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The Phnom Penh Post
Written by Robbie Corey-Boulet
Friday, 27 February 2009
Though the Kingdom has made progress since the health-related development goals were adopted, officials must now combat emergent trends as well as problems that persist WHEN Mony Pen discovered five years ago that she was HIV-positive, the list of things she did not know about the disease included how she got it, how she could treat it and how long she could live with it.
"People told me I was probably going to die very soon," said the 28-year-old Phnom Penh native, who learned of her status only when her husband, a policeman, died of full-blown Aids two years after they married.
These days, Mony Pen, now an adviser to the Cambodian Community of Women Living with HIV/Aids (CCW), knows all about transmission and treatment, and can discuss in detail everything from antiretroviral drugs to the threats posed by opportunistic infection.
She also knows this expertise sets her apart from the majority of Cambodian women, particularly those outside Phnom Penh. The 2005 Cambodia Demographic and Health Survey (CDHS) found, for example, that 67 percent of women in Mondulkiri and Ratanakkiri provinces believed HIV/Aids could be transmitted by a mosquito bite and 56 percent believed it could be spread "by supernatural means".
Mony Pen said she believes this lack of knowledge could fuel a resurgence of the disease that might erase the much-touted gains made against it in recent years.
This concern is not hers alone. UNAIDS Country Director Tony Lisle told the Post this week that several trends - in particular, the rise in so-called indirect sex work performed in beer halls and karaoke bars - could trigger an increase in new infections that might even "set the scene for a second-wave epidemic".
In this regard, Cambodia's fight against HIV/Aids resembles its broader effort to meet targets under the three health-related Millennium Development Goals (MDGs).
With some exceptions, notably in the area of maternal health, available data shows that Cambodia met or exceeded targets for 2005 and is likely to do the same in 2010 and 2015. But certain recent trends have muddied the picture, reinforcing the fact that progress is not inevitable.
Speaking in reference to HIV/Aids, Lisle captured a widely held view of the general health picture in the Kingdom, one articulated in recent interviews by doctors, NGO workers and government officials: "Yes, Cambodia, you've done a fabulous job," he said. "But it's not over."
Photo by: ROBBIE COREY-BOULETMony Pen, whose late husband gave her HIV, works to give women access to HIV/Aids information.
The HIV/Aids fight
One target already surpassed is that pertaining to HIV/Aids infection, a leading indicator of progress made in achieving the sixth MDG: to combat HIV/Aids, malaria and other diseases.
Meeting the target resulted in part because of a statistical error that caused the rate of infection in the late-1990s - which was used as a base in establishing benchmarks through 2015 - to be artificially inflated when the MDGs were adopted. Because of the adjustment that occurred when better data became available, current rates of infection are already lower than the targets.
For example, the estimated prevalence among Cambodian adults in 2006 was 0.9 percent, lower than the 2005 target (2.3 percent), the 2010 target (2 percent) and even the 2015 target (1.8 percent).
According to a 2008 UNAIDS report, however, Cambodia's prevalence rate is the second-highest among all countries in South and Southeast Asia (only Thailand's is higher). And, while acknowledging progress, Lisle and other experts cited a range of persistent problems.
Mony Pen said she has concluded from her own observations that discrimination against those infected with the disease remains high.
Sou Sina, 29, who is from Sihanoukville and now works at CCW in Phnom Penh, said she encountered this very obstacle when she tested positive at the age of 20.
"At the time, my family took care of me, but they were afraid," she said. "They didn't understand the disease. And that broke my heart."
Like Mony Pen, Sou Sina learned of her status only when her husband died. She also found out then that her son had been infected through mother-to-child transmission, but she did not know how to obtain treatment for him. He died two years later - at the age of four - of tuberculosis.
Lisle said it is common for women to become infected by their husbands unwittingly. In addition, he pointed to data suggesting that programs designed to prevent mother-to-child transmission have been ineffective.
Data from 2008 indicated a mother-to-child transmission rate for HIV-positive pregnant women of 35 percent.
Lisle said Cambodia has traditionally "led the region" in the fight against HIV/Aids, adding that he has every reason to believe this will continue. But a failure to respond to these emergent trends, he said, could quickly render the Kingdom's recent progress aberrational.
In Cambodia, Lisle cautioned, there exists the threat of "a second epidemic waiting right around the corner".
ADDITIONAL REPORTING BY MOM KUNTHEAR AND CHEANG SOKHA