World Aids Day today is a time to remember the lives lost, rejoice in the progress made, and recommit to ending Aids.
In Cambodia, there is much to celebrate. Just ask Dy Sokha. When she was diagnosed with HIV some 20 years ago, her life fell apart. She hid herself away, afraid of dying and the cool eyes of her family and community who regarded Aids with fear. She struggled with poor health. But then in 2004, Dy Sokha started taking medicine to treat HIV and within six months she felt healthy and strong. Today she works as a peer counsellor at an NGO in Phnom Penh that supports people receiving HIV treatment where her smile brightens everyone’s day.
A new UNAIDS report shows that across the world treatment for those with Aids has risen significantly. Treatment restores fullness and health to life. Cambodia has made remarkable progress on HIV treatment. In 2001 just 71 people living with HIV were receiving treatment in Cambodia. By June 2017, that number had increased to more than 58,000, which is about 80% of all people living with HIV.
The increase in treatment is due to the leadership and commitment of the government of Cambodia, which has made ending Aids a public health priority. For example, the government has made HIV services available even in remote rural areas. In 2016, the country was among the first in Asia to adopt
a strategy to treat everyone as soon as they are diagnosed with HIV.
Reaching the global 90-90-90 targets is a cornerstone of Cambodia’s national Aids response: that’s 90 percent of people knowing their HIV status, 90 percent of people who know their status getting treatment, and 90 percent of people on treatment being virally suppressed. Cambodia is one of only seven countries worldwide to have achieved the overall 90-90-90 target.
This high level of HIV treatment in Cambodia means that the national HIV programme is reducing the number of new HIV infections. Scientific research has shown that a person living with HIV who is adhering to their treatment is up to 97% less likely to transmit HIV. Cambodia also has implemented innovative prevention programmes that work with community organisations. As a result, the number of new HIV infections in a year has declined from a peak of over 21,000 in 1996 to less than 1,000 in 2016. These achievements are a result of the leadership by the Royal Government of Cambodia, strong partnerships with civil society organisations, UN and development partners, and the active engagement of people living with HIV and communities of key populations.
Despite these immense achievements, the Aids epidemic is not yet over. Cambodia has committed to reaching 95-95-95 targets by the year 2025. While the finish line is within reach, the last few steps are often the hardest. HIV continues to affect certain groups of people more than others. These include female entertainment workers, men who have sex with men, people who inject drugs, and transgender people. For example, HIV prevalence among people who inject drugs is estimated to be as high as 25 percent in some urban settings. And, among the estimated 3,000 transgender people in Cambodia, about 6 percent are living with HIV. And many newly infected individuals do not come from the key populations, making them harder to find. Efforts must be made to better understand how to find people infected with HIV in Cambodia.
In addition, people living with HIV, particularly from key populations, continue to face numerous challenges. These include persistent stigma and discrimination, limited access to high quality HIV treatment, and financial challenges associated with living with a chronic disease.
To reach the national goal of ending Aids, a strong and continued investment in scientifically sound HIV programmes is crucial. In 2015, Cambodia spent $46.9 million on the national Aids response. Only 17% of the total expenditure came from the government. Over the past three years, external financing for Cambodia’s HIV programme has been declining, and a recent analysis suggests that such outside financial support will continue to fall in the coming years.
Cambodia has worked hard to use funds as efficiently as possible. However, unless the national government increases contributions to the country’s HIV response, the strong and impressive achievements Cambodia has attained over the past two decades could be at risk. In particular, support for the invaluable work of non-governmental and community organisations is shrinking. Without the partnership of community organisations, Cambodia’s strong HIV programme faces a worrying gap in the prevention, care, and treatment of people living with HIV.
Cambodia is a recognised leader in the global HIV response. With a focus on finding undiagnosed people living with HIV and assuring quality of HIV services, the country can be among the first in Asia to end Aids as a public health threat.
Aids is not yet over, but it can be.
Vladanka Andreeva is the UNAIDS Country Director.
William Heidt is the United States Ambassador to Cambodia.