KINGDOMOFCAMBODIA
NationReligionKing
CAMBODIA
COUNTRYPROGRESSREPORT
MonitoringtheProgresstowardsthe
ImplementationoftheDeclarationofCommitment
onHIVandAIDS
Reportingperiod:
January2008ͲDecember2009
PreparedandSubmittedby:
TheNationalAIDSAuthority
March,2010
Supportedby
TheNationalAIDSAuthority
Address: Building16,St.271&cornerSt.150,
ToeukLaark2,TuolKork
PhnomPenh,Cambodia
Tel: (855)23883540
Fax: (855)23885129
Website: www.naa.org.kh
i
Acknowledgements
The development of the 2010 UNGASS Country Progress Report was led by the National
AIDSAuthority(NAA)withsupportfromHIV/AIDSCoordinatingCommittee(HACC)andthe
Cambodia UNAIDS Country Office. The report is the result of a participatory process
involvingextensiveconsultationswithawiderangeofstakeholdersincludingGovernment,
national and international NGOs, multilateral and bilateral agencies, faithͲbased
organizations,andprivatesectorinstitutions.Theconstructiveparticipationofallpartners
isgratefullyacknowledged.
Data included in the report were obtained from the Cambodia Demographic and Health
Survey (CDHS), the Behavioural Surveillance Survey (BSS), HIV Sentinel Surveillance (HSS),
STI Sentinel Survey (SSS) and the HIV Prevalence among Drug Users Survey as well as
programmemonitoringdatafrom theNationalCentreforHIV/AIDS,DermatologyandSTDs
(NCHADS),theNationalMaternalandChildHealthCentre(NMCHC),theNationalCentrefor
Tuberculosis and Leprosy Control (CENAT) and the National Blood Transfusion Centre
(NBTC) at the Ministry of Health (MoH), as well as the Ministry of Education, Youth and
Sports(MoEYS).
Data collection and entry as well as the preparation of national consultation and data
vettingmeetingswereledbystaffofNAA’sPlanning,Monitoring,EvaluationandResearch
(PMER)department,especiallyDr.LyChanravuthandMs.SovannVitouunderthedirection
ofH.E.Dr.HorBunLeng,DeputySecretaryGeneraloftheNAA.
The National AIDS Spending Assessment (NASA) was carried out under the leadership of
NAAwithsupervisionbyH.E.Dr.HorBunLenganddayͲtoͲdaycoordinationoftheprocess
by Mr. Sok Serey. Dr. Savina Ammassari, Ms. Alexandra Illmer and Mr. John Keating
(UNAIDS Country Office) together with Mr. Christian Aran (UNAIDS Geneva) provided
technicalsupportinthedesignandimplementationoftheNASA.
The team at HACC, under the guidance of Mr. Tim Vora, facilitated the collection of
informationfromcivilsocietyorganisationsbothatsubͲnationalandnationallevel.Thishas
ensuredthatviewsofrepresentativesfromnetworksofpeoplelivingwithHIV(PLHIV)and
mostͲatͲriskpopulations(MARPs)arereflectedinthereport.
Dr. Savina Ammassari, Ms. Madelene Eichhorn and Ms. Barbara Donaldson (UNAIDS
Country Office) provided technical, managerial, and coordination support in the UNGASS
reportingprocess.
Mr. Jan de Jong, recruited through the Swiss Tropical and Public Health Institute (Swiss
TPH), helped ensure data was reported in line with the UNGASS guidelines and assisted
with the report writing. Sheryl Keller provided technical support to conduct secondary
analysis of CDHS data. Technical assistance was also granted by Dr. Nicole Seguy and Dr.
RajendraͲPrasadYadavfromtheWorldHealthOrganization(WHO)inCambodia.
The 2010 UNGASS Country Progress Report was developed with financial assistance
providedbyUNAIDS.
