The research branch of the NGO Khana has argued in a new peer-reviewed study that livelihood programs for people living with HIV – which address recipients’ economic rather than medical needs – could be the key to significant improvements in quality of life for the estimated 74,000 Cambodians living with the disease.

However, despite the programs’ promise, one of the study’s authors and others in the field yesterday cautioned that such programs could be threatened by dwindling donor funds as Cambodia transitions from a “least-developed” to a “lower middle-income” country.

According to the new report in this month’s American Journal of Public Health Research – conducted by the Khana Center for Population Health Research and universities in Cambodia, Japan and the US – people in Cambodia with HIV/AIDS generally have their basic health needs met, but poverty, compounded by social stigma, low self-esteem and a lack of skills, proves to be the most persistent challenge.

People participating in Khana-led livelihood programs – which teach people living with HIV/AIDS how to support themselves and their families – for three years or more had a monthly income 13.6 per cent higher than their peers who did not participate, the researchers found. The participants were also less likely to experience food insecurity, or to report feeling worthless, ashamed, dirty or guilty because of the disease.

The positive results suggest the programs – which were implemented in Battambang, Kampong Cham, Kampong Speu, Pursat, Siem Reap and Takeo provinces – should be implemented on a wider scale throughout the country.

But experts said yesterday the World Bank’s recent decision to bump up Cambodia’s economic ranking is threatening funding for the disease.

“Funding is an issue even to sustain the programs. [Money] for HIV is going down now that Cambodia has been categorised as a lower middle-income country,” said Siyan Yi, director of the Khana Center for Public Health Research, and one of the report’s main authors.

Meanwhile, Tim Vora, executive director at the non-profit HIV/AIDS Coordinating Committee, said livelihood programs would become especially crucial as the donor money dried up.

“These programs are really important because the HIV/AIDS money is decreasing but the people are still very vulnerable,” said Vora, who was not involved with the Khana study. For example, he noted, people could obtain medicine for free at the hospital, but they often did not have enough money to travel to the hospital to get it.

“As we become a lower-middle income country the development organisations are focusing on different things,” Vora said. “So it’s very important for people to have livelihoods in the long run.”

Tia Phalla, of the government’s National AIDS Authority, said yesterday that the government recognised the need for the programs and was starting to initiate its own.

But the government-sponsored programs, which were implemented in eight provinces in 2016, also needed to expand.

“People can’t just rely on food handouts; they have to go beyond that and make an income for both health and dignity,” Phalla said. “Right now we are working hard with the Ministry of Planning to support income-generation for people with HIV/AIDS, but we need to increase the number of programs.”