Decades of political turmoil and civil war have left much of Cambodia’s infrastructure in tatters. Education, health care, the transport network–all are being rebuilt more or less from scratch as peace gradually returns to the country. In the meantime Cambodian soldiers, many of them teenagers with no schooling, continue to battle Khmer Rouge rebels in the northwest of the country. For them, risk is a way of life, whether from combat, malaria or land mines.
It is understandable that many of these young men view sex as a source of comfort, not of special danger. The risk of HIV infection, which will not in any case kill them for at least a decade, can seem negligible. “The regular troops are there at the front because they have no education and nothing to eat at home,” says a military doctor. “They have no idea of the future. They first think day by day.”
But the HIV risks are not negligible at all. Behavioural research shows that over a third of Cambodian soldiers have visited a brothel just in the last month, including many of the married men in the army and the police force who are separated for long periods from their wives and children. Some 43% of sex workers tested positive in Cambodia’s brothels in 1998, while HIV prevalence in the military was around 7%.
One in five soldiers say that besides visiting prostitutes, they also have girlfriends–often waitresses or “beer girls” who promote various brands of the beverage in restaurants or nightclubs. Both the beer girls and their soldier partners make a distinction between their relationship and an act of commercial sex in a brothel, for condom use with these girlfriends is abysmally low–just 8%. Yet over 20% of beer girls tested positive for HIV in 1998.
To decrease risky behaviour and new infections, Cambodia’s military has trained a number of soldiers about HIV and other STDs and given them support in spreading the prevention message to other soldiers. This system, known as peer education, works well in the military because, as one officer said, “Soldiers live and fight and die together. They have the same problems and the same habits. They are not intellectuals but are very pragmatic and can follow others’ example”.
While it is still early days in the peer education programme, there is already evidence that Cambodian soldiers are reducing their risk of HIV infection. Condom use by soldiers in brothels is now 63%–16% more than in 1997–and visits to brothels in the month preceding the survey fell by 40%, a remarkable change in a single year.