A preview of my completed manuscript “Cambodia 2000: The AIDS year”

After watching my sister Sue die at the age of 41 from a melanoma my own life seemed meaningless. It was August 1998. At her deathbed with my parents Gill and Ray and my younger sister Lil, I sensed a very powerful spiritual force. I also felt the presence of my brother Pete and his wife Wendy, who had died with two of their three children in a car accident over ten years earlier.

I continued grieving. Night after night I couldn’t sleep and stood at my window overlooking the park waiting for dawn. One night I woke after a vivid dream. I had seen six Asian village women wearing long cotton skirts, their faces darkened by the sun, standing in the shade near a dry riverbed. They begged me to come over. They were terrified because their husbands were dying. If they refused sex they were beaten.

I woke knowing I had to find them. I’d had dreams like this before and they’d always been right. I began to look for volunteer positions and found one for a nurse with Australian Volunteers International (AVI) in Cambodia. They had the fastest growing AIDS epidemic in Asia. I’d worked as a nurse and journalist in the Solomons and faced multiple challenges. I applied, was accepted, and began to learn all I could about HIV/AIDS in Cambodia.

It was a crisis threatening to overwhelm their health system and economy and threatening to become the new killing field. It was fuelled by brothel-based sex workers with from one third to one half testing HIV positive. A survey found that sixty percent of Cambodian men regularly visited brothels (Agence France Press, 1999).

The women in the dream were right. It was passing into the general population with the HIV positive prevalence rate between 3 to 4 %. The figures from the year before showed 160,000 people were infected including 2,200 children. There were already over 5000 AIDS orphans (Godwin, 2000).

The weeklong orientation course in Melbourne was depressing. Another volunteer, a doctor, said he would never volunteer for such a position. There would be few working hospitals, very few laboratories and no antiretrovirals. What could I do? He was right but I went anyway.

I met Dr Tia Phalla when I arrived in Phnom Penh in March 2000. In 1991 he recognised AIDS had the potential to destroy his country as Pol Pot had done earlier. He formed the National AIDS Committee, spoke with communities countrywide and advocated with leaders. He became the Secretary General of the National AIDS Authority (NAA). (Buler 2006).

He asked me to go to Poipet, on the Thai border, where AIDS was growing faster than anywhere else. The poor from all over Cambodia migrated there. There was a high tax on goods carried by trucks across the border, so human labourers carried goods between the trucks on either side.

“They think its heaven, but it’s hell,” he said.

Could I make a difference? I had little confidence but at least I’d try.

This happened over twenty years ago so why does this story matter now?

There was a global resurgence of HIV/AIDS while the world was diverted by COVID.

In 2021 around 1.5 million people were diagnosed with HIV/AIDS and approximately 650,000 died (UNAIDS, 2022). In Fiji in 2021 there were 151 cases and 25 deaths (Fiji Ministry of Health and Medical Services, 2022).

The UNAIDS Director for the South Pacific based in Fiji, Renata Ram, described it a s ticking timebomb (RAM, 2022). The UNAIDS Global update for Fiji estimated 1400 people were HIV positive, but only 57% knew their status and only 45% were on antiretrovirals. The virus was spread by injecting drug uses and risky sex with multiple partners. They met online first and then again at a secret location.

As a Pacific Hub risky trends in Fiji tend to be exported, including by students attending the University of the South Pacific (USP). Ms Ram recommended countries in the region upgrade surveillance, support community education and mobilisation, and introduce harm reduction measures.

The Australian Government supported this response by announcing an extra $12million for new HIV prevention and treatment options in communities and countries in the Pacific and South East Asia the day before World AIDS Day on 1 December 2023. As Professor Darryl O’Donnell, the CEO of Health Equity Matters, one of the three partners alongside the Australia Government and UNAIDS, said “The most effective way to treat and prevent HIV is to empower the people who most feel its impact (Wong& Conroy, 2023).

This is community mobilisation, not only the central intervention in the Cambodian response, but initially the only one. And yet that country was one of only three countries worldwide in 2000 that turned their epidemic around.

With a young Cambodian girl

A Cambodian food stall

In the MSF hospital in Thma Puok

Poipet

An underused clinic on the Cambodian/Thai border