Fighting HIV/AIDS on All Fronts

In this "Development Outreach" article published by the World Bank, Dr. Mean Chhi Vun aims to provide an explanation for the declining prevalence of HIV among adults (15-49) in Cambodia.

"The first HIV positive was detected in 1991 at the National Blood Bank in Phnom Penh and the first AIDS case was diagnosed at Calmette Hospital in 1993. The HIV epidemic quickly spread countrywide. The peak of the epidemic was in 1998 with about 179,000 people living HIV/AIDS. By 1998, however, as people progressed to advanced and symptomatic HIV disease, it also became clear that prevalence rates were starting to fall. The increased number of people dying partly explains the reduction in the overall prevalence of HIV in the country, as people already infected started to disappear. However, the number of new HIV infections each year has also dropped, particularly among young people, as prevention strategies take effect."

Dr. Mean Chhi Vun asserts that it was the government's fast response and mulisectoral approach that made an impact on the declining prevalence of HIV in Cambodia. "HIV prevalence continues to decline because the government recognizes that HIV/AIDS is more than a health issue. It is a socio-economic issue, and therefore all the relevant sectors should be involved.

"In 1993, a National AIDS Program (NAP) and a National AIDS Committee (NAC) were established to manage the response to HIV in the country. The inter-ministerial response started with 6 line ministries.... In 1999, the National AIDS Authority was set up to coordinate and mobilize resources for the multi-sectoral response to HIV/AIDS. Sixteen ministries are members of this entity."

The government's strategy has included several specific interventions such as:

"The 100 percent condom use program at brothels. It is the government's "priority strategy" to interrupt HIV transmission in high-risk situations. It also creates an important enabling environment for all stakeholders to work together.

BCC (behavior change communication) activities are becoming more sophisticated and targeted as general awareness levels rise in the population. Recent BSS (behavioral surveillance survey) data showed that over 94 percent of all groups had heard of HIV/AIDS; the 2000 Demographic Health Service showed that over 70 percent of rural women had heard of HIV/AIDS. So BCC concentrates both on mass media programs, and on special, targeted campaigns using peer education and community outreach approaches.

Blood safety is managed by the National Blood Transfusion Centre; this has been strengthened and new blood transfusion centers have been built in provinces. Universal precautions have been introduced in all referral hospitals and health centers."

As a result of the government's efforts, STI (sexually transmitted infection) prevalence rates have fallen, and HIV prevalence has decreased. Regardless of these successes however, "by the end of 2002, over 94,000 young people had already died as a result of HIV infection; and over 25,000 were living with AIDS. During 2003 another 22,000 developed serious AIDS related illnesses requirifg medical care. It has been estimated that presently in Cambodia over 50 percent of all deaths among men aged 25-35, and 46 percent among women in the same age group, are HIV-related."

Dr. Mean Chhi Vun is Deputy Director General of Health, and Director of the National Center for HIV/AIDS, Dermatology and STD, Ministry of Health, Cambodia.

"Development Outreach" is a magazine in the field of global knowledge for development which reflects the learning programmes of the World Bank and aim to present a range of viewpoints by renowned authors and specialists worldwide. It is published three times a year and is designed to occupy a middle ground between the scholarly journal and the general interest magazine.