Concerns grow over Cambodia’s “AIDS colony”

The Lancet September 2009

The forced eviction of HIV-aff ected families from Phnom Penh has drawn criticism from human rights groups, amid fears for their health and access to treatment and care. David Brill reports.

On the outskirts of Phnom Penh stands a makeshift village of green metal shacks. There is little food, no clean water, and open sewers that flow alongside the buildings. More than 40 families live in the settlement, each occupying a space no bigger than 4 m by 5 m. All have one thing in common: each has at least one member who is HIV positive.

The residents of Tuol Sambo are just a few of the thousands of people who have been evicted from central Phnom Penh in recent years but their plight has captured international attention. Resettlement began in June, when 20 families were moved from the central Borei Keila neighbourhood to their new home outside the city. The eviction, to make way for a new Ministry of Tourism development, had been planned for some time, and went ahead despite appeals from the UN and other groups. The remainder of the families followed in July.

Far from the treatment and services they need, there are now fears that their health is declining amid the cramped, unsanitary conditions. Moreover, their isolation from nearby settlements has created a “de-facto AIDS colony” which promotes stigmatisation and discrimination, over 100 human rights and HIV/AIDS activists said in a recent open letter to Cambodian leaders. The letter called on the government to improve the “grossly inadequate” housing conditions at Tuol Sambo, guarantee access to medical services and stop moving people there.

Morale is already low among the residents of Tuol Sambo, according to Sara Colm of Human Rights Watch (HRW). Living conditions were no better in Borei Keila but people were close to medical care and had access to livelihoods, she said. “Some of them have a good fighting spirit…but it’s being whittled down by this sense that they’ve been banished out of town to this remote site. They don’t have much hope, and don’t know what their future is”, she said.

Medical care at Tuol Sambo is presently limited to mobile clinic visits every week from the Sihanouk Hospital Centre of Hope (SHCH) in Phnom Penh, which provides free antiretroviral therapy and treatment for opportunistic infections. Gerlinda Lucas, grants programme manager at SHCH, confi rmed that this arrangement will remain in place while funding is available presently until August next year. Residents have reported diarrhoea, fever, and cough since moving to Tuol Sambo, she added. Lucas also admitted concerns about the longer-term eff ect of the living conditions, particularly since temperatures can become stifling inside the metal shacks and could pose a problem for the storage of drugs. Some of the residents have already told HRW that their drugs are deteriorating in the heat.

The Cambodian Government, which has been praised in the past for its HIV/AIDS programmes, has told UN officials that disruption to treatment will be minimised and that a nearby health centre will be developed to provide antiretroviral therapy. The timeline and details of this, however, are unclear. The UN intends to visit Tuol Sambo shortly, along with government representatives, and will continue to “follow up vigorously on the treatment and broader health issues”, UNAIDS Cambodia coordinator Tony Lisle told The Lancet. Offi cials are also working
on the wider picture of evictions and resettlements in Cambodia, and pressing for the development of coherent national guidelines, he added.

Although continuity of treatment at Tuol Sambo has been discussed, other issues such as segregation remain unresolved. Set apart from nearby communities, the HIV-positive families have faced theft, discrimination from neighbours, and attacks from gangs, according to Prum Dalish of the Cambodian Community of Women Living with HIV and AIDS. “When the children go to school, the other children don’t want to play with the [HIV] positive children. These kinds of problems can make their health worse and worse”, she said.

HRW says it has yet to receive an official response to the letter decrying the conditions at Tuol Sambo, despite showing it to Cambodian minsters days before its public release. In the meantime, the families at Tuol Sambo face an uncertain future. “We’re heading into the rainy season now, which comes with flooding and disease”, said Colm.