, as well as direct and indirect sex workers.

“Since condom use is often associated with disease prevention and to some extent with sex work, condom use is less likely to occur within sweetheart relationships,” the PSI report pointed out.

In cases where condoms are used, one of the reasons cited by respondents is to prevent pregnancy, it added.

The PSI study highlights men’s belief that condom use is unnecessary with “good women”, who are assumed to be virgins and then faithful spouses or sweethearts.

The non-use of condoms is due in part to a perception of low risk on the part of men, the study said, adding: “Very few men appeared to be cognisant of the fact that they might be a source of infection for partners whom they care about.”

A government report on HIV/AIDS last year said most married women with HIV in fact got it from their husbands.

Nhean Sakhen, a social worker from the non-government organisation Bantey Srei in Siem Reap, recounts that in one of her discussions with married women in a remote district, the wives asked her to tell their husbands to use condoms when having sex with them.

She said the women were afraid to raise the subject with their husbands, who they knew were visiting brothels.

Sok Pun, HIV/AIDS Programme Manager for CARE Cambodia, said the rising trend of no-condom use in affectionate relationships needs to be addressed, but acknowledged it was not easy.

“It is difficult to make interventions because we cannot just say ‘do not trust your partner’,” he said in an interview in the capital Phnom Penh.

But the doctor says that behavioural change is imperative if Cambodia hopes to win its battle against the disease from which 12,000 Cambodians have died as of 2001.

“HIV/AIDS is dynamic. Without effective interventions we will lag behind the epidemic. We have to move faster than the epidemic,” he said.