Sub - Plenary Session,

The state of the epidemic in the Asia Pacific Region
Tim Brown -East West Center Hawaii, Karen Stanecki -US Census Bureau, Nguyen Thanh Thuy -World Health Organisation, Hor Bun Leng -Cambodia, Tasmin Azim -Bangladesh.

The regional overview provided some interesting points of comparison between countries, including:

• Identifying Cambodia, Burma and Thailand as the three countries with infection rates of 1.8 percent and over. In the case of Cambodia the rate is 2.8 percent for those aged 15 - 49;
• noting that the rates of infection are increasing in India, Burma, Malaysia, PNG,Vietnam, China, Nepal and Indonesia;
• but that they are reducing in Thailand and Cambodia. In Cambodia more people are now dying from AIDS than are being newly infected;
• in Malaysia and China the highest incidence rates are recorded amongst IV drug users, whereas in Cambodia it is the commercial sex workers, and both IV drug use and the infection rate among users seems to be low;
• there are substantial differences between countries in the numbers of clients seen weekly by commercial sex workers. In the Philippines it is around seven, whereas in Cambodia this rises to over 40.

Cambodia is one of the poorest countries in the region. It has recently completed its seventh HIV/AIDS surveillance survey. The results of this survey state that the rates of new infection are dropping, despite the fact that high-risk sexual practices remain common.Men regard the use of commercial sex workers as culturally acceptable. There are, however, differences in frequency of visiting sex workers between urban and rural men and between different age groups and between married and unmarried men. There are also substantial differences in the levels of condom use. Under the National AIDS Plan a pilot program of "100 percent condom use" was introduced in one province in Cambodia in 1998 and has since been extended and incorporated into the national strategy, which includes government and non-government agencies. It has recently extended into more remote parts of the country. Levels of usage vary but have been rising steadily if erratically. The Ministry of Health is aiming for 90 percent usage by the end of the current five-year plan.

Given these facts, it is hardly surprising that the Cambodian AIDS strategy has identified men as the Ôbridge group' by which they hope to continue reducing transmission rates. In general, married women are monogamous; their husbands infect them. Sex workers - both formal and informal sex workers - have only limited capacity to insist on condom use. Therefore, targeting the male clients for self-protection appears to have the potential to protect all three. This may be a pragmatic assessment of the options available to a country as impoverished as Cambodia. However, the next step should be to acknowledge that poverty underpins the growth in the numbers of women and girls forced into commercial sex. To accept that commercial sex is "culturally acceptable" ignores the extent to which the industry has grown in recent years and the extent of the trafficking of young women from rural areas to work in the urban ones.

The links between poverty and HIV/AIDS have not yet been fully acknowledged but are crucial to any comprehensive national or regional prevention strategy. By recognizing how poverty underpins so many aspects of the epidemic, both as a condition which puts people at greater risk of infection, and once infected impacts on their capacity to earn a living, it is possible to move from seeing HIV as being something that only affects "groups" within a community or country, to seeing it as one very real result of poverty and inequality, similar to other socio-economic factors in society.