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This paper will provide a discussion of the Cambodian prevention programs of HIV/AIDS. It will be based on the links between the Cambodian governance of HIV/AIDS, the involvement of Nongovernmental organisations (NGO) and the emphasis of human rights. It will analyze the current strategy of this disease and will review the positive and negative impacts of the patients and communities who live with HIV/AIDS disease.
Background of HIV/AIDS in Cambodia:
The Human Immunodeficiency Virus (HIV) is a unique kind of virus, which mainly aims at targeting the immune system of individuals and thereby results in weakening the people’s defence systems against a large number of different infections and various types of cancer. In such cases, the infected persons becomes immunodeficient that mainly results in destruction as well as impairment of the immune cells by the virus. The most vulnerable stage in HIV infections is the Acquired immunodeficiency Syndrome that can develop over a period of 2 to 15 years and depends upon the immunity system of the individuals. Different types of cancer, infections and other types of several clinical manifestations are found in the individuals who have developed AIDS. If one makes an estimate globally , it would be found that about 34 to 39.8 million people are infected with HIV at the end of 2015 and this infection have claimed about more than half a of 25 million lives so far in spite of large number of initiative s were taken to eradicate HIV. It is yet one of the most important challenges in the public health sector mainly in low and middle income countries as like that in Cambodia. This infection can spread through a number of medium such as exchange of different types of body fluids from infected individuals all over the world. These modes of fluid exchange may contain blood, breast milk, vaginal secretions and also semen (World Health Organisation, 2016). The UN Millenium Declaration was adopted in the The Millennium Summit in the year 2000 in September under the guidance of the world’s top leaders in history. They proposed eight Millenium Development goals among which fighting the infection of HIV was a goal which was numbered six. This addition of the treatment of the disease to the Millennium Goals easily gives us the hint how this disease and its treatment has been challenging to every researchers and scientists among all other diseases. It is very surprising to see that Cambodia is one of the very few countries that have become successful in achieving the Millennium Development Goals in relation to that of HIV. If one looks over the past decade, he can easily notice how Cambodia has cut off the prevalence of adult HIV by nearly 60%. Therefore it has also been successful in achieving the Universal access target for treatment as seen in 80% cases in adults and children. Cambodia has recently launched another strategic plan called Cambodia 3.0 that is built on the previous successes and aims at an approach that would help to eliminate any new HIV infection cases and deaths due to AIDS by the year 2020 (Centre for disease Control and prevention 2015). Cambodia experiences a middle lower economy after 20 years of Gross national Income increase. The garment sector, Construction and services are the main drivers of the Cambodian Economy. Cambodia has achieved the MDG in spite of facing the same poverty and they also developed the health and an education system which is still considered to be their development priorities and also challenges (The World Bank, 2016).
The success of Cambodia in its initiative to eradicate the infection of HIV has been recognised internationally. The incidences of new occurrence of HIV cases have reduced by 67% from the amount of 3500 patients to 1300 in the year 2013. More than two thirds of the individuals infected by HIV have received interventions in the form of antiretroviral therapy. Pregnant women have also achieved various interventions that had prevented the spread of the infections to their wards. However the a high rate of infection is still noted among various other cases such as in those cases where there is sexual relationships between two males, people taking drugs by injection, transgender categories, male polices, workers in garment factories, workers in the entertainment industry and also sex workers. The government has adopted a landmark ministerial regulation with a motive to improve the condition of the occupational safety and health systems. This newly launched policy covers all the cases of sexual harassment and provides access to different health services in the health care sectors. This initiative taken by the government shows an example how Cambodia has planned out to provide attention to search solutions to other health and human right issues by using the HIV models which can be declared as a very new model to this region( United Nations Programme on HIV/AIDS UNAIDS, 2014).
This paer will evaluate avital HIV/AIDS strategy being conducted in Cambodia 2011 called “Cambodia 3.0”., which has been the main initiative and aim of the framework proposed which is to eradicate the new HIV infections by the year 2020.
