In the pagoda?s shelter

The Aids epidemic is sweeping Cambodia, but an innovative alliance between Buddhist monks and Cafod is helping to make a difference

THE Venerable Hoeun Somnieg rises before dawn to meditate at his pagoda, situated near Cambodia?s mythic Angkor Wat temples. Twenty of his fellow monks join him, chanting in rhythm, as they bow their heads to the Lord Buddha. The saffron robes, shaved heads, the swirls of incense, and the golden Buddha statue suggest an ascetic life of contemplation and study. But Venerable Somnieg?s day will be acutely different from his predecessors ? he is on Cambodia?s frontline in the fight against HIV and Aids.

Over the last decade, the monks in Siem Reap were being asked to give blessings at more and more funerals of poor villagers who had died of Aids as Cambodia?s HIV infections rocketed to 3 per cent, the highest rate in South East Asia.

As the men died, so the wives became sicker when HIV destroyed their bodies? immune systems. Then there were the children, with nobody to care for them, some infected with HIV. Whole families were ostracised from village life, as their neighbours grew scared of catching a disease they did not understand. ?The future was desperate. I had to act to stop the suffering,? says Venerable Somnieg.

Cambodia is one of the world?s poorest countries, with a third of the population living on less than $1 a day. The country?s infrastructure is still recovering from two decades of civil war and the aftermath of the bloody madness of the Khmer Rouge, when more than 1 million people were butchered or starved to death as its leader Pol Pot set the clock back to Year Zero.

Health workers in Cambodia are predicting a tidal wave of 200,000 children orphaned by Aids within five years. At least 15,000 will be HIV positive. The country does not have hospitals or doctors to cope with the HIV epidemic. From birth to death, less than 1 per cent of the population are ever treated in a government clinic. Education is poor, and the mostly rural population had no understanding of Aids. Despite its costing only 50 pence for the drugs necessary to stop mother-to-child infections, there are not enough available. Seven months ago, Somnieg started to work on providing prevention and care with the support of the Catholic aid agency Cafod. It?s at first an unlikely union, but both the monks and Cafod believe religious community leaders of all faiths can play an effective role.

With 54,000 monks and 4,000 pagodas, the Buddhist infrastructure provides great potential for building an effective response to the epidemic.

Somnieg is building a shelter in the pagoda for people with Aids: he runs education and counselling programmes, and he provides food and comfort to children orphaned by the disease.

Perched on the back of a moped, as Buddhist teaching prevents monks from driving, Venerable Somnieg travels into the countryside, the orange of his robe marked against the verdant green of the rice paddies. He is going into a small hamlet to speak with a group of people with Aids.

Once muscular wiry farmers, their bodies are now emaciated with illness, their faces have become drawn, and their skin scaly and lifeless. Everyone seems to have a warm smile for you in Cambodia, but for these people it has become too much effort. Besides, one imagines they have little to smile about.

?Buddha taught that good health is an important part of spiritual health,? says Somnieg. He teaches the people to eat properly, stay clean, and exercise. He listens to their problems, answers their questions about Aids, and counsels them on coming to terms with their ill health.

Monks are revered in the country. By embracing people with Aids, they have changed the way Cambodians deal with the epidemic in the community. It is now much more accepted. The Aids patients say it has given them hope. The meeting ends with meditation and a blessing of holy water ? a symbol of life for Buddhists.

Fast forward to the plethora of sex bars in the capital, Phnom Penh. Loud karaoke blares, while beer girls offer customers a choice of drinks and more. Brothels are commonplace ? ranging from the high-priced joints catering for foreigners to small huts on the banks of the Mekong where you can pay the equivalent of a couple of pence. Despite South-East Asia?s reputation for sex tourism, the overwhelming majority of prostitutes in Cambodia cater for other Cambodians.

The girls come from poor families in the countryside. They can earn much more here than at home. For some there is no choice. Kea is a 20-year-old prostitute working in Phnom Penh. Her previous boyfriend sold her to the brothel. He tricked her into signing a contract with the brothel owners that meant she has to work there to pay off his $100 debt to them. Gangs of men regularly rape her.

