banteay meanchey province, O’Chrou district – Nhov Pich is barely able to sit upright. The AIDS virus has made his skin a wasteland of lesions and itchy, gray fungus. Since becoming seriously ill in 2002, he rarely leaves his home. From his living room, he can see the Thai border just a few hundred meters away.
The 39-year-old man crossed this border many times during his days as a soldier and construction worker, when he was single and visiting brothels frequently. He contracted HIV from sleeping with sex workers during these migratory years.
This transitory lifestyle is one of several reasons why Banteay Menchey province has the highest prevalence of HIV in Cambodia, officials say.
“The epidemic starts in this province,” said Dr Tia Phalla, secretary-general of the National AIDS Authority. “It’s very severe because of high population mobility and the large number of people who are not native to the area.”
An official at the Poipet checkpoint estimated that 6,000 to 7,000 Cambodians cross at that checkpoint into Thailand every day to work as laborers or sell their wares in the market.
Casinos also operate in this province, bringing in rich customers and accompanying sex workers, Tia Phalla said.
Banteay Menchey province began a Home and Community Based Care program in 2001 because many people living with HIV/AIDS were shunned by their communities.
Two of Nhov Pich’s three young children are afraid to eat with him, even though they have been told the virus cannot be transmitted by food.
“When a husband or wife knows that his or her spouse has the virus, they will divorce each other, or the victim will be abandoned by friends and neighbors,” said Koy Vanlyn, deputy program director for the Social, Environment, Agricultural Development Organization.
“They are forced to live alone or in isolation. There is no one to talk with them,” she said.
The first home care programs were initiated in 1998, first in Siem Reap and Phnom Penh, by the World Health Organization in cooperation with the Cambodian government. The program has since increased to more than 50 teams who train affected families nationwide.
AIDS prevalence in Banteay Menchey is aggravated by those who fear discrimination. Victims often hide the fact that they are HIV- positive, Koy Vanlyn said. Most people living along the border are not educated and are not aware how HIV is transmitted, she added.
“People never believed that the HIV epidemic existed in the world. They never believed humans transmitted such a disease. The people don’t have enough education, so they could not read the materials,” she said.
The home-based care program works in cooperation with NGOs to right these misunderstandings by providing information on preventing transmission as well as psychological support to encourage families to interact with their communities.
Suy Am, 33, another soldier who contracted AIDS from sex workers, said he “loves the home care program” because he can stay with his family instead of being treated at a hospital.
“We were educated on how to take care of ourselves,” he said. “I clear grasses and forest around my house in order to make it fresh. We take our clothes, mats and mosquito nets to dry in order to kill diseases.”
It is not clear who will care for Suy Am if the disease becomes debilitating, because he has transmitted the virus to his wife and 6-year-old son as well.
All three experience discrimination from fellow villagers. His wife used to sell dried fishes and cakes, but since discovering the family has AIDS, the neighbors no longer buy her food.
They have also prohibited the family from using local ponds and lakes.
Suy Am’s wife, Chhoung Ream, 28, wanted to commit suicide because of the stigma of her disease, but after she began the home care program she wanted to continue living, she said.
“I am going to tell other HIV/AIDS victims and neighbors the necessity of encouraging victims to live in the community,” she said. “Do not keep them isolated.”
When SEADO officials arrived at Suy Am’s home in 2004, they trained the family to stop hiding from the community. The arrival of outsiders who are willing to touch those infected with the disease also encourages villagers to interact with those who have the virus, said Pok Panhavichetr, executive director of Khmer HIV/AIDS NGO Alliance.
There are currently 87 home care teams in Cambodia reaching about 70 to 100 people a month. KHANA estimates that more than 5,000 people living with HIV/AIDS have been helped by home-based care training in 2004 alone.
Early in the HIV epidemic, health care officials concentrated on prevention, not psychological or social support, said Dr Mean Chhi Vun, deputy director general of health at National Center for HIV/AIDS, Dermatology and STI.
The government started looking at home care in 1998, because there were not enough hospital beds to support the growing number of AIDS victims, he said.
Only 8,000 hospital beds exist in the country for all diseases. Adding to the problem, villagers in remote provinces must travel great distances to health centers for treatment and medicines and cannot afford the transportation or medical costs, Pok Panhavichetr said.
In the 2003 “HIV Sentinel Surveillance” report, the Ministry of Health estimates that 2.1 percent of the adult population has HIV, the highest rate of infection in the region.
Cambodia’s HIV/AIDS rate “is still considered the highest prevalence compared to neighboring countries like Vietnam, Thailand and Laos,” said Rodney Hatfield, UN Children’s Fund representative in Cambodia.
“When a population is displaced, there is kind of civil strife, HIV/AIDS spreads quickly, especially when you have a large number of military forces, displaced people, people living in camps,” he added.
For someone like Chhoeun Ream, her husband’s lifestyle as a soldier proved devastating. But she does not feel angry that he gave her AIDS. She said that home based care has given her a will to live.
“I do not want to die today,” she said. “Now I will do everything for my life.
