The HIV/AIDS Rate in Cambodia is going down: How was it done?

1. The HIV/AIDS Rate in Cambodia is going down: How was it done? Good Governance: Implementing Behavioral Change April 29-30, 2004, Sunway Hotel Phnom Penh, Cambodia Ty Chettra, MD, MPH Country Director The POLICY Project Cambodia

2. Outline • Background • Strategic framework • Specific objectives regarding behavioral change • Actions taken • Empirical evidence of success • Challenges ahead • Lesson learnt • Conclusion

3. Background (1) • First case of HIV infection diagnosed in 1991 • First person diagnosed with AIDS in 1993 • National prevalence rate among adults aged 15-49 dropped from 3.3% in 1997 • Estimated 157,000 people living with HIV/AIDS • Unprotected sexual intercourse with many partners is the main cause of transmission

4. Country Cambodia Thailand Viet Nam Lao PDR Myanmar HIV prevalence 2.6% 1.8% 0.3% 0.05% 0.04-2.2% Background (2): HIV/AIDS in South East Asia, 2000

5. Strategic Framework • HIV/AIDS is not a health, but a social development issue • Fighting HIV/AIDS has been going through behavioral change at all level: • Individual • Family • Community • Society

6. Specific Objectives regarding BC • Getting the prevalence of HIV/AIDS infection down among target groups and general population • Generate an enabling social and policy environment for PLWHA living free from stigma and discrimination • Mobilize national and international resources to fight HIV/AIDS and to address its socio-economic impact

7. Actions taken (1): Outline • Specific intervention: 100% condom use • IEC campaigns with peer educations • Faith-based interventions • Establish a Multi-sectoral framework • Formulating law and policies • Empirical evidence of success and of further policy & strategy development

8. Actions taken (2): Specific intervention - 100% CUP • Promoting ‘always using condom when having sex’ – no condom, no sex • Involvement of wide range of stakeholders - local government, police, and brothel owners • Potential to create normative behavior concerning condom use • Placing responsibility for condom use with brothel owners and not just with sex workers

9. Actions taken (3): IEC & Peer Educations • All relevant sectors including uniform sectors, youth, and workers • Promote normative prevention behaviors and practices: protected sexual intercourses with one partner • Having reduced stigma and discrimination and greater support and care to PLWHA • Lots of technical and financial resources have been used to develop IEC materials and to conduct training

10. Actions taken (4): Faith-based interventions • Using religious theory & principles to promote HIV/AIDS prevention • Depending on believe & trust of people to religious organizations • Changing from traditional perception on social roles of religious organizations • Effective in reducing stigma & discrimination and greater care and support to PLWHA • Need commitments and support from its hierarchy

11. Actions taken (5): Development a multisectoral framework • NAA Established in 1999 • Cross-government multi-sectoral policy and coordination body for Cambodia’s response to HIV/AIDS • Members represent 26 line Ministries, Cambodian Red Cross, and 24 provinces and municipalities • Based on community involvement, gender equality, respect for human rights principles

12. Actions taken (6): Development a multisectoral framework (cont.) • NAA strategic plan is a holistic approach involving government, civil society, international community and PLWHA • Strategies to fight HIV/AIDS was included in the National Poverty Reduction Strategy (NPRS) • Institutional policies were developed to fight HIV/AIDS • Strong support from international community, e.g UNAIDS, Global Fund

13. Actions taken (7): Formulation Law on the Prevention and Control of HIV/AIDS • Passed in June 2002 • Prohibition of discrimination • Prohibition of HIV screening in connection with employment, education, freedom of movement or abode, the provision of medical services • Legal protection of confidentiality of information about a person’s HIV/AIDS status • Comprehensive epidemiological monitoring

14. Actions taken (8): facilitation the Implementing the HIV/AIDS Law An implementing Code of Conduct has been drafted to: • Explain the law in plain language • Identify the people and institutions with responsibilities under the law • Identify means and timetables for fulfilling these responsibilities

15. Empirical evidence of success(1): Reduced HIV/AIDS Prevalence

16. Empirical evidence of success (2):Consistent Condom Use with Clients, 1997-2003 Source: NCHADS, BSS, 2004

17. Challenges ahead • Fighting HIV/AIDS is conflicting with other social development agenda, • Implementation of multisectoral framework is always difficult and some time not feasible • Questions of sustainability • Stigma, discrimination and Human rights violation against PLWHA remain a critical problem

18. Challenges ahead: Sexual behaviors Source: NCHADS, BSS, 2004

19. Challenges ahead: Reasons for not using condoms with sweethearts Source: NCHADS, BSS, 2004

20. Lessons learnt (1) • Political commitment and support from all level are essential to the success of the program to fight HIV/AIDS • Resources and support mobilized from national and international community have significantly contributed to the success • Behavioral change is center • Behavioral change can be done by a combination of different actions

21. Lessons learnt (2) • Building holistic approaches with multisectoral engagement and framework has added value to behavioral change • Participation from all stakeholders including people infected & affected is of utmost importance • Empirical evidence is needed for good governance and providing guidance for further actions

22. Conclusions • Cambodia’s response to HIV/AIDS is recognized internationally for achieving successes • Behavioral change is center to generate an enabling environment to fight HIV/AIDS • Good governance can be reflected in HIV/AIDS program as it associates with responsibility, accountability, participation, evidence based and respond to needs of community and society