HIV Infections Declining in Cambodia

The estimated number of Cam­bodian adults infected by HIV continued to decline from 1999 to 2000, while the number of AIDS patients is rising, health experts said Monday.

According to the annual survey of the National Center for HIV/ AIDS, 169,000 people be­tween the ages of 15 and 49 are thought to be living with HIV. In 1999, 184,000 Cambodians were thought to have HIV, while in 1997, 210,000 were estimated to have the virus that causes AIDS.

Health experts gathered at the Sunway Hotel Monday said the decline is due to more effective prevention efforts and the fact that an increasing number of people are dying of AIDS.

“Most of the decline is probably because people are dying,” said Dr Tim Brown, a consultant on the survey.

The number of AIDS deaths reported to the National Center for HIV/AIDS in 2000 was 533, compared to 314 in 1999. But Brown said that an estimated 15,000 people died from AIDS last year. Experts say the government does not have the infrastructure to keep accurate figures on AIDS deaths.

Additionally, they say, people are hesitant to identify themselves or family members as AIDS patients because of the stigma associated with the disease.

While the total number of Cambodians infected with HIV has decreased, the number of new HIV infections reported to the National Center for HIV/AIDS in 2000 was 13,854. That is an inc­rease from the 7,726 reported in 1999.

But Roger Detels, a professor at the University of California at Los Angeles and an AIDS expert who served as a consultant for the survey, said Cambodia is one of just three developing countries in the world that appears to have slowed their HIV/AIDS epidemics. Thai­land and Uganda are the others.

“This is very encouraging because it demonstrates that it is possible to fight the epidemic and to have some success,” he said.

The annual survey is done to help the government and others estimate HIV prevalence among target groups, such as commercial sex workers, and to understand trends of the epidemic.

Data was collected through random blood samples taken from six target groups in 21 provinces and municipalities. Hundreds of male policemen, female sex workers, tuberculosis patients, hospital inpatients and pregnant women were sampled in each province.

Kiv Bun Sany, provincial health director in Kompong Som, expressed disappointment that garment factory workers were not included in the survey. Others also questioned why moto drivers and migrant workers along the Thai border were not sampled.

Among high risk groups, the percentage of prostitutes infected with HIV dropped slightly from 33.2 percent in 1999 to 31.9 percent in 2000 while 3.8 percent of policemen in urban areas are thought to have HIV, compared with 6.2 percent in 1998.

Nationwide, 2.8 percent of Cambodian are estimated to have HIV—a rate that exceeds other Asian countries. In 1999, that number was 3.2 percent.

“That rate could take off again very easily,” Brown said. “You can’t say you’ve won and then go home.”

Brown, who has followed the battle against AIDS in Thailand since 1988, warned against be­coming complacent at the first sign of success.

He noted that Thailand substantially cut government funding for HIV/AIDS programs after the 1997 Asian financial crisis. Before 1997, Thailand was supplying half the condoms for its population, he said.

“The fundamental goal of a government is that a condom has to be available wherever needed,” he said. “Cambodia has learned a lot from the Thais. They have a very broad-based approach.”

Mum Bunheng, secretary of state at the Ministry of Health, said the government needs to continue telling Cambodians that it is the “up-to-date person who carries a condom in his pocket.”

Nonetheless, the survey found that 30 percent of men do not use condoms consistently. The percentage of married men in urban areas who use a condom during commercial sex is 18 percent, compared to 25 percent for single men.

That figure shows that the problem of men infecting their wives will likely continue. Men with HIV outnumber women in Cambodia by a rate of 3 to 2.

One of the more striking figures was that the number of men between the ages of 20 and 25 who visited a brothel in 2000 was 25.1 percent. That is double the national rate of 12.7 percent for all men.

The survey also found that only 13 percent of Cambodian males have ever been tested for HIV.

There are 36 million people infected with HIV worldwide, according to the UN. With 5 million HIV-infected people, the South and Southeast Asia region has the second highest concentration of HIV cases region in the world, next to sub-Saharan Africa, which has 25 million HIV infected cases.

“Many developing countries have not yet seen the peak of AIDS cases that will be thrust on their health care systems,” Detels said. “More than 95 percent of new infections are in developing countries, which have the fewest resources to combat the epidemic. This, of course, underscores the obligation of developed countries to help.”

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