Report on the Global HIV/AIDS epidemic

Report on the global HIV/AIDS epidemic - June 2000

In other countries, governments have pragmatically organized AIDS prevention campaigns for 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 prime
example, but the results obtained in Cambodia show that lower-income countries
can also effectively reduce vulnerability.
Cambodia, one of South-East Asia's poorest countries and the one with the highest
rate of HIV infection among adults, faces a host of development challenges as it
emerges from decades of war and political turmoil. When early efforts to track the
spread of HIV infection showed that the prevalence among sex workers had already
reached 40%, that men who were frequent clients were also heavily infected with
HIV and that they were passing the infection on to their wives, the Government
placed HIV prevention high on its agenda. A regular behavioural surveillance system
was set up to identify risk behaviour, plan a response and monitor success.
The surveillance system, which covers Cambodia's five main urban centres, showed
that visiting sex workers was the norm among men in some occupational groups,
including soldiers, policemen and motorcycle taxi drivers, all of whom are relatively
mobile and have ready cash, and many of whom are married. Yet condom use was
S relatively low. Because sex workers may not have the power to insist on condom
use, reducing their vulnerability must involve working with their clients. In 1998, a
"100% condom use" campaign was piloted in the port city of Sihanoukville. Inspired
7by Thailand's successful effort but adapted to the local situation, the campaign took
a 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 use
in all high-risk sexual encounters, working with brothel owners and sex workers as
well as with clients. At the same time, strengthened health care services - including
care for sexually transmitted infections - were made available for the sex workers,
S while public information campaigns were conducted to help the population understand the HIV threat from unprotected sex.
SAs Figure 17 shows, men are now far more likely to report using a condom when
they buy sex. The same is true of brothel-based prostitutes. While only two-fifths
reported always using a condom with clients in 1997, this figure had reached almost
four-fifths by 1999. In addition, women hired to promote beer reported a near-quadrupling of 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 reasons
Women of all ages are more likely than men to become infected with HIV during
>1 unprotected vaginal intercourse. This vulnerability is especially marked in girls
<whose genital tract is still not fully mature.

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