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Some Fear Cambodia AIDS Deaths Could Rival 'Killing Fields' Toll - 2002-11-28


Cambodia has the highest rate of HIV infection in Asia. Some experts fear the country could face a disaster worse than the infamous killing fields of the old Khmer Rouge regime. But, the Cambodian government and its partners are taking steps to fight the epidemic.

The Water Festival in Cambodia's capital Phnom Penh is a three-day celebration that marks the end of the rainy season. More than 40,000 oarsmen turned up in late November to race their slender boats on the river. The city's population more than doubled as around two million spectators descended on the capital to watch the races.

In most years, the competitors make full use of the city's numerous brothels, leaving their oars piled up outside.

This year, Phnom Penh officials ordered all brothels closed during the festival in a bid to prevent the spread of HIV, the virus that causes AIDS.

Cambodia's government knows it faces an AIDS epidemic. The country has the highest infection rate in Asia: 160,000 people are infected with HIV - 2.6 percent of the adult population. AIDS has already killed 80,000 Cambodians in a population of only 12 million.

Fighting the epidemic would be difficult in any country, but in Southeast Asia's poorest nation, with low education levels, poor health care, and appalling infrastructure, spreading the safe-sex message is even harder.

That is why the international charity, Population Services International, or PSI, regards the Water Festival as a good chance to teach people about the risks of unsafe sex, the main method of transmitting AIDS.

"The Water Festival for us is a great opportunity to reach people from the rural areas," said Natacha Bobin, PSI's research and communications coordinator. "As in the past few years, we have this year three stands selling condoms and holding game shows, that sort of thing, with promotional items."

The education effort at the festival, says Ms. Bobin, has contributed to changing attitudes about discussing sex and sexual behavior. Men are now more likely to use a condom when visiting a brothel than they were several years ago.

But more work is needed. To mark World AIDS Day on December 1, the government and charity groups will put on plays and concerts across the country. Thousands of volunteers will hand out pamphlets and condoms.

Dr. Tia Phalla, secretary-general of the government's National AIDS Authority, says the country's focus on prevention has paid off. In 1994, HIV was infecting 110 people each day. That figure is now running at 20 a day.

But Dr. Tia warns the country is facing a challenge similar to the so-called killing fields of the 1970s, when more than a million Cambodians died under the brutal Khmer Rouge.

"Our prime minister said that the civil war for 20 years or 30 years was not causing that number of deaths - so it is like a killing field; really it could be worse than the killing field," he said.

People from the impoverished rural areas often leave their families and local support systems in search of work. Once away from home, they are more likely to engage in unsafe sex, and thus more likely to become infected with HIV. That is why, says Dr. Tia, the government's new plan to tackle the epidemic also takes in development issues, such as poverty and human rights.

Those who become infected face a bleak future, unable to afford expensive drugs to keep the disease in check. In October, Prime Minister Hun Sen said he supports the idea that all Cambodians who need the drugs should be able to get them.

But Dr. Tia says the government needs international help to ensure AIDS patients can get the drugs. Now, only a few hundred Cambodians have access to them.

Although efforts such as a campaign to encourage condom use in brothels are cutting the transmission rate in brothels, new problems are cropping up.

A recent government survey shows the epidemic now is spreading within families. Half of all new infections are from husbands to their wives, while mothers passing the virus to their children account for almost a third.

Ravy, 35, discovered two years ago she had contracted HIV from her husband. It is likely he caught the virus from prostitutes.

Ravy worries about her children, who do not carry the virus.

"When I visit the homes of my neighbors, they don't openly show any discrimination towards me," she said. "But the small children tell each other not to play with my children for fear of catching the disease."

Ravy is fortunate in that she is still healthy. In Cambodia there are not enough beds for patients with full-blown AIDS.

One place where the very poorest can go is a hospice run by Maryknoll, a Catholic charity. Father Jim Noonan runs the hospice. Its 12 beds are always full. Father Noonan says if the patients were not at the hospice, they would die on the streets.

But Father Noonan is most concerned about the children who lose their parents to AIDS. Some forecasts say Cambodia will have 145,000 AIDS orphans by 2005.

"And if something doesn't happen to these children, that they don't get education, they are going to become slaves of the worst degree of slavery, and all the human rights for children will be an absolute luxury for these children of the future," he said.

AIDS experts say that Cambodia's actions now will determine the fate of those children, and the prospects for the country's economic development. An unchecked AIDS epidemic will cut into the work force, consume precious health care funds and slow the development of stable economy.

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