Bati district, Takeo province – Kim Seak does not remember much about the place she used to call home, though she never forgot the way she was teased and shunned there by the healthier kids in her village.
Smaller than most children her age, the 5-year-old girl smiles, but her face is too honest—her black eyes show a solemn stare, the expression of someone who has experienced hardship beyond her years.
Kim Seak’s parents both died of HIV/AIDS, and now she, too, is infected.
The Joint UN Program on HIV/
AIDS and the World Health Organization estimate that between 7,300 and 14,000 children are infected with HIV/AIDS in Cambodia.
Up until a few years ago, sex workers had the highest rates of infection in the country. But 14 years after Cambodia’s first recorded case, the main route of transmission is now from men to their regular partners and their children, said Tia Phalla, secretary- general of the National AIDS Authority.
“It’s everywhere,” he said, “and it’s on everybody’s agenda.”
Currently, the government estimates there are 77,000 HIV/ AIDS orphans in Cambodia, Tia Phalla said. And, as stories like Kim Seak’s become unfortunately commonplace, government officials and NGOs are scrambling to build the safety nets necessary to catch the country’s newest and youngest HIV/AIDS victims.
Despite her tragic story, Kim Seak is one of the lucky ones. After losing both her mother and her father to the disease, she had a grandmother willing to take care of her in her village.
But as the discrimination became unbearable, Kim Seak’s grandmother brought her to Wat Opot in Sramouch He village, a haven for HIV/AIDS orphans and infected adults who are unable to support themselves, said Vandin San, co-founder and co-director of the village.
Located just off of Takeo province’s dusty National Route 2 in Chambok commune, it is home to 45 HIV/AIDS orphans and infected people and their children.
“When I stayed with my grandmother, I had no friends; now I have friends, and I’m happy,” Kim Seak said, standing outside the schoolhouse where she attends morning classes with 18 other orphans and children infected with the disease.
Kang Sorin, the teacher at the one-room school, says Kim Seak is one of her smartest students and one of the most resilient. “She can count, read and write,” the teacher said, “and she’s not afraid.”
Founded and directed by Cambodian Vandin San and US national Wayne Matthysse, Wat Opot is part of Partners in Compassion, an organization providing medical and social care to Takeo province’s poorest and most vulnerable victims of HIV/AIDS, Matthysse said.
With a school, dormitory, dining room, work-training facilities and even its own crematorium, the village serves as a transitional home for most who pass through its gates. Typically, children are placed with family members or foster parents who can meet standards set out by Partners in Compassion.
Most children live at the village for about a year, so that they can become healthy and “learn to be responsible for themselves,” Matthysse said. But for children who don’t have family members to care for them, the village becomes a permanent home.
Besides the village, the NGO provides home care to around 800 HIV/AIDS victims throughout the province. Patients receive schooling, free food and medication according to need. For adults and teenagers, job training and work projects are also available.
Chet Navy, 28, is one of the women who makes extra money weaving with the village’s silk looms. Sitting in the village weaving room, waiting for her 7-month-old daughter to fall asleep before beginning work, Chet Navy explained that she came to Wat Opot last year when she became pregnant and her boyfriend left her.
Most of the infected children at the village contracted HIV/AIDS from their mothers. Women dealing with HIV/AIDS often have a very different experience from men, said Chhim Sarath, program manager for the Khmer HIV/ AIDS NGO Alliance, one of Partners in Compassion’s largest donors.
In Cambodia, it is more difficult for AIDS programs to reach women, Chhim Sarath said. Campaigns often target populated areas and classrooms, and since men are more likely than women to travel to towns and cities, they tend to receive HIV/AIDS information, he said.
In addition, women are often excluded from campaigns on television, especially in rural areas, he said.
“The family might not try to let the women watch television,” said Chhim Sarath, noting that in villages where television sets are a luxury, a family might invite only neighborhood men to watch it.
Many girls also miss out on HIV/AIDS school campaigns because they often stop attending school at a younger age than boys, he added.
The increasing number of married women infected by unfaithful husbands makes this uneven playing field even worse, Chhim Sarath said. Women act as caretaker for their husbands, but when their husbands die, they are left without an income and without a caretaker for themselves, he added.
For Sau Nita, 13, and her sister, Sau Nika, 9, HIV/AIDS has been part of their lives for as long as they can remember. Their father died of of the disease in 1999, and their mother a year later.
Now Sau Nika is infected, too.
“If my younger sister dies, I am very scared that I will have nobody,” Sau Nita said.
When Partners in Compassion started in 2000, Sau Nita and Sau Nika were the first children to receive support from the organization.
“When we first picked up [Sau Nika], I didn’t expect her to live more than a few months,” said Matthysse, adding that at the time she was skinny, sickly and covered with sores.
Although the girls live with their grandmother, the NGO still provides the family with food and anti-retroviral drugs.
Kath Reth, the girls’ grandmother, says she always makes sure that Sau Nika makes it to her twice-monthly anti-retroviral treatments at Takeo provincial hospital.
When Sau Nika was first diagnosed with HIV/AIDS, she was allowed to play only with her cousins because her rashes, sores and flaky skin kept wary parents from letting their children play with the girl.
But Kath Reth hopes attitudes toward the disease are changing—if only slightly. Just a few years ago, when her daughter and son-in-law had HIV/AIDS, the couple could not even eat in local restaurants. Now, people in the village are better educated, she said.
“Most children play with her; parents will ask her not to play when she has scabs, but they don’t refuse,” the grandmother said.
All too typical in Cambodia, Kath Reth describes how her son-in-law caught the disease from prostitutes and infected his wife before he became sick. Sau Nika was born infected.
Until recently, NGOs and government efforts honed-in on specific populations, such as bar girls, prostitutes and sex workers. These efforts were successful, Tia Phalla said, but as the virus’ progress slowed down in targeted groups, new cases in married women and children started to increase, he said.
One solution may be organizations such as Partners in Compassion that imbed themselves in communities, offering a wide-range of support options or “decentralized care,” said Tia Phalla.
He sees this approach as the future of HIV/AIDS prevention and treatment. The NGO’s attentiveness to children, adults and the community, creates “participation, care and empowerment,” Tia Phalla said. Unlike centralized care that concentrates on reducing infection in high-risk populations, decentralized care focuses on the entire community, he said.
“Some [organizations] that are interested in care and support aren’t interested in prevention,” Tia Phalla said.
In a country with more than 150 NGOs involved with HIV/AIDS, both Tia Phalla and Chhim Sarath encourage more organizations to follow the decentralized model to create comprehensive, community-based HIV/AIDS programs.
“To respond to HIV/AIDS, no single organization can work alone,” Chhim Sarath said.