Editorial | Articles about Cambodia | Khmer
This story is part of a series celebrating HIV/AIDS activists in honor of Thursday's World AIDS Day.
Her house has been burned down. She's had her car jacked. Her daughter was kidnapped, drugged and raped. But still, sex trafficking survivor Somaly Mam says she would rather risk death than give up her work saving slaves in Cambodia.
Sold into prostitution at 12 by her grandfather, Mam was brutalized and raped -- sometimes up to 10 times a day -- throughout her teenage years. While Mam made an unlikely escape to France from the brothel in Cambodia, she couldn't tolerate the cushy life there knowing that thousands of girls were being tortured at home.
So in 1996, Mam returned to the slums of Cambodia and has been fighting forced prostitution and the rampant transmission of HIV/AIDS ever since.
"Our foundation is about the survivor," said Mam, who estimates her age to be about 40. "A survivor in my program means no one can feel how we feel. We know how to talk to them. The foundation empowers the victims and lets them know that we are the survivors."
Mam has saved more than 4,000 slaves since she started her advocacy work.
While an estimated 30,000 children are sold into slavery in Southeast Asia, according to The Somaly Mam Foundation, young girls -- as young as 6 -- are particularly vulnerable in Cambodia. There, it's believed that sleeping with a virgin can cure AIDS.
But at the moment a girl loses her virginity, she completely loses her allure and value.
"Once you're in a brothel, you are bad luck," Mam told The Huffington Post. "You can't get married. They completely destroy you. So you come to hate the people around you. You can't be happy."
She feels as though she will never completely overcome the horror she experienced, getting locked in a cellar with snakes, getting raped on a constant basis and watching her friend get shot and killed. Now, she says the charity she founded and runs is what gives her strength to carry on.
Mam first established AFESIP (Agir Pour les Femmes en Situation Precaire) 15 years ago out of her two-room home. She raids brothels and scours health clinics for victims to save, risking her life each time as she enrages the pimps and brothel owners. Her program, which provides shelter, education and job skills to the victims of sex-trafficking, gained even more momentum in 2007 when she established her funding vehicle, the Somaly Mam Foundation.
Oftentimes Mam gets to the girls after they've already contracted HIV. But whether they're in good health or suffering with the fatal disease, Mam said she pushes all of them to meet their potential.
One survivor, who Mam named "Monday" after the day of the week she was saved, was sold into slavery when she was 6 years old. Today, she's 19 and studying law.
"She was talking about wanting to go [work at] the court because the court treated her really badly," Mam said. "She wore short skirts so the judge talked to her like it made sense that they raped her."
Part of the healing process, Mam shared from her own experience, is being honest and open with the pain she and the survivors have endured. Now divorced, Mam said she isn't interested in sex or developing intimate relationships. The smell of sperm and getting close with men is just too painful a reminder of the torture to which she was subjected.
Though she's abstaining from relationships, Mam makes sure to remind herself to tend to her needs, to stay strong and healthy to fulfill her work.
"I realized I had to take care of myself for my girls," Mam said. "I don't want any of them to get pain from me."
Want to help Somaly Mam's cause? Donate to her foundation here.
Huffingtonpost.com
Labels: AIDS, HIV, Human Traffic, Somaly Mam
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PHNOM PENH(Xinhua) – Cambodia's Vice-Chair of National AIDS Authority Tia Phalla said Tuesday that it's estimated that some 2,500 HIV/AIDS patients died this year and the deaths would decline to about 2,300 in 2012.
"Cambodia has seen success in fighting HIV/AIDS -- the prevalence rate among adults aged 15 to 49 has dropped to 0.8 percent in 2010 from 2.5 percent in 1998," he said on Tuesday at a press meeting and photo exhibition to commemorate the World AIDS Day. "However, the deaths, new infections and discrimination against people living with HIV/AIDS still persist in this country. "
He said that the number of new infections exceeds 1,000 a year.
In Cambodia, the first HIV infection was detected and diagnosed in 1991 and the first AIDS case was found in 1993.
Tia Phalla said that it is difficult to verify the number of Cambodian people who have died from the disease since then as some AIDS infected people had been killed by opportunity diseases such as hepatitis or tuberculosis.
Meanwhile, he said that the country has seen good results in promoting the use of condoms.
According to a recent annual research survey, he said, condom use of male clients of the entertainment industry and with sweethearts has been steadily increasing.
The survey showed that the condom use among commercial partners increased from 85 percent in 2008 to 96 percent in 2011 thanks to sustained investment and targeted outreach to this important target group.
On the other hand, condom use among sweethearts has increased from 58 percent in 2008 to 60 percent this year, he said.
Currently, the country has an estimated 67,000 people living with HIV/AIDS. Some 6,000 of them are children, according to the National AIDS Authority.