The Government has a well-publicised campaign to encourage 100-per-cent use of condoms in brothels. But Kea says that only about one in 10 men want to use condoms.

She does not know if she has HIV. She is too afraid to get tested. She is worried that if men continue not to use condoms she will become infected. ?If I refuse to sleep with them then they just rape me anyway, so what can I do??

Her eyes are expressionless. They are dead ? the eyes of someone who has borne the unbearable. The pink nail varnish on her fingernails is mostly chipped off.

Amo Stharku, the current Minister for Women, blames the HIV/Aids problem in her country on the low position of women. ?Cambodians say that men are like a piece of gold: if you drop them in mud, it washes off. Women on the other hand are a piece of white cloth: if it gets a fleck of dirt it is ruined.? She says that men feel free to act as they like while women have no power to say no.

The biggest increase in new infections is now from husband to wife, and from new mother to her baby. One of the key responses by the Government and aid workers is education. A nationwide media campaign is due to be launched this month. It will feature the superhero Mr Help, an animated condom and the hugely popular film star Jackie Chan.

For Lon Hieng and her family it has come too late. She lives with her parents in their typical farmhouse on stilts. Her husband was a taxi driver in Phnom Penh, where he would work during the week, visiting brothels, and return to her at the weekend. He died in 1999 of Aids-related infections. She is infected with HIV.

?I was very angry with my husband when I found out he tested positive for HIV. In the end, I took pity on my husband. I sold my house to buy medicine. I looked after him until the end. Now I am sick, I am worried about the future. If I die, who will look after my children??

She found out her second child was HIV positive a year ago. She took the daughter to the Russian Hospital in Phnom Penh to get the anti-retroviral (Arv) drugs that will block the virus, but they did not have any left. The girl has just died. The child she was carrying when her husband died has so far tested negative.

The fortunate few will be taken in by one of the four orphanages run by John Tucker in Phnom Penh. He is a brash, big-hearted American from Ohio, a former businessman who has come with his wife to help the children of Cambodia. But he can only help a fraction. He has room for 200 children with HIV, and says it is the only project in the country providing Arv drugs to such children.

The orphanage is in the heart of the garment factory district. More than threequarters of garment workers are women, economic migrants from the provinces. For $40 a week, they make the designer shirts you buy on our high streets. Lonely, young, and ill-educated, aid workers say they are one of the most vulnerable groups.

Many of the children who come to the orphanage are found abandoned on the streets, close to death. Sray Neing, aged three, weighed only 6 lb. when they took her in. The photo they have of her then shows little more than a tiny skeleton. Six months after receiving Arv drug therapy, she is a plump, healthy- looking 22 lb.

?The drugs work. They can extend somebody?s life by 15 to 20 years. By then we might have a cure,? says Tucker. ?Half of HIV-positive children who don?t receive the drugs will die with the first year.?

Despite Cambodia being a World Health Organisation target country for access to Aids drugs, only 3,000 people receive them out of 170,000 infected with HIV. It is symptomatic of the worldwide picture. Only about 300,000 people in the world?s poorest nations are getting the drugs, of the 6 million who need them, according to the WHO.

Tucker says a course of drugs for one of the children costs about $500 per year, including secondary care. ?It is a question of money, it is a question of political will by the international community.?

Donations to the Global Fund to Fight Aids, Tuberculosis, and Malaria are now about $1.6 billion a year, barely one fifth of what the UN Secretary-General Kofi Annan called for when he set up the fund in 2001.

Last week?s International Aids Conference in Bangkok was subtitled ?Access For All?. But for John Tucker it translates to empty rhetoric in Cambodia, where access to prevention, education and care is being hamstrung by poverty and the indifference of the international community.

The stark alternative to providing the necessary funds is highlighted by the Maryknoll Hospice in Phnom Penh. It takes people off the streets, and provides beds and round-the-clock healthcare for them in the last days of their illness. All it can do is provide them with some dignity in which to die.

Patrick Nicholson works for Cafod.