AIDS-Related Stigma and Mental Disorders among People Living with HIV: A Cross-Sectional Study in Cambodia

Background: AIDS-related stigma and mental disorders are the most common conditions in people living with HIV (PLHIV). We therefore conducted this study to examine the association of AIDS-related stigma and discrimination with mental disorders among PLHIV in Cambodia. Methods: A two-stage cluster sampling method was used to select 1,003 adult PLHIV from six provinces. The People Living with HIV Stigma Index was used to measure stigma and discrimination, and a short version of general health questionnaire (GHQ-12) was used to measure mental disorders. Multivariate logistic regression analysis was conducted. Results: The reported experiences of discrimination in communities in the past 12 months ranged from 0.8% for reports of being denied health services to 42.3% for being aware of being gossiped about. Internal stigma was also common ranging from 2.8% for avoiding going to a local clinic and/or hospital to 59.6% for deciding not to have (more) children. The proportions of PLHIV who reported fear of stigma and discrimination ranged from 13.9% for fear of being physically assaulted to 34.5% for fear of being gossiped about. The mean score of GHQ-12 was 3.2 (SD = 2.4). After controlling for several potential confounders, higher levels of mental disorders (GHQ-12\u3e4) remained significantly associated with higher levels of experiences of stigma and discrimination in family and communities (AOR = 1.9, 95% CI = 1.4–2.6), higher levels of internal stigma (AOR = 1.7, 95% CI = 1.2–2.3), and higher levels of fear of stigma and discrimination in family and communities (AOR = 1.5, 95% CI = 1.1– 2.2). Conclusions: AIDS-related stigma and discrimination among PLHIV in Cambodia are common and may have potential impacts on their mental health conditions. These findings indicate a need for community-based interventions to reduce stigma and discrimination in the general public and to help PLHIV to cope with this situation

Determinants of Inconsistent Condom Use among HIV Serodiscordant Couples in Cambodia

Background: Globally, heterosexual transmission within serodiscordant relationships is a significant source of new HIV infections. In 2012, there were an estimated 1,350 incident cases of HIV in Cambodia, of which 37% were between heterosexual couples and 30% among sex workers. In combination with antiretroviral therapy (ART), consistent condom use can significantly reduce HIV transmission risk among serodiscordant couples. This study explored determinants of inconsistent condom use among serodiscordant couples in Cambodia. Methods: A cross-sectional study was conducted in Battambang, Pursat and Takeo provinces in September 2013. A structured questionnaire was used to collect data on condom use and other HIV-related risk behaviors from HIV-positive partners of 262 serodiscordant couples. A two-stage cluster sampling method was used to randomly select participants from a list of serodiscordant couples who were receiving care and support services from community-based organizations in the selected sites. Multivariate logistic regression analysis was conducted to identify factors associated with inconsistent condom use. Results: In total, 239 respondents were included in the analysis with a mean age of 41.6 years [standard deviation (SD) = 6.7 years], of whom 60.2% were male and 80.3% were consistent condom users. The mean duration of living in the serodiscordant relationship was 13.4 years (SD = 7.8 years). After controlling for other covariates, inconsistent condom users were significantly more likely to be female (OR = 2.8; 95% CI = 1.261, 6.462), to have been living in a shorter HIV serodiscordant relationship (OR = 0.89; 95% CI = 0.902, 0.998), and to be frequent alcohol users (OR = 2.9; 95% CI = 1.323, 6.483). In addition, inconsistent condom users were significantly more likely to agree that ART prevents transmission of HIV (OR = 2.7; 95% CI = 1.344, 5.443). Conclusions: Gender-sensitive interventions to promote consistent condom use and to mitigate alcohol-associated risky sexual behaviors, especially unprotected sex, should form part of HIV prevention interventions for serodiscordant couples in addition to early ART initiation. Further research is required to explore the role of pre-exposure prophylaxis among this population

The Sustainable Action against HIV and AIDS in Communities (SAHACOM): Impacts on Health and Quality of Life of People Living with HIV in Cambodia

