The National AIDS Program has launched a pilot campaign in Sihanoukville requiring men to use condoms when having sex with prostitutes.
The program’s chief adviser, Dr Wiwat Rojanapithayakorn of Thailand, said Monday it is possible that the campaign, if established nationwide, could prevent hundreds of thousands of HIV transmissions and eventual AIDS-related illnesses.
“If [men] do not use condoms, they cannot have sex with prostitutes,” said Dr Tia Phalla, National AIDS Program director.
To be successful, though, the program will require cooperation between police and brothel owners, marking a crucial tactical change in the fight against the spread of HIV, officials and activists said.
The condom-use campaign is modeled after an 8-year-old program in Thailand that its creators credit with helping stabilize that country’s HIV transmission rate.
HIV, or the human-immuno deficiency virus, leads to the deadly disease known as AIDS.
About 150,000 of Cambodia’s 11 million people carry the HIV virus, Tia Phalla said. The UN has estimated that with prevention and education 500,000 Cambodians will be infected with HIV by the year 2006. Without it, the UN projects 1 million HIV cases by then.
Cambodia has the fastest HIV transmission rate in Asia, with some 20,000 sex workers serving as the prime transmitters, officials say.
The drive kicked off Saturday at a ceremony in Sihanoukville attended by about 6,000 people, including government officials, Tia Phalla and the World Health Organization’s resident representative, Dr Georg Petersen.
First Deputy Governor Khim Bo last week signed a citywide ordinance making it illegal for men to go without condoms while having sex with prostitutes.
“It is not an order to forcibly coerce [men] to use condoms, but ask them to use them while having sex with the sex workers,” said Hing Sarin, Sihanoukville’s second deputy governor.
The signing followed about a week’s worth of meetings between provincial officials, police and owners of establishments where commercial sex workers operate, officials said.
Notification letters of the campaign have been sent to brothels. As part of the program, National AIDS Program investigators will survey prostitutes to monitor percentages of condom use. And brothel owners and sex workers have been advised to complain to the police if they have a problem with an unruly patron.
“If the men force the girls to have sex without condoms, the police will intervene,” Hing Sarin said.
It is unclear what the punishment will be, although officials said police will close brothels found to be allowing men to circumvent the ordinance.
Tia Phalla said there are 400 prostitutes in Sihanoukville brothels.
But the estimated 200 additional freelance sex workers will be difficult to monitor for condom use, he acknowledged.
The National AIDS Program chose Sihanoukville for the pilot program because of the relatively small community there and the high incidence of HIV transmission, Tia Phalla said. One-hundred fifteen people have died of AIDS-related illnesses in Sihanoukville, he said.
The campaign will be evaluated after three months. If it is deemed to be at least 80 percent successful—in other words, if 80 percent of brothel patrons are determined to have worn condoms during intercourse—the program could be started in Battambang, Banteay Meanchey and Siem Reap provinces.
AIDS activists said Monday that the chief ingredient for success is the cooperation of the government.
“I was personally very skeptical of this [plan] to mobilize people,” said Peterson of WHO. “But on the other hand, this is a country where local authorities have a lot of influence. If you have the local governor and local police enthusiastic…we can achieve a lot.”
Pawana Wienrawee, a Thai technical adviser to UNAIDS, said Monday that the effect on the HIV-infected population could be known in three or four years. Differences in sexually transmitted disease rates will be evident in less than six months.
Wiwat Rojanapithayakorn, the program’s chief adviser, said a French scientist reported that the prototype campaign in Thailand prevented 2 million infections of HIV from 1989 to 1996.
While Thailand’s larger population generates higher numbers of HIV transmissions, Wiwat said the transmission rate is faster here—giving the Cambodian campaign a greater potential for success.