Nicki Sobecki

A Khmer Prognosis

Cambodia is a success story in the global landscape of AIDS. In 1997 the rate of infections peaked and three of every 100 inhabitants were HIV positive. Today, behavior changes have led to an infection rate of 0.9 percent. Despite this dramatic decline, Cambodia still has the highest rate of HIV in Southeast Asia and one of the highest in Asia, and it risks coming back.

Signs suggest a fresh wave of HIV infections among populations most at risk. Possible donor funding cuts from abroad doubly threatens the current success. Today, the epidemic has also matured beyond these populations, passing along the chain from prostitutes to their clients, and from the clients to their wives and children. Compounding the physical effects of the disease, the stigma attached to AIDS cripples its victims both socially and economically.

Whether or not Cambodia will be able to maintain its current rate of success will depend on wide-reaching social and economic shifts. Empowering women, reducing the stigma of the disease and encouraging a greater reduction in the number of sex partners are critical to sustaining a low percentage of infections.

In this way, as well as so many others, AIDS tells the story of power. Those who have it and those who do not. For the poor and the powerless, the options for avoiding infection will always be more difficult.

Donations earmarked for HIV/AIDS treatment allows nurses and other healthcare workers to branch out into rural communities to provide care for those who cannot otherwise access medical treatment, July 2008, outside Siem Reap, Cambodia.
   
(l) Migrant workers relax after their shift at an urban construction site, where they also live, and struggle to provide for their families in a faltering economy. (r) Extreme poverty outside of Siem Reap forces rural villagers to gather food any way they can. Eels are electrocuted with a makeshift device to provide the bare nutrition needed to survive.
  
In a village outside Phnom Penh a daughter rests on the lap of her mother, who is HIV-positive, July 2008.
     
  
(l) A potential client negotiates with a transgender prostitute on a street corner.(r) Transgender prostitutes work the street outside Pokambor Park, a common place to attract clients. Many fear a possible resurgence of HIV/AIDS among populations most at risk, a concern stemming primarily from low levels of condom use among men who have sex with men and an increase in independent prostitution occurring outside of brothels.
   
A family visits a sick patient in the overcrowded Siem Reap Provincial Hospital. Food and other daily necessities must be provided by relatives and friends in a health system plagued with financial and social obstacles, July 2008.
   
Overcrowding forces patients to recover from injury or illness anywhere they can find space, July 2008, Siem Reap, Cambodia.
     
  
(l) Medication for tuberculosis is provided at a hospital in Siem Reap.(r) A doctor examines the x-ray of a patient suffering from pulmonary tuberculosis.
   
Substandard health care, exacerbated by unsanitary conditions, high heat, and unclean water, can in some cases worsen the health of those seeking treatment, July 2008, Siem Reap, Cambodia.
   
(l) Donations earmarked for HIV/AIDS treatment allows nurses and other healthcare workers to branch out into rural communities to provide care for those who cannot otherwise access medical treatment. A boy, with a rare spinal disease, is visited by a nurse from the Angkor Hospital for Children. (r) A young mother boosts the moral of her ailing son as she playfully swings him in her arms.
     
  
An open sided straw hut is home to an impoverished family in a village outside of Siem Reap, July 2008.