CAMBODIA:Free condoms and low-cost generic drugs are helping to reduce the rate of new Aids infections in Cambodia, writes Rory Byrne
On the face of it, Cambodia - war-ravaged, impoverished, awash with hard drugs and teeming with brothels - should be decimated by Aids. Yet surprisingly, the rate of new Aids infections in Cambodia continues to drop steadily. The reason: condoms.
The Cambodian government, in conjunction with several international Aids charities, has spent millions of dollars distributing free condoms to brothels and health clinics throughout the country. In addition, a grassroots education campaign continues to drive home the message that unprotected sex kills.
Health clinics lack modern medical equipment, but they all have phalluses to show visitors how to use condoms. Billboards and posters promoting condoms can be seen in every town and village while brothels are encouraged to host regular discussion groups promoting condom use among their workers.
The growing availability of cheap, generic anti-retroviral drugs to treat the disease has also been key in helping to contain the pandemic.
The government's anti-Aids campaign, coupled with a savage rate of natural attrition in the years before cheap treatment became available, has seen Aids infections among sex workers fall from over 40 per cent in 1997 to about 22 per cent today. Among the general population the infection rate has fallen from 3 per cent to 1.6 per cent over the same period.
"I think it is an achievement. Treatment but also prevention has caused this," said Prof Hoot Eng, Cambodia's secretary of state for health.
However, despite the apparent success of the safe sex campaign, most experts continue to urge caution. "We have success but it can change at any time," said Jane Battle of UNAids, citing Uganda, where after positive reports, the rate of HIV/Aids infections is now increasing rapidly.
This sentiment is shared by health consultant David Wilkinson, who co-authored UNAids 2006 report, Turning the Tide: Cambodia's Response to HIV/Aids 1991-2005.
The problem of Aids will dissipate only when "the deep-rooted sources of risky sexual behaviour" are tackled, he said.
"It seems acceptable behaviour [ in Cambodia] to visit brothels and sex workers. Even within marital relationships men will seek commercial sex. I would define the highest-risk groups as wives and children. The husband transmits the virus to the wife and then it travels from mother to child. This is a critical issue in prevention," he said.
Chan Dina, head of the Cambodian Prostitutes' Union, estimated that about half of the sex workers in the poorest slum areas are informed about safe sex practices.
"In my area in Toul Kok [ a slum about 12km from Phnom Penh] there are 200 sex workers and about 60 have HIV/Aids; six have died from Aids this year," she said.
"The problem now with sex workers is the increasing number of drug users who are taking yama and ice [ forms of metamphetine]. It's difficult to teach them about HIV/Aids because they just don't care."
An epidemic of gang rape, known in Cambodia by the common term bauk, is also causing concern.
A recent study found that 59 per cent of secondary school students know somebody that had been involved in a gang rape.
"This figure - more than half - is extremely worrying, extremely disturbing and doesn't bode well for the future pattern of the epidemic," said Wilkinson.
Yet despite these concerns, analysts agree that Cambodia's vigorous promotion of condoms has saved thousands of lives. "Cambodia is a low-income country in a state of recent post-conflict. Its achievements should be acknowledged and applauded," said Wilkinson.
"But the caveat is that success must be maintained and this emerges as a donor and funding issue. If things look too rosy there's a danger that donors would reduce levels of funding," he warned.