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Perspective

Perspective
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  Volume I Issue II    Perspective    November,1998

Teri Shaffer Yamada, PhD
Director of Southeast Asian Studies Center,
California State University, Long Beach
European Association for Southeast Asian Studies
Hamburg conference, 3-6 September 1998
"Buddhism and Healing: Cambodians in Long Beach California"

SYNOPSIS

 AIDS in Cambodia/Long Beach



   Several WWW sites contain updated information about the HIV/AIDS epidemic in Cambodia. Recent studies indicate that since 1991, when Cambodia seemed to be virtually AIDS-free, nearly 1% of its population(11 million) and 2.5% of pregnant women are now infected. Such information reveals that Cambodia has one of the highest HIV infection rates in Southeast Asia. The U.N. estimates that up to one million individuals could be infected by 2006. Similar high infection rates are probable in border areas between Cambodia and Vietnam; Cambodia and Thailand; Burma and Thailand.

   All these border areas are sites of high-density sex-worker populations. In Cambodia, The Ministry of Health reported in 1996 that between 300,000-500,000 women are engaged in the commercial sex industry. A UNICEF survey has revealed that one-third of Phnom Penh's prostitutes are under 18 years of age. Many of them appear to have been forced or sold into prostitution by their husbands or parents. A survey of 1,173 sex workers nationwide in 1995 showed that an average of 38% were HIV infected. Reported in April 1998, a survey done by Caroline A. Ryan and colleagues from the Centers for Disease Control and Prevention found a 40.6 percent HIV-1 seroposivity rate for the 437 brothel-based sex workers who were examined.

(1.)http://hivinsite.ucsf.edu/img/
international/Asia/cambodia.html

(1.)citing source as Washington Times, Nov. 22,1996. The UNAIDS branch of the World Health Organization reported in 1996 that the HIV epidemic began in the last decade. Populations most affected are heterosexuals with multiple sex partners, especially sex workers, soldiers and pregnant women. (Source: The Status and Trends of the Global HIV/AIDS Pandemic Official Satellite Symposium presented at the XI International Conference on AIDS in Vancouver, July 5-6, 1996).

    An excellent study of this epidemic has been done by Dr. Maurice Eisenbruch, "Dr. Hansen and the Crouching Mango: The Anthopology of STI and HIV/AIDS in Cambodia." Paper presented at the Association of Asian Studies 50th Annual Meeting 26-29 March 1998, Washington, D.C.

(1) Washington Times, Nov. 22,1996; (2), Reuters, Oct 17. 1997.
(1)citing source as Business Times (Malaysia), Oct. 14, 1996.
(1)citing source as Nation, July 18, 1996.
(2)http://www.utopia-asia.com/aidscam.htm#1604 ("Explosive Spread of HIV-1 and Sexually Transmitted Diseases").
The reseachers also interviewed 322 male police and military personnel. 56 percent claimed they had sex with a female sex worker in the preceding month and 88.5 percent in the past year. To my knowledge there has been no study on the HIV-status of wives whose husbands are in the police or military.


    Irrespective of traditional cultural values (cbap srey) that advocate per-marital sexual abstinence for women, the Cambodian AIDS Social Research Project has reported, based upon a two-year study, that one-third of Cambodia's young women are sexually active but do not use condoms. Of the young men surveyed, 87% said they have sex with their girlfriends or prostitutes and nearly half of the sexually active men said they never use a condom.

   Perhaps one of the most tragic consequences of the AIDS epidemic in Cambodia is the transmission of the virus to infants, In the 1996, tests conducted at two hospitals in Phnom Penh revealed that 20 and 35 percent of babies below the age of 18 months are HIV-positive. In the same year, Dr. Annie Macarry of WHO's AIDS programme, reported that in a special survey of pregnant women 4% were found to be infected. Perinatal HIV transmission and HIV transmission through breast milk have become a serious problem in Cambodia. UNAIDS will launch a plan to reduce HIV in babies within Cambodia in the year 2000. The project, supported by WHO and UNICEF, will provide women in the project with a short course of AZT, shown in Thailand to halve the risk of non-breast fed infants contracting the virus from their mothers.


