Cambodia Key Data Issues and Suggestions

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2 DECEMBER 2011 REFERENCE SOURCES This review of reference sources is categorized into two groups, namely general sources and country sources. The general sources include the regional or global documents, such as the Report on the Global AIDS Epidemic, Towards Universal Access Progress Report, The World Health Report, World Health Statistics, State of World Population, The Human Development Report, and data from the UN Population Division, and The World Bank Database. The country sources are classified into three: 1) surveys 2) others and 3) journal articles. The surveys include Demographic and Health Survey (DHS), HIV Sentinel Surveillance Survey (HSS), Behaviour Surveillance Survey (BSS), and Integrated Biological and Behavioural Survey (IBBS). The others include studies, research, plans and guidelines. Most reference documents utilized for Cambodia are available in electronic format and can be accessed through the internet. GENERAL SOURCES All the general sources are available on Cambodia. The socio-economic and demographic information/indicators are drawn from these sources. An overall picture of the HIV epidemic in Cambodia can be presented with the help of these general sources. COUNTRY SOURCES Surveys National Institute of Public Health, Ministry of Health Cambodia. (1998). Cambodia Demographic and Health Survey National Institute of Statistics Cambodia. (2000). Cambodia Demographic and Health Survey National Institute of Public Health, National Institute of Statistics Cambodia, & ORC Macro. (2006). Cambodia Demographic and Health Survey 2005: Phnom Penh, Cambodia and Calverton, Maryland, USA: National Institute of Public Health, National Institute of Statistics and ORC Macro. National Institute of Statistics Ministry of Planning, Directorate General for Health Ministry of Health, & MEASURE DHS ICF Macro. (2011). Cambodia Demographic and Health Survey NCHADS, HIV Sentinel Surveillance, 1997, 1998, 1999 National Centre for HIV/AIDS Dermatology and STD Cambodia. (2000). HIV Sentinel Surveillance 2000 Cambodia National Centre for HIV/AIDS Dermatology and STD Cambodia. (2004). Report on HIV Sentinel Surveillance in Cambodia

3 National Centre for HIV/AIDS Dermatology and STD Cambodia, CDC, FHI, & USAID. (2004). HIV Sentinel Surveillance (HSS) 2003: Results, Trends, and Estimates. National STD/AIDS Control Programme. (2008). Report on HIV Sentinel Surveillance in Cambodia, National AIDS Programme Cambodia. (1997). The Cambodian Behavioral Surveillance Survey, First Round: National Center for HIV/AIDS Dermatology and STD Cambodia. (1998). Survey: Cambodia's Behavioral Surveillance Survey II 1998: Beer Promoters. Gorbach, P. M., Sopheab, H., Phalkun, M., Someth, E., et al. (1999). BSS II 1998: Changes in Sexual Behavior and Commercial Sex in Cambodia: Final Report National Center for HIV/AIDS Dermatology and STD Cambodia. (1999). Survey: Cambodia's Behavioral Surveillance Survey III 1999: Female Sex Workers. National Center for HIV/AIDS Dermatology and STD Cambodia. (2000). Cambodian Household Male Survey BSS IV National Center for HIV/AIDS Dermatology and STD Cambodia. (2003). Behavioral Sentinel Survey (BSS) V: Sexual Behavior among Urban Sentinel Groups, Cambodia National Centre for HIV/AIDS Dermatology and STD Cambodia. (2003). Integrated HIV, STD and Behavior Surveillance (IHSBS) Survey in Banteay Meanchey Province, Cambodia. National Center for HIV/AIDS Dermatology and STD Cambodia. (2004). BSS 2003: Sexual behavior among sentinel groups, Cambodia- BSS Trends National Center for HIV/AIDS Dermatology and STD Cambodia, FHI, & USAID. (2007). Cambodia 2007 Behavioral Surveillance Survey: HIV/AIDS Related Sexual Behaviors among Sentinel Groups. National Center for HIV/AIDS Dermatology & STD (NCHADS). (2010). Cambodia Behavioral Sentinel Survey (BSS) Power Point Presentation. Naga World Hotel 30th December USAID, & FHI. (2000). Sexual Behavior, STIs and HIV among Men who have Sex with Men in Phnom Penh, Cambodia National Centre for HIV/AIDS Dermatology and STD Cambodia, FHI, & USAID. (2001) Cambodia STI Prevalence Survey. Sopheab, H. (2004). Passive Surveillance Report on HIV/AIDS and Sexually Transmitted Infections, VCCT and Others HIV/AID Related in Cambodia in UNICEF, & UNESCO. (2004). Cambodia National Youth Risk Behaviour Survey: Summary Report. National Centre for HIV/AIDS Dermatology and STD Cambodia. (2005). Passive Surveillance Report on HIV/AIDS and Sexually Transmitted Infections, VCCT and Others HIV/AIDS Related in Cambodia in