DrTengKunthy
SecretaryGeneralofNAA
iii
TableofContents
Foreword ... i
Acknowledgements ... ii
TableofContents... iii
AcronymsandAbbreviations ...iv
I.Statusataglance ... 1
III.NationalResponsetotheAIDSEpidemic ... 11
IV.Bestpractices... 28
V.Majorchallengesandremedialactions... 29
VI.Supportfromthecountry’sdevelopmentpartners... 33
VII.Monitoringandevaluationenvironment ... 37
ANNEX1: Consultation/preparationprocessforthecountryreportonmonitoring theprogresstowardstheimplementationoftheDeclarationofCommitmenton HIV/AIDS ... 41
ANNEX2:NationalCompositePolicyIndexquestionnaire ... 43
Annex3:NationalFundingMatrixfor2008and2009 ... 44
Annex4:DataSheetsfor25CoreIndicators ... 45
AcronymsandAbbreviations
AEM AsianEpidemicModel
AIDS AcquiredImmunodeficiencySyndrome
ART Antiretroviraltherapy
ASC AIDSSpendingCategories
BSS BehaviouralSurveillanceSurvey
CCC CountryCoordinatingCommittee
CDHS CambodiaDemographicandHealthSurvey
CENAT NationalCentreforTuberculosisandLeprosyControl
CoC ContinuumofCare
CQIͲATR ContinuedQualityImprovementforAntiͲRetroviralTherapy
CRIS CountryResponseInformationSystem
CSO Civilsocietyorganization
DFID DepartmentforInternationalDevelopment
FTA FunctionalTaskAnalysis
GDJͲTWG GovernmentͲDonorJointTechnicalWorkingGrouponHIV/AIDS
HACC HIV/AIDSCoordinationCommittee
HIV HumanImmunodeficiencyVirus
HSS HIVSentinelSurveillance
IBSS IntegratedBiologicalandBehaviouralSurveillance
IDU Injectingdrugusers
MARP MostͲatͲriskpopulation
MDG MillenniumDevelopmentGoal
M&E Monitoringandevaluation
MoH MinistryofHealth
MSM Menwhohavesexwithmen
MoEYS MinistryofEducation,YouthandSports
MoSVY MinistryofSocialAffairs,VeteranandYouthRehabilitation
NAA NationalAIDSAuthority
NACD NationalAuthorityforCombatingDrugs
NASA NationalAIDSSpendingAssessment
NBTC NationalBloodTransfusionCentre
NCHADS NationalCentreforHIV/AIDS,DermatologyandSTDs
NCPI NationalCompositePolicyIndex
NGO NonͲgovernmentalorganization
NMCHC NationalMaternalandChildHealthCentre
NOVCTF NationalOVCTaskForce
NSPII NationalStrategicPlanforaComprehensiveandMultisectoral
ResponsetoHIVandAIDS,2006Ͳ2010
NSPIII NationalStrategicPlanforaComprehensiveandMultisectoral
ResponsetoHIVandAIDS,2011Ͳ2015
OD Operational(Health)District
OI Opportunisticinfection
OVC Orphansandvulnerablechildren
PLHIV PeoplelivingwithHIV
PMER Planning,Monitoring,EvaluationandResearch
PMTCT PreventionofmotherͲtoͲchildtransmission
PSI PopulationServicesInternational
v
SOP StandardOperatingProcedure
STD Sexuallytransmitteddisease
SRA Situationandresponseanalysis
SSS STISentinelSurveillance
TB Tuberculosis
TRaC TrackingResultsContinuously
TWG TechnicalWorkingGroup
VCCT Voluntaryconfidentialcounsellingandtesting
UA UniversalAccess
UCO UNAIDSCountryOffice
UN UnitedNations
UNAIDS JointUnitedNationsProgrammeonHIV/AIDS
UNDAF UNDevelopmentAssistanceFramework
UNGASS UnitedNationsGeneralAssemblySpecialSessiononHIV/AIDS
UNJSPͲOPB JointUNSupportProgrammeOperationalPlanandBudget
WHO WorldHealthOrganization
I.Statusataglance
(A)TheInclusivenessoftheStakeholdersintheReportWritingProcess
The preparation of this report has involved participation from a broad range of
stakeholdersinthenationalresponsetoHIVandAIDSinCambodia1.Theprocesswas
led by the National AIDS Authority (NAA) with assistance from the HIV/AIDS
CoordinationCommittee(HACC)andtheUNAIDSCountryOffice(UCO)inCambodia.It
followed a similar approach to the one used in the previous round of UNGASS
reporting two years ago and was guided by the 2010 UNGASS Guidelines on
ConstructionofCoreIndicators2.
In order to inform all stakeholders about the aim of the UNGASS 2010 reporting
process and the suggested method to develop the report, a concept note was
circulated. The note also called for the involvement of all stakeholders in order to
ensurethecorrectreflectionofinformationpresented.
Data for the measurement of the indicators were collected from various sources,
including the National Centre for HIV/AIDS, Dermatology and STDs (NCHADS), the
National Blood Transfusion Centre (NBTC), the National Maternal and Child Health
Centre(NMCHC),theNationalCentreforTuberculosisandLeprosyControl(CENAT)as
wellastheMinistryofEducation,Youthand Sports(MoEYS).Datawerealsoderived
from various surveys such as the Cambodia Demographic and Health Survey (CDHS),
theBehaviouralSurveillanceSurvey(BSS),theHIVSentinelSurveillance(HSS),theSTI
SentinelSurvey(SSS)andtheHIVPrevalenceamongDrugUsersSurvey.
ThedatawereenteredandreportedthroughtheUNGASS2010onlinereportingtool3.. All stakeholders were encouraged to review the data while data collection and data
entryweregoingonoveranumberofmonths.
SeveralconsultationmeetingswereheldatsubͲnationalandnationallevelinorderto
completetheNationalCompositePolicyIndex(NCPI).Duringthesemeetingsinputwas
collected from government institutions, civil society organizations, representatives
from people living with HIV (PLHIV) and mostͲatͲrisk populations (MARPs) networks,
theprivatesectoranddevelopmentpartnerssuchasbiͲandmultilateralorganizations
includingtheUnitedNations(UN).
Part A of the NCPI was administered to officials from key ministries and other
government departments during a nationalͲlevel consultation meeting. Part B was
completed through consultation meetings involving civil society organizations in two
regions of Cambodia as well as meetings at the national level which aggregated the
collectedinformationtoincorporatethevoicesfromasmanycivilsocietystakeholders
aspossible.
1SpecialmentioningshouldbemadeofthefactthatactiveparticipationfromPLHIVandMARPSwassoughtand
encouragedatallstagesoftheconsultationandreportingpreparationprocess.Representativesfromcivilsociety
alsogaveopeningremarksatthe2010UNGASSReportNationalConsultationMeetingandValidationMeeting.
