KINGDOM OF CAMBODIA Nation Religion King CAMBODIA COUNTRY PROGRESS REPORT

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1 KINGDOMOFCAMBODIA NationReligionKing CAMBODIA COUNTRYPROGRESSREPORT MonitoringtheProgresstowardsthe ImplementationoftheDeclarationofCommitment onhivandaids Reportingperiod: January2008December2009 PreparedandSubmittedby: TheNationalAIDSAuthority March,2010

2 Address: TheNationalAIDSAuthority Building16,St.271&cornerSt.150, ToeukLaark2,TuolKork PhnomPenh,Cambodia Tel: (855) Fax: (855) Website: Supportedby

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4 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, faithbased organizations,andprivatesectorinstitutions.theconstructiveparticipationofallpartners isgratefullyacknowledged. Data included in the report were obtained from the Cambodia Demographic and Health Survey(CDHS),theBehaviouralSurveillanceSurvey(BSS),HIVSentinelSurveillance(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.HorBunLenganddaytodaycoordinationoftheprocess 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 informationfromcivilsocietyorganisationsbothatsubnationalandnationallevel.thishas ensuredthatviewsofrepresentativesfromnetworksofpeoplelivingwithhiv(plhiv)and mostatriskpopulations(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 analysisofcdhsdata.technicalassistancewas alsograntedbydr.nicoleseguyanddr. RajendraPrasadYadavfromtheWorldHealthOrganization(WHO)inCambodia. The 2010 UNGASS Country Progress Report was developed with financial assistance providedbyunaids. DrTengKunthy SecretaryGeneralofNAA ii

5 TableofContents Foreword... i Acknowledgements... ii TableofContents... iii AcronymsandAbbreviations...iv I.Statusataglance... 1 III.NationalResponsetotheAIDSEpidemic IV.Bestpractices V.Majorchallengesandremedialactions VI.Supportfromthecountry sdevelopmentpartners VII.Monitoringandevaluationenvironment ANNEX1: Consultation/preparationprocessforthecountryreportonmonitoring theprogresstowardstheimplementationofthedeclarationofcommitmenton HIV/AIDS ANNEX2:NationalCompositePolicyIndexquestionnaire Annex3:NationalFundingMatrixfor2008and Annex4:DataSheetsfor25CoreIndicators iii

6 iv AcronymsandAbbreviations AEM AsianEpidemicModel AIDS AcquiredImmunodeficiencySyndrome ART Antiretroviraltherapy ASC AIDSSpendingCategories BSS BehaviouralSurveillanceSurvey CCC CountryCoordinatingCommittee CDHS CambodiaDemographicandHealthSurvey CENAT NationalCentreforTuberculosisandLeprosyControl CoC ContinuumofCare CQIATR ContinuedQualityImprovementforAntiRetroviralTherapy CRIS CountryResponseInformationSystem CSO Civilsocietyorganization DFID DepartmentforInternationalDevelopment FTA FunctionalTaskAnalysis GDJTWG GovernmentDonorJointTechnicalWorkingGrouponHIV/AIDS HACC HIV/AIDSCoordinationCommittee HIV HumanImmunodeficiencyVirus HSS HIVSentinelSurveillance IBSS IntegratedBiologicalandBehaviouralSurveillance IDU Injectingdrugusers MARP Mostatriskpopulation 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 Nongovernmentalorganization NMCHC NationalMaternalandChildHealthCentre NOVCTF NationalOVCTaskForce NSPII NationalStrategicPlanforaComprehensiveandMultisectoral ResponsetoHIVandAIDS, NSPIII NationalStrategicPlanforaComprehensiveandMultisectoral ResponsetoHIVandAIDS, OD Operational(Health)District OI Opportunisticinfection OVC Orphansandvulnerablechildren PLHIV PeoplelivingwithHIV PMER Planning,Monitoring,EvaluationandResearch PMTCT Preventionofmothertochildtransmission PSI PopulationServicesInternational

7 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 UNJSPOPB JointUNSupportProgrammeOperationalPlanandBudget WHO WorldHealthOrganization v

8 I.Statusataglance (A)TheInclusivenessoftheStakeholdersintheReportWritingProcess The preparation of this report has involved participation from a broad range of stakeholdersinthenationalresponsetohivandaidsincambodia 1.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 ConstructionofCoreIndicators 2. 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,youthandsports(moeys).datawerealsoderived fromvarioussurveyssuchasthecambodiademographicandhealthsurvey(cdhs), thebehaviouralsurveillancesurvey(bss),thehivsentinelsurveillance(hss),thesti SentinelSurvey(SSS)andtheHIVPrevalenceamongDrugUsersSurvey. ThedatawereenteredandreportedthroughtheUNGASS2010onlinereportingtool 3.. Allstakeholderswereencouragedtoreviewthedatawhiledatacollectionanddata entryweregoingonoveranumberofmonths. Severalconsultationmeetingswereheldatsubnationalandnationallevelinorderto completethenationalcompositepolicyindex(ncpi).duringthesemeetingsinputwas collected from government institutions, civil society organizations, representatives frompeoplelivingwithhiv(plhiv)andmostatriskpopulations(marps)networks, theprivatesectoranddevelopmentpartnerssuchasbiandmultilateralorganizations includingtheunitednations(un). Part A of the NCPI was administered to officials from key ministries and other government departments during a nationallevel consultation meeting. Part B was completedthroughconsultationmeetingsinvolvingcivilsocietyorganizationsintwo regions ofcambodia aswellas meetingsat the national level whichaggregatedthe collectedinformationtoincorporatethevoicesfromasmanycivilsocietystakeholders aspossible. 1 SpecialmentioningshouldbemadeofthefactthatactiveparticipationfromPLHIVandMARPSwassoughtand encouragedatallstagesoftheconsultationandreportingpreparationprocess.representativesfromcivilsociety alsogaveopeningremarksatthe2010ungassreportnationalconsultationmeetingandvalidationmeeting. 2 UNAIDS(2009)UNGASSGuidelinesonConstructionofCoreIndicatorsfor2010reporting(see 3 See reporting tool at with Country viewer username: cv_kh and Password: KHme1453C

