InterPress News Service (IPS); Saturday, 27 July 1996.
Andrew Nette

Since screening for the disease began in 1991, detected cases of the AIDS-causing Human Immunodeficiency Virus (HIV), have increased alarmingly.

Figures released in June by the World Health Organisation (WHO), estimate that there are now between 100,000-150,000 HIV cases nationwide in Cambodia, up from an estimate of around 50,000- 90,000 issued by the organisation last November.

In addition, WHO says the country now has around 2,000 full- blown AIDS cases, and maintains that by the turn of the century there will be 40,000, with up to 12,000 new cases every year.

Among blood donors in Phnom Penh, HIV infection rates increased more than seven-fold between 1992 and 1994.

A sampling of sex workers from around the country tested in 1995 found infection rates of 38 per cent. Testing of military recruits in two provinces last year revealed that 8.5 per cent had the virus.

All observers agree that the disease is spreading faster in Cambodia than in any other nation in Asia, with the exception of Burma (also known as Myanmar) and India.

"If they (Phnom Penh authorities) are not careful they will have a situation equal to the devastation caused by Pol Pot on their hands," says Graham Miller, the country programme director for Care International -- a non-governmental organisation (NGO) which has conducted a number of important studies on the issue.

Pol Pot is the Khmer Rouge guerrilla leader who overran the nation in a reign of terror that lasted almost four years, starting in 1975.

He forcibly evacuated all cities in a single day, abolished money, religion, property rights, traditional marriage, books, and music. He also sealed Cambodia off from the rest of the world by mining its borders, slashing its phone and telex lines, banishing foreigners and cutting trade.

Survivors said torture or death was meted out for even minor infractions, such as taking a banana to survive starvation. Because bullets were too expensive, many were executed by having their heads hacked off.

By 1979, when Vietnamese troops invaded the tiny South-east Asian nation and occupied it for 10 years, toppling the Khmer Rouge guerrilla leader, an estimated two million Cambodians had been killed. Pol Pot escaped into the hills and continues to lead the weakened, but still destructive guerrilla force.

Compounding the problem is endemic poverty, an explosive growth in the sex industry and low rates of condom use.

"They (the Khmer government) realise that AIDS is a huge problem and they genuinely want to tackle it, but they have been constrained by the country's poor socio-economic situation," says Miller.

"Of course combating AIDS is a priority for our country. But look around you - we have so many priorities," says Dr Hong Song Huot, Secretary General of the Cambodian Red Cross, one of several Khmer organisations working to prevent the spread of disease.

The truth behind Dr Huot's words is revealed by just taking a 30 minute drive from central Phnom Penh. From lines of glittering hotels and karaoke bars, the scenery quickly transforms into a landscape of shanty towns, with no electricity or access to clean water.

Malnutrition, malaria, tuberculosis and regular epidemics of diseases such as dengue fever and cholera are rife. The country has some of the highest rates of maternal and child mortality in the world. Even relatively simple health problems which have been eliminated in most parts of the world, like polio, are widespread.

After decades of devastating war within and outside its borders, Cambodia is still paralysed by the ongoing Khmer Rouge insurgency, which although severely weakened, continues to extract a huge financial and moral drain on the people.

The unstable security situation renders large parts of the country inaccessible to anti-HIV/AIDS interventions. The health system is stretched to deal with the casualties caused by the prolific use of landmines.

Blood screening capacity is low, and counselling and support services for those found with the disease are scarce. There is also widespread denial and ignorance regarding the disease.

Indeed, the extent of the epidemic is matched only by widespread lack of awareness about it. Surveys carried out by international NGOs have revealed beliefs such as using condoms is bad for your health, and the conviction on the part of some men that the disease can be removed or 'passed on' by sleeping with another person preferably a virgin.

There is a strong belief that AIDS can be cured through traditional Khmer medicines, and the country's TV and newspapers regularly run advertisements touting miracle cures for the disease.

"There is also feeling that AIDS is an offshoot of syphilis, and that traditional ways of treating STDs (sexually transmitted diseases) will get rid of the disease," says John Vijghen, a social researcher involved in the anti-AIDS campaign.

According to Vijghen, the vulnerable position of females in Cambodian society has also bred a fatalistic attitude on the part of women towards the disease.

"Many women know about AIDS, but in many cases they accept it as apart of life. The low status of women reduces their ability to force their partners to adopt safe behaviour and use condoms," he observes.

But while the situation is serious, there has been a growing concern about the spread of the disease at the official level, dating back to the creation of a National Aids Committee in 1992.

The Committee includes representatives from ministries involved in health, education, economics and agriculture, as well as the governors of each of the country's provinces, in recognition of what Dr Tea Phalla, Manager of the National Aids Programme, calls "the need for a multi-sectoral approach".

The Committee has formulated a national AIDS policy, overseeing the implementation of pilot projects for peer education among commercial sex workers, condom distribution and the production of media materials and videos.

"So far, most of our activities have been limited to Phnom Penh because of the political instability in the rest of the country," says Phalla, "but we plan to start moving out into the rural areas."

These efforts have been helped by the fact that there is now a firm recognition among high level members of the government regarding the extent of the disease and the need for effective responses.

Although supportive of the government's efforts, some foreign NGO workers have criticised what they believe is their emphasis on so- called 'high risk groups' such as sex workers.

"A lot of the work that has been done to date has been targeted at sex workers," argues Inkhiane Desvongsa, as Australian Red Cross delegate working on HIV/AIDS in Phnom Penh. "This type of stuff is totally unsuitable for the general public. It also ignores the more important issue of the behaviour of men."

Although he agrees that "the number one means of transmission of the disease is the irresponsible sexual activity of Cambodian men, particularly their low awareness of the importance of condom use", Phalla stresses the need to work closely with commercial sex workers."We have limited funds and we need to direct them into areas where we can have a definite impact." (END/IPS/AP-HE-PR/AN/CPG/96)

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