Cambodia has the most severe HIV/AIDS epidemic in Asia with about 8,000 new infections per year. As of 2005, it was estimated that 130,000 Cambodians were living with HIV/AIDS. The prevalence among the adult population (ages 15-49) was estimated to be 1.6 percent. The primary form of HIV transmission has been identified as unprotected heterosexual sex between female sex workers and male clients who in turn pass it on to their wives who then transmit it to their unborn children. The Cambodian government responded to the HIV epidemic by establishing a National AIDS Program in 1991 which is currently known as The National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases (NCHADS). Since the start of the 100 percent condom law, which requires sex workers to insist on the usage of condoms, the HIV prevalence among direct female sex workers (DSW’s) has dropped from 42.6 percent in 1999 to 28.8 percent in 2002. The National Strategic Plan for HIV/AIDS and STI Prevention and Care also includes a National Voluntary Confidential Counseling and Testing (VCCT) Program which provides access to free and confidential counseling, testing and referral services.

During my ten week internship with NCHADS, I worked on a study assessing factors pertaining to the usage of VCCT clinics by direct female sex workers in Phnom Penh. From a research perspective, I gained invaluable hands on experience cleaning and analyzing data from the survey. I was then able to assess which factors were significant in the DSW’s usage of the clinics and, from there, I composed a manuscript detailing my findings. I was also fortunate enough to accompany the surveillance team from The National Institute of Public Health (NIPH) into the provinces where I was able to observe the conditions of the referral hospital as well as witness the interview process. Additionally, I was also invited to attend a number of dissemination meetings in the company of health professionals from CDC, WHO, UNAIDS, FHI and USAID. I am very grateful to have had the chance to be able to exercise the skills that my UCLA education has thus far provided me.

I have gained an invaluable experience that can never truly be put into words. The people of this remarkable country have captured my heart. My interest in international public health has multiplied and this internship has catalyzed me, more than ever, towards a future in global health. I’ve learned things that can never be taught in any classroom while being able to put the skills that I had learned in the classroom to use. I believe that my time in Cambodia, what I’ve learned and experienced there, has and forever will play an integral role in my future as a public health professional.

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I was fortunate to spend my summer working at the Cambodian National Center for HIV, AIDS, STDs and Dermatology (NCHADS), located in Phnom Penh . Cambodia has had one of the highest prevalence rates of HIV in Asia . In the early 1990’s, the Cambodian government responded to the epidemic by establishing a National AIDS program. This program eventually evolved into NCHADS, and now, is responsible for all HIV/AIDS prevention and care in Cambodia . One of the first policies implemented to tackle the immense problem it faced was a 100% condom campaign. As a result, the prevalence of HIV decreased amongst brothel based sex workers and subsequently the general population.   As the epidemic in Cambodia matured, there was concern that other groups of vulnerable women not previously targeted by intervention efforts could be at risk for disease acquisition. As a result, a cohort of young women, called the Cambodian Young Women’s Cohort, was established in 2002 – 2003, to assess disease prevalence and gain insights regarding sexual and partnership behaviors.

My summer internship focused on one group of potentially vulnerable women within this cohort, factory workers. Typically, factory workers migrate from rural areas into the city to work and provide support for their families. Economic and social injustices result in these young women working long hours for very little pay. Therefore, they are potential targets of recruiters from the sex industry who are aware of their need for supplemental income. Over the summer, I completed a detailed analysis of the study findings and compiled a report to disseminate the information.