9 CambodiaCountryProgressReport,2010Reporting Spendingdatafor2006,2007,and 2008includedinthisreportwereobtainedfrom 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 ProgressReport.ThelatestestimatesonHIVprevalencearebasedondatafromthe 2006HIVSentinelSurveillance(HSS)andthe2005CambodiaDemographicandHealth Survey(CDHS)andoncalculationsandmodellingperformedbyateamofnationaland international experts at Cambodia s Consensus Workshop on HIV Estimates and ProjectionsinJune TheseestimatesshowedthatHIVprevalenceamongadultsaged15to49decreasedto 0.9percentin2006from1.2%in2003.HIVprevalencewasestimatedtohavedropped to0.7percentinthecurrentreportingperiod( ).theprojectionsarebased ontheassumptionthatinterventionsaresustainedatthesamelevel. EpidemiologicaldatashowthattheepidemicinCambodiaisconcentratedamongsex workersandentertainmentworkers,menwhohavesexwithmenandinjectingdrug users.althoughpreventionprogrammeshavehadsignificantresults,hivprevalence among these mostatrisk populations continues to be high and there is a general consensus that there is a real risk of a secondwave of HIV infections within these groups. (C)ThePolicyandProgrammaticResponse Political commitment at the highest level in the Royal Government of Cambodia is recognizedtobeanimportantfactorincambodia ssuccessincreatingasupportive legalandpolicyenvironmentandinbuildingastrongnationalresponsetohiv. Therehasbeensignificantprogressinleadershipandhighlevelcommitmentthrough theworkofthefirstladylokchumtievbunranyhunsen,membersofthenational Assembly,theNationalAIDSAuthority,businessleaders,civilsocietyleaders,positive women, and through faithbased 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 4 NCHADS(2007)ReportofConsensusWorkshop HIVEstimatesandProjectionforCambodia

10 CambodiaCountryProgressReport,2010Reporting entertainment establishments 5. However, some new laws and policies that are not conducive to HIV prevention have seen the light in the reporting period and their implicationswillbediscussedinthisreport. Cambodiahasmadesignificanteffortstoreviewtheprogresstowardsachievingthe Universal Access (UA) targets set for 2008 and 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 throughtherapidscalingupofthecontinuumofcare(coc),butadditionaleffortsare neededtoscaleuphivpreventioninterventionsespeciallyamonghighriskgroups. ItisgenerallyagreedthatinordertosustaintheachievementsinthereductionofHIV prevalenceamongthegeneralpopulation,preventioninterventionsthattargetmost atriskpopulationsneedtobescaledup.progresshasbeenmadeinrespondingtothe quickly changing policy and institutional environment and in developing better targeted interventions. Considerable challenges remain, however, in particular the questionofhowtorespondtocurrentchangesinfemalesexworkasforcedbrothel closureshaveledtoanincreaseinthenumberofwomenworkinginentertainment 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 participation 6.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/AIDSfor (NSPII)in2007.ThesevenstrategiesoftheNSPII andtheestimatedcostsforeachofthesestrategiesarepresentedintable1. Table1: TheSecondNationalStrategicPlanforaMultisectoralResponsetoHIVandAIDS, 2006to2010(NSPII) Unit:USD NSPIIStrategies Amount % Amount % Amount % Prevention 51,988, ,902, ,659, CareandTreatment 11,696, ,774, ,195, NCHADS(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. 3

