INTRODUCTION
Since HIV was first detected in 1991 and since the first cases of AIDS were diagnosed in late 1993, the HIV/AIDS epidemic has grown so rapidly in Cambodia that its rate of growth is now said to be the fastest in Asia. As of September 1999:
n An estimated 180,000 people have been infected although a big percentage of HIV positive persons are not aware of their infection.
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There are an estimated 100 new infections per day mainly through heterosexual trans- mission.
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The number of infected persons- representing 3.75% of the sexually active adult
population-15-49 years old-is the highest in the region.
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Although the ratio of male to female infection is thought to be 2 to 1, it is also estimated that the male to female ratio is narrowing as more women become infected.
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An estimated 60,000 people have AIDS and it is projected that there will be a rapid increase in the number of people with AIDS as the disease matures in those infected.
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Although AIDS deaths are not routinely reported due to the stigma attached to a diagnosis of and death due to AIDS, the crude mortality rate in one of the main government hospitals ranges from 30-35% every month.
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AIDS has orphaned many children. The number of infected children due to mother- child transmission is increasing. As of 1999, it has been estimated that about 5,000 children have died from AIDS.
The rapid spread of the epidemic is impacting families and communities who are largely ill prepared to handle the problem.
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Many families affected by HIV/AIDS have extreme difficulty coping with economic, psychological, and socio-cultural problems attendant to HIV/AIDS.
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Communities face disruption of community relations and functions due to a lack of basic knowledge and skills in dealing with the epidemic and the persistence of certain myths and biases about HIV/AIDS and people with HIV/AIDS.
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Society's labor resources are drained when infected persons become physically weak, and other economically active members of the family are required to give up
employment or work part time in order to care for the infected family member.
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Many areas of government, particularly agencies that are supposed to provide basic social services face severe shortages in skilled personnel, facilities and materials to deal with the epidemic and related problems such as tuberculosis.
KEY ISSUES
The Government has responded with the formulation of a National AIDS Program, the creation of structures like the National AIDS Authority and National and Provincial AIDS Committees, the adoption of a multi-sectoral approach to the problem, and the promulgation of laws and policies related to HlV/AlDS. There are also numerous international, national, and local NGOs engaged in HIV/AIDS work who established the HIV/AIDS
Coordinating Committee (HACC) in 1993. There is close cooperation between government and non-government agencies. There are however weaknesses and gaps in current responses. These include:
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Weak/poor implementation of law and policy;
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Given the increasing number of people with HIV/AIDs, there is still less attention and resources for medical, care, counseling and social services to people with HIV/AIDs and their families compared to
educational/preventive activities. This is especially true in relation to destitute/very poor families;
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Inadequate attention to and resources for HIV/AIDS programs in rural areas (resulting in increased stress on existing meager facilities and resources);
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Inadequate attention to and resources for addressing needs of women-headed house- holds resulting from HIV/AIDS;
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Inadequate attention to and resources for addressing needs of children affected by HIV/AIDS;
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Weak capacity to integrate multi-disciplinary responses in formulating and
implementing HIV/AIDS programs;
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Weak sensitisation and mobilisation of both electronic and print media, owners of media outlets continue to charge fees for public education programs of NGOs;
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Poor involvement of people with HIV/AIDS in policy and planning, in some cases it is absent; and there is no systematic attention or approach given to organizing people with HIV/AIDS and getting them involved in
preventive, care and advocacy work,
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The increasing number of people with AIDS, as distinct from people infected with HIV, is beginning to shift issues of care, particularly the human rights dimensions of HIV/AIDS more directly into the forefront of the HIV/AIDS response in Cambodia. This will continue as the disease matures in those infected. The UNAIDS Country profile points out that by the year 2000 there will be an annual demand for at least 12000 hospital beds for AIDS patients, increasing pressure on a health care system that currently provides a total of 8500 beds for all medical conditions.
RECOMMENDATIONS
In order to address the key issues, NGOs impress upon the Royal Government of Cambodia and donors the urgent need to upgrade and expand HIV/AIDS programs. Consideration in formulating and undertaking programs for the future should include the need:
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For more programs in rural areas and for women-headed households and children affected by HIV/AIDS
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To establish greater balance between preventive and care approaches and of the importance of linking and
coordinating these approaches
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To balance HIV/AIDS care services with services for other chronic diseases, given limited money available for health/medical services and to place HIV/AIDS work in the context of the overall improvement of efforts to promote health care for the poor
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To involve people with HIV/AIDS and increase efforts towards organising people with
HIV/AIDs
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To undertake monitoring and advocacy activities to stop exploitation of those with HIV/AIDS such as selling of expensive "cures" and inadequate regimen of anti-retroviral drugs
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To deal with the problems of stigma and discrimination not only in terms of
education but also as part of a general community building and human rights promotion approach
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To monitor programs to ensure that money and other resources are being used to answer needs of people with HIV/AIDs and their families.
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