Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
UN Integrated Regional Information System - November 11, 2008
"I think it's pretty common. A lot of men I know do this in secret without their wives knowing," he told IRIN/PlusNews. When asked about using condoms during sex, he said, "Sometimes, but never with my wife."
After police cracked down on the brothels he visited, Lux turned to the streets, taking nightly strolls through Hun Sen Park, where he pays transsexuals for sex at least once a month.
"Sometimes I get regular women, and sometimes I hire lady-boys," he said. He has never been tested for HIV and does not think it an issue, given Cambodia's falling HIV rate.
HIV prevalence dropped to just 0.9 percent in 2006 from 3.7 percent in 1997. But among men who have sex with men (MSMs), the rate remained an uncomfortably high 5.1 percent nationally, and 8.7 percent in Phnom Penh in 2006, the most recent year for which UNAIDS data is available.
Advocacy groups warn that the lack of outreach programmes to educate MSM about HIV risks could undo the progress that Cambodia as a whole has achieved.
"There are underestimated contributions of MSM to the overall environment of HIV," Tony Lisle, UNAIDS Cambodia country coordinator, told IRIN/PlusNews. "The HIV epidemic has been largely ignored among MSM."
Cambodian MSM see themselves as belonging to two distinct groups, which complicates outreach efforts. They define themselves as either "short-haired" - masculine-acting MSM who tend to have sex with each other - or "long-haired", transgender MSM, whose sexual partners can be from either group.
Half of long-haired MSM and 38 percent of short-haired MSM reported having unprotected sex in the past month, according to a UNAIDS survey in 2006. "We need to achieve an 80 percent condom-use rate to have an impact," Lisle noted.
Hidden MSMs
Long-haired MSMs had double the number of sexual partners as short-haired men (5.7 male partners in a month compared to 2.9 partners for short-haired MSM), and were far more likely to have sold sex (60 percent to 36 percent of short-haired men).
"These hidden MSM are difficult to reach because they're not self-identifying," Lisle said. "Many also engage in unsafe behaviours, like injecting drugs."
Lux does not consider himself homosexual, or at a heightened risk of HIV. "I'm not a gay person. I just do this for pleasure, like a lot of men," he told IRIN/PlusNews. "From the TV programmes I've seen that are run by NGOs, I think gay people spread AIDS, but not people who just do this on the side."
Makara, a male sex worker, is aware of the HIV risk and wears a condom, but does not panic if his condom breaks. "If it breaks for a second, that's fine," he said. "I just get a new one. I don't worry about HIV for that short amount of time it breaks."
Over a three-month period in 2006, according to UNAIDS, 20 percent of long-haired MSM who engaged in risky behaviour reported condom breakage, but nearly half said they had obtained their most recent condom from an NGO, showing that targeted prevention efforts have been making headway.
"If NGOs can get more prevention services to this vulnerable group, we could maintain the great progress we've seen for the last five years," Lisle said.
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