2UNAIDS(2009)UNGASSGuidelinesonConstructionofCoreIndicatorsfor2010reporting(see
http://data.unaids.org/pub/Manual/2009/JC1676_Core_Indicators_2009_en.pdf).
3 See reporting tool athttp://ungass2010.unaids.org with Country viewer username: cv_KH and Password:
KHme1453C
Spending data for 2006, 2007, and 2008 included in this report were obtained from
twoNationalAIDSSpendingAssessments(NASA)conductedin2007andin2009.
Adraftofthisreportwascirculatedtoallstakeholdersfortheirreviewandcomments.
The report was also presented and discussed during an inclusive national meeting
involving all the stakeholders to vet the data and validate findings and
recommendationsbeforesubmittingthereporttotheUNAIDSSecretariatinGeneva.
(B)StatusoftheEpidemic
No new data on HIV prevalence have become available since the previous Country
Progress Report. The latest estimates on HIVprevalenceare basedondatafromthe
2006HIVSentinelSurveillance(HSS)andthe2005CambodiaDemographicandHealth
Survey(CDHS)andoncalculationsandmodellingperformedbyateamofnationaland
international experts at Cambodia’s Consensus Workshop on HIV Estimates and
ProjectionsinJune20074.
TheseestimatesshowedthatHIVprevalenceamongadultsaged15to49decreasedto
0.9percentin2006from1.2%in2003.HIVprevalencewasestimatedtohavedropped
to0.7percentinthecurrentreportingperiod(2008Ͳ2009).Theprojectionsarebased
ontheassumptionthatinterventionsaresustainedatthesamelevel.
EpidemiologicaldatashowthattheepidemicinCambodiaisconcentratedamongsex
workersandentertainmentworkers,menwhohavesexwithmenandinjectingdrug
users. Although prevention programmes have had significant results, HIV prevalence
among these mostͲatͲrisk populations continues to be high and there is a general
consensus that there is a real risk of a secondͲwave of HIV infections within these
groups.
(C)ThePolicyandProgrammaticResponse
Political commitment at the highest level in the Royal Government of Cambodia is
recognized to be an important factor in Cambodia’s success in creating a supportive
legalandpolicyenvironmentandinbuildingastrongnationalresponsetoHIV.
Therehasbeensignificantprogressinleadershipandhighlevelcommitmentthrough
theworkoftheFirstLadyLokChumtievBunRanyHunSen,membersoftheNational
Assembly,theNationalAIDSAuthority,businessleaders,civilsocietyleaders,positive
women, and through faithͲbased leaders. The Prime Minister Samdech Hun Sen
formallyacceptedandendorsedtherecommendationsoftheAIDSinAsiaCommission
inMay2008.
In the past two years new policies for HIV interventions have been developed, and
various existing policies have been revised in an attempt to better reflect the
challenges that have been arising in the national response to HIV in Cambodia. For
example the Law on Drug Control is under revision and a new Standard Operating
Procedure(SOP)hasbeendevelopedtofurtherimproveinterventionswithworkersin
4NCHADS(2007)ReportofConsensusWorkshop–HIVEstimatesandProjectionforCambodia2006Ͳ2012
entertainment establishments5. However, some new laws and policies that are not
conducive to HIV prevention have seen the light in the reporting period and their
implicationswillbediscussedinthisreport.
Cambodia has made significant efforts to review the progress towards achieving the
Universal Access (UA) targets set for 2008 and 2010. These review processes have
resulted in clear documentation of the current status and challenges as well as
recommendationstoinformfuturestrategicplanning.Ingeneral,thefindingsindicate
that Cambodia is seeing remarkable progress in the health sector response to HIV
throughtherapidscalingͲupoftheContinuumofCare(CoC),butadditionaleffortsare
neededtoscaleupHIVpreventioninterventionsespeciallyamonghighriskgroups.
ItisgenerallyagreedthatinordertosustaintheachievementsinthereductionofHIV
prevalenceamongthegeneralpopulation,preventioninterventionsthattargetmostͲ atͲriskpopulationsneedtobescaledup.Progresshasbeenmadeinrespondingtothe
quickly changing policy and institutional environment and in developing better
targeted interventions. Considerable challenges remain, however, in particular the
questionofhowtorespondtocurrentchangesinfemalesexworkasforcedbrothel
closures have led to an increase in the number of women working in entertainment
establishmentssuchaskaraokebars,beergardens,andmassageparlourswhosellsex.
Civilsocietyorganizations(CSOs)playasignificantroleinthenationalresponsetoHIV.
Recognition of their role has resulted in a good relationship between them and the
government as well as in better coordination through the participation of CSOs in
consultation meetings. However, the application of a tool to measure civil society
participationintheplanningandimplementationofeffortstoreachUniversalAccess
foundthatcivilsocietyinvolvementintheseprocessescannotbeseenasmeaningful
participation6.ThisviewisalsoreflectedinPartBoftheNCPIenclosedinAnnex2of
thisreport.
FollowingtheHIVprevalenceestimatesandprojectionsthatwerepublishedin2007,
NAA led the development of the Cambodia’s Situation and Response Analysis (SRA)
and the revision of the second costed National Strategic Plan for a Multisectoral
ResponsetoHIV/AIDSfor2006Ͳ2010(NSPII)in2007.ThesevenstrategiesoftheNSPII
andtheestimatedcostsforeachofthesestrategiesarepresentedinTable1.
