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Cambodia has a population of 12 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. The recent history of the country has been marked by civil war and only in the last few years has a fragile parliamentary democracy emerged at the national level.

Cambodia is rebuilding after 20 years of internal conflict and 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. As a result, health and community services are having to working hard 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, 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 the current budget allocation.

From 1991, when the first case of HIV infection was reported, to 1998, Cambodia experienced rapid spread of HIV. However, over the last few years, sustained decreases in adult prevalence rates from over 4% to 2.6% provide hope for the future. Contributing factors to the 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.

Although the Government is in the process of undertaking health reform, including more efficient allocation of resources, 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 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 contributing to the epidemic in Cambodia.

Burden adult prevalence (age group 15-49) in Cambodia is 2.6% (2002). Due to the turbulent past of Cambodia, almost half the population is under the age of 20, 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.

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

A national strategic framework to address HIV/AIDS has been completed for the period 2001-2005. Priority action areas include programmes to: reduce vulnerability to HIV/AIDS; strengthen care services; strengthen institutional structures, processes and mechanisms; and implement the AIDS Law. A key partnership in addressing the HIV/AIDS epidemic is the National AIDS Authority (NAA). 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.

Implementation work plans have been developed for both the NAA Secretariat and the larger NAA partnership. Sectoral plans and some provincial plans have also been developed. These work plans have been costed and will be implemented nationwide. In addition, a multisectoral thematic working group on monitoring, evaluation and reporting is in the process of being established. A framework for this has already been drafted, which is linked to the UNGASS-AIDS Declaration.

National policies and strategies have been developed and the AIDS Law has been passed by the National Assembly. The Prime Minister reiterated a strong commitment to the fight against HIV/AIDS during the closing ceremony of the 2nd National AIDS Conference, October 2002.

Government departments have been encouraged to fund HIV prevention activities from their regular budgets but with limited success to date. World Bank loans to support the response to HIV/AIDS at a national level have been made available through the Ministry of Health.