Author’s note: In 1997, Cambodia was embroiled in a brutal civil war, while still reeling in the aftermath of the Khmer Rouge’s reign of terror that led to the deaths of nearly a quarter of the population through execution, torture, starvation and disease.

At the same time, Cambodia was experiencing the most serious and rapidly progressing HIV/AIDS epidemic in Asia, and was on the brink of becoming one of the worst affected countries in the world. As Project Officer for STD/HIV/AIDS, I was responsible for setting up and managing UNICEF’s country program of assistance to government and international aid agencies in Cambodia, which included development of innovative multi-sector capacities for the prevention and control of HIV/AIDS in the country.

Bed Nets and Condoms

The trip with the Royal Cambodian Navy and the WHO Malaria Team was up-lifting in a number of ways.  A five hour voyage to an off-shore island on a comfortable Naval battleship, hosted by the fine crew and their impeccable leadership. In a flawless white uniform, the Cambodian Admiral embodied honor, responsibility, and respect.

We delivered insecticide treated bed nets and prevention education to soldiers based on three outer islands and treated the soldiers who were suffering with Malaria. The National AIDS Program was responsible for provision of condoms to the military, and UNDP provided HIV prevention information leaflets with colorful graphics tailored to members of the armed forces. It was refreshing to witness some humanity in the midst of so much turmoil in the society. The young men were clearly appreciative, and their leadership worthy and honorable.

It was encouraging to see effective medical treatment so swiftly remedy an infectious disease like Malaria – at least in the short term. But consistent use of bed nets, condoms and prevention education would be necessary for long-term control of Malaria and HIV. 

The life-saving combination drug therapy known as the “AIDS cocktail” can help manage HIV infection as a chronic disease, but it is not a cure. And the widespread poverty and years of armed conflict which had created conditions favorable for HIV transmission in Cambodia required longer-term, multi-sector interventions to promote safer behaviors. 

For example, a string of brothels on the mainland hosted many of the young men on shore leave. But would they use the condoms we gave them, and sleep under the bed nets?

An Unexpected Visitor

Then there was the time I walked into my apartment and found a strange girl asleep in my bed.  It was the height of the dry season. Whatever had been dumped, spilled, drained, coughed, sneezed, shat or spat into the streets was now a swirling cloud of fine dust – just waiting to deposit germs in your lungs, resulting in a nasty bronchitis that had the whole town coughing and gagging, and I was feeling pretty sick as well.

I had just finished eating lunch at a restaurant near my apartment and was headed home for a nap. As I was leaving, I noticed an attractive Cambodian woman of about 30 eyeing me from a table next to the door. So while passing, I politely said hello, and in my limited Khmer briefly explained that I was not feeling well and needed to go home to rest before returning to work.

We parted, and I continued home. But no sooner had I put my feet up, there was a knock at the door. She had followed me home, and talked my guard into letting her in the gate!

So, I offered her a glass of water, and again tried my limited Khmer for some small talk before ushering her to the door and bidding her farewell – and again, thought nothing more of this. After all, I was feeling miserable and just wanted a nap before returning to the office. So it came as a complete surprise when arriving home that night to find her fast asleep in my bed – wearing my tee shirt and gym shorts, her long black hair spilling over the pillow she clutched.

So began my friendly relationship with Vany – who had lived through the all-too-common stark suffering, horrific trauma and loss of loved ones as a result of the brutal Pol Pot years. Her parents were presumed dead, and so were her husband and child. She had been working at the floating casino moored in the center of town and had been laid off – and for some reason could no longer stay with her sister, who was also working in town.

Vany spoke no English, but knew some French, and I suspected she may have been the girlfriend of a resident Frenchman who had since left Cambodia, and was looking for a new boyfriend/ benefactor.

So we made a deal – she could be my housekeeper and do the marketing in return for room and board, as long as she was looking for a new job. Vany also became my Khmer language tutor, and stayed with me for the remainder of my time in Cambodia. The Mekong Project was up and running and my contract with UNICEF was soon coming to a close. But before I left Phnom Penh, Vany found a job in town and moved back in with her sister.

The Mekong STD/HIV/AIDS Project in Cambodia

A 1999 external review of the UNICEF Mekong Region STD/HIV/AIDS Project concluded:

“The Project has been successfully implemented and made valuable contributions at both country and inter-country levels to strengthen the capacity of a range of partners to respond more effectively to STD/HIV/AIDS prevention and care needs. Project implementation has been well managed and technical guidance has been good at all levels of project implementation. Activities undertaken have been appropriate, well designed and delivered, consistent with national priorities and responsive to emerging trends in the epidemic, and can be demonstrated to have considerable impact and have the potential to be sustainable. UNICEF’s commitment to collaborate with a wide range of national and international partners means that the effort is not isolated and has had an impact on, and benefited from the programming approaches of other agencies.”  