11 CambodiaCountryProgressReport,2010Reporting ImpactMitigation 6,212, ,544, ,665,444 9 Coordination,Management andadministration LegalandPolicyEnabling Environment M&E,Researchand Surveillance 2,859, ,280, ,386, ,039, ,444, , ,198, ,152, ,565,944 7 ResourceMobilization 519, , ,594 1 GrandTotal 79,516, % 101,757, % 113,985, Source: The Second National Strategic Plan for a Multisectoral Response to HIV and AIDS, (NSPII). In 2010, NAA will develop a costed NSP III for with support from government institutions, civil society organisations, representatives from PLHIV and MARPsnetworksaswellastechnicalagenciesanddevelopmentpartners. (D)OverviewofUNGASSIndicatorData Sincethelastreportingnonewdatahavebecomeavailablefromregularlyconducted surveys,withexceptionofthehivprevalencesurveyamongdrugusers,whichwas conducted by the National Center for HIV/AIDS, Dermatology and STIs (NCHADS) in 2007.Therefore,mostofthesamesurveydatasourceshavebeenusedasforthe2008 CountryProgressReport:theCambodiaandDemographicHealthSurvey(CDHS),2005; thestisentinelsurveillancesurvey(sss),2005;thehivsentinelsurveillancesurvey (HSS),2006;andtheBehaviouralSentinelSurveillanceSurvey(BSS),2007. Following the firstever 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 noninjecting drug users in 11 rehabilitation centers in four cities/provinces, and noninstitutionalised 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). 4

12 CambodiaCountryProgressReport,2010Reporting 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: UNGASSIndicatorsataGlance 7 UNGASSIndicator Status Description Value 1 DomesticandinternationalAIDSspending Completed Completed 2 NationalCompositePolicyIndex Completed Completed 3 BloodSafety2009 Completed Completed 100% HIVTreatment:AntiretroviralTherapy2008 HIVTreatment:AntiretroviralTherapy2009 PreventionofMothertoChildTransmission2008 PreventionofMothertoChildTransmission2009 CoManagementofTuberculosisandHIVTreatment 2009 Partially Completed (2006) Partially Completed (2007) Completed (2006) Completed (2007) NoData Partially Completed Partially Completed Completed Completed Partially Completed 94.9% (adults) 100% (adults) 27.0% 32.3% 4.8% 7 HIVTestingintheGeneralPopulation Completed Completed 4.1% HIVTestinginmostatriskpopulationsSexWorkers Partially Completed Partially Completed 68.1% 8 HIVTestinginmostatriskpopulationsMenWhohave SexwithMen Partially Completed Partially Completed 58.0% HIVTestinginmostatriskpopulationsInjectingDrug Users NoData Partially Completed 35.3% 9 Mostatriskpopulations:PreventionProgrammesSex Workers Mostatriskpopulations:PreventionProgrammesMen WhohaveSexwithMen NoData NoData NoData NoData 7 PartiallyCompletedindicatesthatnotalltherequireddisaggregateddata(e.g.bysex,agegroups)wasavailable forentryintheonlinereportingtool.nodataindicatesthattheindicatorcouldnotbereportedinlinewiththe definition included in the Guidelines on Construction of Core Indicators. However, for most of these indicators relateddataareavailable,whicharepresentedintherelevantsectionsofthisnarrativereport. 5

13 CambodiaCountryProgressReport,2010Reporting MostatriskPopulations:PreventionProgrammes InjectingDrugUsers NoData Partially Completed 10 SupportforChildrenAffectedbyHIVandAIDS Not Relevant tocountry Not Relevantto Country 11 LifeSkillsbasedHIVEducationinSchools2009 Completed Completed 34.1% 12 Orphans:SchoolAttendancePartA Completed Completed 76.1% NonOrphans:SchoolAttendancePartB Completed Completed 91.6% 13 YoungPeople:KnowledgeaboutHIVPrevention Completed Completed 47.6% 14 MostatriskPopulations:KnowledgeaboutHIV PreventionSexWorkers MostatriskPopulations:KnowledgeaboutHIV PreventionMenWhohaveSexwithMen MostatriskPopulations:KnowledgeaboutHIV PreventionInjectingDrugUsers NoData NoData NoData NoData NoData Partially Completed 15 SexBeforetheAgeof15 Completed Completed 0.6% 16 HigherriskSex Completed Completed 3% 17 CondomUseDuringHigherriskSex Completed Completed 40% 18 SexWorkers:CondomUse Partially Completed Partially Completed 99% 19 MenWhoHaveSexwithMen:CondomUse Completed Completed 86.5% 20 InjectingDrugUsers:CondomUse NoData NoData 21 InjectingDrugUsers:SafeInjectingPractices NoData NoData 22 ReductioninHIVPrevalence Completed Completed 0.4% MostatriskPopulations:ReductioninHIVPrevalence SexWorkers MostatriskPopulations:ReductioninHIVPrevalence MenWhohaveSexwithMen MostatriskPopulations:ReductioninHIVPrevalence InjectingDrugUsers HIVTreatment:SurvivalAfter12Monthson AntiretroviralTherapy 2009 Partially Completed Partially Completed 14.7% Completed Completed 4.5% 8 NoData NoData Partially Completed Partially Completed 24.4% 86.7% 25 ReductioninMothertoChildTransmission2009 NoData NoData 8 ThisistheHIVprevalencefornontransgendersinPhnomPenh,whichwasthelargestsubgroupincludedinthe SSS

