International Federation of Red Cross and Red Cresent Societies - 9 July 2004
Hout Cheng Chhay, Cambodian Red Cross and Rosemarie North in Phnom Penh

What kept her going was the thought of what would happen to her five children, the youngest of whom is four years old, and the two children she took in after two of her brothers died of AIDS.

"I was very angry with my husband because he transmitted HIV to me," says Hour Sina, 42, who lives in Cambodia's Kampong Cham province. "I wanted to jump into the river to drown myself but I did not because my children are still so young."

Now Hour Sina is not strong enough to work so hard in her noodle stand, an essential part of her family's income. And she is resentful that she didn't have any power to protect herself from HIV, which affects 2.6 per cent of people aged 15-49 in Cambodia, the highest rate in the Asia-Pacific region.

She says she used to give Ros Sophat, her policeman husband, money to go out with his colleagues to eat, drink alcohol and have sex in brothels. If she refused, he would hit her, she says.

In a frightening trend, monogamous women like Hour Sina have become one of the most at-risk groups in Cambodia, says Dr Tia Phalla, secretary-general of the National AIDS Authority of Cambodia.

"We have an average of 20 new infections daily but out of them, seven housewives get infected and seven babies get infected. That's a pity, a very sad story," he says.

Mobile groups like the police can act as a bridge to move HIV/AIDS from high risk groups like sex workers to broader sections of the population, including married women and children, producing a more generalised epidemic.

"Often when policemen are away from home they like to engage in high-risk activities including commercial sex, especially when they are drunk," says Captain Lim Sarun, deputy chief of the Kampung Cham Police Health Unit, and an HIV/AIDS peer trainer.

Many of the sex workers are young. By the time they have acquired the confidence to insist on clients using condoms, they may have already got HIV from a client.

The fact that HIV/AIDS is spreading from traditionally high-risk groups into the general population is one of the reasons why the Cambodian Red Cross has launched a peer education programme with police.

In two- or five-day training sessions, the police learn the facts about HIV/AIDS and how it is transmitted; they consider their own behaviour and options, resisting peer pressure to go out partying with their colleagues; they are introduced to gender awareness and goal setting.

So far about 2,100 of Kampung Cham's 3,800 policemen have been through the programme. The province is Cambodia's largest, with 1.7 million people, and one of seven provinces to have had the programme since 1999.

The programme is funded by the Australian and Swedish Red Cross Societies, the OPEC Fund for International Development, FHI Impact, the Policy Project and the Global Fund to Fight AIDS, TB and Malaria.

The male-dominated nature of Cambodian society contributes to the spread of HIV, says V.A. Sopheak, deputy HIV/AIDS programme manager in the Cambodian Red Cross.

"We can see very clearly in Cambodia that men are dominant over women. So it's about gender imbalance," he says. "Men have a lot of power. Men have the right to go out and have sex, to have extra partners, whereas women normally have to listen to their husbands, be quiet, and accept their husbands' behaviour."

The consequence is that women don't know how to protect themselves from HIV, and often don't have the power to insist on their husbands' wearing a condom. The Cambodian Red Cross training addresses this by asking policemen to put themselves in their wives' shoes - what kind of treatment would they like?

An evaluation found the peer education and life skills programme was a unique approach that worked well with the hierarchy of the police and that had the support of all stakeholders. The programme had resulted in a substantial shift in police attitudes and behaviour, the evaluation found.

Kampung Cham deputy commissioner Nuon Samin says he's seen policemen change after the training. "Those who have attended training and obtained knowledge of HIV, they have better behaviour than the others and better health. They become better police. They become role models."

Phan Sophy, whose husband is a police inspector, remembers the exact date he went on the Red Cross peer education course - it was March 11, 2003. She knows the date because his behaviour changed so radically afterwards, she says.

Before his five-day training to become a peer educator, Sam Nal would often go out to bars and brothels. When he came home late, the fence to his home would be shut, indicating his wife's displeasure. That was all the power she had to influence his behaviour.

"What could I do? If he didn't think it about it himself, what could I do?" says Phan Sophy.

Sam Nal's lifestyle meant he didn't have much time or energy to help at home with their three children and the 15-20 pigs that supplemented his police income of $US20 a month.

After the Red Cross course, Sam Nal stopped drinking and started to do some more household chores. Now he comes home at lunchtime to feed the pigs, says his smiling wife, and thanks to his savings, the family's pig herd has expanded to more than 100, a tangible sign of Sam Nal's commitment to his family's future and to his responsibilities.

"Before the course I usually went out every night drinking with my work colleagues, singing karaoke and sometimes going to have sex with sex workers. After the course I was really afraid of getting HIV/AIDS so I had to change my behaviour. Now I leave the office and immediately go home to help with household chores. My wife is happy and life is easier."
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