Table1: TheSecondNationalStrategicPlanforaMultisectoralResponsetoHIVandAIDS,
2006to2010(NSPII)
Unit:USD
2008 2009 2010
NSPIIStrategies
Amount % Amount % Amount %
Prevention 51,988,444 65 64,902,548 64 75,659,438 66
CareandTreatment 11,696,942 15 13,774,308 14 14,195,742 12
5NCHADS(2009)StandardOperatingProcedureforaContinuumofPreventiontoCareandTreatmentforFemale
EntertainmentWorkers
6 A tool developed by the Seven Sisters, adapted to suit the Cambodian context. The tool was filled by
representativesofCSOsthroughgroupdiscussionsandplenarysessionsorganizedbyHACCinOctober2009.This
resultedinascoreoflevel2(influence)onascaleof0to4where4representsthemaximumlevelofinfluence.
ImpactMitigation 6,212,778 8 8,544,867 8 10,665,444 9
Coordination,Management
andAdministration 2,859,364 4 4,280,815 4 4,386,162 4
LegalandPolicyEnabling
Environment 1,039,769 1 1,444,072 1 756,594 1
M&E,Researchand
Surveillance 5,198,844 7 8,152,119 8 7,565,944 7
ResourceMobilization 519,884 1 659,208 1 756,594 1
GrandTotal 79,516,026 100% 101,757,938 100% 113,985,918 100
Source: The Second National Strategic Plan for a Multisectoral Response to HIV and AIDS, 2006 –
2010(NSPII).
In 2010, NAA will develop a costed NSP III for 2011Ͳ2015 with support from
government institutions, civil society organisations, representatives from PLHIV and
MARPsnetworksaswellastechnicalagenciesanddevelopmentpartners.
(D)OverviewofUNGASSIndicatorData
Sincethelastreportingnonewdatahavebecomeavailablefromregularlyconducted
surveys, with exception of the HIV Prevalence Survey among Drug Users, which was
conducted by the National Center for HIV/AIDS, Dermatology and STIs (NCHADS) in
2007.Therefore,mostofthesamesurveydatasourceshavebeenusedasforthe2008
CountryProgressReport:theCambodiaandDemographicHealthSurvey(CDHS),2005;
the STI Sentinel Surveillance Survey (SSS), 2005; the HIV Sentinel Surveillance Survey
(HSS),2006;andtheBehaviouralSentinelSurveillanceSurvey(BSS),2007.
Following the firstͲever survey on HIV and drug users (DU/IDU Survey), data is now
available to measure several indicators dealing with drug users. The HIV Prevalence
Survey among Drug Users surveyed 528 injecting and nonͲinjecting drug users in 11
rehabilitation centers in four cities/provinces, and nonͲinstitutionalised drug user
communitiesinPhnomPenh.
NewHIVestimatesforthegeneralpopulationareexpectedtobecomeavailableafter
theHSShasbeenrepeatedlaterthisyear.
Thestatusofthe25UNGASSindicatorsissummarizedbelow,andfurtherinTable2
which gives the details on the status of each indicator per 2008 and 2010 UNGASS
reportingtoolrounds:
NASA II (indicator 1) covered the years 2007 and 2008 and hence two National
FundingMatrixesareincludedinthereportasAnnex3.Thedataarepresentedin
SectionVIofthisreport,togetherwithdataon2006withatrendinspendinginthe
lastthreeyears.
ThecompletedNCPI(PartAandPartB)(indicator2)isattached(Annex2).
Thirteen indicators are reported in full (indicators 1,2,3,5,7,11,12, 13,15,16,17,19,22).
Other indicators could only be reported partially, because not all required
disaggregated data (e.g. by sex, age groups) are available (indicators
4,6,8,9,14,18,23,24).
Three indicators cannot be reported at all because of a lack of data (indicator
20,21,25);and
Indicator 10 is not reported because Cambodia is not a high prevalence country
(i.e.prevalencelessthan5percent).
Table2: UNGASSIndicatorsataGlance7
UNGASSIndicator Status
Description 2008 2010
Value
1 DomesticandinternationalAIDSspending Completed Completed
2 NationalCompositePolicyIndex Completed Completed
3 BloodSafetyͲ2009 Completed Completed 100%
HIVTreatment:AntiretroviralTherapyͲ2008
Partially
Completed
(2006)
Partially
Completed
94.9%
(adults) 4
HIVTreatment:AntiretroviralTherapyͲ2009
Partially
Completed
(2007)
Partially
Completed
100%
(adults) PreventionofMotherͲtoͲChildTransmissionͲ2008 Completed
(2006) Completed 27.0%
5
PreventionofMotherͲtoͲChildTransmissionͲ2009 Completed
(2007) Completed 32.3%
6 CoͲManagementofTuberculosisandHIVTreatmentͲ
2009 NoData Partially
Completed 4.8%
7 HIVTestingintheGeneralPopulation Completed Completed 4.1%
HIVTestinginmostͲatͲriskpopulationsͲSexWorkers Partially
Completed
Partially
Completed 68.1%
HIVTestinginmostͲatͲriskpopulationsͲMenWhohave
SexwithMen
Partially
Completed
Partially
Completed 58.0%
8
HIVTestinginmostͲatͲriskpopulationsͲInjectingDrug
Users NoData Partially
Completed 35.3%
MostͲatͲriskpopulations:PreventionProgrammesͲSex
Workers NoData NoData Ͳ
9
MostͲatͲriskpopulations:PreventionProgrammesͲMen
WhohaveSexwithMen NoData NoData Ͳ
7PartiallyCompletedindicatesthatnotalltherequireddisaggregateddata(e.g.bysex,agegroups)wasavailable
forentryinthe onlinereportingtool.NoDataindicatesthattheindicatorcouldnotbereportedinlinewiththe
definition included in the Guidelines on Construction of Core Indicators. However, for most of these indicators
relateddataareavailable,whicharepresentedintherelevantsectionsofthisnarrativereport.