14 II.OverviewoftheAIDSEpidemic HIVPrevalenceintheGeneralPopulation CambodiaCountryProgressReport,2010Reporting FollowingtheConsensusWorkshopofHIVEstimatesandProjectionsinJune2007,HIV prevalenceinthegeneralpopulation(adultsaged15to45years)wasestimatedtobe 0.9 percent in 2006 and 0.7 percent in the 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( ) Percentage Year Source: Report on Consensus Workshop on HIV Estimates and Projections for Cambodia ; MinistryofHealth,NationalCentreforHIV/AIDS,DermatologyandSTDs;2529June2007. ThenumberofadultslivingwithHIVwasforecastedtodeclinesteadily(Figure2).In 2008and2009therewererespectivelyanestimated58,700and57,900peopleaged 1545livingwithHIV.Anestimated52percentofthemwerewomen. Cambodia s epidemic has been attributed primarily to heterosexual transmission amonghighriskgroups,particularlyfemalesex workers,theirclients,andtheother sexpartnersofclients.astheepidemichasmatured,theproportionofwomenamong personslivingwithhiv/aidshasincreased. 7

15 CambodiaCountryProgressReport,2010Reporting Figure2: Projectednumberofpeopleaged1549livingwithHIVinCambodia( ) Number 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10, ,200 61,400 58,700 57,900 56,200 53,100 51,200 35,000 32,200 30,800 30,300 29,500 27,800 26,800 32,200 29,200 27,900 27,600 26,700 25,300 24, Year men women total Source: Report on Consensus Workshop on HIV Estimates and Projections for Cambodia ; MinistryofHealth,NationalCentreforHIV/AIDS,DermatologyandSTDs;2529June2007. UNGASSIndicator22:HIVPrevalenceinYoungPeople InlinewiththeGuidelinesonConstructionofCoreIndicators,HIVprevalenceinyoung people is calculated using data from pregnant women attending antenatal clinics in HIVsentinelsurveillancesites 9. ThelastHSS(2006)foundanHIVprevalenceof0.41percentamongpregnantwomen aged15to24yearsattendingantenatalclinicsandof1.1percentamongallpregnant womenattendingantenatalclinics. The2005CDHSreported0.2percentHIVprevalenceinyoungpeopleaged15to24. Prevalence in this group was found to be higher among women (0.3 percent) than amongmen(0.1percent). HIVIncidenceintheGeneralPopulation Figure3showsthatthefallingprevalenceisassociatedwithadecreasingnumberof 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 The number of newly infected people in 2009 was estimatedtobe740;410menand330women. 9 UNAIDS(2009)GuidelinesonConstructionofCoreIndicators:2010Reporting 8

16 CambodiaCountryProgressReport,2010Reporting Figure3: Projected number of new HIV infections annually among the general population aged1549years( ) Number Year Women Men Source: Report on Consensus Workshop on HIV Estimates and Projections for Cambodia ; MinistryofHealth,NationalCentreforHIV/AIDS,DermatologyandSTDs;2529June2007. AIDSrelatedMortalityintheGeneralPopulation The number of AIDSrelated 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,thenumberofAIDSrelateddeathsis expected to almost double between 2009 and 2011, before it will start decreasing again. Figure4:ProjectednumberofAIDSrelateddeathsannuallyamongthegeneralpopulation aged1549( ) 14,000 Number 12,000 10,000 8,000 6,000 4,000 2, ,040 10,800 9,950 9,500 8,310 6,890 7,200 6,170 5,260 3,590 1,450 2,400 1,740 1, Year WithART WithoutART Source: ReportonConsensusWorkshoponHIVEstimatesandProjectionsforCambodia ; MinistryofHealth,NationalCentreforHIV/AIDS,DermatologyandSTDs;2529June

17 CambodiaCountryProgressReport,2010Reporting Projections of the number of AIDSrelated 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:HIVPrevalenceamongMostatriskPopulations (i) HIVPrevalenceamongFemaleSexWorkers Themostrecentdatacomesfromthe2006HSSandshowsthatHIVprevalenceamong brothelbasedfemalesexworkerswas14.7percentin2006,downfrom23.4percent in2003(hss2003) 10. HSS2006foundconsiderabledifferencesinthisindicatoramongthe22provincesand municipalitiescoveredbythesurvey.hivprevalenceamongbrothelbasedfemalesex 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 against0.8percentinthetwoprovincialtowns)andamongtransgendergroups(7.9 percent compared to 2 percent for nontransgender MSM). HIV prevalence was highestamongtransgendergroupsinphnompenh(17percent). Thelargestsubsampleinthe2005SSSwasthatofnontransgenderMSMinPhnom 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 injectingdrugusersisashighas24.4 percent.hivprevalenceamongnoninjecting drugusersismuchlowerandisestimatedtobe1.1percent. 10 TheHIVprevalencereportedhereisafterstatisticalcorrectionsweremade(EPPsmoothed),whiletheFigureof 12.7percentreportedinthepreviousCountryProgressReportisbasedontherawdatasetofHSS The2005SSSprovidesdataonHIVprevalenceforcertainsubgroups,suchasMSMinPhnomPenhversusthe two provincial towns and transgender versus nontransgender groups. However, the survey did not provide an overallestimateofhivprevalenceamongmsm. 10

