HEALTH: Cambodia Shows Gains in War on HIV/AIDS – Experts

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

BANGKOK, Jul 15 2002 (IPS) - Cambodia’s healthy approach to combating the spread of HIV/AIDS has been identified as an example of a poverty-stricken nation that can stare the killer epidemic in the face — with the hope of actually winning over it one day.

Central to Cambodia’s progress in lowering the rate of HIV prevalence has been the government’s will to pursue across the board measures, targeting programmes in groups from the defence sector to ordinary people, and including local communities in strategies to combat the pandemic.

The country’s national strategic plan for AIDS is “something based on solid evidence,” says Anthony Lisle, head of the South-East Asia division of the Joint United Nations Programme on HIV/AIDS (UNAIDS). This, in turn, “has made it credible for donors to fund HIV/AIDS-related programmes” that benefit the country.

Another enlightened feature, according to Lisle, is Phnom Penh’s creation of the National Aids Authority (NAA) in 1999. This body has been working with many sectors of the government and civil society than before, when only the health ministry was involved in fighting HIV/AIDS.

“The nature of the epidemic is such that it is essential to have a multi-sector approach for success,” says Paul Cawthorne, who heads the Thai division of the medical aid agency Doctors Without Borders (MSF, for Medecins Sans Frontieres). “HIV/AIDS is not an issue for only the health ministry.”

Early this month, UNAIDS drew attention to this Cambodian feat in its annual global report on the epidemic. “HIV/AIDS has now been mainstreamed into the strategic plans of several ministries, including the ministry of national defence,” it states.

“This allows Cambodia to expand successful projects nationally and to tackle outstanding issues such as blood safety, which remains a major concern,” it adds.

According to 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 as a result of a broad national response, including “a 100 percent condom use programme and steps to counter stigma”.

By the end of 2001, this country of 13.4 million people had 170,000 Cambodians between 15 to 49 living with HIV, down from the 210,000 in 1997.

The World Health Organisation (WHO) points to other encouraging indicators: drops in HIV prevalence among pregnant women and sex workers since HIV/AIDS was first detected in Cambodia in 1991.

Infection rates among sex workers has gone down from 41 percent in 1998 to 23 percent in 2001, WHO reports.

According to Lisle and Cawthorne, Cambodia’s push to decentralise its HIV/AIDS campaign has also helped, because it has made local governments and communities take on greater responsibility and participate fully in prevention and caring efforts.

“Grassroots measures matter,” Cawthorne asserts. “Cambodia’s efforts strengthen the case that unless you get communities actively involved, you will lose the battle against AIDS.”

This month, the United Nations Development Programme (UNDP) declared in a report on Cambodia that the efforts of this South-east Asian nation may very well see it achieving the goal of “halting and beginning to reverse the spread of HIV/AIDS by 2015”.

“Cambodia is characterised by a good level of awareness of the HIV/AIDS epidemic,” states the UNDP’s ‘Cambodia Human Development Report’ released last week in Phnom Penh.

This is reflected in a survey of women between 15 to 19 years and 30 to 39 years. Among the youth, some 71 percent said they were aware of ways to avoid HIV, the virus that causes AIDS. The remaining 22 percent admitted knowing about the killer disease but not being aware of preventive measures.

Among older women, the percentages were as impressive: 75 percent say they knew how to avoid HIV, while 20 percent said they knew about it but unaware of preventive measures.

Likewise, according to the UNDP report, efforts are growing to finally give voice and visibility to those people living with HIV/AIDS. Support groups “run by and for people living with HIV have played an important part in establishing opportunities for advocacy,” it states.

For instance, different groups teamed up to form Cambodia’s first network of people with HIV. “The member groups and organisations that currently make up the network have a total membership of approximately 800 people,” the report points out.

Such recognition and mutual support is a significant step in helping to secure the rights of people living with HIV, says Jon Ungphakorn, a Thai senator who is secretary of the Bangkok-based AIDS Access Foundation. “Communities need to see people living with HIV/AIDS as people. Involving them in all programmes matter for any successful drive against the disease.”

However, as he observes, countries like Cambodia cannot avoid facing the crunch in battling the epidemic – access to anti-retroviral drugs for patients with HIV. “It is here that resource poor countries suffer, despite reducing the spread of HIV through preventive programmes,” Ungpakorn adds.

Cambodia is still in search of answers to secure the affordable cocktail of anti-AIDS drugs. Approaching UNAIDS is one route the Cambodians are contemplating, so they can get the drugs through the U.N. agency’s initiative to provide cheaper access to anti-retrovirals.

But that is not all of why this country, devastated by two decades of war, cannot be complacent in its new battle to protect its people from the pandemic.

As the UNDP report states, “Tens of thousands have already died from the disease, and an estimated 200,000 people, including children, will develop AIDS within the next five to 10 years.”