MostͲatͲriskPopulations:PreventionProgrammesͲ
InjectingDrugUsers NoData Partially
Completed Ͳ
10 SupportforChildrenAffectedbyHIVandAIDS
Not
Relevant
toCountry
Not
Relevantto
Country
Ͳ
11 LifeSkillsͲbasedHIVEducationinSchoolsͲ2009 Completed Completed 34.1%
Orphans:SchoolAttendanceͲPartA Completed Completed 76.1%
12
NonͲOrphans:SchoolAttendanceͲPartB Completed Completed 91.6%
13 YoungPeople:KnowledgeaboutHIVPrevention Completed Completed 47.6%
MostͲatͲriskPopulations:KnowledgeaboutHIV
PreventionͲSexWorkers NoData NoData Ͳ
MostͲatͲriskPopulations:KnowledgeaboutHIV
PreventionͲMenWhohaveSexwithMen NoData NoData Ͳ
14
MostͲatͲriskPopulations:KnowledgeaboutHIV
PreventionͲInjectingDrugUsers NoData Partially
Completed Ͳ
15 SexBeforetheAgeof15 Completed Completed 0.6%
16 HigherͲriskSex Completed Completed 3%
17 CondomUseDuringHigherͲriskSex Completed Completed 40%
18 SexWorkers:CondomUse Partially
Completed
Partially
Completed 99%
19 MenWhoHaveSexwithMen:CondomUse Completed Completed 86.5%
20 InjectingDrugUsers:CondomUse NoData NoData Ͳ
21 InjectingDrugUsers:SafeInjectingPractices NoData NoData Ͳ
22 ReductioninHIVPrevalence Completed Completed 0.4%
MostͲatͲriskPopulations:ReductioninHIVPrevalenceͲ
SexWorkers
Partially
Completed
Partially
Completed 14.7%
MostͲatͲriskPopulations:ReductioninHIVPrevalenceͲ
MenWhohaveSexwithMen Completed Completed 4.5%8
23
MostͲatͲriskPopulations:ReductioninHIVPrevalenceͲ
InjectingDrugUsers NoData Partially
Completed 24.4%
24 HIVTreatment:SurvivalAfter12Monthson
AntiretroviralTherapy–2009 NoData Partially
Completed 86.7%
25 ReductioninMotherͲtoͲChildTransmissionͲ2009 NoData NoData Ͳ
8ThisistheHIVprevalencefornonͲtransgendersinPhnomPenh,whichwasthelargestsubͲgroupincludedinthe
SSS2005.
II.OverviewoftheAIDSEpidemic
HIVPrevalenceintheGeneralPopulation
FollowingtheConsensusWorkshopofHIVEstimatesandProjectionsinJune2007,HIV
prevalenceinthegeneralpopulation(adultsaged15to45years)wasestimatedtobe
0.9 percent in 2006 and 0.7 percent in the 2008Ͳ2010 period (Figure 1). It was
predicted that HIV prevalence in the general population would drop further to an
estimated0.6percentoftheadultpopulationin2011and2012.
This decrease in the proportion of persons living with HIV can be attributed to the
declineinthenumberofnewinfectionsandtheincreasingnumberofdeathsamong
personswhowereinfectedintheearlyyearsoftheepidemic.
Figure1: ProjectedprevalenceofHIVamongthegeneralpopulationaged15–49yearswith
ARTavailable(2006–2012)
0.9
0.8
0.7 0.7 0.7
0.6 0.6
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
2006 2007 2008 2009 2010 2011 2012
Year
Percentage
Source: Report on Consensus Workshop on HIV Estimates and Projections for Cambodia 2006Ͳ2012;
MinistryofHealth,NationalCentreforHIV/AIDS,DermatologyandSTDs;25Ͳ29June2007.
ThenumberofadultslivingwithHIVwasforecastedtodeclinesteadily(Figure2).In
2008and2009therewererespectivelyanestimated58,700and57,900peopleaged
15Ͳ45livingwithHIV.Anestimated52percentofthemwerewomen.
Cambodia’s epidemic has been attributed primarily to heterosexual transmission
among high risk groups, particularly female sex workers, their clients, and the other
sexpartnersofclients.Astheepidemichasmatured,theproportionofwomenamong
personslivingwithHIV/AIDShasincreased.
Figure2: Projectednumberofpeopleaged15Ͳ49livingwithHIVinCambodia(2006–2012)
32,200
29,200 27,900 27,600 26,700 25,300 24,400
35,000
32,200 30,800 30,300 29,500 27,800 26,800
67,200
61,400
58,700 57,900 56,200
53,100 51,200
0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000
2006 2007 2008 2009 2010 2011 2012
Year
Number
men women total
Source: Report on Consensus Workshop on HIV Estimates and Projections for Cambodia 2006Ͳ2012;
MinistryofHealth,NationalCentreforHIV/AIDS,DermatologyandSTDs;25Ͳ29June2007.