18 CambodiaCountryProgressReport,2010Reporting III.NationalResponsetotheAIDSEpidemic New data on prevention show that progress has been made in blood safety, preventionofmothertochildtransmissionandlifeskillsbasededucationprogrammes 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 sexworkersandmsmorpreventionprogrammesformostatriskpopulations 12. 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 exceptionofsuchdataconcerningdrugusers.thepreviouscountryprogressreport stressedthatincreasedeffortstargetingyoungpeopleisneededasthemajoritystill lackcomprehensiveknowledgeabouthivpreventionasshownbytheresultsofthe 2005CDHS. Impact alleviation efforts continued to focus on orphans and vulnerable children. Again,reportingreliesondatafromCDHS,whichisplannedtoberepeatedlaterthis year. However, areview 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. Asourceofparticularconcernisthechangesthathaveoccurredinthebehaviourof sex workers, their clients and their sweethearts and more generally in the entertainmentindustry.overthelastyearsmenhaveturnedawayfrombrothelsand increasingly seek sex in nonbrothel settings and through relationships with sweetheartswhereconsistentcondomuseremainsverylow. 12 ThesedataareobtainedfromtheCDHSandBSSwhichhaveyettoberepeated. 11

19 CambodiaCountryProgressReport,2010Reporting The 2008 Law on the Suppression of Human Trafficking and Sexual Exploitation has exacerbatedthissituationandhasresultedintheclosureofbrothelsandagrowing 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 This figure fell to 35,895 units in 2009, which still represents a 12 percent increaseincomparisonwiththenumberofbloodunitscollectedin2007.thenbtc 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 onethird (31 percent) of all blood units donatedbyvoluntarydonorsin2009.however,voluntaryblooddonationsareupfrom around25percentin2007. UNGASSIndicator5:PreventionofMothertoChildTransmission ThenumberofHIVinfectedpregnantwomenwhoreceivedantiretroviraltherapyto reducetheriskofmothertochildtransmissionofhivincreasedfrom505in2007to 777in2008and798in2009. Figure5,below,illustratestheexpansionincoverageofpreventionofmothertochild transmission (PMTCT) interventions during the reporting period. The percentage of HIVinfectedpregnantwomenwhoreceivedantiretroviraltherapytoreducetheriskof mothertochildtransmissionincreasedto32.3percentin2009from11.2percentin 2007and1.2percentin2003. ThenumberofHIVinfectedpregnantwomenwasestimatedat2,475in2009bythe National Mother and Child Health Centre (NMCHC) of the Ministry of Health. This denominatorisbasedonnewcensusdata 13 andanestimatedhivprevalenceamong pregnantwomenof0.71percentin (HSS2006). 13 The2008GeneralPopulationCensusofCambodia,NationalInstituteofStatistics,MinistryofPlanning, September HSS2006reportedanHIVprevalenceamongpregnantwomenattendingantenatalclinicsof1.1percent.The estimatedhivprevalenceinpregnantwomenin2009,isbasedonprojectionsusingdatafromhss2006andother sources. 12

20 CambodiaCountryProgressReport,2010Reporting ThegeographicalcoverageofPMTCTservicesfurtherexpandedduringthereporting period. At the end of 2009, PMTCT services were available at 200 sites in 67 operationaldistricts(ods)upfrom98sitesin58odsinseptember2007and27sites in16odsindecember Figure5: PercentageofHIVinfectedpregnantwomen whoreceivedantiretroviraltherapy toreducetheriskofmothertochildtransmission( ) Percentage Year Source: PMTCTProgramoftheNMCHC, UNGASSIndicator7:HIVTestingintheGeneralPopulation Cambodia s 2005 Demographic and Health Survey (CDHS) included HIV testing. The resultsshowthat4.1percentofadultsaged1549hadreceivedanhivtestinthe12 monthsprecedingthesurveyandknewtheirresult. Table3belowillustratesthatahigherpercentageofmales(5.1)thanfemales(3.2)had received an HIV test and knew theirresults. Respondentsaged 20 to24 years were morelikelytohavetestedandtoknowtheirresultscomparedtothosebelongingto otheragegroups SeeCambodia s2008countryprogressreport. 16 Followingtheslightlymodifieddisaggregationrequirementsforthe2010UNGASSreport,thefiguresprovidedin thisreportingroundsomewhatdiffersfromthefigurespresentedinthe2008ungass.denominatorfiguresand percentagesforthemaleandfemalerespondentsandtheagegroupswereaccessedthroughmeasuredhs websiteathttp:// data.thedatapresentedas All isweightedusingthefollowingmaleweight andfemale weight

21 CambodiaCountryProgressReport,2010Reporting Table3:Percentageofadultsaged1549whoreceivedanHIVtestandknowtheirresult. Indicator All Male Female All All Percentage testedand 4.1% 5.1% 1.3% 7.8% 5.8% 3.2% 1.9% 5.4% 2.9% knowtheir result Source:CambodiaDemographicandHealthSurvey,2005 DatafromroutinemonitoringbyNCHADScannotbecomparedwiththe2005CDHS, which are shown in Table 3 below, because the latter is a populationbasedsurvey, while NCHADS reportsthe number of peopletested in VCCTsites. Still, the NCHADS datacanprovideamoreuptodateoverviewofthecoverageanduptakeofvoluntary 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 throughposttestcounselling. Datafor2009showafurtherincreasewith361,052testsconductedforwhichtest resultswereprovidedthroughposttestcounselling.thisrepresentsanincreaseof 22percentincomparisonwith2008andanincreaseof42percentsince2007. Figure 6 also shows that for most of the HIV tests conducted the result are provided through posttest counselling. For the period covered by the previous CountryProgressReport,thiswas98percent.Thispercentagefurtherincreasedto 99percentfortheyears2008and2009. Figure6:Numberofpeopletestedandwhoknowtheirresult( ) Number 400, , , , , , ,000 50, , , , , , , , , , , Year Tested KnowResult Source:AnnualReports2005to2009,NationalCentreforHIV/AIDS,DermatologyandSTDs(NCHADS) 14

