HIV Testing in Cambodia - The Disparities
Written by Ritika Jhawar
Edited by Justin Gambill
July 31st 2021
Edited by Justin Gambill
July 31st 2021
In 2019, there were an estimated 3.5 million people who acquired HIV/AIDs, making it one of the largest public health issues across the globe (HIV.Gov, 2020). According to the CDC et al. (2021), Human Immunodeficiency Virus (HIV) attacks the immune system, and is acquired through sexual contact, sharing needles, or from mother to child. It cannot be transmitted through air/water, fluids such as sweat, saliva, or tears, insects/pets, or food/drinks. As of today, there is no cure. But, through proper treatment of symptoms, it can be very manageable. However, if left untreated, it can develop into AIDS (Acquired Immunodeficiency Syndrome), Stage 3 of HIV.
Transgender women are one of the highest risk groups for HIV and have been focused on for intervention (WHO et al., 2015; Baral et al., 2013; Herbst et al., 2008; Operario et al., 2008). In Cambodia, transgender women face many healthcare barriers which prevent them from obtaining proper resources regarding sexual and reproductive health (Kaplan RL et al., 2016; Shaikh et al., 2016; Silva-Santisteban et al., 2016; Yi et al., 2018). To further understand the access they have to HIV testing and treatment, studies were conducted in Phnom Penh and other provinces.
To be enrolled in the study, participants had to be at least 18 years old, transitioned from male to female, had sex with at least one man within the past year, able to speak Kmer (national language of Cambodia), and provide written consent. The participants would then be interviewed through a HIV questionnaire (Yi, S., Sok S. et al., 2019; Yi, S., Tuot, S. et al., 2018; Yi, S., Tuot, S. et al., 2015; Yi, S., Tuot, S. et al., 2019). The questions involved demographics, gender expression, sexual behaviors and use of condoms, symptoms of STIs (sexually transmitted infections) and whether they sought care for them, and access to HIV programs.
When the surveys were later reviewed, the majority of the participants indicated they were from urban backgrounds, lived alone with no partner, and had around 9 years of schooling. Non-governmental Organization facilities dominated as being the most-visited for HIV testing, followed by community-based facilities, and finally public facilities. An important trend recognized was that increased HIV testing was associated with marital status, occupation, level of formal education, and income (Sok et al., 2020). Another statistic of note was that non-profit facilities were the most common locations to receive HIV testing resources, which further fuels the argument that more intervention programs should be created and continued.
Even with the many free HIV testing services offered in Cambodia, it is reported that one out of five transgender women have never been tested for HIV before. This shows the need for promotion of more testing, along with proper education on HIV to the younger community of undergraduate students. The current low rates of testing could be due to them not being sexually active, believing that they are at a lower risk of getting HIV, or due to fear, stigma, and discrimination (Oppong Asante et al., 2013; Lindley et al., 2003; Peltzer et al., 2004; Gyasi et al., 2018).
Despite reaching adequate conclusions, there are some limitations that need to be noted. Only specific provinces that had higher HIV levels and transgender women populations were focused on in the study, there were no other HIV testing trends to compare with, and surveys were dependent on self-reporting. Regardless of these factors though, this survey was very helpful in providing an understanding in regards to the difficulties transgender women with HIV face in Cambodia. It has shown that prevention and education efforts should be directed towards undergraduate students, along with utilization of social media platforms to further promote the importance of HIV testing. It is essential to understand these forms of outreach to help anyone who may be struggling to find proper resources, along with the creation of HIV programs that include self-testing treatments (Pal et al., 2016; Yi et al., 2017).
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Image Source: “Human immunodeficiency virus (HIV)” by Ivan Konstantinov licensed under CC BY-NC-SA 2.0