Cambodia 3.0 is one of the top Cambodia’s HIV strategies which have mainly focused on the eradication of new HIV incidents by the year 2020. This strategized programme for mitigating the HIV incidences mainly based on improving detection of cases through early HIV testing followed by immediate enrolment in care sectors for key affected populations, pregnant women as well as partners of people living with the infection. This would help in strengthening links between the testing and treatment as well as monitoring. Overall the total HIV/AIDS spending in Cambodia in 2010 was US$ 58.1 million. Global fund was the largest finance source to fight AIDS. There are also other multilateral as well as bilateral donors, who are mainly from United Nations; the royal government of Cambodia had helped by a contribution of only 4 % of the total budget. This programme of Cambodia 3.0 budget is mainly covering external donors (UNAIDS, 2012)
Control and treatment of HIV/ AIDS programs and policies in Cambodia has several purposes. The main purpose of this strategy is to eradicate new HIV infection by the year 2020. This would be mainly achieved by producing new impetus to achieve the national targets within the year 2020. The aims would include reduction of the HIV incidence in the population from 18/100,000 to 3/10,000 or less. Reduction of the incidences of the of transmission of HIV from mothers to their children would aim at decreasing it from 13% in the year 2010 to 2% or even less than that. This program also helps by increasing the overall coverage of different types of screening interventions and treatments to a limit of 95 %. This initiative shad a clear motto and its framework has been clearly discussed in the chart. It focuses on the improvement in case detection through early HIV testing and also immediate enrolment in care sectors for the affected vulnerable populations including: Most at risk Population (MARPS), their partners as well as people living with HIV (PLHIV) and their partners and also involves the individuals who use antiretroviral drugs. (ART). This strategy also intensifies the link between testing and treatment but introduction of immediate CD4 testing at Voluntary Confidential Counselling and Testing centres (VCCT), enhancing pre (ART) and ART care and monitoring thereby improving retention and incorporating treatment as preventions (UNAIDS, 2012).
Positive and negative impacts on health of the strategy:
This strategy has a strong and direct positive health impact as in case when this strategy Cambodia 3.0 adopted this new policy it was found that there was a surge in the number of individuals those who were found to be eligible for the treatment of ART. This strategy implemented the use of condom with clients, this appeared stable, and this caused the increase in HIV testing. This program also produced different ways that helped in the identification of then priority actions that has resulted in the acceleration of detention of cases, maximise the cases of retention and help in preparation to attain sustainability in health provisions. Under this new strategy, the estimated number of new perinatal infections have been found to be below 200 cases each year since its time of implementation from the year 2011. Presently it is found that the mother to child transmission rate is estimated to be 7%. While Cambodia is trying in the complete elimination of AIDS during transmission from mother to child and also a generation that would be free from AIDS, challenges and difficulties are still encountered. Again, negative aspect of this programme is that initial testing is conducted at over 150 sites, confirmatory testing and entry into care and treatment are offered only at 62 sites nationwide, therefore resulting in patients being lost along the cascade of steps after the initial testing is found positive. (Cambodia Country Operational Plan (COP) 2015).
Under this strategy, critical analysis is required in order to refocus on the HIV projects to make sure that the implementations are cost efficient and show cost effectiveness. Royal Cambodian Government gas also conducted more researches on it. Along with them, WHO and other partners have also taken steps to confirm the proper implementation of the newly introduced strategy. At present, the project of the National HIV response is handled by international donors who are the main donors like global fund, although Cambodian governments contribution to the project is also seen to increase every year (Cambodian Country Progress Report 2014).
