Report: Condom-Use Policy Not Enforced

A recently published report criticized a region-wide condom policy among sex workers which sanctions brothels that do not man­date condom use among its sex workers, citing police corruption and poor involvement in the program.

The policy—called the 100 Per­cent Condom Use Program—was adopted by Cambodia in 1999. Among its demands, the program requires that sex workers in brothels use condoms and threatens brothel owners with closure if they do not institute the policy.

“The existence of the 100% CUP per se is not enough to en­sure consistent condom use,” ac­cording to the report, issued in March by the NGO Policy Pro­ject and funded by the US Agen­cy for International Development—the aid branch of the US government. “There is very little evidence of any sex worker participation in the operation of the 100% CUP, apart from passive requirements regarding compliance.”

The report also said that local authorities have had little involvement in the implementation of the program.

According to the report, the pro­gram is conducted at the prov­incial level through the “Condom Use Monitoring and Evaluation Committees”—committees that are chaired by the provincial governor or deputy governor. They are responsible for establishing the program in their provinces.

Other officials in the provinces, such as police, military police and health care workers, are also re­sponsible for implementing the program.

According to the report, however, the local authorities in many cases have not met with sex work­ers to explain how the program works.

The report goes on to say that co­operation among police, brothel management and sex workers is es­sential if the program is to be suc­cessful at the local level. How­ever, corrupt police officials often hinder the success of the program.

lungs under a microscope showed that the coronavirus caused a pattern of lung damage similar to what affected humans have suffered.

Scientists from the W.H.O.’s network of 12 international laboratories who have been seeking the cause of SARS will meet Wednesday in Geneva and by teleconference to review the evidence concerning the new coronavirus.

The monkey experiments are essential in fulfilling the steps known as Koch’s postulates that are needed to establish proof that a virus or other microbe causes a disease. Applying the postulates to SARS, scientists must determine whether injecting the coronavirus into animals causes similar symptoms to those that humans experience. A formal announcement that the likely cause of SARS has been found could come as early as Wednesday.

Verifying the cause of SARS is essential for the development of reliable diagnostic tests to determine who has the disease so that affected patients can be treated in isolation and those who are not affected can carry on with their normal activities. A principal aim of the W.H.O meeting on Wednesday is to discuss how close researchers have come to developing such tests and to reach a consensus on their use in controlling the epidemic.

As of today, the disease has affected 3,042 people and caused the deaths of 154 of them in 22 countries and Hong Kong. The fatality rate has risen to 5.1 percent from 4 percent in recent days.

Dr. Heymann, in addressing United Nations delegates and staff today, expressed hope that new tests aimed at the coronavirus would eventually help contain SARS.

There is no determination yet whether SARS has the potential to cause epidemics around the world and become a permanent cause of disease like tuberculosis, Dr. Heymann said. “We can’t make any predictions until we understand what is going on in China.”

China has come under severe worldwide criticism for not fully reporting until recent weeks the number of SARS cases that have occurred there since November, and for not allowing international teams of experts to visit affected areas until recently.

Despite China’s pledge to report SARS cases fully, in recent days Chinese doctors have contended that they have treated many cases in military hospitals that the Chinese government has not reported to W.H.O. A team of experts from W.H.O. had been denied access to military hospitals. W.H.O. reported today, however, that its team of experts had visited one military hospital in Beijing and expected to visit others soon.

The Chinese government’s decision to allow the W.H.O. team to visit military hospitals “is a welcome indication of China’s willingness to come to terms with the SARS outbreak on the mainland,” the organization stated. On Monday, China’s president, Hu Jintao, said on state television that he was “very worried” about SARS.

Dr. Heymann said that China had developed a national SARS reporting system over the last three weeks and had elevated SARS to the status of two diseases, cholera and yellow fever, for which the government can impose quarantines.

Nine patients in Hong Kong died of SARS on Tuesday, setting a new single-day record for such fatalities. Five of those who died were younger than 45 and included a pregnant woman and four patients with no underlying illnesses.

On Tuesday, Shanghai imposed the first travel restrictions within China by ordering a halt to all group tours to Hong Kong.

As of today, doctors in the United States have reported 193 cases and no deaths. All but 19 of the cases have involved travelers to affected areas. The 19 cases represent secondary transmission to 14 family members and 5 health care workers.

Later this week, the Centers for Disease Control and Prevention in Atlanta is expected to lower the total of SARS cases in the United States to about 30. The C.D.C. has deliberately used a broader case definition than W.H.O. because federal officials wanted to cast a wide net to make sure they did not miss a mild case.

Over the weekend, W.H.O. added the United States to its list of SARS-affected areas. The agency took the step after the C.D.C. was criticized for not reporting secondary transmission of cases to W.H.O., as other countries have done.

The list includes Toronto; Singapore; China (Beijing, Guangdong, Hong Kong and Shanxi); Taiwan; Hanoi, Vietnam; and London. W.H.O. said that the United States and Britain had limited local transmission and there was no no evidence of international spread from those areas since March 15 and no transmission other than close person-to-person contact reported.

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