Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000In other countries, governments have pragmatically organized AIDS prevention campaignsfor the benefit of men in prison, drug users, or sex workers and their clients.Thailand with its “100% condom use” campaign for commercial sex is a primeexample, but the results obtained in Cambodia show that lower-income countriescan also effectively reduce vulnerability.Cambodia, one of South-East Asia’s poorest countries and the one with the highestrate of HIV infection among adults, faces a host of development challenges as itemerges from decades of war and political turmoil. When early efforts to track thespread of HIV infection showed that the prevalence among sex workers had alreadyreached 40%, that men who were frequent clients were also heavily infected withHIV and that they were passing the infection on to their wives, the Governmentplaced HIV prevention high on its agenda. A regular behavioural surveillance systemwas set up to identify risk behaviour, plan a response and monitor success.The surveillance system, which covers Cambodia’s five main urban centres, showedthat visiting sex workers was the norm among men in some occupational groups,including soldiers, policemen and motorcycle taxi drivers, all of whom are relativelymobile and have ready cash, and many of whom are married. Yet condom use wasrelatively low. Because sex workers may not have the power to insist on condomuse, reducing their vulnerability must involve working with their clients. In 1998, a“100% condom use” campaign was piloted in the port city of Sihanoukville. Inspiredby Thailand’s successful effort but adapted to the local situation, the campaign tooka pragmatic approach to the sex trade, which is illegal but widespread in Cambodia.Public health authorities elicited the help of local authorities to promote condom usein all high-risk sexual encounters, working with brothel owners and sex workers aswell as with clients. At the same time, strengthened health care services – includingcare for sexually transmitted infections – were made available for the sex workers,while public information campaigns were conducted to help the population understandthe HIV threat from unprotected sex.As Figure 17 shows, men are now far more likely to report using a condom whenthey buy sex. The same is true of brothel-based prostitutes. While only two-fifthsreported always using a condom with clients in 1997, this figure had reached almostfour-fifths by 1999. In addition, women hired to promote beer reported a near-quadruplingof consistent condom use by men who paid them for sex, from close to 10%in 1997 to almost 40% in 1999. These reports are corroborated by condom sales,which have shot up over the years.Young girls: vulnerable for many reasonsWomen of all ages are more likely than men to become infected with HIV duringunprotected vaginal intercourse. This vulnerability is especially marked in girlswhose genital tract is still not fully mature.46