Cambodia
HIV/AIDS profile
Cambodia has a population of more than 14 million, composed mostly of ethnic Khmer, who are involved in complex relationships with large populations of Thai and Vietnamese on either side of their country. After 20 years of internal conflict, Cambodia is faced with significant and ongoing development challenges. These challenges include a lack of skilled human resources and infrastructure, as well as rampant poverty. Persistent poverty and political turmoil have led to a weak health infrastructure badly in need of rehabilitation. The 2005 per capita expenditure on health was only US$ 30 with almost 80% of the population living on less than US$ 2 a day.
As a result, there is a limited capacity to cope with the added burden of HIV/AIDS. Despite the fact that the capacity and skill level of the health sector has significantly improved in recent years, the annual HIV/AIDS budget remains underfunded. Estimates of the impact of HIV/AIDS on the country's economy range from US$2 billion to US$3 billion by 2006, an amount that cannot be met by current budget allocation. In 2006, it was estimated that government expenditure from domestic sources was just over one million US dollars.
From 1991, when the first case of HIV infection was reported, to 1997, Cambodia experienced rapid spread of HIV. After peaking at 3% in 1997, national adult HIV prevalence in Cambodia fell by one third, to 1.9% in 2003. The reasons for this are twofold: increasing mortality and a decline in HIV incidence which, according to recent estimations, fell steeply between 1994 and 1998, before stabilizing. A closer examination of HIV incidence among sex workers shows that the rates of new infections among both brothel-based and non-brothel-based sex workers decreased by half between 1999 and 2002, and HIV prevalence among the former dropped from 43% in 1998 to 21% in 2003. Condom use among sex workers has been steadily increasing since the 1990s. In 2003, 80% of sex workers said that they consistently used condoms during commercial sex in the previous three months, as did their clients.
Contributing factors to this success in addressing HIV/AIDS include political commitment, a strong response from civil society and a wide range of activities by the Ministry of Health, including the 100% condom use programme and comprehensive behaviour change activities. It is estimated that, to date, 60% of all sex workers and 97% of injecting drug users have been reached by prevention activities.
It is critical that efforts to address HIV/AIDS are sustained. Recent behavioural surveys show more men are now visiting sex workers. In 2001, an estimated 22–26% of moto-taxi drivers, and police and military personnel said they had paid for sex in the previous three months; two years later, more than 35% said they had bought sex.
There is also concern that the epidemic is shifting. Cambodia’s 2003 HIV Sentinel Surveillance reported that women now made up for increasing proportion of persons living with HIV. In 2005, UNAIDS reported that husband-to-wife infection is now the major mode of transmission and one third of all new HIV infections are from mother to child. Meanwhile, the rate of new infections among pregnant women nationally appears to have stabilized in recent years. There is one anomaly, however, that warrants concern. In the west of Cambodia (along the Thai border), HIV incidence among pregnant women has increased significantly (rising from 0.35% to 1.48% between 1999 and 2002); it is also the only region in the country where HIV incidence among sex workers has not declined (Saphonn et al., 2005).
Although the Government is in the process of undertaking health reform, including more efficient allocation of resources, general health status remains low. Sexually transmitted infections (STI) prevalence appears to be declining, but there is still a shortage of affordable and accessible STI drugs. The country’s voluntary counseling and testing (VCT) services remain limited outside of the capital Phnom Penh, blood safety remains a major concern and management of sexually transmitted infections requires expanded efforts. At present, the main mode of HIV transmission is through heterosexual intercourse and more research is needed to better understand sexual behaviour and sexual networks contributing to the epidemic in Cambodia.
Burden adult prevalence (age group 15-49) in Cambodia is 1.6% (2006). Due to the turbulent past of Cambodia, almost half the population is under the age of 25, including adolescents who are especially vulnerable to HIV infection. In addition, gender inequality and sexual violence are also shaping the epidemic and are particularly visible in Cambodia’s widespread sex industry. Increasing youth risk behaviour, drug use among youth and people in labor intensive activities, and increased internal migration all have the potential to become significant drivers of HIV infection in Cambodia.
AIDS has reduced life expectancy and increased infant and under-five mortality rates. As a result, population growth is projected to slow slightly. Family structure is also changing as more orphans and grandparents in families affected by HIV/AIDS head households. Many children have dropped out of school and have had to find work in order to support their families, while at the same time taking on additional household chores. Due to widespread gender inequality, girls are more vulnerable to these socio-economic impacts of HIV/AIDS than boys.
Knowledge of HIV transmission and prevention is improving, though misperceptions persist. Stigma and fear surrounding HIV/AIDS persist at household and community levels, often due to a lack of basic information. In particular, children affected by HIV/AIDS are exposed to high levels of stigma and psychosocial stress.
National Strategic Framework
The National Strategic Plan for a Comprehensive and Multisectoral Response to HIV/AIDS 2006-2010, or NSP-II, Builds on the first National Strategic Plan and includes specific objectives, strategies, and an operational plan with broad activities of all stakeholders, from government, the private sector and civil society.
The NSP-II has been developed through review and revision of the first NSP by the National AIDS Authority (NAA); supervised by a core group consisting of national stakeholders, development partners, civil society organisations and people affected by HIV/AIDS. The NAA is an interministerial body consisting of over 20 ministries, the Cambodian Red Cross and provincial governments. It is responsible for formulating and monitoring the national response to HIV/AIDS.
The overall goals of the National Strategic Plan 2006-2010 are:
- To reduce new infection of HIV;
- To provide care and support to people living with and infected by HIV/AIDS; and
- To alleviate the socio-economic and human impact of AIDS on the individual, family, community and society
National Strategic Plan (2006-2010) strategies are:
- Increase coverage of effective prevention interventions and additional interventions developed.
- Increase coverage of effective interventions for comprehensive care and support and additional interventions developed.
- Increase coverage of effective interventions for impact mitigation and additional interventions developed.
- Effective leadership by government and non-government sectors for implementation of the response to HIV/AIDS, at central and local levels.
- A supportive legal and public policy environment for the HIV/AIDS response.
- Increase availability of information for policy makers and programme planners through monitoring, evaluation and research.
- Increase sustainable and equitably allocated resources for the national response.
The information presented in the HIV/AIDS country watch originates from the web site of the Joint United Nations Programme on AIDS (UNAIDS) – www.unaids.org (November 2006).
For more information visit:
http://portal.unesco.org/en/... (Cambodia country office link)