UNGASSIndicator22:HIVPrevalenceinYoungPeople
InlinewiththeGuidelinesonConstructionofCoreIndicators,HIVprevalenceinyoung
people is calculated using data from pregnant women attending antenatal clinics in
HIVsentinelsurveillancesites9.
ThelastHSS(2006)foundanHIVprevalenceof0.41percentamongpregnantwomen
aged15to24yearsattendingantenatalclinicsandof1.1percentamongallpregnant
womenattendingantenatalclinics.
The2005 CDHSreported0.2percentHIVprevalenceinyoungpeopleaged15to 24.
Prevalence in this group was found to be higher among women (0.3 percent) than
amongmen(0.1percent).
HIVIncidenceintheGeneralPopulation
Figure3showsthatthefalling prevalenceis associatedwithadecreasing numberof
new HIV infections. The number of newly infected women was projected to have
exceededthenumberofnewlyinfectedmenuntil2007.Afterwards,HIVincidencewas
anticipatedtobehigherinthemalepopulation.
Figure 3 also shows that 900 people (480 men and 420 women) were estimated to
have been infected in 2008. The number of newly infected people in 2009 was
estimatedtobe740;410menand330women.
9UNAIDS(2009)GuidelinesonConstructionofCoreIndicators:2010Reporting
Figure3: Projected number of new HIV infections annually among the general population
aged15Ͳ49years(2006Ͳ2012)
540
420
330
270 230
200 630
550
480
410
360
300 260
700
0 100 200 300 400 500 600 700 800
2006 2007 2008 2009 2010 2011 2012
Year
Number
Women Men
Source: Report on Consensus Workshop on HIV Estimates and Projections for Cambodia 2006Ͳ2012;
MinistryofHealth,NationalCentreforHIV/AIDS,DermatologyandSTDs;25Ͳ29June2007.
AIDSrelatedMortalityintheGeneralPopulation
The number of AIDSͲrelated deaths in 2006 was estimated at approximately 10,000
peopleandisprojectedtohavefallensharplysincethen.Basedontheprojections,in
the presence of antiretroviral therapy (ART), an estimated 4,800 people were
predictedtohavediedofAIDSduringthetwoyearscoveredbythisreport.
Figure4showsthat,despitethepresenceofART,thenumberofAIDSͲrelateddeathsis
expected to almost double between 2009 and 2011, before it will start decreasing
again.
Figure4:ProjectednumberofAIDSrelateddeathsannuallyamongthegeneralpopulation
aged15Ͳ49(2006Ͳ2012)
9,950
6,890
3,590
1,740 12,040
10,800
5,260
1,210
1,450 2,400
7,200
6,170 9,500
8,310
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000
2006 2007 2008 2009 2010 2011 2012
Year
Number
Wi thART Wi thoutART
Source: ReportonConsensusWorkshoponHIVEstimatesandProjectionsforCambodia2006Ͳ2012;
MinistryofHealth,NationalCentreforHIV/AIDS,DermatologyandSTDs;25Ͳ29June2007.
Projections of the number of AIDSͲrelated deaths in the absence of ART provide an
estimateofthenumberoflivessavedowingtotreatment.Thedifferencebetweenthe
two curves in Figure 4 represents the number of lives saved. It is estimated that
approximately13,000livesweresavedduringtheyears2008and2009.
UNGASSIndicator23:HIVPrevalenceamongMostͲatͲriskPopulations
(i) HIVPrevalenceamongFemaleSexWorkers
Themostrecentdatacomesfromthe2006HSSandshowsthatHIVprevalenceamong
brothelͲbasedfemalesexworkerswas14.7percentin2006,downfrom23.4percent
in2003(HSS2003)10.
HSS2006foundconsiderabledifferencesinthisindicatoramongthe22provincesand
municipalitiescoveredbythesurvey.HIVprevalenceamongbrothelͲbasedfemalesex
workers was over 20 percent in six provinces – Banteay Meanchey, Battambang,
Kompong Speu, Koh Kong, Siem Reap, and Sihanoukville. In Banteay Meanchey
province,theprevalenceratewasfoundtobeashighas30percent.
It should be noted that HIV surveillance surveys focused exclusively on female sex
workersandhence,HIVprevalencedataarenotavailableformalesexworkers.
(ii)HIVPrevalenceamongMenwhohaveSexwithMen
Men who have sex with men (MSM) were for the first time included as a sentinel
groupinthe2005STISentinelSurveillance(SSS),whichcoveredPhnomPenhandtwo
provincialtowns(BattambangandSiemReap)11.
HIV prevalence was found to be highest among MSM in Phnom Penh (8.7 percent
against 0.8 percent in the two provincial towns) and among transgender groups (7.9
percent compared to 2 percent for nonͲtransgender MSM). HIV prevalence was
highestamongtransgendergroupsinPhnomPenh(17percent).
ThelargestsubͲsampleinthe2005SSS wasthatofnonͲtransgenderMSMin Phnom
Penh among whom HIV prevalence was 4.5 percent. It should be noted that the
prevalence reported through the UNGASS online reporting tool concerns only this
groupwhichisatalowerriskofHIVinfectioncomparedtothetransgendergroup.
