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FEATURE |
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| Condom use in brothels nips
Cambodia HIV prevalence rates |
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| Phnom Penh, Cambodia -- Although Cambodia
has the highest HIV/AIDS infection rate in Asia, the impoverished
nation is making major inroads in its war against the epidemic. |
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| According to UNAIDS, 160,000 people between 15
and 49 have HIV in a population of only 12 million. AIDS related
diseases have already killed 80,000, primarily from heterosexual
sex, and the government expects the death toll to reach 230,000
by 2010. There are also more than 50,000 AIDS orphans. |
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| "Almost everyone knows someone diagnosed
with AIDS," said the Rev. James Noonan, a Maryknoll priest
who has headed the Seedling of Hope HIV/AIDS program in Phnom
Penh for eight years. |
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| But despite such grim statistics, the prevalence
rate of HIV cases among adult Cambodians has dropped from more
than 4 percent in 1999 to 2.6 percent at the end of 2002, due
to a multifaceted campaign by the Cambodian government, the
United Nations and several nongovernmental organisations. |
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| Tia Phalia, secretary-general of the government's
National AIDS Authority, says the number of new HIV infections
among Cambodians has dropped from 110 a day in 1994 to 20 a
day in 2002. |
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| "With recovering health and education systems,
the last thing I would expect to see is a falling prevalence
rate," said Geoff Manthey, who until recently was the UNAIDS
Program Adviser in Cambodia. |
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| At the heart of the success is the government's
decision to order all brothels, which are legal in Cambodia,
to require sex workers to insist on the use of condoms. The
most common method of transmission of HIV in Cambodia is through
males who have unprotected sex with sex workers and then bring
it home to their wives, who in turn pass it to their newborn
children during childbirth. |
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| The 100 percent condom law is aimed at female
sex workers, who have the nation's highest HIV/AIDS prevalence
rate -- more than 40 percent, according to UNAIDS. |
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| "The only choice for many girls is to become
a sex worker. They are then heavily exploited and don't know
much about HIV," said Hor Bun-leng, Deputy Director of
the National Center for HIV/AIDS, Dermatology and STDs. "If
a girl will not use condoms, she no longer works. If a brothel
does not apply the rule, we close it down." |
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| In November, Phnom Penh officials ordered all
brothels closed to prevent the spread of AIDS during the annual
three-day Water Festival that marks the end of the rainy season. |
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| The government has also targeted pregnant women,
providing treatment so they don't pass the disease to their
babies, and police officers, whose prevalence rates fell from
8 percent in 1995 to 3 percent in 2000. Many police officers
frequent brothels. |
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| The annual budget of just $15 million a year
to fight the epidemic has been spent primarily on condom distribution,
sex education, blood tests, patient care and a government programme
to employ young women in garment factories. "The factories
here are a good alternative to brothels," said Manthey. |
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| But while neighboring countries such as Thailand
have a much larger budget to deal with the AIDS epidemic, Cambodia
has a more daunting task because of its extreme poverty. |
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| Cambodia is still recovering from the damage
the Khmer Rouge did in the 1970s -- the Maoist rebels killed
as many as 2 million people and destroyed the nation's health
and education systems. |
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| Today, Cambodians earn an average annual per
capita income of just $260, compared with $2,010 in Thailand.
Only a few hundred can afford the drugs needed to keep the virus
in check, and there are not enough hospital beds for those with
AIDS. "Poverty limits a population's access to education,"
said Hor Bun-leng. |
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| In addition, health workers concede that they
have made little headway with Cambodia's teenage males in a
nation where 55 percent of the population is under 20. "I
think we are still playing catch-up with the younger (male)
generation," Manthey said. "We are still battling
against a sense of invincibility and misconceptions. For instance,
some believe that if you have sex with a virgin, you will be
cured of the (HIV) infection." |
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| Most health observers agree that the nation's
weak economy and lack of infrastructure must be addressed before
the government can further curb the epidemic. "Poverty
drives HIV, and HIV drives poverty, like a cycle," said
Hor Bun- leng. |
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| This article is part of the series, AIDS
in Asia; and has been republished with permission from the San
Francisco Chronicle Press. |
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