22 UNGASSIndicator8:HIVTestinginMostatriskPopulations (i)hivtestingamongfemalesexworkers CambodiaCountryProgressReport,2010Reporting The2007BSSfoundthat68.1percentofbrothelbased(direct)femalesexworkershad beentestedforhivandknewtheirresult.furthermore,thesurveyalsoshowedthat the percentage of nonbrothel based (indirect) female sex workers that had been testedandknewtheirresultwas51.8percent.nchadswillconductthenextbsslater thisyear. PreliminaryresultsofthelastTrackingResultsContinuously(TRaC)survey,conducted bypopulationservicesinternational(psi)duringthesecondhalfof2009,showthat64 percentofwomenworkinginentertainmentestablishmentsuchaskaraokebars,beer gardensandmassageparlourshadbeentestedinthe12monthsprecedingthesurvey. The survey also found that 91 percent of those tested had received posttest counselling. (ii)hivtestingamongmenwhohavesexwithmen The 2007 BSSshowed thatmore thanhalf of MSM (58percent)surveyedhad been tested and knew their result. This BSS was the first that covered MSM and thus no comparisonwithearlierdataispossible. However,twoyearsearlier,the2005STISentinelSurveillanceSurvey(2005SSS)found thatonly20percentofmsmhadbeentestedinthe12monthsprecedingthesurvey andknewtheirresults. (iii)hivtestingamonginjectingdrugusers The 2007 DU/IDUSurvey, which was the firstof its kindin Cambodia, revealed that 35.3percentofinjectingdrugsusershadbeentestedinthe12monthsprecedingthe surveyandknewtheresultoftheirtest. UNGASSIndicator9:PreventionProgrammesforMostatriskPopulations The 2010 Guidelines on Construction of Core Indicators describe this indicator as measuredbasedonthefollowingquestions: DoyouknowwhereyoucangoifyouwishtoreceiveanHIVtest? In the last 12 months, have you been given condoms (e.g. through an outreachservice,dropincentreorsexualhealthclinic? Injectingdrugusersshouldbeaskedthefollowingadditionalquestion: Inthelast12months,haveyoubeengivensterileneedlesandsyringes(e.g. by an outreach worker, peer educator or from a needle exchange program)? Boththe2007BSSandtheDU/IDUSurveydidnotaskthesespecificquestions. 15

23 CambodiaCountryProgressReport,2010Reporting Nonetheless, the 2007 BSS asked female sex workers and MSM whether they had received HIV/AIDS education in the past 6 months and the results are presented below. (i)preventionprogrammes:sexworkers Table4belowshowsthat93.8percentofbrothelbased(direct)femalesexworkers hadreceivedhiv/aidseducationinthe6monthsprecedingthesurveycomparedto 90.6percentfornonbrothelbased(indirect)femalesexworkers. Agewasadeterminantfactorwithyoungerfemalesexworkershavingbeenexposed to HIV/AIDS education to a lesser extent than older ones especially in nonbrothel settings. Table4: PercentageoffemalesexworkersandMSMthatreceivedHIV/AIDSeducationin thepastsixmonths Education All <25Years 25+Years Brothelbased(direct)female sexworkers 93.8% 92.0% 95.4% Nonbrothelbased(indirect) femalesexworkers 90.6% 88.8% 93.5% MenhavingSexwithMen (MSM) 96.2% 95.9% 96.8% Source:BehaviouralSentinelSurveillance2007 The2007BSSdidnotsurveymalesexworkersandhence,theirexposuretoHIV/AIDS preventionprogrammesisnotknown. The 2009 TRaC Survey found a much lower percentage of women working in entertainmentestablishmentswhohadbeenexposedtohivinterventionsinthesix monthsprecedingthesurvey(75percent).hivinterventionsincludedservicessuchas peer education (27 percent of entertainment workers reached), family planning (26 percent), interpersonal communication campaign (1 percent), HIV testing and counselling(41percent)andstiservices(15percent). (ii)preventionprogrammes:menwhohavesexwithmen AsshowninTable4,96.2percentofMSMsurveyedbythe2007BSSreportedtohave receivedhiveducationinthe6monthsprecedingthesurvey. (iii)preventionprogrammes:injectingdrugusers This indicator cannot be reported in full, but the 2007 DU/IDU Survey among Drug Users did ask if respondents knew where VCCT services were available in their communities.53.3percentofinjectingdrugusersinterviewedgaveapositiveanswer. Thetwootherquestionsconcerningreceiptinthelast12monthsofcondomsandof sterile needles and syringes were not asked in the drug user survey. However, the 16