(iii)HIVPrevalenceamongInjectingDrugUsers
The results of the 2007 DU/IDU Survey showed that the HIV prevalence among
injecting drug users is as high as 24.4 percent. HIV prevalence among nonͲinjecting
drugusersismuchlowerandisestimatedtobe1.1percent.
10TheHIVprevalencereportedhereisafterstatisticalcorrectionsweremade(EPPsmoothed),whiletheFigureof
12.7percentreportedinthepreviousCountryProgressReportisbasedontherawdatasetofHSS2006.
11The2005SSSprovidesdataonHIVprevalenceforcertainsubͲgroups,suchasMSMinPhnomPenhversusthe
two provincial towns and transgender versus nonͲtransgender groups. However, the survey did not provide an
overallestimateofHIVprevalenceamongMSM.
III.NationalResponsetotheAIDSEpidemic
New data on prevention show that progress has been made in blood safety,
preventionofmotherͲtoͲchildtransmissionandlifeͲskillsbasededucationprogrammes
inschools.Forthefirsttime,Cambodiaisabletoreportonvoluntarycounsellingand
testing among injecting drug users. However, no new data has become available
concerning voluntary counselling and testing among the general population, female
sexworkersandMSMorpreventionprogrammesformostͲatͲriskpopulations12. Cambodiacontinuestoshowremarkableprogressincoverageofcareandtreatment
services. Data presented here show that the number of PLHIV with advanced HIV
infectiononARTincreasedbyanother40percentfrom2007to2009.Moreover,the
survivalofPLHIVonARTafter12monthsiscurrentlyestimatedtobe86.7percentfor
adultsand93.9percentforchildren.
No new data has become available on knowledge and behaviour change with the
exception of such dataconcerningdrug users.The previous Country Progress Report
stressed that increased efforts targeting young people is needed as the majority still
lack comprehensive knowledge about HIV prevention as shown by the results of the
2005CDHS.
Impact alleviation efforts continued to focus on orphans and vulnerable children.
Again,reportingreliesondatafromCDHS,whichisplannedtoberepeatedlaterthis
year. However, a review of progress made with the implementation of the National
Action Plan for Orphans and Vulnerable Children shows that growing numbers of
orphans and vulnerable children are being reached by essential care and support
services.
(A)Prevention
TheconsiderableeffortsledbyCambodiaintheareaofHIVpreventionhavehelpedto
reverse the epidemic with steady declines in HIV prevalence and incidence rates.
However, high HIV prevalence rates remain among people belonging to high risk
groups including entertainment workers, men who have sex with men and injecting
drugusers.
It is recognised that progress in scaling up HIV prevention interventions has been
insufficient.Interventionsneedtobemorestrategicandpragmaticintacklingsomeof
the new challenges the national response is facing and require adequate financing.
NASA II revealed that spending on prevention declined by 6 percent from 2006 to
2008,whichexceedsthedropinoverallAIDSspending(2.6percent)inthatperiod.
Asourceofparticular concernisthechangesthathaveoccurredinthebehaviourof
sex workers, their clients and their sweethearts and more generally in the
entertainmentindustry.Overthelastyearsmenhaveturnedawayfrombrothelsand
increasingly seek sex in nonͲbrothel settings and through relationships with
sweetheartswhereconsistentcondomuseremainsverylow.
12ThesedataareobtainedfromtheCDHSandBSSwhichhaveyettoberepeated.
The 2008 Law on the Suppression of Human Trafficking and Sexual Exploitation has
exacerbated this situation and has resulted in the closure of brothels and a growing
numberofwomensellingsexinentertainmentestablishmentssuchasbeergardens,
karaoke bars and massage parlours. These women are much more difficult to reach
withHIVpreventioninterventionssuchascondoms,HIVandSTIinformationaswellas
healthservicereferral.
UNGASSIndicator3:BloodSafety
Allofthebloodunitsthatweredonatedin2008andin2009havebeenscreenedfor
HIV according to data from the National Blood Transfusion Centre (NBTC). The
screeningfolloweddocumentedstandardoperatingproceduresandparticipatedinan
external quality assurance programme. This is a further improvement on the 97.3
percentreportedbytheNBTCinthepreviousCountryProgressReport.
Thenumberofbloodunitsdonatedincreasedfrom31,802in2007to39,733unitsin
2008. This figure fell to 35,895 units in 2009, which still represents a 12 percent
increase in comparison with the number of blood units collected in 2007. The NBTC
reportsthat0.81percentofdonatedbloodunitstestedHIVpositivein2009.
One concern, though, is the limited use of blood components in Cambodia, with 77
percent of all blood transfusions (2008) using whole blood rather than blood
components. Moreover, the relatively small number of voluntary blood donors
continues to be of concern, with less than oneͲthird (31 percent) of all blood units
donatedbyvoluntarydonorsin2009.However,voluntaryblooddonationsareupfrom
around25percentin2007.
UNGASSIndicator5:PreventionofMotherͲtoͲChildTransmission
The number of HIVͲinfected pregnant women who received antiretroviral therapy to
reducetheriskofmotherͲtoͲchildtransmissionofHIVincreasedfrom505in2007to
777in2008and798in2009.
