Introduction
Key Issues
Recommendations
Introduction
Since HIV was first detected in 1991 and the first cases of AIDS were diagnosed in 1993, the epidemic has spread rapidly and the national prevalence of HIV in Cambodia is the highest in Asia, affecting all regions in Cambodia and all sectors of the population. As of 2000:
- There are approximately 169,000 adults living with HIV/AIDS in Cambodia, 2.8% of the population aged 15-49 years. Many HIV positive people are unaware of their HIV status.
- There were an estimated 49,228 new HIV infections in 2000, mainly through heterosexual transmission.
- The ratio of male to female infection is estimated at about 2:1. However, recent research suggests this gap is narrowing as more women become infected.
- There were an estimated 13,243 new AIDS cases in 2000 and an estimated 20 from AIDS everyday.
- An estimated 12,000 People Living with HIV/AIDS (PLHA) sought care and support in 2000, in a health care system with a total of 8, 500 beds for all medical conditions.
- The number of AIDS orphans continues to rise. The number of children infected with HIV through parent-child transmission is also rising as more women are infected.
The rapid spread of the epidemic is impacting on individuals, families, children and communities who are largely ill-prepared and lacking in resources to respond to the situation.
Many people cannot afford medical care, even where this is available. Health-related household expenditure, without HIV/AIDS present, is already about a quarter of total household expenditure, with the poorest families spending the highest proportion of their household income on health. Health services remain inaccessible to a large proportion of the population, especially in rural areas.
The biggest burden of AIDS is on the household. Many households affected by HIV/AIDS face extreme economic, social, and psychological difficulties in responding to HIV/AIDS. Stigma and fear persist at household and community levels, often due to a lack of basic information, leading to a breakdown in relationships and functions within families and communities.
AIDS impacts heavily on economically active members of society. Infected persons become physically weak. Other economically active family members are required to give up or reduce work in order to provide care or are unable to continue working due to social discrimination and fear in the wider community.
Government agencies mandated to provide the basic medical and social services necessary to respond to the epidemic and related problems such as tuberculosis, face acute shortages of skilled staff, facilities and materials.
Key Issues
The government has responded to the HIV/AIDS epidemic with the formulation of a National AIDS program, the creation of structures at national and provincial levels, the adoption of a multi-sectoral approach and the promulgation of laws and policies related to HIV/AIDS. There are many local, national and international NGOs engaged in HIV/AIDS work, coordinated through the HIV/AIDS Coordinating Committee since 1993. There is close cooperation between government and non-government responses. Issues include:
- Weak/poor implementation of law and policy - The legal status of sex workers and their rights to protection from exploitation and trafficking are somewhat unclear. Some laws exist but are not enforced.
- Responding to increasing demand for care and support for PLHA, their families and care givers, particularly for the poorest or destitute - Government, NGO and joint government-NGO initiatives are providing institutional and homebased care and support services. A number of local rural NGOs are responding to their needs by integrating care and support initiatives into their prevention programs. Scaling up of these programs and support responses, particularly in rural areas, remains a key issue.
- Attention and resources for children affected by AIDS - There is an increasing amount of NGO activity aimed at addressing the needs of children affected by AIDS. Again, scaling up the coverage remains a key issue.
- Integration of multi-disciplinary responses in formulating and implementing HIV/AIDS programs - Increasingly, NGOs are seeking to maximize the impact of their programs by linking HIV/AIDS programs with other community development initiatives. There remains a need to share lessons from these initiatives in order to build NGO capacity for integrated programming.
- Involvement of PLHA in policy and planning - There are now three active organizations of PLHA providing effective advocacy and involvement in prevention and care work, developed through the active support of the national and international NGO communities. These networks are largely focused in Phnom Penh. They are already proving an important resource for other agencies seeking to extend PLHA networks and organizations elsewhere.
- Shifting the focus of care, particularly in regard to the human rights dimensions of care, in response to increasing numbers of people living with AIDS - The increasing visibility of the epidemic is a key factor in developing appropriate care and support responses. At village level, local NGOs find an increasing awareness of the importance of community mobilization to tackle issues such as discrimination and mobilize available resources. Reform and improvement of health services continue, but the number of PLHA able to access medical services remains a key issue. Trials of anti-retroviral drugs are currently underway and will guide the writing of a national protocol for
anti-retrovirals.
Recommendations
Progress is being made on key aspects of HIV/AIDS programming. However, given the continued epidemic and increasing numbers of people affected by HIV/AIDS, NGOs impress upon the RGC and donors, the continuing and urgent need for expanding and upgrading HIV/AIDS programming. When formulating and undertaking programs in the future, consideration should include the need:
- For scaling up responses that address the needs of the most vulnerable populations, including women and children affected by AIDS
- For scaling up responses that extend coverage in rural areas
- For scaling up involvement of PLHA in advocacy and HIV/AIDS policy formulation and programming
- For building on lessons learned about mobilizing community level responses to HIV/AIDS
- To integrate HIV/AIDS prevention with care and support and to integrate HIV/AIDS programming into other development initiatives, including economic and human rights focused work
- To continue to balance HIV/AIDS care services with services for other chronic diseases, given the limited resources available and the need to place HIV/AIDS work in the overall context of efforts to promote access and quality of health care for the poor
- To continue to monitor and advocate for effective responses to the exploitation of PLHA by sellers of expensive and ineffective or harmful 'cures' and inadequate regimens of anti-retroviral drugs
- To continue to focus on developing processes and mechanisms for coordinating activities and ensuring the sharing of lessons learned
- To continue to focus on effective monitoring systems to ensure that resources are used efficiently and effectively to reduce the spread of HIV/AIDS and mitigate the impact of HIV/AIDS
For more information on the issues raised in this paper, please contact:
The HIV/AIDS Coordination Committee, Tel: 023 217 964, Email: HACC_ES@bigpond.com.kh |
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