Cambodia

Health and HIV Situation

It is estimated that there were 64,750 people living with HIV in Cambodia in 2007, out of which 3,350 were children under the age of 15. The total number of people living with HIV who receive ART has more than doubled from 12,247 in December 2005 to 25,353 in September 2007.

The adult national HIV prevalence rate decreased to 0.9% in 2006 from 1.2% in 2003 following the successful implementation of the 100% Condom Use Programme and extensive information campaigns on condom use and HIV transmission risks targeting sex workers and their clients. In 2006, among the total number of people living with HIV, 52% were estimated to be women compared to 37% in 1998. In 2005, UNAIDS reported that married women accounted for almost half of new infections.

The sex trade has driven the HIV epidemic in Cambodia and female sex workers remain one of the most at-risk groups of HIV infection, despite a significant decrease of the HIV prevalence rate among this group from 21.4% in 2003 to 12.7% in 2006.

National HIV Programme and Response

The National Strategic Plan for a Comprehensive and Multisectoral Response to HIV/AIDS (2006-2010) was developed with development partners, civil society organizations and people affected by HIV/AIDS. The Plan has specific objectives and strategies and an operational plan that involves all stakeholders, including the Government, civil society and the private sector. The Plan aims to reduce new HIV infections among at-risk groups, to provide care and treatment to people living with HIV/AIDS (PLWHA), and to address the socio-economic and human impacts of HIV.

In its commitment to provide universal access to treatment and continuum of care for PLWHA, the Cambodian Government has accelerated the de-centralized implementation of the Operational Framework for the Continuum of Care for People Living with HIV/AIDS.

The Ministry of Health provides public health services through provincial health departments and operational health districts. From December 2005 to September 2007, the number of facilities that provide ART increased by 60%; there are currently 48 facilities providing ART in Cambodia. In addition, the number of health facilities providing voluntary and confidential counseling and testing increased from 109 in December 2005 to 140 by December 2006. Prevention interventions are carried out by non-profit organizations, and by private and public sector agencies, and have had particular success among high-risk groups, especially female sex workers in brothels.

Despite national efforts to address the HIV epidemic, access to health care, treatment and reproductive health services is limited, notably in rural areas where most Cambodians live and migrate from.

In 2004, the National AIDS Authority set up a Mobility Working Group on HIV/AIDS, first to address HIV issues among migrants, and second to strengthen government capacity to deal with these issues. In May 2006, the Ministry of Labor and Vocational Training issued a regulation, Education of HIV/AIDS, Safe Migration and Labour Rights for Cambodian Workers Abroad. Its objectives are to raise awareness on HIV/AIDS for migrant workers and their families, to provide pre- and post-departure training on HIV/AIDS, and to inform migrants on safe migration and labour rights.

In 2006, the Ministry signed an MOU with CARAM Cambodia to provide training on HIV/AIDS to migrant workers, and an MOU with the Cambodian non-profit organization, Legal Support for Children and Women, to provide outgoing migrant workers with training on legal issues and migrants' rights.

Migration Patterns

Cambodia is a major sending country of migrant workers to booming Asian economies, including Malaysia, the Republic of Korea and neighbouring Thailand. From 1998 to 2007, 8,969 documented migrants worked in Malaysia, 7,042 of them women. An estimated 10,000, regular and irregular Cambodian migrants worked in Malaysia in 2003, and 2,464 Cambodian migrants currently work in the Republic of Korea. In 2002-2003, remittances to Cambodia amounted to approximately USD 3,177,600.

Documented migrant workers to Malaysia and the Republic of Korea receive a three month pre-departure vocational training course from recruitment agencies that focuses on reproductive health, HIV/AIDS and general medical exams. There are no evaluation and monitoring processes to ensure the delivery of such training courses and to assess their quality. Undocumented migrant workers, who are especially exposed to exploitative forms of labour in their destination countries, are difficult to reach with information on HIV-risk situations and safe migration.

In 2005, 181,579 Cambodians were registered with the Thailand Ministry of Interior, 123,998 male and 57,581 female, representing approximately 13% of all registered migrants in Thailand but this figure decreased to an estimated 37,142 by 2006 as few new work permits are being issued. It is estimated that there are another 180,000 undocumented migrants. Male migrant workers tend to stay short term in Thailand, while female migrant workers usually stay longer.

Undocumented migration from Cambodia to Thailand is an increasing concern. Documented migrant workers in Thailand have limited access to health care and treatment services due to language and cultural barriers. Undocumented migrants, who are less visible and thus more difficult to reach by non-profit organizations, remain largely isolated from HIV prevention, care and treatment services. Poor living conditions and discrimination are just some of the difficulties Cambodian migrants face.

Cambodia is a destination country for labour migrants, mainly from Viet Nam and China. The sex industry employs Vietnamese female migrants, who are quite vulnerable to HIV due to their profession and irregular status. The country has also been a major host for Vietnamese asylum seekers and refugees.

Cambodia is a source and transit country for men, women, and children trafficked for commercial sexual exploitation and forced labour to Thailand and Malaysia; it is also a transit and destination country for Vietnamese and Chinese women and children for sexual exploitation.

There is a lack of comprehensive information on HIV infection rates and risk behaviours among mobile populations.

HIV Response for Migrant Populations: Gaps and Opportunities

Cambodia's commitment to address the HIV epidemic has translated into the development of impactful prevention strategies and expanded care and treatment coverage for those in need. However, HIV interventions and programmes specifically targeting migrant and mobile populations remain to be developed and the capacity of national institutions to address HIV and mobility issue needs to be strengthened.

Comprehensive gender-based data collection mechanisms and surveillance systems are necessary to develop evidence-based, targeted HIV interventions among migrants and mobile populations.

Evaluation and monitoring mechanisms need to be put in place to ensure the delivery of good quality pre- and post-departure training courses on HIV/AIDS issues to migrants. HIV prevention, care, treatment, and support services for returning migrants are also required, as well as provisions that address trafficked persons' specific health and psychological needs.