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   It can be predicted that as mobility between Phnom Penh and Long Beach increases, the HIV/AIDS virus will increase in Long Beach. Cross-border mobility in HIV transmission between Vietnam and Cambodia is linked to social change in the wake of market reform, liberalization, and increasing trade. The situation in the United States for HIV/AIDS transmission to the Cambodian population remains obscure. The number of reported AIDS cases for Asians is very small, about 1% of all reported cases in the United States. This may well be due to underreporting and the lack of detailed HIV surveillance about Asians may mask the true nature of the epidemic in expatriate communities.

    Meredith Delaney of the city of Long Beach's Department of Health and Human Services is very concerned about the 1% of AIDS cases for all Asians in Long Beach.

She considers "the statistics to be too low for this group." Some factors for underreporting are that HIV infection is not reportable; private physicians are not required to report AIDS infections; refusal to testing.

    There appears to be very high rate of disbelief among the Asian/Pacific American group about being infected.

(1) citing source as Reuters, Oct. 11, 1996. Source is Reaksmey Kongkea, Cambodia Times August 12-18, 1996 from "Cambodia Times on the Net"
Source Cambodia Times on the Net, "More Infected With HIV Positive, says World Health Organization"
"Indochina Interchange" Vol 8.2(Summer 1998),24.
Report from the Third International Conference on AIDS in Asia and the Pacific, Chiang Mai, Thailand, 17-21 September.
"What Are Asian and the Pacific Islander HIV Prevention Needs?"
UCSF Center for AIDS Prevention Studies, April 1998. Fact Sheet #33E. (http://www.epibiostat.ucsf.edu/capsweb/API.html)
Personal conversation in August 1998. I would like to thank both Meredith Delaney and Sarady C. Kong of the city of Long Beach Department of Health and Human Services for providing me with information and statistics of STD and HIV/AIDS rates for the city of Long Beach.


   This may also apply to Cambodians. The rate of Asian/Pacific Islander women reporting sex with an HIV+ or high risk partner as a risk indicator is higher(46%) than for White(39%) or Black(36%) women. Since the Asian immigrant population is one of the fastest growing in the US and given that by the year 2000, Asia will report the highest number of new HIV infections globally, the Center for AIDS Prevention at U.C. San Francisco advocates more research on HIV/AIDS transmission and culturally sensitive prevention programs for this group. They discuss barriers to prevention for Asian and Pacific Islanders as follows:

   "There are cultural, linguistic, economic and legal barriers to HIV prevention among Asian and Pacific Islanders. For example, cultural avoidance of discussing issues of sexual behavior, illness and death can be barriers to HIV prevention...Foreign-born Asian and Pacific Islanders may have low or no English skills, and very few programs provide prevention intervention in Asian and Pacific Islander languages. The exclusion of most HIV+ individuals under US immigration law prevents many from obtaining permanent immigration status and scares immigrants away from government services such as HIV testing. The disqualification of many immigrants for Medicaid, SII and other public benefits under welfare and immigration laws also deters them from preventive health care, including HIV prevention."

   Although the greatest at-risk in both Cambodia and the United States is the 15-24 age group, a significant number of STD(late latent syphilis) cases in Long Beach and AIDS in Cambodia for the 45+ age group, indicates that special prevention and education measures should be taken for this older age group as well. UCSF Center for AIDS Prevention Studies, April 1998, Fact Sheet #33E. A current joke in Phnom Penh, involving clever word play, reported to me by a Cambodian colleague is translated as follows: "I'm not afraid of getting AIDS; I'm afraid of not getting any."

   There is a dramatic increase in the late latent syphilis for the Asian group reported by the Department of Health and Human Services, Long Beach City, 1995 statistics. The increase is most for the 45-65 year-old group. And perhaps more remarkable, this is the only STD category where Asians had a higher rate than any other ethnic group. STDs increase risk for HIV infection(see "HIV Prevention Through Early Detection and Treatment of Sexually Transmitted Diseases" -- United States CDC," Vol. 47/No. RR-12)
"UNAIDS Cambodia:Eidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Diseases," p.4 remarkably shows a high percentage of AIDS reported among the 50+ group.



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