HIV Infections on the Decline in Cambodia
Cambodia is one of only three developing countries in the world where the HIV/AIDS epidemic appears to have slowed. This was one of the conclusions of a consensus workshop on the epidemiology of HIV and AIDS conducted by the Cambodian Ministry of Health in Phnom Penh in early May. The workshop was sponsored by the World Health Organization, the United Nations Childrens Fund, Family Health International and the Ministry of Health, and was attended by national and international experts.
Data generated from the national HIV surveillance system demonstrated a steady decline in the number of persons infected with HIV in Cambodia over the past three years. During the 1990s, Cambodia had a rapidly escalating HIV epidemic and by 1997 it had the highest HIV prevalence in Asia. The estimates prepared at the workshop suggest that in that year there were 210 000 HIV infected adults (15-49 years old) in Cambodia, representing 3.9% of this age group. However, it has recently been estimated that there are now only 169 000 HIV infected adults (2.8 % of the age group). The new figures confirm a trend that was observed at the annual consensus meeting last year.
The national HIV surveillance system, initiated with WHO and USAID support in 1994 -1995, is now largely funded by the Government itself from a World Bank loan. The surveillance system conducts annual blood and behavioural surveys at specially designated sentinel sites in 21 of Cambodia's 24 provinces, and behavioural surveys in five provinces. Information from these surveys is used to monitor the epidemic and as a management tool by national policy and programme managers. The surveys target groups known to be at high-risk for acquiring and spreading HIV infection: female sex workers and their clients, as well as groups representative of the general population such as women in antenatal clinics. HIV infection rates in all these groups have been on the decline.
The decline in HIV infections can be attributed to a reduction in the number of persons newly infected each year, (for example, the rate of HIV infections among sex workers below 20 years of age dropped from more than 40% in 1998 to 23% in 2000) as well as to the increase in the number of people dying from AIDS each year, which would be expected in an epidemic that has lasted more than ten years.
The Workshop noted the worrying implications of the fact that increasing numbers of people who became infected with HIV in the early 1990s are now dying; this will place increasing stress on Cambodia's health services in the coming years. The number of people dying each year from AIDS is already greater than the total number of hospital beds in Cambodia's public health services.
The decline in the number of persons newly infected is a tribute to the pragmatic, broad-based, comprehensive, frank and open national HIV/AIDS prevention programme. The key components of HIV prevention activities in Cambodia have been open and pragmatic information, education and communication through a variety of channels, as well as vigorous promotion of condom use during high-risk sexual encounters, in particular through the national "100% Condom Use" in all commercial sex establishments. This has been accompanied by targeted STI services and outreach programmes. Regular condom use has been on the increase in all surveyed groups and especially among female commercial sex workers. From 1997 - 1999, the percentage of female sex workers reporting consistent condom use in commercial sex increased from 42% to 78%.
Dr Mam Bunheng, Secretary of State in the Ministry of Health, said that the fundamental goal of the government is to ensure that ""a condom is available where needed"". He continued by stressing that the government will continue to tell people that the ""up-to-date person carries a condom in his pocket.""
For his part, Dr Shigeru Omi, WHO Regional Director for the Western Pacific commented that: "WHO is very proud to have been a partner with the Cambodian Government and its other international supporters in the achievement of this quite remarkable result." He added: "This is not the end of the HIV epidemic in Cambodia but it shows that a sound epidemiologically-based prevention strategy can work. It also shows that national commitment and leadership to implement sound strategies in a coordinated manner with national and international agencies can reverse this epidemic. I hope it will serve as an inspiration to strengthen such activities throughout our Region and urge national governments and international partners to increase resources and support for condom promotion among individuals with high-risk behaviours."
To facilitate a greater dissemination of national experiences, to explore even better ways of advocating condom use and to finalize technical instruments to promote such programmes, WHO will organize a ""Meeting on Condom Promotion in High Risk Situations in Asia."" The meeting will take place in Ha Noi, Viet Nam, from 13 to 17 August 2001 and will be attended by international partners and experts from 10 countries.
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More data available in WPRO website: http://www.wpro.who.int/themes_focuses/theme1/focus4/t1f4data.asp