4 National Center for HIV/AIDS Dermatology and STD Cambodia, FHI, ADB, & CDC GAP. (2006). Cambodian STI Survey 2005: Key Risk Behaviors and STI Prevalence. National Centre for HIV/AIDS Dermatology and STD Cambodia. (2007). Report of a Consensus Workshop HIV Estimates and Projections for Cambodia Phalkun, M. (2008). NCHADS Dissemination Presentation: HIV Prevalence among Drug Users 2007 in Cambodia. Ministry of Education Youth and Sport Cambodia. (2010). Most at Risk Young People Survey: Cambodia National Center for HIV/AIDS Dermatology and STD Cambodia. (2011). Estimation of the HIV Prevalence among General Population in Cambodia, Other Sources Cercone, J., Pinder, E., & Fallas, L. (2010). The Socioeconomic Impact of HIV at the Household Level in Cambodia. National AIDS Authority Cambodia. (2010). The National Strategic Plan for Comprehensive and Multi-sectoral Response to HIV/AIDS III ( ) in Cambodia. Royal Government of the Kingdom of Cambodia. (2008). National Strategic Plan for Illicit Drug Use Related HIV/AIDS National Center of HIV/AIDS Dermatology and STD Cambodia. (2010). VCCT Annual Report National Center for HIV/AIDS Dermatology and STD Cambodia. (2009). VCCT Annual Report National Center for HIV/AIDS Dermatology and STD. (2006). Annual Report National Centre for HIV/AIDS Dermatology and STD Cambodia. (2006). Cambodia: Annual Report National Center for HIV/AIDS Dermatology and STD. (2008). Annual Report 2007 National Center for HIV/AIDS Dermatology and STD. (2009). Annual Report National Center for HIV/AIDS, & Dermatology and STDs Cambodia. (2010). NCHADS Annual Report National Center for HIV/AIDS Dermatology and STD Cambodia. (2011). NCHADS Annual Report National Centre for HIV/AIDS Dermatology and STD Cambodia. (2005). Third Quarterly Progress Report, 2005 HIV/AIDS & STI Prevention and Care Programme. National Centre for HIV/AIDS Dermatology and STD Cambodia. (2006). First Quarterly Progress Report, 2006 HIV/AIDS & STI Prevention and Care Programme. 4

5 National Centre for HIV/AIDS Dermatology and STD Cambodia. (2006). Second Quarterly Progress Report, 2006 HIV/AIDS & STI Prevention and Care Programme. National Centre for HIV/AIDS Dermatology and STD Cambodia. (2006). Third Quarterly Comprehensive Report, 2006 HIV/AIDS & STI Prevention and Care Programme. National Centre for HIV/AIDS Dermatology and STD Cambodia. (2006). Fourth Quarterly Comprehensive Report, 2006 HIV/AIDS & STI Prevention and Care Programme. National Centre for HIV/AIDS Dermatology and STD Cambodia. (2007). First Quarterly Comprehensive Report, 2007 HIV/AIDS & STI Prevention and Care Programme. National Center for HIV/AIDS Dermatology and STD Cambodia. (2009). Third Quarterly Comprehensive Report, 2009 HIV/AIDS & STI Prevention and Care Programme. National Center for HIV/AIDS Dermatology and STD Cambodia. (2010). First Quarterly Comprehensive Report, 2010 HIV/AIDS & STI Prevention and Care Programme. National Center for HIV/AIDS Dermatology and STD Cambodia. (2010). Third Quarterly Comprehensive Report, 2010 HIV/AIDS & STI Prevention and Care Programme. National Center for HIV/AIDS Dermatology and STD Cambodia. (2010). Fourth Quarterly Comprehensive Report, 2009 HIV/AIDS & STI Prevention and Care Programme. PSI (2006). A longitudinal Assessment of HIV/AIDS Knowledge, Risk and Behaviour in Cambodia ( ); Presented in XVI International AIDS Conference, Toronto, Canada, August 16th USAID. (2006). Violence and Exposure to HIV among Sex Workers in Phnom Penh, Cambodia. National Centre for HIV/AIDS Dermatology and STD, & University of California Los Angeles. (2006). Sexual Risk and HIV/STD in Vulnerable Cambodian Females- The Cambodian Young Women s Cohort: Factory Workers. National Centre for HIV/AIDS Dermatology and STD Cambodia. (2007). Report of a Consensus Workshop HIV Estimates and Projections for Cambodia FHI, USAID, & PRASIT. (2008). Population Size Estimation of MSM in Cambodia, Hor, B. L. (2008). Mapping the Pattern of Sex Workers, Entertainment Establishments and Men who have Sex with Men in Cambodia. PSI. (2008). Cambodia 2008: HIV TRaC Study Evaluating Condom Use with Sweethearts among High Risk Urban Men from Phnom Penh, Siem Reap, Sihanoukville, and Battambang, Cambodia. 5