24 CambodiaCountryProgressReport,2010Reporting surveyaskedwhetherrespondentknewwheretoobtaincondomsandsterileneedles andsyringes.thesurveyfoundthat93percentofinjectingdrugusersknewwhereto findcondomsand99.4percentknewwheretogetcleanneedlesandsyringes. UNGASSIndicator11:LifeSkillsBasedHIVEducationinSchools The School Health Department of the Ministry of Education, Youths and Sports (MoEYS) reported that 2,738 schools provided lifeskills based HIV education during the school year lasting from September 2008 to June This represented 34.1 percent of all primary and secondaryschools inthe country which is aconsiderable increase from the 25.6 percent reported in the previous UNGASS Country Progress Report.ItneedstobenoticedthatlifeskillsbasedHIVeducationistaughtinselected schoolsin14outof24provincesandmunicipalities. It is important to mention that in the school year 2008/9 only 5.2 percent of the secondaryschoolsprovidedlifeskillsbasededucationtotheirstudentscomparedto 40.6percentofprimaryschools. Figure 7 below shows data for both primary and secondary schools for the last five schoolyears.thegraphshowsthatintheschoolyear2007/8therewasaconsiderable dropinthepercentageofsecondaryschoolsprovidinglifeskillsbasedhiveducation. This was the result of an externally funded program coming to a close. The loss of fundingdidnothaveanimpactonprimaryschools,becausehiveducationhasbeen integrated in the primary school curriculum and is funded through the national educationbudget. Figure7:PercentageofschoolsthatprovidelifeskillsbasedHIVeducation( ) Percentage Year Primary Secondary AllSchools Source:DataprovidedbytheSchoolHealthDepartmentoftheMinistryofEducation,YouthandSports (MoEYS). 17

25 CambodiaCountryProgressReport,2010Reporting (B)Care,TreatmentandSupport TherapidscaleupofcareandtreatmenttowardstheachievementofUniversalAccess targetscontinuestobeimpressive,inparticulartheincreaseinthenumberofadults andchildrenwithadvancedhivinfectionreceivingantiretroviraltherapy(art). With these outstanding results, attention in the past two years has shifted from coverage to the quality of ART services. The Continued Quality Improvement (CQI) initiativewaslaunchedbynchadsinlate2007withtheaimtoimprovethequalityof careandtreatmentservicesandtostrengthenthecommunicationamongthedifferent actors involved in the Continuum of Care (CoC). This initiative is now rapidly being takentoscaleandisgatheringpromisingresults. UNGASSIndicator4:AntiretroviralTherapy AccesstoARTcontinuedtoincreaseduringthereportingperiod.ByDecember2009, ART was available at 52 health facilities, with more than half of these facilities also providingpaediatricartasshownintable5. Table5:CoverageofAntiretroviralTherapy, Coverage Dec.05 Dec.06 Dec.07 Dec.08 Dec.09 FacilitieswithART Provincescovered(outof24) OperationalDistrictscovered(outof78) FacilitieswithpaediatricART Source:AnnualReports2005to2009,NationalCentreforHIV/AIDS,DermatologyandSTDs(NCHADS) ThenumberofpatientsonARTincreasedby40percentduringthereportingperiod, from26,664indecember2007to37,315indecember2009.thenumberofchildren (youngerthan15yearsofage)onartwas2,541indecember2007andincreasedby 43percentto3,638inDecember2009. Figure8belowpresentsanoverviewofnumberofadultsandchildrenreceivingART from2005to BecauseasizeestimateforchildreninneedofARTisunknown,theproportionofchildreninneedandreceiving ART(i.e.coverage)isnotavailable. 18

26 CambodiaCountryProgressReport,2010Reporting Figure8:Numberofadultsandchildren(<15ofage)onART, Number 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5, ,315 31,999 33,677 26,664 28,932 20,131 24,123 12,247 18,344 11,168 1,079 1,787 2,541 3,067 3, Year Adults Children Total Source:AnnualReports2005to2009,NationalCentreforHIV/AIDS,DermatologyandSTDs(NCHADS) NCHADSreportsthatbytheendoftheyear2009,100.53%percentoftheestimated number of adults with advanced HIV infection were receiving ART, up from 82.6 percentreportedinthepreviouscountryprogressreportfor UNGASSIndicator6:ComanagementofTuberculosisandHIVTreatment This is the first time this indicator can be reported, owing to the significant improvements made in TB/HIV data collection. As a result, data on the number of adultswithadvancedhivinfectionwhoarereceivingantiretroviraltherapyandwho havestartedtbtreatment(thenumerator)arenowavailableforall24provincesfor theyearsfrom2007to CENAT reports that there were 526 adults with advanced HIV infection who were receivingantiretroviraltherapyandstartedtbtreatment.whoestimatedtheincident TBcasesinthepeoplelivingwithHIVat11,000,resultinginanindicatorvalueof4.8 percentfortheyear2009. HIVtestingofTBpatientshasincreasedsignificantlyasshowninFigure9below.The percentage of registered TB patients with unknown HIV status that were tested increasedfrom38percentin2007to68percentin ThedenominatoriscalculatedusingtheAsiaEpidemicModelandconsensuswasreachedontheprojectionsand estimatesinjune2007.themodelseemstounderestimatethenumberofadultsandchildrenwithadvancedhiv infection.theestimateswillberevisedendof2010whennewhssdatawillhavebecomeavailable. 19 It should be noted that the denominator (estimated numberof incident TBcases in people living with HIV) is calculatedannuallybywhoandisavailableathttp:// 19

