The social impact of HIV/AIDS on children in Cambodia

INTRODUCTION

Cambodia is a country of rapid progress, but in certain areas it has a negative impact on its population. From the point of view of social work, it is a country of many challenges. In this paper, we focus on just one of many critical areas, namely the social impact of HIV/AIDS on children in Cambodia. This topic is vast and it is impossible to summarize it in just a few basic points. HIV infection affects a person as a complex being, not only his state of health, but also social relationships and his interactions with the environment. In this complex system, an HIV-positive child should also be the object of attention of social workers.

Cambodia and HIV/AIDS

The country with the local name Preăh Réachéanachâkr Kâmpŭchea is a country in Southeast Asia with a population of more than 13 million. Cambodia borders Thailand, Laos and Vietnam; in the southwest it has access to the Gulf of Thailand of the Pacific Ocean. The country is among the poorest in the region, partly due to the genocidal civil war caused by the Khmer Rouge in 1975-1979, when about 2 million inhabitants (roughly a quarter of the then population) were slaughtered. The capital is Phnom Penh. (Cambodia, 2010) According to data in an article by Lewis (2010), the first case of HIV in Cambodia was detected in 1991. In 1993, the first case of AIDS was identified, and in 1997, the HIV prevalence rate rapidly increased to 2.2% (some sources report 3.3%), which was the highest prevalence in Asia at that time. The epidemic came at a time when the fragile country was beginning to recover from previous events.

As can be seen from graph no. 1, HIV prevalence is declining. It should be noted that Cambodia has earned international recognition in the fight against HIV, having managed to reduce its prevalence from 3.3% in 1997 to 0.6% in 2005, according to the 2009 UNAIDS report.

HIV/AIDS in children

Children and young people aged 15-24 can be described as the first generation that was born and grew up during the HIV/AIDS epidemic. The WHO reports in its 2004 report that nine out of ten children infected with HIV were infected by their mothers either during pregnancy, childbirth or breastfeeding. Without treatment, about 15-30% of children born to HIV-positive women become infected with HIV during breastfeeding. In developed countries, preventive measures ensure that mother-to-child transmission of HIV is relatively rare, and in cases where it does occur, there are a range of treatment options to help the child survive - often into adulthood. This shows that with funding, trained staff and resources, the infections and deaths of many thousands of children could be avoided. It is important that HIV-infected children are diagnosed as quickly as possible so that appropriate treatment and care can be instituted. Children represent a specific group that must be taken into account with particular care. They are the most vulnerable link in the chain reaction caused by the HIV/AIDS epidemic. Not only do they clearly feel inadequacies in treatment or services, but they also have their own needs, which are often different from the needs of the adult population. They are the future of that country, and that is why it is important to find resources, either human or financial, to meet their needs.

The social impact of HIV/AIDS on children in Cambodia

According to UNICEF, there are 570,000 orphans in Cambodia. We consider an orphan to be a child who has lost one or both parents. According to Marseille and Garbus (2003), the percentage of orphans in Cambodia attributable to AIDS increased from 1.4% in 1995 to 10.9% in 2001; it is expected to continue to grow, as the 2010 forecast was 27.5%.

Due to genocide, civil war and famine, the Cambodian family's ability to cope with orphans is severely limited. Children affected by HIV/AIDS are exposed to high levels of stigmatization and psycho-social stress, with girls being a more vulnerable group. War and poverty left vulnerable members of society. Few of the grandparents are still alive, and many of the parents are orphans themselves. Forced labor, neglect and confiscation of property pose serious problems for orphaned children, especially girls. A 2000 study by the Khmer HIV/AIDS NGO Alliance (Khana) found that approximately 21% of children in AIDS-affected families had to start working to support their families. More than 30% take on other extensive additional homework. Of these children, 40% had to drop out of school, and the same percentage had to give up basic needs such as food and clothing. Twenty-eight percent of the children interviewed left home or were sent away from home. The impact of HIV/AIDS on children has serious consequences, and therefore they constitute a high-risk group. As a result of HIV, children are often the ones who care for their chronically ill parents and watch them die. The oldest children thus become the head of the family prematurely, girls take care of their younger siblings. After the death of their parents, these children often find themselves on the street or in a family of strangers, in which they are used for work around the house or in the fields. Many times in this case, siblings are separated, which only contributes to more stress after the loss of parents. Children on the street create groups focused on begging or selling small products, books or cleaning shoes. Many of these children live in extreme poverty, migrate for work and are exposed to the risk of abuse and sexual violence. Children using drugs (eg inhaling glue) are also not uncommon. Children exposed to existential problems leave school, thereby losing the possibility of at least basic education. This, of course, determines their future employment and further life in poverty. The cost of treatment is another barrier. Even if the ARV treatment itself is free, the drugs for the opportunistic infections that children suffer from are a big expense for the child. Since adherence is highly necessary, a child without adult supervision is much more prone to acquiring resistance. All these factors create a circle that is difficult to overcome. There is a lack of sufficient tools from the state, but also from the executive branch. The level of corruption in the country is high, so many times the fate of a child depends only on the will of the individual. The following diagram shows the impact of HIV/AIDS on a child's life. It shows the most common problem areas such as the loss of a parent, economic problems and their consequences. Among these areas, we could include the intergenerational problems typical for Cambodia, since a large group of children are raised by grandparents who often strictly adhere to strict traditions, and this also causes, especially for teenagers, insurmountable contradictions that end with the child leaving the family for the street.

As reported by Bundy et al. (2002) the impact of HIV/AIDS on education depends on three attributes, namely demand for education, supply and quality of education. Demand is represented by pupils and the population. The education offer is represented by access to education as well as qualified teachers. And the price of education also affects the quality. The HIV/AIDS pandemic threatens all three attributes of education. HIV-positive students often come from poor households and suffer from opportunistic infections that cause frequent absences. Frequent absences are also a problem for HIV-positive teachers, and the quality of education is also threatened by low salaries.

CONCLUSION

An orphanage is one of the solutions for orphaned children. According to our information, there are about 20 government orphanages in the country, but they are struggling with financial problems on a daily basis. We are not aware of any of these that are aimed at helping children with HIV/AIDS. Therefore, non-governmental organizations have taken over the provision of such services. One of them is the project of the University of Health and Social Work of St. Alžbety in Bratislava, House of Family.

Author: Mgr. Petra Sláviková The author worked as a social worker in Cambodia on a project of the University of Health and Social Work St. Alžbety - House of Family, worked in orphanages for HIV-positive children in the cities of Phnom Penh and Sihanoukville. Photos used in the article: archive of the author

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