- May 8, 2017
Cambodia’s success in reducing HIV adult prevalence to 0.6% in 2015 from a high of 2% in 1998 has made it a world and regional leader. These successes cannot be underestimated. The number of new infections has dropped from over 15,000 in the early 1990s to only about 2,000 per year currently. More progress has certainly been made in 2012 but the race against the HIV virus is not over yet - much more needs to be done.
Being at the forefront of the AIDS response implies maintaining the achievements in terms of sustaining quality treatment, care and support for PLHIV as well as breaking new ground to prevent new HIV infections amongst those who are the most vulnerable and usually difficult to reach. It also implies high expectations for Cambodia to further show the way forward in a global context of new scientific evidence but also shrinking resources for AIDS and remaining high stigma and discrimination. Prevention of parent to child transmission of HIV will thus continue to be one of the country’s main focuses in the year to come. Indeed, numerous challenges remain for achieving full access to optimized interventions to avoid HIV infection among newborn infants and improve maternal health and survival. In a dynamic society, young people’s behaviours are evolving. The country needs to ensure they have the information and means to protect themselves. Gender and sexual violence also remain serious concerns to address.
While the prevalence of HIV has been declining in the general population, the National AIDS Authority has identified the following high risk groups who are most at risk of contracting HIV:
Out of School Youth: Out of school youth are the young men and women who do not attend school and are therefore free to work. Some of them migrate outside for work. In Cambodia in 2005, the percentage of 6–17 year old girls not in school was 27.5% (28.7% in rural areas and 23.2% in urban areas) and the corresponding figure for boys was 24.5% (25.9% in rural areas and 19.3% in urban areas); 1.3% of girls and 1.0% of boys aged 10–14 were neither in school nor living with either parent.
Highly mobile populations: A recent review of the youth situation in Cambodia (UN Country Team 2009) revealed that the rural-to-urban migration of young people for employment and education contributes to their exposure to sexual and reproductive health risks, including increased risk-taking behavior associated with HIV infection. Migration also led to other health development risks, including drug abuse and gender-based violence.
MSM and Transgender Populations: Men who have sex with men (MSM) are a high risk group for HIV transmission. The most recent size estimation for MSM was carried out in 2009 by the Khmer HIV/AIDS NGO Alliance (KHANA) and Family International (FHI) in their respective areas of work around Cambodia. KHANA and FHI estimated that there were 21,327 MSM in 10 selected areas. However, this number might be an underestimation because a substantial part of Cambodia MSM population is hidden. In 2005, the Health Surveillance Survey found that Transgender (TG) had the highest HIV prevalence at 9.8% compared to the MSM whose prevalence was 8.7% in Phnom Penh. TGs are estimated at nearly 6,000 persons and the MSM high-risk group at 15,400.
IDU/DU: A study conducted by NCHADS on drug users (DU) and injection drug users (IDU) estimated that there were 13,000 DU and 2,000 IDU in Cambodia. The majority of drug users are young (80% are under 25 years of age and 17% under 18 years of age). A mapping of over 3,000 street children found that 42% of them used drugs, with 14% reporting injecting drugs. In 2007 HIV prevalence among IDUs was 24.4%, representing the highest prevalence among all of the MARPs in Cambodia (NCHADS 2007). Technical working group experts estimated that presently there are approximately 1,900 IDUs in Cambodia. Of these 1,900, approximately 300 are covered by the Needle and Syringe Programme (NSP) and 107 by the Methadone Maintenance Treatment (MMT) program.
Entertainment Workers: There are approximately 34,193 (NCHADS 2009) Cambodian entertainment workers, and the majority of them (45.1%) were aged 20-24 years. Female sex workers are projected to constitute 30% of new HIV infections in 2012 – the highest proportion of new infections for one population group. HSS 2010 found that HIV prevalence amongst female entertainment workers (EW) is 14% in the high-risk group (more than fourteen clients per week) and is 4.1% for the low-risk group (less than fourteen clients per week). According to the CMDG report in 2010, 100 percent condom campaigns in brothels contributed to a spectacular decrease in HIV prevalence from 1.6 percent in 2000 to 0.7 percent in 2009.
Sexual health knowledge among youth still needs to be improved. Among female adolescents aged 10–19, 41.2% knew of condoms, 19.6% knew of the pill, 1.0% knew of injectable methods and 5.9% knew of withdrawal as birth spacing methods. Among male adolescents aged 10–19, 81.6% knew of the pill, 71.9% knew of the condom and 60.2% knew of the IUD as birth spacing methods. Among those who reported having STI symptoms in the past year, up to 43% of females and 30% of males did not seek any treatment.
A review of high risk groups by an independent HIV consultant found that there were relatively few MSM, TG, IDU/DU, entertainment workers and highly mobile individuals within the CHEC target areas.
These high risk groups tend to be present in urban areas and the majority of the CHEC target areas are rural. However, there are a significant number of out of school youth in the CHEC target areas, with 51% of youth currently out of school, and therefore at higher risk of contracting HIV. Therefore, out of school youth were selected as a key target group for this proposal.
The major challenge now is to maintain and increase the gains made in HIV education and prevention (the proportion of young people aged 15-24 years old reporting use of a condom during sexual intercourse with a non-regular sexual partner is still below target) and to address the risks of a second wave epidemic due to behaviors among groups at particular risk of HIV infections and other communicable diseases.
Young people become more vulnerable if their health and development needs are not met, i.e. if they do not have access to information and services, do not live and learn in environments that are safe and supportive, and do not have opportunities to participate in the decision that affect their lives. All young people, in particular out of school youth, should receive information, life-skills development, and HIV prevention services and commodities, including services related to sexual and reproductive health. In relation to this program, CHEC has addressed the issues of out of school youth through using Youth HIV Prevention approaches and effective models of behavior change communication. As experience from the other NGOs the best behavior change results are produced by a “systems approach, which combines multiple mass media activities with community collaborations, and training that has credibility with target groups. Interpersonal communication between peers or between youth and those who influence them enhance and reinforce learning that aims to persuade individuals to try new services or behaviors.
Local mechanisms for the involvement of out of school youth have been established and implemented. All youth need community and policy support and the opportunity to improve knowledge, attitudes, and behaviors related to reproductive health and HIV. HIV/AIDS prevention among out of school youth will have a specific focus on gender issues which are inherent to HIV/AIDS risk and prevention in Cambodia, and link directly with GBV. All project activities involving training, the mass media campaign, which specifically addressed the gender norms, including those related to interpersonal relationship, empowerment, and social expectations that affect an individual’s risk of HIV/AIDS infection. CHEC regularly addressed gender as part of its activities. For example, gender issues are addressed in community forums, debates, discussions at the youth friendly centres, and training courses implemented by CHEC. CHEC’s peer educators and Home Based Care teams also address gender issues when providing education and care directly to community members.
The purpose of the training is not only to impart information but to encourage people to reflect upon the phenomenon itself, to delve into deeply held feelings to challenge themselves. The project aims to reduce gender inequality and inequity among the target groups and encourage change from within. In addition to this, we mobilize community leaders to add social credibility, support and sustainability to reproductive health and HIV programs. The project works in conjunction with local government health centers and Voluntary Centers for Counseling and Testing (VCCT) as CHEC partners.
The Youth Friendly Centres involved youth and men together to discuss issues related to gender, reproductive/sexual health, HIV/AIDS and youth’s health.
Increased knowledge resulted in lower rates of single out of school youth and married males having sex with outside partners
Increased rate of condom use
Rate of both male and female accessing VCCT at HC when HIV is suspected increased since the implementation of the project.
STI and Behaviours
83.3% reported that they have heard about STIs, (slight reduction) but their knowledge on types of STI and how to access STI treatment at HC/RH is increased
They also indicated that contact with friends has not been negatively impacted even if they have been diagnosed with an STI
They share information with other STI patients on how to access STI treatment at HC/RH.
Knowledge increased by 6.9% from 55.6% to 62.5% in this period.
Female out of school youth understand better than males (69.3%).
- The number of OSY who identified as in their adolescence having sexual relations, which may result in pregnancy increased in the last six months.