27 Figure9:HIVtestingofregisteredTBpatients, CambodiaCountryProgressReport,2010Reporting Percentage Year Source:TBProgrammeRoutineReportingSystem,CENAT UNGASSIndicator24:Survivalafter12monthsonAntiretroviralTherapy Data on survival of adult patients after 12 months on ART are now available for 21 sites.ofthe3,296patientswhostartedartatthesesitesin2008(2008cohort)and werenottransferredtoanotherartsite,2,858or86.7percentwerestillonartafter 12months. Thesurvivalrateafter12monthsonARTforallpatientsincludedinthe2008cohort (adults and children) is 87.4 percent. Survival rates reported by individual facilities rangedfrom76to99percent. The2008cohortforchildrenundertheageof15consistsof342childrenwith321of thesechildren(93.9percent)stillbeingonartafter12months. TheNationalProgramalsoreportsonthesurvivalofadultpatientsafter24,36and48 monthsonart,whichareshownbelowintable6. Table6:Survivalofadultpatientsafter12,24,36and48monthsonART Indicator 12months (2008cohort) 24months (2007cohort) 36months (2006cohort) 48months (2005cohort) Percentageofadult patientsstillonart 87% 79% 72% 70% Source: DataprovidedbytheNationalCentreforHIV/AIDS,DermatologyandSTDs(NCHADS) UNGASSIndicator25:ReductioninMothertoChildTransmission According to the Guidelines on Construction of Core Indicators, the percentage of infantsborntohivinfectedmotherswhoareinfectedismeasuredthroughspectrum orotherstatisticalmodelling.thisindicatorcannotbereported,becausethissortof modellinghasnotbeendoneforcambodia.moreover,expertsincambodiabelieve that, given the available data, this type of modelling would most likely result in an 20

28 CambodiaCountryProgressReport,2010Reporting underestimation of the number of infants born to HIVinfected mothers who are infected. Program data for the year 2008 show that out of 635 children born to HIVpositive mothers, 283 were tested after 18 months and 27 were found to be HIVpositive. Comprehensive data are not yet available for However, 2009 program data compiledsofarshowsthat750childrenwereborntohivpositivewomen,ofwhich 326weretestedand51ofthesetestedHIVpositive. (C)KnowledgeandBehaviourChange Data on HIV knowledge and behaviour come from surveys which have not been repeatedsincethelastreporting.whilethepreviouscountryprogressreportcould notreporton knowledgeandbehaviourofinjectingdrugusers,thisnowispossible basedondatafromthedu/idusurvey.itshouldbenoted,however,thatcondomuse and safe injecting practices among this high risk group could not be reported in conformitywiththeindicatorguidelines. DataoncondomuseamongMSMandinjectingdrugusersislimitedwhiletrendsin condom use among female sex workers have been monitored for several years. Monitoringshowsthatcondomuseincommercialsexsettingsisgenerallyveryhigh. However,condomusewithmoreregularpartners,suchassweethearts,ismuchlower. AswasindicatedinthepreviousUNGASSCountryProgressReport,reachingwomen workinginvarioustypesofentertainmentestablishmentssuchaskaraokebars,beer gardens and massage parlours, is a considerable challenge. Prevention efforts with MARPs have further been complicated by the new Law on Suppression of Human Trafficking and Sexual Exploitation promulgated at the beginning of the current reportingperiod. Key stakeholders in thenational response to HIV and AIDS are currently engaged in addressingthechanginghivpreventionenvironment.effortsareunderwaytoextend the 100% Condom Use Program (100% CUP) to all types of entertainment establishmentsincambodia. UNGASSIndicator13:KnowledgeaboutHIVPreventionamongYoungPeople ThedatareportedhereisbasedonthefivequestionsregardingknowledgeaboutHIV preventionwhichwereincludedincdhs TheresultsinTable7showthatalthoughthemajorityofyoungpeopleaged15to24 were able togive thecorrect answer to some of theindividualquestions, only 47.6 percentansweredallfivequestionscorrectly. 20 Thisdatawasobtainedthroughasecondaryanalysisofthe2005CDHSandvariesslightlyfromtheprevious UNGASSreport.Onlyasubsetofhouseholdswereselectedforinterviewswithmales,hencethereareabouttwice asmanyfemalerespondentsastherearemales.inordertocompileanaccuratetotalestimate(male+females), bothnumeratoranddenominatorwereweightedproportionatetotheactualdistributionofmaleandfemale respondentsintherelevantagegroupasshowninthecdhshouseholdmemberdataset.maleweight: ;femaleweight: