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HIV in Cambodia: Attending to Great Loss

By Laura Sheahen

"I was exhausted. We had no money. My wife was vomiting and coughing," says Tev Vibol, a father living in a small village in Cambodia. He, his wife and his young daughter were very sick, and they didn't know why. "I couldn't think, I was so worried. We went to a private clinic two or three times, but they couldn't find out what was wrong," he says.

Neighborhood children

Neighborhood children play in the yard during a visit by a CRS volunteer. Such home care is the backbone of community-based campaigns to halt the spread of HIV in Cambodia. Photo by David Snyder for CRS

It was 2007. Fifteen years earlier, Vibol had suffered a nightmarish catastrophe: Both his legs were amputated at the knee after he had stepped on a landmine near the Thailand-Cambodia border. Still, he had managed to build a life. He married and earned a few cents a day repairing shoes. He used prosthetic limbs to get around.

Now, though, he felt helpless. He sold his land so he could afford treatment for his daughter. "We thought we would die."

One day a woman named Poa Sony visited the family. She had seen their symptoms before; she had them herself. "She said we should be tested for HIV," says Vibol.

When tests confirmed that all three family members were HIV-positive, Vibol felt even more desperate. But, he says, "Poa Sony encouraged us and told us not to lose hope. She said, 'A lot of people have this disease. Now we have medicine for it.' "

Combating Discrimination and Fear

Sony was trained by Catholic Relief Services' partner AHEAD, or Action for Health Development. She told the family that the government provided free antiretroviral drugs, and she arranged for AHEAD to pay their bus fare to the clinic about 20 miles away. She checks up on the family, making sure they are taking the medication and getting their immune systems tested regularly. And to supplement the meager income Vibol earns, AHEAD gave the family chickens to raise.

Living with HIV is enormously difficult, even for people with plenty of money and a support network. In Cambodia, CRS focuses on those who lack both: people in prison, people with disabilities and children whose parents have died or can't take care of them.

CRS' partners also focus on impoverished patients whose neighbors might reject them. "In the early 2000s, discrimination was very bad," says Vanna Moul, a doctor with AHEAD. "If someone with HIV was selling, say, papayas and bananas, no one would buy them."

"When an HIV-positive child goes to school, the kids don't want to play with him," she says. This happened with Vibol's daughter, who was shunned by her fellow 7-year-olds after her diagnosis. Sony's family experienced prejudice too: "When my children were playing at the river, other kids would yell, 'Your mom has HIV.' "

AHEAD goes to schools and villages to tell communities how HIV is transmitted. During education sessions, or via leaflets and posters, AHEAD explains that neighbors have nothing to fear from casual contact. AHEAD also forms role model groups: "They go to a person's house, eat with them, talk with them. People see that HIV isn't transmitted by a visit," says Dr. Moul. Now Sony's children and Vibol's daughter play freely with other neighborhood children.

Growing Up HIV-Positive

In some cases, healthy but impoverished parents are unable to care for their HIV-positive children. Sampong, now 17 years old, remembers being "very sick and thin" when she was 6. Her mother was sick too and died of AIDS when Sampong was 10.

When Sampong's father could no longer support her, much less give her the special care she needed, priests and sisters from the Catholic group Maryknoll came to the rescue. Sampong and hundreds of other HIV-positive children grew up in loving group homes as part of Maryknoll's Seedlings of Hope program.

CRS volunteers provide alarm clocks for clients

CRS volunteers provide alarm clocks to remind people to take their antiretroviral medications daily. Photo by David Snyder for CRS

Living in a house with about 10 other girls, Sampong goes to school and gets plenty of food and rest—a critical requirement for effective HIV medical treatment. In the classroom, she likes chemistry and language classes; after school, she enjoys traditional Khmer dancing and being a crossing guard as part of her Girl Scout duties. She and her roommate also like papering their bedroom walls with posters of boy bands: "I like to listen to Korean love songs," Sampong says, smiling.

"A lot of HIV-positive children were left on their own" in the late 1990s, says Sister Leonor Montiel, who supervises Seedlings of Hope. Maryknoll was the first organization to bring pediatric antiretroviral medications to Cambodia, and saved the lives of hundreds of children. In 2010 alone, Maryknoll cared for more than 700 Cambodian children who, in some way, were affected by AIDS or were HIV-positive. With CRS funding, young people who grew up in the Seedlings of Hope program will move to transitional homes, where they will learn job and life skills so they may manage their own lives.

Giving Inmates Hope

Prisoners with the virus are another vulnerable group. In Cambodia's jails, a sentence for counterfeiting or stealing was a death sentence for those with undiagnosed HIV. To help clinic staff in prisons recognize symptoms and treat patients properly, CRS partners began training them. "The health staff at the prisons started at zero," says AHEAD's Dr. Moul. "They didn't have the knowledge. They now know how to draw blood and collect sputum." The samples are sent outside the prison for testing. AHEAD also worked with the government to ensure that tuberculosis and HIV medicines reached the prisons.

Koi Kieu, 48, has experienced little freedom in his life. As a teenager, he was forced to work in one of the labor camps for young people run by Pol Pot's Khmer Rouge. There, children were separated from their parents and received little food as they farmed the land 12 hours a day.

Today, Kieu lives in a prison outside the city of Battambang. It was here that he first starting taking medicine to combat his HIV.

Although most prisoners receive only lunch and dinner each day, AHEAD provides food to Kieu and other patients in the morning; it's not good to take antiretroviral medications on an empty stomach. AHEAD trains the prison health staff to watch as prisoners take the tablets, so they don't skip a dose. And, after the prisoners are released, the organization follows up to make sure they know where to find medicine in their towns.

Kieu is looking forward to a healthy, productive life outside of prison. "I have one more year, and then I leave," he says. "I feel fine. I will go back to my hometown and see my mother, and farm rice."

Sampong lost her mother; Vibol lost his legs; Kieu lost years. But none has lost their lives, thanks to CRS partners who have helped thousands of HIV-positive Cambodians. In addition to receiving medical information and checkups, they know that someone cares about them.

"If a girl like me came, I would tell the kids here to encourage and support her," says Sampong about her group home. "I want everyone to treat her warmly and make her feel safe."

Laura Sheahen is CRS' regional information officer for Asia. She is based in Cambodia.

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