6 Recent Journal Articles Couture, M.-C., Sansothy, N., Sapphon, V., Phal, S., et al. (2011). Young Women Engaged in Sex Work in Phnom Penh, Cambodia, Have High Incidence of HIV and Sexually Transmitted Infections, and Amphetamine-Type Stimulant Use: New Challenges to HIV Prevention and Risk. Sexually Transmitted Diseases, 38(1), (limited access) Delvaux, T., Samreth, S., Barr-DiChiara, M., Seguy, N., et al. (2011). Linked Response for Prevention, Care, and Treatment of HIV/AIDS, STIs, and Reproductive Health Issues: Results After 18 Months of Implementation in Five Operational Districts in Cambodia. Journal of Acquired Immune Deficiency Syndromes, 57(3), e47-e55. (limited access) Sopheab, H., Morineau, G., Neal, J. J., et al. (2008). Sustained High Prevalence of Sexually Transmitted Infections among Female Sex workers in Cambodia: High Turnover Seriously Challenges the 100% Condom Use Programme. BMC Infectious Diseases 8(167) (open access) Hor, L. B., Detels, Roger, Heng, S., et al. (2005). The Role of Sex Worker Clients in Transmission of HIV in Cambodia. International Journal of STD & AIDS 16, (limited access) Sopheab, H., Fylkesnes, K., Philos, et al. (2006). HIV-Related Risk Behaviors in Cambodia and Effects of Mobility. Journal of Acquired Immune Deficiency Syndrome 41(1). (limited access) INDICATORS HIV prevalence and epidemiological status: HIV sentinel surveillance system was established in 1994 focusing on key affected and high risk populations in hot hit provinces. The table below depicts the sentinel populations and sentinel sites in rounds of HSS. Table 1: Sentinel Populations and scale up of sentinel sites of HSS in Cambodia ( ) Year No. of Provin ce DFS W IDFS W MIL PoL ANC TB MWR A HIPN HH (M & F)

7 Year No. of Provin ce DFS W IDFS W MIL PoL ANC TB MWR A HIPN HH (M & F) DFSW= Direct FSW, IDFSW= Indirect FSW, MIL= Military, PoL= Police, ANC=ANC attendees, TB= TB patients, MWRA= Married Women of Reproductive Age, HIPN= Hospital Inpatients, HH (M& F) = Household (Male & Female) Since 1998, surveillance data have been used to estimate national HIV prevalence and project trends in HIV incidence and mortality. In addition, HIV prevalence among adults (15-49) is available from DHS Trend data is available for both direct and indirect sex workers based on the annual surveillance surveys. Since MSM are not included in the sentinel populations, limited prevalence data is available from the surveys of Sexual Behaviour, STIs, and HIV among MSM in Phnom Penh, 2000 and Cambodia STI Survey, 2005 ( Phnom Penh, Battambang, and Siem Reap). Regarding IDUs, only one serological and behavioural survey is available and it was conducted in 2007 among drug users in 11 rehabilitation centers in 4 cities/provinces and the drug users in Phnom Penh community. In terms of case reporting, the number of people tested at VCCT services and HIV positivity rate among VCCT clients are available from annual reports. Vulnerability and HIV knowledge: HIV knowledge among general population is available from a series of DHS conducted in 1998, 2000, 2005, and In addition, data on HIV knowledge and vulnerability among different population groups are available from various rounds of behavior surveillance surveys as listed in Risk Behaviours section below. However, data on HIV knowledge among young people is quite limited and the most recent published source of data is DHS 2010 preliminary report. Risk behaviours: Since 1997, behaviour surveillance system has established to monitor behaviours, their changes, and trends in selected high-risk groups. Surveyed populations and year of survey are listed in the table below and all these behavioral surveillance surveys are conducted in 5 sites: Phnom Penh, Siem Reap, Battambang, Kampong Cham, and Sihanoukville. 7

