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Last Updated: Monday, 12 July, 2004, 12:13 GMT 13:13 UK
The brutal truth of Aids in Cambodia
Sray Neing
Drugs have saved Sray Neing from death
The International Aids Conference in Bangkok is pushing for greater availability of HIV drugs under the slogan "Access for All".

Patrick Nicholson, a press officer with the aid agency Cafod, has travelled to Cambodia to investigate what that means for a poor country struggling to keep the HIV epidemic in check.

The Venerable Hoeun Somnieg rises before dawn to meditate at his pagoda, situated near Cambodia's mythic Angkor Wat Temples.

Twenty of his fellow monks join him, chanting in rhythm, as they bow their heads to the Lord Buddha.

The saffron robes, the swirls of incense, and the golden Buddha statue - an ascetic life of contemplation and study.

The future was desperate. I had to act to stop the suffering.
The Venerable Hoeun Somnieg
But Venerable Somnieg's day will be acutely different from his predecessors - he is on Cambodia's frontline in the fight against HIV and Aids.

Over the last decade, the monks in Siem Reap were being asked to give blessings at more and more funerals of poor villagers who had died of Aids.

Ostracised families

Cambodia's HIV infections have rocketed to 3%, the highest in South East Asia.

Whole families were ostracised from village life, as their neighbours grew scared of catching a disease they did not understand.

"The future was desperate. I had to act to stop the suffering," said Venerable Somnieg.

Seven months ago, he started to work on providing prevention and care with the support of British aid agency Cafod providing counselling, education and care.

Cambodia is one of the world's poorest countries, with a third of the population living on less than a dollar a day.

The country's infrastructure is still recovering from two decades of civil war and the aftermath of the tyranny of the Khymer Rouge.

The country does not have hospitals to cope with the HIV epidemic. From birth to death, less than 1% of the population are ever treated by a government doctor.

Spreading the message

Woman dying of aids in Phonm Penh Hospice
Infection rates are very high
Perched on the back of a moped, as Buddhist teaching prevents monks from driving, Venerable Somnieg travels to a small hamlet to speak with a group of people with Aids.

Once muscular wiry farmers, their bodies are now emaciated with illness, their faces have become drawn, and their skin scaly and lifeless.

"Buddha taught that good health is an important part of spiritual health," said Venerable Somnieg.

He teaches the people to eat properly, stay clean, and exercise.

He listens to their problems, answers their questions about Aids, and gives psychological counselling on how to come to terms with their ill health.

The monks work with Aids patients has broken down the stigma - now the whole villages supports those who are ill.

The meeting ends with meditation and a blessing of holy water - a symbol of life for Buddhists.

Sex bars

Fast forward to the plethora of sex bars in the capital Phnom Penh. Loud karaoke blares, while beer girls offer customers a choice of drinks and more.

Brothels are common place - ranging from the high priced joints catering to foreigners to small huts on the banks of the Mekong where you can pay the equivalent of a couple of pence.

Despite South-East Asia's reputation for sex tourism, the overwhelming majority of prostitutes in Cambodia cater to other Cambodians.

The girls come from poor families in the countryside.

They can earn much more here than at home. It is a difficult choice. For some there is no choice.

If I refuse to sleep with them without a condom then they just rape me anyway.
Kea, a 20-year-old prostitute
Kea is a 20-year-old prostitute working in Phnom Penh. Her previous boyfriend sold her to the brothel.

He tricked her into signing a contract with the brothel owners that meant she has to work there to pay off his $100 debt to them.

Gangs of men regularly rape her.

One man gives her extra to come to the fields to use her - an irresistible $5.

When she arrives, there are five or six men waiting, who rape her in turn.

Condoms rare

The government has a well-publicised 100% condom use in brothels campaign. But Tea said that only about one in ten men want to use condoms.

Monk rings bell to announce meditation in pagoda
Monks spread the prevention message
She said: "If I refuse to sleep with them without a condom then they just rape me anyway so what can I do."

Her eyes are expressionless. They are dead - the eyes of someone who has born the unbearable.

The biggest increase in new infections is now from husband to wife, and from new mother to her baby.

One of the key responses by the government and aid workers is education.

Local community leaders in Sang Ang province go into the villages with simple flip charts showing how HIV is transmitted and how to avoid becoming infected.

Too late

For Lon Hieng and her family it has come too late.

She lives with her parents in their typical farmhouse on stilts. Her husband was a taxi driver in Phnom Penh, where he would visit brothels, and return to her at the weekend.

He died five years ago of Aids related infections.

"I was very angry with my husband when I found out he tested positive for HIV," she said.

"Men in Cambodia need to stay faithful to their wives."

She is now infected with the virus.

She found out her second child was HIV positive a year ago. She took the daughter to the hospital in the capital to get the anti-retro viral drugs that will block the HIV virus, but they did not have any left. The girl has just died.

Despite the drugs necessary to stop mother-to-child infections costing less than 50 pence, there are not enough available.

Many orphans

Health workers in Cambodia are predicting a tidal wave of 200,000 children orphaned by Aids within five years. At least 15,000 will be HIV positive.

A few will be taken in by one of the four orphanages run by John Tucker in Phnom Penh.

He is a brash big-hearted American from Ohio, a former businessman who has given it all up and come with his wife to help the children of Cambodia.

But he can only help a fraction. He has room for 200 children with HIV, and he said it is the only project in the country providing anti-retroviral drugs to such children.

Many of the children who come to the orphanage are found abandoned on the streets, close to death.

Sray Neing, aged three, weighed only six pounds when they took her in. The photo they have of her then shows little more than a tiny skeleton.

Six months after receiving anti-retroviral drug therapy, she is a plump healthy looking 22 pounds.

"The drugs work. They can extend somebody's life by 15 to 20 years. By then we might have a cure, " said Tucker.

No access to drugs

Despite Cambodia being a World Health Organisation target country for access to Aids drugs, only 3000 people receive them out of 170,000 infected with HIV.

A course of drugs for one of the children costs about $500 per year, including secondary care. Tucker said.

"It is a question of money, it is a question of political will by the international community."

The government of Cambodia has been singled out for its good work on HIV/AIDS, but ministers say it still does not have the money to properly tackle the epidemic.

The stark alternative to providing the necessary funds is highlighted by one of the hospices in Phnom Penh.

It takes people off the streets, and provides beds and around the clock healthcare for them in the last days of their illness.

The need is greater than the number of beds.

It is a bleak indictment of the international response to the HIV epidemic that only the lucky few in Phnom Penh will have a bed to die in with dignity.

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