Figure5,below,illustratestheexpansionincoverageofpreventionofmotherͲtoͲchild
transmission (PMTCT) interventions during the reporting period. The percentage of
HIVͲinfectedpregnantwomenwhoreceivedantiretroviraltherapytoreducetheriskof
motherͲtoͲchild transmission increased to 32.3 percent in 2009 from 11.2 percent in
2007and1.2percentin2003.
ThenumberofHIVͲinfectedpregnantwomenwasestimatedat2,475in2009bythe
National Mother and Child Health Centre (NMCHC) of the Ministry of Health. This
denominatorisbasedonnewcensusdata13andanestimatedHIVprevalenceamong
pregnantwomenof0.71percentin200914(HSS2006).
13The2008GeneralPopulationCensusofCambodia,NationalInstituteofStatistics,MinistryofPlanning,
September2009.
14HSS2006reportedanHIVprevalenceamongpregnantwomenattendingantenatalclinicsof1.1percent.The
estimatedHIVprevalenceinpregnantwomenin2009,isbasedonprojectionsusingdatafromHSS2006andother
sources.
The geographical coverage of PMTCT services further expanded during the reporting
period. At the end of 2009, PMTCT services were available at 200 sites in 67
operationaldistricts(ODs)upfrom98sitesin58ODsinSeptember2007and27sites
in16ODsinDecember200515.
Figure5: Percentage of HIVͲinfected pregnant women who received antiretroviral therapy
toreducetheriskofmotherͲtoͲchildtransmission(2003Ͳ2009)
1.2
3.8 5.0
7.0
11.2
27.0
32.3
0 5 10 15 20 25 30 35
2003 2004 2005 2006 2007 2008 2009
Year
Percentage
Source: PMTCTProgramoftheNMCHC,2003Ͳ2009
UNGASSIndicator7:HIVTestingintheGeneralPopulation
Cambodia’s 2005 Demographic and Health Survey (CDHS) included HIV testing. The
resultsshowthat4.1percentofadultsaged15Ͳ49hadreceivedanHIVtestinthe12
monthsprecedingthesurveyandknewtheirresult.
Table3belowillustratesthatahigherpercentageofmales(5.1)thanfemales(3.2)had
received an HIV test and knew their results. Respondents aged 20 to 24 years were
morelikelytohavetestedandtoknowtheirresultscomparedtothosebelongingto
otheragegroups16.
15SeeCambodia’s2008CountryProgressReport.
16Followingtheslightlymodifieddisaggregationrequirementsforthe2010UNGASSreport,thefiguresprovidedin
thisreportingroundsomewhatdiffersfromthefigurespresentedinthe2008UNGASS.Denominatorfiguresand
percentagesforthemaleandfemalerespondentsandtheagegroupswereaccessedthroughMEASUREDHS
websiteathttp://www.measuredhs.com/hivdata/data/start.cfm.Thenumeratorfigureswerecalculatedfromthis
data.Thedatapresentedas“All”isweightedusingthefollowingmaleweight1.66978375966686andfemale
weight0.732150231949566
Table3:Percentageofadultsaged15Ͳ49whoreceivedanHIVtestandknowtheirresult.
Male Female
Indicator All
All 15Ͳ19 20Ͳ24 25Ͳ49 All 15Ͳ19 20Ͳ24 25Ͳ49
Percentage
testedand
knowtheir
result
4.1% 5.1% 1.3% 7.8% 5.8% 3.2% 1.9% 5.4% 2.9%
Source:CambodiaDemographicandHealthSurvey,2005
DatafromroutinemonitoringbyNCHADScannotbecomparedwiththe2005CDHS,
which are shown in Table 3 below, because the latter is a populationͲbased survey,
while NCHADS reports the number of people tested in VCCT sites.Still, the NCHADS
datacanprovideamoreupͲtoͲdateoverviewofthecoverageanduptakeofvoluntary
andconfidentialHIVcounsellingandtesting(VCCT)inthecountry:
The number of health facilities that provide VCCT further increased from 197
healthfacilitiesinSeptember2007to233inDecember2009.
Thenumberofpeopletestedandwhoknowtheirresultcontinuestoincrease,as
shown in Figure 6 below. It should be noted that the number of people tested
reportedbyNCHADSincludespeoplethatmayhavebeentestedmorethanoncein
the same year. Therefore, it would be more correct to say that this number
representsthenumberofHIVtestsconductedforwhichtestresultswereprovided
throughpostͲtestcounselling.
Datafor2009showafurtherincreasewith361,052testsconductedforwhichtest
resultswereprovidedthroughpostͲtestcounselling.Thisrepresentsanincreaseof
22percentincomparisonwith2008andanincreaseof42percentsince2007.
Figure 6 also shows that for most of the HIV tests conducted the result are
provided through postͲtest counselling. For the period covered by the previous
CountryProgressReport,thiswas98percent.Thispercentagefurtherincreasedto
99percentfortheyears2008and2009.
Figure6:Numberofpeopletestedandwhoknowtheirresult(2005Ͳ2009)
152,147
212,789
259,883
299,368
363,799
148,336
208,858
254,574
296,510
361,052
0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000
2005 2006 2007 2008 2009
Year
Number
Tested KnowResult
Source:AnnualReports2005to2009,NationalCentreforHIV/AIDS,DermatologyandSTDs(NCHADS)
