CAMBODIA: Wives at Risk of HIV Infection

PHNOM PENH, 3 January 2007 (IRIN) - "I don't know how my husband contracted HIV - he just did," said Phary, 27, staring blankly out the window of the two-room apartment she shares with her parents and two children in the Cambodian capital, Phnom Penh. Answering that question has never been easy.

Like many Cambodian women in similar circumstances, she is devoted to the memory of her husband. Few people know about her HIV-positive status, but her challenge is the here and now: how she will care for her children if her health deteriorates.

According to UNAIDS, Cambodia has the highest prevalence of HIV/AIDS in South East Asia, with 1.6 percent of adults aged 15 to 49 infected. Although the country has made significant inroads in reversing the spread of the virus - adult prevalence was one-third lower in 2005 than in the late 1990s - the outlook for women remains grim.

Cambodian women constitute a growing share of people living with the virus - 47 percent in 2003, up from an estimated 37 percent in 1998 - suggesting that significant numbers of women are being infected by their husbands and boyfriends, who probably contracted the virus in commercial sex encounters.

Compounding the problem, a UNAIDS report warned there were signs that men were ignoring the awareness campaigns centred on the sex industry, and evidence of increasing drug usage, including among commercial sex workers, in Phnom Penh.

The traditionally subordinate role of women in Khmer society manifests in high levels of sexual violence and unsafe sexual behaviour by men, exacerbated by a culture of impunity, which limits women's ability to negotiate sex and condom use.

"Women need empowerment if they are to negotiate safer sex practices," said Pry Phally Phuong, senior programme officer of the Women's Agenda for Change, a local NGO.

That is easier said than done. According to a study cited in a government report reviewing its HIV/AIDS strategy, women do not have equal access to education, paid employment, land ownership and property rights: "They are generally in a disadvantaged position in both family and society."

Prior to marriage, women are expected to be virgins; once they are married they are often blamed for not having enough sexual expertise to keep their husbands faithful.

Sophal Kheng, executive director of the Positive Women of Hope Organisation, a local NGO dedicated in providing training and support for women living with HIV/AIDS. Credit: David Swanson/IRIN

The report also found that many women believe male sexuality necessitates several partners - men who are away from home seek sexual services, and their wives accept this as normal; marriage needs to be maintained at all costs, regardless of suffering and humiliation; and it is not possible for women to talk with their husbands about the use of condoms. The researchers said educating men to use condoms when they have extramarital sex seemed to be the best solution.

A visit to a centre for HIV-positive women, funded by ActionAid and run by the local NGO, Positive Women of Hope Organisation, underlined just how vulnerable women are in Cambodia.

"I would never dare insist that my husband use a condom," said an HIV-positive housewife - one of the few who would speak openly. "He would, of course, question why, and even think that perhaps I was sleeping around instead."

Most women at the centre were concentrating on rebuilding their lives. "When I learned that I was HIV positive, I thought my world had collapsed. I wanted to die," said a woman who has lived with the virus for at least a decade. Her husband passed away in 1999, followed by her two-year-old daughter shortly afterwards. Since then she has relied on the close circle of friends at the centre, where she is learning handicraft skills.

The NGO was set up in 2004 to provide training and support for women living with the virus, and to help with school enrolment for their children. "It's very difficult for HIV-positive women to maintain themselves and their children," said Sophal Kheng, executive director of Positive Women of Hope Organisation. "Most of the women will never reveal their HIV status to their community, forever conscious that they will be stigmatised."

There are currently 20 women at the centre, most of whom were unknowingly infected by their husbands. The colourful handbags they make are now sold in the local markets and exported as far away as Australia, providing a flicker of optimism. "I want to stay here forever," one housewife said. "Here people understand each other."