Since NCHADS is responsible for nationwide surveillance, I had many opportunities to visit clinics all over Cambodia . I went to local hospitals as well as a few along the border of Thailand . Because NCHADS is part of the Ministry of Health, I also had a first hand view of the health system’s bureaucracy. Even though my project was focused on HIV/AIDS and sex workers, I got exposure to many other reproductive issues as well. I witnessed the effect of the United States ’ restrictive global aid policies on reproductive justice and the subsequent adjustments required from NGOs and governmental agencies to maintain certain inalienable rights to services and care. Prior to my internship, I had a very limited understanding of international health agencies and their ability to positively and negatively influence the countries they enter. Since Cambodia is overpopulated with such agencies, there are many opportunities to see how agendas play themselves out. Many expatriates from all over Europe , Australia , and the United States have set up a presence within the country. From teaching English to coordinating nationwide legal projects, there is a definite immigrant culture that has made living in Cambodia very easy. I did not speak the language or know anyone prior to my arrival and found myself immediately engulfed in a world within another world. The country has been through many internal and external hardships, and the losses from the days of the Khmer Rouge are ever present; the remnants of foreign invasion and foreign control of the future well-being of the country are on display.

From a research perspective, I got a great deal of epidemiological hands-on training that will be very important for my continuing doctoral education. In terms of my interests in behavioral research, Cambodia is a unique story. Its reduction of HIV is a social commitment to battling disease, a solution discussed theoretically but rarely seen in actuality.

I highly recommend Cambodia for anyone interested in learning more about international reproductive health and justice. My experience was integral to my education and future direction. I had an amazing time and experience in a beautiful country and thank Bixby and Dr. Gorbach for allowing me the opportunity.

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This past summer, I spent ten weeks working at NCHADS in Phnom Penh, Cambodia. The bulk of my responsibilities involved the management of the 1997-2003 BSS datasets. I worked to coordinate these datasets, labeling variables, developing codebooks, and reconciling any differences across the yearly interviews. In resolving these discrepancies, the comparability between the datasets has been enhanced, which will facilitate the identification and analysis of behavioral trends and patterns over the past and future annual interviews. In addition, I had the opportunity to participate in a number of field survey trips to Battambang, Sva Reing, and Koh Kong provinces. In these provinces, I visited multiple clinics and hospitals, brothels, and police stations, and was able to observe firsthand surveillance methods, interview techniques, and data collection. Beyond these activities, I also feel that I have gained a deeper understanding of the Cambodian people - their traditions, attitudes, and lifestyles. This internship provided invaluable experience in international HIV/AIDS surveillance and research and enabled me to understand the causes and effects of this disease within the Cambodian community in the context of their culture, behavior, and resources.

ORGANIZATION: National Center for HIV/AIDS, Dermatology and STDs
LOCATION: Cambodia
STUDENT: Shahed Ghanimati
YEAR: Summer 2003

This past summer I spent 5 weeks in Cambodia working with the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) within the Cambodian Ministry of Health. My project had two components. One aspect was based on analyzing data sets developed from questionnaires administered to indirect female sex workers (IDFSW) in Phnom Penh, the capital, and Benteay Meanchey, a site bordering Thailand. I was responsible for cleaning, creating codebooks and the comparative analysis of the data. For the second part of my internship I had the opportunity to be a part of a fieldwork team for the HIV Sentinel Surveillance (HSS) and to conduct participatory observations.

The data analysis portion of the project was extremely educational. The staff members at NCHADS were phenomenal. They not only were tremendously helpful in regards to my statistical questions but also demonstrated great dedication to their projects aimed at understanding the HIV epidemic in Cambodia. As a result of the data analysis I was able to determine the differences and similarities between IDFSW in Phnom Penh and Banteay Meanchey, and elucidate possible risk factors for HIV infection.

During the second part of my internship I was given the opportunity to travel to Siem Reap, a province in Cambodia located northwest of the capital. As part of the HSS team I was able to attend Health Clinics and visit brothels where blood sample collection was taking place to determine the prevalence of HIV. I also had the opportunity to see the laboratory where rapid HIV tests were conducted.

The experiences I had while in Cambodia in addition to those mentioned above were truly amazing. I could have never imagined the impact this internship would make on my views on international health care and promotion. Through out this journey I was moved by the kindness and generosity that has prevailed irrespective of the relentless epidemic that has plagued this nation and its people. This country has a soul and spirit that can not be described with words. As a result, I am now more determined than ever to pursue international health as a career.