This study evaluated the impacts of the Sustainable Action against HIV and AIDS in Communities (SAHACOM) Project on health and quality of life of people living with HIV (PLHIV). Outcome indicators from baseline documentation (2010) were compared to those obtained at midterm (2012) and end line (2014). Results showed that HIV prevalence among pregnant women aged 15–24 attending antenatal care decreased from 0.5% at baseline to 0.3% at midterm and end line. Proportion of PLHIV who were on antiretroviral therapy (ART) 12 months after the initiation of the treatment increased from 85% at baseline and midterm to 89.5% at end line. Proportion of PLHIV in need for ART and currently on the treatment increased from 90.0% at baseline to 92.5% at midterm and to 96.0% at end line. Regarding their health status, proportion of PLHIV reporting their overall health as good increased from 52.0% at baseline to 78.3% and 80.2% at midterm and end line, respectively. Similarly, proportion of respondents reporting their overall quality of life as good increased sharply from 35.0% at baseline to 73.3% and 72.0% at midterm and end line, respectively. In conclusion, the SAHACOM is effective in improving health and quality of life of PLHIV in Cambodia

Health and Socio-Economic Impacts of Livelihoods Programs among People Living with HIV in Cambodia: A Case-Control Study

Background: In Cambodia, the circumstances surrounding people living with HIV (PLHIV) remain serious conditions. To ameliorate these situations, KHANA has implemented livelihoods programs since 2010, including village saving and loans (VSL), skill trainings, and cash grants with on-going technical support. This study aims to evaluate the impacts of the programs in improving socio-economic conditions, health, and psychological well-being of PLHIV in Cambodia. Methods: In August 2014, a case-control study was conducted in six selected provinces. The cases were defined as PLHIV who lived in the selected operational districts where KHANA has implemented the livelihoods programs, and have participated in the programs for at least one year. Several indicators in socio-economic situations, food security, health conditions, and psychological well-being of the cases (n= 358) and the controls (n= 329) were compared. Results:The mean of monthly income of the cases who attended the programs for three years or more was 13.6% higher than that of the controls. A significantly higher proportion of the cases reported having three meals per day, while a significantly lower proportion of them received food assistance in the past 12 months. The mean total score for frequency of occurrence also indicated less severity of food insecurity among the cases. Regarding child education, the cases reported a significantly lower rate of out-of-school children. The proportion of the cases who rated their quality of life as good was significantly higher, and they were significantly less likely to report that they felt guilty being HIV-positive persons. Regarding psychological well-being, the mean total score of depressive symptoms for the cases was significantly lower than that for the controls, and the proportion of the cases with a cut-off score smaller than 1.75, which indicated less depressive symptoms, was also significantly higher than that of the controls. Conclusions: Findings from this study portray the positive impacts of KHANA’s livelihoods programs in maintaining and upgrading the livelihoods and quality of life of PLHIV in Cambodia. With these noticeable impacts, the programs should be scaled up to support PLHIV and vulnerable households across the country

Implementation of National Action Plans on Noncommunicable Diseases, Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam

By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with the Global action plan for the prevention and control of noncommunicable diseases (2013–2020). In 2018, we assessed the implementation status of the recommended best-buy noncommunicable diseases interventions in seven Asian countries: Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. We gathered data from a range of published reports and directly from health ministries. We included interventions that addressed the use of tobacco and alcohol, inadequate physical activity and high salt intake, as well as health-systems responses, and we identified gaps and proposed solutions. In 2018, progress was uneven across countries. Implementation gaps were largely due to inadequate funding; limited institutional capacity (despite designated noncommunicable diseases units); inadequate action across different sectors within and outside the health system; and a lack of standardized monitoring and evaluation mechanisms to inform policies. To address implementation gaps, governments need to invest more in effective interventions such as the WHO-recommended best-buy interventions, improve action across different sectors, and enhance capacity in monitoring and evaluation and in research. Learning from the Framework Convention on Tobacco Control, the WHO and international partners should develop a standardized, comprehensive monitoring tool on alcohol, salt and unhealthy food consumption, physical activity and health-systems response