The country needs about 58 million U.S. dollars a year to fight against HIV/AIDS, said Tia Phalla, adding that the current challenge for the country is fund shortage due to the recent announcement of the cancellation of the next round of funding from the Global Fund to Cambodia.
Labels: AIDS, HIV
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February/March 2011
Staff | WOMEN IN DEVELOPMENT
USAID FRONTLINE
The exchange of sex for money remains a major driver of the spread of HIV/AIDS throughout Southeast Asia, but the karaoke bars, massage parlors, beer gardens, and other settings where these transactions are brokered remain some of the most viable employment venues for vulnerable women.
In Cambodia—where more than 10 percent of female entertainment workers are infected with HIV, and more than 25 percent of these women and girls report having no education—USAID programming supported by the U.S. President's Emergency Plan for HIV/AIDS Relief (PEPFAR) is implementing a new approach to reducing HIV risk by focusing on the central principle of the Global Health Initiative: that the health and well-being of women is key to the health of all.
Instead of exclusively focusing on distributing condoms and conducting risk-reduction education for high-risk women, the SmartGirl program aims to improve the sexual and reproductive health of its beneficiaries more broadly through linkages to personal counseling, voluntary family planning services, clinical care, savings schemes, and legal services.
Late last year, the program received a PEPFAR Heroes award from the Office of the U.S. Global AIDS Coordinator for its efforts to reduce the risks associated with entertainment work, while also supporting women in the pursuit of other employment.
"We're committed to having women in the driver's seat," said Michael Cassell, the coordinator of the PEPFAR initiative in Cambodia. "SmartGirl is largely designed and run by entertainment workers to address their own felt needs. And the skills they acquire in the process help many of them to consider and pursue other careers, including ones in HIV and reproductive health service delivery."
Avoiding "Message Fatigue"
Previous HIV/AIDS programs have focused on raising awareness of HIV, and educating people about how to avoid getting infected. But by demonstrating that staying healthy is key to the pursuit of education, wealth, happiness, and other personal objectives, SmartGirl strives to engage beneficiaries while sidestepping some of the "message fatigue" and monotony associated with more didactic approaches. Education sessions are run by peers, cover a broad range of topics that are updated regularly, and offer referrals to free HIV testing, family planning, and other services.
During a recent visit to a SmartGirl club in Phnom Penh, U.S. Rep. Laura Richardson (D-Calif.) was inspired to join program beneficiaries in a rousing karaoke rendition of Gloria Gaynor's "I Will Survive," noting her appreciation for the leadership of club members in providing health education and referrals to health care, vocational training, and legal services to other entertainment workers.
"I am so proud of you," Richardson told the club members.
The SmartGirl program, which is implemented by USAID-partner Family Health International, currently provides services to 12,600 of the estimated 35,000 women working in clubs and night spots in Cambodia. The program is funded by PEPFAR but is consistent with the overarching objectives of the Global Health Initiative, the U.S. government's six-year, $63 billion commitment to help partner countries strengthen their health systems, with a particular focus on improving the health of women, newborns, and children.
"Almost 30 percent of entertainment workers in Cambodia report having an abortion in the past year, suggesting inconsistent condom use and unmet needs for family planning," said Cassell. "By linking these women to sexual and reproductive health services, we stand to prevent new HIV infections while also reducing maternal mortality—the latter arguably being Cambodia's biggest public health challenge."
A Model Approach
Cambodia is home to one of the most renowned national success stories in the fight against HIV/AIDS. Late last year, the country received international recognition in the form of a Millennium Development Goals country award for cutting adult HIV prevalence in half, from 2 percent to 0.9 percent between 1998 and 2006, while extending HIV-related care to more than 70 percent of HIV-infected adults, and HIV treatment to more than 90 percent of eligible individuals.
The estimated proportion of sex workers infected with HIV is down to around 10 percent from over 21 percent in 2003, according to the 2006 HIV Sentinel Surveillance (HSS). However, the maternal mortality ratio in Cambodia remains the second highest in East Asia.
"We're particularly excited about the potential of this program to serve as a model for the scale up of higher quality and more holistic approaches to address the needs of populations at high risk for HIV infection," said Cassell. "Many of the service delivery and referral protocols pioneered through SmartGirl are now being implemented as part of Cambodia's national program with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria."
In the past decade, the U.S. government has invested more than $150 million in HIV/AIDS programs in the Southeast Asian nation, providing almost 40 percent of the resources available to the national response.
Labels: AIDS, HIV, Women
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Can HIV Infection Be Prevented with a Once-Daily Pill?
Once the bane of global activists and politicians in developing nations, pre-exposure HIV preventatives are being tested in AIDS-stricken Africa
By Nicole Itano
Scientific American
JOHANNESBURG, SOUTH AFRICA—Nearly four years after political pressure shut down two trials that would have tested whether a once-a-day pill could prevent high-risk HIV-negative people from catching the AIDS-causing virus, there’s a surge of renewed interest in the concept, known as Pre-Exposure Prophylaxis, or PrEP.