8 Table 2: Behaviour Surveillance Surveys in Cambodia ( ) Year No. of sites DFSW IDFSW PoL/ MIL Moto MSM WW VS HH-M PLHIV * DFSW= Direct FSW, IDFSW= Indirect FSW, MIL= Military, PoL= Police, Moto= Moto-taxi driver, MSM= Men who have sex with men, WW= Working women, VS = Vocational Students, HH-M= Household male (15-49) years, PLHIV= People living with HIV and AIDS * Household based survey In addition to the surveys listed above, Integrated HIV, STD and Behaviour Surveillance Survey was conducted in Banteay Meanchey Province in 2003 among Direct and indirect sex workers, Policemen, Military, TB patients, Male and female casino workers, and ANC attendees. Avaialblity of behaviour data varies across populations and female sex workers are inclded as sample populations in all rounds of behaviour survyes though MSM are sampled in only one round. Regarding youth and young people, National Youth Risk Behaviour Survey was conducted in 2004 among youth years old. More recently, Most-at-risk Young People Survey, 2010 could provide information on alcohol, drug, sex related behaviors and utilization of sexual and reproductive health services among most-at-risk young people. DHS 2005 and DHS 2010 reports can also provide information on risk behavior among general youth. Socio-economic impact of the epidemic: Data and indicators on socio-impact of HIV at the household level are available from the recent publication by National AIDS Authority and the UN. The data from earlier years are available from ADB regional reports such as Macro Economic Impact of HIV/AIDS in the Asia and Pacific Region and Asia-Pacific s Opportunity: Investing to Avert an HIV/AIDS Crisis. Data on HIV expenditure and spending by categories are available for 2007 and 2008, as reported in the UNAIDS Report on the Global AIDS Epidemic Furthermore, summary of annual expenditure by sources can be found in comprehensive annual reports. National response: Most recent HIV testing among general population is available from DHS 2005 and the number of people tested at VCCT services are available from the annual reports published by NCHADS. Concerning KAPs, HIV testing among key affected populations is available from recent behavior surveillance surveys. However, prevention coverage among KAPs could not be 8

9 reported for the standardized global HIV and AIDS indicators (such as UNGASS indicators) since the BSS and the recent survey among drug users and IDUs did not include the specific questions which are required to calculate the prevention coverage. ART and PPTCT coverage data are available from UNGASS and Universal Access reports. Furthermore, other details about ART programme such as: number of patients on ART, new patients on ART, and survival of patients on ART are available from comprehensive annual reports. OVERALL IMPRESSION AFTER THE DATA REVIEW Strengths Series of behavior and sentinel surveillance data is available since the mid-90s and trend analysis can be done to monitor and observe the changes. Survey sites (cities/provinces) are consistent in all 8 rounds of behavior surveys and it aids in comparability of data. Though the sentinel sites for HSS are not consistent throughout the years, there are many consistent sentinel sites available and the changes over time can be analyzed and observed. Population-based knowledge and risk behavior data are available from DHS 2005 and DHS 2010 reports. DHS 2005 also included serological component and HIV prevalence among adults is available. Most recent data on socio-economic impact of AIDS is also available. Weaknesses Both serological and behavior data is quite limited among MSM and transgender. The data is available only from BSS 2007, STI survey 2005, and Sexual behavior, HIV and STI survey in Phnom Penh Lack of data among male sex workers. Only one survey is available among drug users and injecting drug users throughout the course of epidemic. Limited data on migrants HIV knowledge, risk behavior and lack of data on HIV and STI prevalence among migrants. 9

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