Essays on land property rights in Cambodia : empirical analysis

Ph.D. University of Hawaii at Manoa 2012.Includes bibliographical references.This dissertation consists of four chapters on land rights in Cambodia. The first chapter focuses on historical background of land rights in Cambodia. De jure private property rights in land were first established in 1863. The civil wars of the 1970s led to an abolition of land property rights and it was again reintroduced in 1989 in which households could register their plots through sporadic land registration. The combination of a poorly functioning land registry system and rising demand for arable land led to a sharp increase in conflicts over land rights in the 1990s. To address these problems, the Cambodian government carried out a series of land policy reforms in the 1990s and introduced a systematic land registration in 2002 to speed up land registration in the country. The second chapter empirically estimates the effect of land property rights on investment in land by farm households in Cambodia using the 2003-2004 Cambodia Socio-Economic Survey (CSES). In this chapter, I use matching regression techniques, in particular Propensity Score Matching (PSM), to account for selection effects in household participation in land titling program. The empirical analysis indicates a positive link between de jure land rights and land investment. The third chapter estimates the effect of de jure land rights on household consumption. Instrumental variable techniques are used to account for endogeneity of de jure land rights. The results show that the choice to obtain de jure land rights results in a statistically significant increase in household consumption. The fourth chapter explores the relationship between de jure land rights and child health in households of land owners in Cambodia. The 2003-2004 CSES which is used to estimate this effect contains information of 8,745 children ages below 6 years old. The findings show that children of titled parcels have higher height-for-age z-scores than children of untitled parcels

Assessing government’s fiscal space for moving towards universal health coverage in Cambodia

Background In line with the global trend, it becomes clear that the Cambodian government’s policy direction is leaning toward universal health coverage, the agreed target within the newly ratified Sustainable Development Goals. Thus, the health system will need to be further reformed to achieve this target by 2030. To assess if the Cambodian government is able to increase the proportion of health budget out of the total government expenditure, this study will evaluate the government’s fiscal space and propose feasible options where and to what extent new resources can be generated for improving the health system. Design The data used for this analysis were obtained from World Bank online database and a series of Cambodia’s economic updates produced by the World Bank office in Cambodia. We observed the trends over time from 2011 to 2018 to provide insights into the extent to which fiscal space for health can be expanded. Findings By assessing the key fiscal indicators, it is unlikely that the Cambodian government is able to increase the proportion of health budget out of its total budget in the short run. Health budget is increased in absolute terms but not in real terms, which is linked tightly to the predicted 7% economic growth per annum. Conclusion The proportion of health budget from now until 2018 is expected to remain the same, and the revenues raised through pre‐payment mechanisms are still too small to address the pressing issues in the current health system. The Ministry of Health could benefit from putting a much stronger effort on improving efficiency and equity in the distribution of resources, as well as transparency and accountability, to achieve the immediate objectives for universal health coverage

The cost of HIV services at health facilities in Cambodia.

BackgroundDonor funding for HIV/AIDS services is declining in Cambodia, and domestic resources need to be mobilized to sustain and expand these services. However, the cost of delivering HIV/AIDS services is not well studied in Cambodia. This study aims to assess the costs of delivering HIV/AIDS services, identify the major components of costs, and sources of funding.MethodsFour of the six highest HIV burden provinces were selected at random for this study. Within each province, four health centers and two hospitals were selected for detailed data collection. A mix of top-down and bottom-up methods were used to assess the costs for HIV testing and antiretroviral therapy (ART) from the provider perspective. We assessed the differences in the quantity and prices of inputs between health facilities of the same type to identify cost-drivers.ResultsThe average cost per visit for HIV testing was $8.92 at health centers and$14.03 at referral hospitals. Differences in the number of visits per staff were the primary determinant of differences in the cost per visit. First-line ART costed about $250 per patient per year, and the number of patients per staff was an important cost driver. Second-line ART costed from$500 to $716 per patient per year, on average, across the types of facilities, with the quantity and mix of second-line antiretroviral drugs being an important cost driver. Inpatient care at referral and provincial hospitals in total represented less than 2 percent of costs of outpatient ART.DiscussionCosts are similar to neighboring countries, but over 50% of the costs of ART are financed by donors. Cambodia now is scaling up social health insurance coverage; the data from this study could serve as one input when setting reimbursement rates for HIV/AIDS services to help ensure that providers are adequately reimbursed for their services

Comparisons of fear of stigma and discrimination experienced in the past 12 months among PLHIV lower and higher levels of mental disorders.

<p>Comparisons of fear of stigma and discrimination experienced in the past 12 months among PLHIV lower and higher levels of mental disorders.</p

Results of bivariate and multivariate logistic regression analyses of the association between stigma and discrimination with levels of mental disorders among PLHIV.

<p>Results of bivariate and multivariate logistic regression analyses of the association between stigma and discrimination with levels of mental disorders among PLHIV.</p