Tell us about your background and how you got into development work?
I graduated from high school just before the Khmer Rouge regime took over [in
April 1975]. There was no opportunity for further education because of the conflict
and confusion - there were bomb explosions every day.
POK PANHAVICHETR, executive director of the Khmer HIV/AIDS NGO Alliance (KHANA)
My mother was very fertile, but she became weak because she had so many children:
I am the oldest of 12. My father's and mother's salaries were not sufficient, so
I needed to support my family but felt so sad because I liked studying and wanted
to go further.
I ended up working as an interpreter for Save the Children when I was 18 because
I spoke very good English. After six months Pol Pot came in and we ran away and ended
up in Battambang then Moung Russei. Only my mother and I were left alive after those
years.
A few months later I got married, had a child and moved to Phnom Penh with my relatives
who were still alive. I worked for the Ministry of Industry and spoke only Russian
because I was responsible for collaboration with Eastern Europe.
During this time I studied languages and political economy through a Russian university
and went to Moscow for one year to complete my degree.
In 1991 I got a job as a program officer with Oxfam and worked there for ten years.
They trained me so much. I was responsible for gender at Oxfam, and also completed
my Masters degree in development in Holland. I came to KHANA at the beginning of
2000.
Which population groups does KHANA target through its HIV/AIDS programs and how
does the organization work?
KHANA is an executing agency and we play a role as a supporting agency, currently
providing technical and financial support to 35 local NGOs to address HIV and AIDS.
We have different types of partners who work with direct and indirect sex workers,
clients of sex workers, the military, transgender, and people living with AIDS.
We supported the formation of the People Living With AIDS (PLWA) organization and
network. KHANA supports many home-based care organizations, prevention and care organizations,
and advocacy networks. KHANA originated from a project of the International HIV/AIDS
Alliance in 1996 and became a national organization in 2000.
What do you see as the main challenges for KHANA and other NGOs in combating the
spread of the HIV/AIDS in a country where an estimated 168,000 people, or 2.8 percent
of the adult population, is HIV positive?
The main challenge is stigma - we cannot avoid that issue. Stigma is reinforced
by the culture. HIV is still not acceptable in the community. Also people's understanding
about HIV, their behavior towards HIV issues, is a big problem. Even though maybe
90 percent of the population know about AIDS, many don't put their knowledge into
practice so behavior is still a barrier to change.
How does KHANA work within the region and with other organizations around the
world to help reduce AIDS and why is this shared knowledge important?
KHANA has relationships with other NGOs through the HIV/AIDS alliance because
they work in more than 20 countries and organize workshops to share experiences on
specific issues. For example they held a workshop in Chiang Mai [Thailand] to build
up skills for working with sex workers. HIV/AIDS is like dealing with gender issues.
We have to go through the cultural issues to make people understand about HIV/AIDS
and break through the barriers. Sharing experiences is so important. If it works
in other countries, why not copy it for Cambodia?
HIV/AIDS is not only a health issue but also a development issue because it impacts
on economic growth and development processes.
Cambodia has received $15 million over three years under the UN's Global Fund
for HIV/AIDS. Is this sufficient given that Cambodia has the highest HIV prevalence
rate in Asia?
The $15 million is absolutely not enough because HIV involves so many issues.
USAID also selected Cambodia as a scale-up country in addressing HIV/AIDS and gives
$9 million a year, and [the UK government arm] DfID and the Asian Development Bank
also spend money.
If you look only at the global fund it is not enough, but include the other money
and it is still not enough. Why? Because Cambodia has come from scratch.
The health system is in the process of reform and we have a lack of facilities. Even
now there are only five volunteer counseling and testing centers recognized by the
government and these are so important. All the donor money is still not enough because
it is spread over so many areas.
There has been much recent debate about the appropriateness of involving monks
in HIV/AIDS education programs. What do you think about this?
It is very much appropriate because HIV [awareness] is the same as gender [awareness]
- it has to cut across culture and religion. It is very advantageous to use Buddhism
to mobilize community support and compassion for people living with AIDS.
One part of Buddhist theory is that people need to do good things so they will get
good things and people need to support each other. Ninety percent of the people still
believe in Buddhism so involvement of Buddhist monks in supporting PLWA is quite
effective.
The historic HIV/AIDS legislation passed on June 14 makes it illegal to discriminate
against people who are HIV positive and also illegal to knowingly infect another
person. What effect do you think the legislation will have on the spread of HIV/AIDS
and on reducing current discrimination?
It will help in the sense of reinforcing the activities of NGOs because it proves
we need to keep confidentiality and mobilize support, but I don't know whether people
will pay attention to it. It is ten times more difficult to put the law into practice
than to produce the law.
