Bill & Melinda Gates Foundation

How HIV, Poverty, and Drugs Intertwine in Cambodia

July 04, 2013

Like many other Cambodians living with HIV, Hem Sreylyn’s story is intertwined with poverty and drug addiction. A mother of two children, Sreylyn was diagnosed with HIV at the age of 26 after she gave birth to her last child.

Sreylyn , 31, and her husband, 27, both scavenge to survive and live off the things other people throw away. The job does not provide much to live on, so Sreylyn chose to become a sex worker to earn extra income for her family. Sreylyn believes she contracted HIV through her work when a condom split.

After discovering her HIV status Sreylyn felt scared as she knew little about the disease and had heard of no treatment. “When I realised I was HIV positive I felt hopeless and began smoking drugs,” Sreylyn said. “I first smoked ice-drug (methamphetamines), then quickly switched to injecting heroin.”

No food on the table

Sreylyn’s husband was upset and disappointed with her after he found out she had passed HIV to him and soon after he also became a drug user. Sreylyn said: “Any money I earned was spent on drugs. I sold all valuable belongings to maintain my habit. We had no money and sometimes my family had no food on the table. My husband and I always quarrelled.”

As a sex worker Sreylyn can earn up to $15 on a good day, but most days she comes home empty handed. She has been arrested several times by the police while waiting for clients and is usually sent to a rehabilitation centre or released after offering money.

“I know society does not value sex workers, but I have no choice, I need to provide for my family,” said Sreylyn. “I understand that knowingly transmitting HIV to another is against the law and I will not accept any client that wishes to sleep with me without a condom, though they are often willing to offer me more than the regular price.”
 
Stigma and discrimination

Although Sreylyn has often heard that discrimination against people living with HIV is dramatically reducing, she consistently experiences it among her family, who are the only ones who know her status. Sreylyn said: “After realising I carry HIV, my parents do not allow me to cook or clean dishes anymore.”

 After discovering her HIV status Sreylyn felt scared as she knew little about the disease and had heard of no treatment.

There are ongoing challenges in Sreylyn’s life but she says things have substantially improved since receiving support from Korsang, an organisation that works with drug users and which has helped her access methadone treatment in the Khmer-Russian Friendship Hospital.

Her HIV is also under control as she receives antiretrovirals from Chouk Sor, an organisation that provides HIV services. Today, both her and her husband have become healthy and can go back to seeking a living around the city.

Support for people living with HIV

A report from the National Centre for HIV/AIDS, Dermatology and STD, published in April 2013, estimated there are 13,000 Cambodians who use drugs, including around 2,000 who are injecting. However, civil society organisations working on the issue estimate the actual figures are higher than the study found.

According to recent studies* , HIV prevalence is 4 percent among people who use drugs, although this rises to 24.8 percent in injecting drug users. The figure is worryingly high in comparison to the general population, which was 0.7 percent in 2011.

This year alone Korsang has worked tirelessly with over 420 drug users, people like Sreylyn, on a regular basis. Taing Phoeuk, executive director of Korsang and a former drug addict, explains: “People’s attitude in Cambodia to injecting drug users is still very stigmatising. They are represented very poorly by media and this needs to change through a media awareness campaign and education programmes.

“No one chooses to be a drug user. Once you get addicted, you have to prioritise. When people want to change they need the right opportunity.”

Sreylyn couldn’t agree more and is very grateful for the support from organisations like Korsang who have improved her situation. “Korsang saved my life and my husband’s,” she said.

*People Who Use Drugs Study 2012: National Population Size Estimation and HIV Prevalence and Related Risk Behaviors: People Who Use Drugs 2012, led by the National Authority for Combating Drugs


 
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