Western doctors and organizations that funded the halted trials of the anti-HIV drug tenofovir in Cameroon and Cambodia say they've learned their lesson from the debacle in 2004 and 2005, when activist groups questioned the quality of medical care impoverished study participants would receive if they suffered side effects or the became infected by HIV. Today, with at least seven U.S.-funded PrEP trials underway at a cost of $39.5 million, researchers are working with local advocates, who have traditionally been distrustful of Big Pharma, to push the studies forward.
"The whole prevention community really had a wake-up call," says Linda-Gail Bekker, an infectious disease researcher at the University of Cape Town’s Desmond Tutu HIV Center, who is running the South African study site for a new PrEP trial that will eventually involve at least 3,000 gay men in South Africa, Asia, South America and the U.S. The study, which is enrolling trial participants now, is being funded by the U.S. National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation. Its first results are expected in 2010.
In August 2004, Cambodian Prime Minister Hun Sen stopped a trial of PrEP on prostitutes in his country under pressure from activists who said the study was exploiting vulnerable trial participants. Cameroon, which was to be part of a larger, three-country western Africa PrEP trial, shut the trial there down in early 2005 after questions were raised about the trial’s health care provisions for participants.
PrEP researchers now acknowledge they made a mistake by not involving local advocates from the start. After years of being told that antiretroviral drugs were toxic, the idea of using them in uninfected people seemed reckless to many. Local activists, along with their international supporters, believed the trials were being run by profit-hungry pharmaceutical companies who were coming to poor countries to do dangerous research that would later pad their own pockets and only end up benefiting people in the developed world.
In fact, the trials were being conducted by university and nonprofit researchers, and funded by the U.S. government and the Bill & Melinda Gates Foundation. Gilead Sciences, Inc., tenofovir's maker, provided the drugs for free but was otherwise not involved in the trial. And the drug's safety had already been proved in previous HIV treatment trials—many of them conducted in the U.S.
“I don’t think there was some wild, unethical conduct,” said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, which has helped facilitate dialogue on PrEP issues. “But there was a little defensiveness and a lot that got lost in translation.”
ACT UP/Paris, which is part of the international AIDS awareness activist coalition and was involved in the Cameroon controversy, and the Treatment Action Campaign (TAC), South Africa's largest organization of people with AIDS, have been involved in new trials from their earliest stages. New guidelines have also been written setting standards for community involvement in prevention trials, which recommend, for example, that researchers hold meetings with communities prior to the beginning of new trials to address what health care will be provided to participants.
The renewed interest in PrEP comes after two high-profile trials of a vaccine candidate produced by Merck were stopped early in 2007. At least 2.7 million people around the world are HIV-positive, according to the United Nations. Public health experts believe an arsenal of effective prevention tools against HIV is needed to curb its spread, because not everyone will practice existing methods known to work, such as condom use, monogamy between uninfected partners, and abstinence. Trials of potential microbicides, a woman-controlled prevention method that would work similarly to spermicides and other topical birth control methods by blocking or killing HIV during sex, have also been disappointing so far and may not be practical for all women to use. PrEP would offer an alternative.
The trials are investigating whether a daily dose of one of two antiretroviral drugs—either tenofovir disoproxil fumarate (TDF), commercially known as Viread, or Truvada (TDF combined with emtricitabine) can protect people at high risk of HIV from becoming infected.
Antiretroviral drugs, which stop retroviruses like HIV from replicating, are used to treat HIV-positive people. In certain cases they are also employed as a prophylactic to prevent the transmission of the virus from a mother to her newborn or to reduce the chance that someone who has been exposed to the virus, such as through rape or a needle prick, becomes infected.
TDF and emtricitabine are being tested for use as PrEP because they are known to cause low levels of resistance and fewer side effects, and because they remain in the bloodstream for a long time.
Results from studies in gay American men and injecting drug users in Thailand may be available next year. But the first full study testing whether PrEP stops the transmission of HIV through heterosexual sex (the main driver of the epidemic in Africa), which is being carried out in Botswana with plans to expand into South Africa, is not expected to yield results until 2011. And the three biggest trials, involving a total of 12,000 people across Africa, will not be complete until at least 2012.
Researchers are already looking forward to the potential issues that will arise if PrEP is found to be effective, such as whether the use of antiretroviral drugs as preventives will lead to increased resistance or how it could affect the future treatment options of people who later become infected.
If it does work, the public health community will also have to grapple with the tough question of when and how to use PrEP as well as how to balance the need to keep drug-resistant strains of HIV from thriving in the population while saving lives in the short term.
"PrEP has to be implemented as part of a formal program with guidelines and a funding stream. We have to start planning for that," says Lynn Paxton, a PrEP researcher at the U.S. Centers for Disease Control and Prevention.Labels: AIDS, HIV
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