It will be helpful for not forcing people to have blood tests when they apply for
jobs. Even if they have HIV/AIDS, people need a job. However, we can't control the
private companies. The law says you can't sack people if they have HIV, but how do
you convert this into practice? If the business knows you have HIV then they will
just find other ways to catch you making mistakes and sack you. We need close monitoring
of how the law is put into practice.
Under the new law, husbands face possible prosecution if they knowingly transmit
the disease to their wives. Realistically, will this ever be enforced?
It is not really practical because how do you monitor it? The husbands will deny
that they knew they had HIV and who will put it [forward] as a case? It is unrealistic
because wives will not prosecute their husbands and we are trying to mobilize support
and not to create that issue.
We try to facilitate an enabling environment to get support for people living with
AIDS. Before you know that the husband has AIDS, the wife already has the disease
so it is not helpful to prosecute him.
Anti-retroviral drugs that can be purchased in Thailand for $27 cost over $200
in Cambodia. KHANA belongs to a working group that has been discussing the high prices
- what options are you looking at?
Médecins Sans Frontières and other organizations provide drugs at
subsidized prices. We want to have cheaper prices like Thailand but it is very difficult.
We try to provide knowledge to people living with AIDS on the use of the drugs, because
some people may have bought them secretly and not understand the side effects. We
are advocating for cheaper prices but our government does not have a budget for subsidies.
The anti-retroviral drugs are cheap in Thailand because the government can subsidize
the prices and maybe the drugs are produced there.
The tendency for men to have sex with their 'sweethearts' has dramatically increased
since 1997. According to a PSI survey, men use condoms with 'sweethearts' only half
as often as they do with sex workers. Is this worrying for the prevention of HIV/AIDS
and what is KHANA going to do about it?
It is a big concern and we work to educate sex workers and those with sweethearts
and others in the high-risk population about condom use. KHANA is providing knowledge
on how to prevent HIV/AIDS and providing life and condom negotiation skills.
We work with garment factories, the military, sex workers and also in the areas which
supply labor to Phnom Penh to prepare those groups so that when they come to garment
factories or to do other work they have some knowledge about HIV/AIDS and its transmission.
Women are often seen as 'bad' if they have had pre-marital sex and recent surveys
show that men see women as carriers of the disease. How can women be empowered to
stand up to men and how do community attitudes change so men also take responsibility
for safe sex practices?
We are working for women's empowerment through our community development programs
so women have a voice and the skills to negotiate condom use with their husband or
sweetheart.
We try to promote the responsibility of men in having safe sex as well as being care
givers in families that have HIV. We work through peer education and group discussion
and in a few cases it has really improved: men are taking care of the children in
families where the mother has HIV/AIDS. Roles are changing in some areas where we
work but it is not widespread. Much more needs to be done.
Since the closure of karaoke bars gang rape appears to have been on the increase
- what can be done about this?
I find it so difficult because rape cases are increasing every day - we need to
help people to understand and consider that rape is violence against women.
We need to use the new violence law so that rape cases are seen as a crime. I think
law enforcers should support this activity otherwise it won't work, because if someone
is raped and the next day the rapist is released without a trial it won't help much.
Law enforcement is very difficult.
According to KHANA's statistics 30,000 children have been orphaned because of
AIDS in Cambodia and this could increase to 140,000 by 2005. How will the population
cope with this emerging crisis?
So many organizations and even the government are supporting orphaned children.
The tendency of people is firstly to think of creating centers for HIV/AIDS orphans
but this is not really an effective option because they want to stay with their families.
If they stay with their relatives they are able to learn how to make a living and
are included in the community. When you put them in centers you create discrimination
- they don't hear from elderly people or get good advice from the elderly. They do
just want they want. And also children feel lonely - they need support from their
relatives.
Is HIV prevention discussed at schools, and at what age should children be educated
about the disease?
I think it should be in the primary school curriculum but when we organized a
youth camp last year there was opposition from a representative of the Ministry of
Education. They thought this was too early and education should start at secondary
school.
In terms of the general population, everybody has the right to know about AIDS and
prevention even if they are not in high-risk groups because they are part of society.
They may get AIDS any time if they are careless about having sex. So why not provide
education? People say we should target men, but having sex involves two parties and
both of them have to understand.
If you work on gender you support women through a gender perspective, but working
with women alone is isolating them from society so you need to work with others to
get support. HIV education is the same.
Is the government doing enough to prevent the spread of HIV/AIDS and educate the
population about the issues; [if not] what else should it do?
The government has a very strong strategy on 100 percent condom use and a very
strong sexually transmitted disease management program. But in terms of HIV/AIDS
prevention it needs to do more and use other strategies. It has information education
materials but there is a gap. Complementary work between the government and NGOs
makes good sense.