An important concern is to make the programme reach every remaining individual who are at a very high risk for infection of HIV/STI and are the main factors that are transmitting the infection to their mates as well as from mothers to children. Therefore, it is found that there is under inclusion for this policy. This project is only implemented in 6 important Burden operational Districts like Siem Reap, PhomPenh, Battambang, Pursat, Kampong Champ and others. Provisions f or inclusion of the individuals present as high-risk individuals and then enrolling them to health care is one of the main limitations of the Strategy. Although Cambodia has become successful in creating a very good response to the HIV eradication program with special reference to preventive strategies however they focus was mainly set on increasing HIV testing procedures and preventive interventions were mainly found in defined populations. They have not considered that risks within this mentioned population may vary. Therefore people who are HIV negative and living in the districts are continuous tested to reduce risks but people present in high risk areas are not being able to be reached. Out of the PLHIV patient who is under treatment, many of them do not have proper access to ART due to lack of transportation price. This is most seen in particularly poor and remote PLHIV (Cambodian National AIDS Authority, 2015). United Sates presidency emergency Plan FOR AIDS Authority (PEPFAR) had stated that there are many laws and policies, which were found to have negative effects on the availability of access and utilisation of the HIV outreach activities. IT also showed that these regulations prevented intervention services in man y cases such as in the strategy Cambodia 3.0 that is present under the law of anti human trafficking and also the important village and commune safety policy. This is mainly because it had resulted many high-risk individuals to conceal them and made it more difficult to make them available to the new strategies (PEPFAR 2014).
Necessitation of restriction of human rights by the policies:
Previously it was believed that HIV is a medical concern over the world but now it is noticed that it has become a concern in the fields of social justice and unfair discrimination mainly against PLHIV. Moreover, gear of stigma has often prevented correct treatment and has become the driving force resulting the soared of HIV/AIDS. This has mitigated the proper understanding as well as realisation of the different types of human rights. Violations of the human rights and the failure of the state to handle the human rights complications had a negative impact on health. It had created obstacles in the fight against the infection. Therefore it impeded the proper association of the public health and human rights which had negative consequences. A proper link between the two always gives the best income (Lara 2008). This strategy has also included gender integration for HIV infection. The main steps that need to be incorporated are that males should be mobilised in case of GBV and also HIV, including government, society, civil, MARPO and PLHIV communities, leadership and various actions, implementation of the concept of equality of gender in the HIV programmes. Proper monitoring to make the women free from any sort of discrimination by CEDAW at both state and national level is also included. However, it is seen that gender integration has found a positive response under this strategy. However, lack of technical and financial resources has impaired the relationship between HIV and GBV (Cambodia country progress report 2014).
Meeting of the criteria:
The Cambodian government has stick to follow all the different human rights which they have already ratified like the CEDAW and also the human rights without any sort of discrimination. However gap is still present which needs attention.
Health and relevant structures and their efficacy:
Addition of new laws helped with the suppression of human trafficking and sexual assaults. These has resulted in a proper shut down on brothels all over the nation and complete inhibition of the activities of outdoor based sex workers by the police. Sex workers were given different regular jobs for living. Many sex workers contact their clients in various means which cannot be traced by the police. These new laws had helped gaining access to hidden areas thereby resulting in reduction of incidences. The already existing laws were strict enough to stealing, drug production, prostitution, domestic violence and others which prevented the drug using population to surrender them and take the help from the HIV programmes. Therefore in order to alter the laws by proper facilitation and reviewing collaboration between law enforcement institutions have resulted in including more high risk individuals(Due to fear from police) to take the help of the programme.
Government to obtain different data and information from various sources through surveillance, researches, routing, modelling and others has implemented Monitoring and Evaluation (M& E). This is mainly done to track the progress made through the establishment of the different initiatives of the programme. Cambodia has submitted Country progress report from 2003 to 2012 timely that shoe promising results.
Cambodia has received the prestigious MDG award for the courageous attempt taken by the nation in the elimination of HIV which was GOAL 6 of the Millennium development goals of U.N. The various challenges like the village commune safety policies, lack of proper accessibility, human resources, quality management and legal barriers if handled with more eminent leadership and planned approaches, there might arise a hope where one can visualise Cambodia as a HIV/AIDS free nation and would be highly honoured with dignity among all the prestigious nations of the world.
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