LEAD EMPOWER DELIVER

Cambodia is a world leader in the fight against HIV & AIDS. In the past decade HIV prevalence has fallen from 2.0% to 0.9% , the number of AIDS related deaths has almost halved , 83% of people living with HIV are receiving antiretroviral treatment, and 198 Voluntary Confidential Counseling and Testing (VCCT) clinics have opened in 20 provinces .

• Cambodia’s leaders have responded swiftly and purposefully to the epidemic, scaling up the health sector response, developing monitoring systems and keeping HIV/AIDS firmly on the political agenda.
• Non-government organizations have been proactive advocates, delivering tailored welfare services and bringing the voice of people living with HIV into the decision-making process.
• The United Nations Country Team, through UNAIDS, has provided technical support to all partners, strengthening national leadership capacities and fostering greater cooperation among stakeholders.
• Donors and development partners have worked hard to make these efforts sustainable.

As a result, Cambodia stands out as one of only a handful of countries on track to reach the global development target of combating HIV/AIDS by 2015. The Royal Government’s ambitious, but achievable goal, to deliver Universal Access, is now being pursued with vigor and determination.

These outstanding achievements demonstrate that investments in HIV prevention, testing, and treatment do deliver results.

But the AIDS epidemic is far from over and World Aids Day reminds us that we cannot afford to be complacent.

HIV is an evolving disease. Anticipating where the next 1,000 infections will come from is critical to making sure that national AIDS programmes can respond to emerging trends. Epidemiological research from the World Health Organisation suggests a second wave of infections in Cambodia is possible, spurred on by lesser known (and harder to reach) at-risk populations. These at-risk populations are also among the most disempowered members of the community.

1. Men Who Have Sex with Men (MSM)

HIV prevalence among MSM in Phnom Penh is at 8.7%, nine times the national average. Behavioural data indicates that MSM tend to have multiple partners (including women) but report consistently low condom use. According to the 2005 HIV Surveillance Survey, stigma and discrimination are the major factors in MSM being unable, or too afraid, to seek medical health services available to the general population. In 2006, a national MSM network formed to advocate for greater equality and promote health and welfare services. Empowering marginalized groups will help to counter the spread of HIV.

2. Injecting Drug Users

HIV prevalence rates among injecting drug users stand at 24.4% , the highest statistic for any single group in the country. Nevertheless, health and social services available to people using drugs remain extremely limited. Levels of stigma and discrimination from all sectors of society are extreme, and there is a tendency for government to take a law enforcement approach to combating drug use rather than evidence -based, good practice, health interventions. As a result, injecting drug users are not receiving the health and welfare services they need. This is particularly the case for drug users in prisons and government-run rehabilitation centres. Drug users need our support, not our judgment.

Community based harm reduction services, including a Needle Syringe Programme, are urgently required to combat the spread of HIV. This should be done in conjunction with HIV prevention, testing, counseling, and mental health services to drug users and their sexual partners. Discrimination will not prevent the spread of the epidemic. HIV awareness, drug rehabilitation, counseling, testing, treatment, and tolerance for injecting and non-injecting drug users will.

3. Out of School Youth (waiting on more information from UNFPA)

HIV Education programmes operate in roughly 25% of schools but young people’s knowledge of HIV prevention is low. Out of school adolescents, who often work far from home are particularly vulnerable. We will never win the fight against AIDS unless we teach our young people how to be responsible for their own reproductive health.

Cambodia’s 4.6 million young people require innovative HIV prevention and behavioural communications tools to teach them about sex and relationships. At the heart of youth awareness programmes, must be a willingness to communicate frankly with our young people about reproductive health. A young woman recently told the United Nations Country Team of her own experience going for HIV testing in Phnom Penh. During her consultation, a number of different people entered the consult room, asking her why she was having sex at her age. So humiliated was by the experience, the young girl was too afraid to return for her results. We must empower our young people through information, education, and support.

4. Sex Workers

The United Nations Country Team has been vocal in its position that the Law on the Suppression of Human Trafficking and Sexual Exploitation (2008) must not obstruct the rights of sex workers to receive HIV prevention, testing, and treatment. The United Nations stands committed to supporting the government to implement its new law correctly by prioritizing the human rights of suspectedtrafficking victims in all anti-trafficking interventions. In particular, the United Nations Country Team supports a pragmatic approach to the implementation of the new law where individuals (both female and male) must be able to carry condoms without threat, extortion, or arrest. To maintain low prevalence rates, Cambodia must continue the 100% condom use policy.

Challenges for 2009 UNAIDS estimates that 64,750 people (including 3,350 children under the age of 15) or one in every 100 Cambodians is living with HIV.

Gender Inequality

Husband to wife transmission now accounts for 42% of all new infections. UNICEF reports that mother to child transmissions (during labour, pregnancy, delivery, or breastfeeding) account for another 32% of infections. HIV and AIDS disproportionally affect women, and there must be concerted efforts at all levels to address the stereotypical gender norms which encourage males to have multiple partners but make negotiation of sexual and reproductive rights very difficult for women. We will never achieve universal access to prevention and treatment until the human rights of sex workers, men who have sex with men, injecting drug users, women and children are fully recognized and upheld.

Stigma

People living with HIV/AIDS are mothers and fathers, wives and husbands, sisters and brothers, partners, colleagues, friends, and neighbours. Many will die of AIDS without ever telling their family or their friends about their illness. This prevents people from receiving the lifesaving treatment they deserve. Stigma and discrimination paralyze our efforts and continue to take lives.

Financing

In the face of a global financial crisis, resourcing the HIV/AIDS response is a key challenge. Every day more and more people in Cambodia will require treatment and care, placing enormous financial burden on their families. The emerging needs of at-risk populations demand new ways of responding and this requires adequate resourcing and proper coordination. HIV and AIDS in Cambodia must remain a development priority at all levels.

On this World AIDS Day, we reflect on the past year remembering with sadness the Cambodian women, children and men who have lost their lives to AIDS. We look forward to 2009 with hope and optimism, to improve the lives of those living with HIV, to prevent new infections and to reach out to lesser-known and marginalized populations.

Let us work to empower the most at-risk members of society in a way that priorities human rights, dignity and equity.

On this day, the United Nations Country Team in Cambodia, through the UN Joint Theme Group on AIDS and the UN Gender and HIV Working Group, rededicates itself to helping the Royal Government, and the people of Cambodia achieve this purpose.

Written by the United Nations Resident Coordinator, Douglas Broderick
On behalf of the United Nations Country Team in Cambodia, 1 December 2008*

http://www.un.org.kh/index.php?option=com_content&view=article&id=101:joint-statement-

from-the-united-nations-country-team&catid=37:news-and-events&Itemid=64