Since that time, Cambodia has made substantial progress in preventing and mitigating the impact of HIV and AIDS, and is one of the few countries in the world which has been successful in reversing its HIV epidemic and achieved near universal access to HIV/AIDS treatment.

This was achieved through targeted prevention programs that increase awareness of transmission and promote condom use, and the expansion of comprehensive care and treatment services throughout the country.

Despite Cambodia’s success in controlling the HIV epidemic, continued efforts are needed to maintain the momentum combating the spread of the virus, especially among the nation’s most vulnerable and marginalized populations, which include women, children and young people.

Hawai’i – The Perfect Refuge

I returned to Hawai’i in June 1998 after two and a half years with UNICEF – six months in Fiji and two years in Cambodia. The East-West Center graciously provided me with an office to edit 20 years of personal journal entries while contemplating my next adventure.

My former landlords also welcomed me back to a quiet, refurbished top floor apartment – with spectacular views up to steep mountains and deep valleys, misty with passing showers and rainbows, and down to the sea, sunsets and the lights of Waikiki.

Biking to the beach each morning brought joy and renewal to my heart. In the cool of the dawn just before the sun appears over the hills, a brisk swim out to the reef and beyond refreshes body and spirit. Moving through crystal clear water with the fish, sea turtles, and an occasional eel or ray. Then, seated with a cup of coffee under the coconuts in the morning sunlight – steady breezes under clear, blue skies, watching the surf roll in – indulging in the artist’s lifestyle.

As 1999 dawned, I joined a friend for six weeks of travelling in Thailand, Indonesia – and Vietnam, where I would soon enter the next chapter of adventure and serendipity.

Stay tuned for more stories, coming soon!

You can read more about Jim’s backstory,  here and here.

December 1997: “Stretched out along the banks of the mighty Mekong, the weather in Phnom Penh is fantastic this time of year. Sunny and breezy, all is green following the rains. The mud-slide streets have dried up and the choking dust and oppressive heat won’t come into full force for another month or so. Most importantly, the city is quiet – for the time being at least. Some fighting resumed in the northwest of the country, but we are back to the calm after (or before?) the storm. One never knows what to expect in Cambodia!”

Civil War

During the months leading up to the fighting in July you could feel the increasing tension in the air. As usual, either utter doldrums of boredom in the blazing heat, with the usual annoyances, or life would suddenly get quite thrilling – as we listened intently for the steady bursting of shells. The situation was the worst it had been in some time.

The stalls in the local vegetable market were empty. My neighbor and I made a last dash to the nearby 7/7 shop and managed to score the few remaining basic food items and bottles of drinking water off the bare shelves before the owners closed the doors, locked the gate, loaded up their motorbike and headed out of town.

All but one of the banks had closed – and it was mobbed with people standing outside with bankbooks in hand watching the lucky ones in front receive hundreds, fifties, twenties, tens, fives, ones, and then, out of cash the bank simply closed its doors, leaving us all standing there with our worthless bankbooks.

Most of the foreign nationals were evacuated from the country. However, many of the international NGOs and United Nations staff remained during and after the fighting. It just so happened that both of my passports – diplomatic and USA national – were in government offices getting visas renewed when all this happened, so even if I could have left the country, I couldn’t travel anywhere. So we waited at home – shelling all day. My landlord’s family stayed too, and was wonderful with food and mutual support throughout.

One of the areas of heavy fighting was near the UNICEF office (and near my apartment!)  Fortunately, the automatic weapons fire and heavy artillery were aimed away from my place.  We were instructed to stay at home – I was literally under the bed and tuned to the two-way radio handset while the fighting swept by.

Others were not so fortunate.  People were killed, and many homes and businesses were either destroyed by the fighting, or cleaned out by widespread looting by roving gangs of drunken young men toting AK 47’s. Many people fled to the countryside, and the deadly political purges followed. Sadly, just around the corner from the UNICEF office, two children were blown up by a hand grenade they found lying on the ground.

After the event, there was an overwhelming and pervasive feeling of depression. Jobs disappeared as foreign investors pulled out. All that had gone towards establishing some form of stability, law and order and a semblance of hope in Cambodia seemed lost.

Eventually, shops re-opened, and investment slowly trickled back into the country, but the economy remained weak. Tourism largely ground to a halt. So, if you were planning a visit to Cambodia, you would have the beautiful temples of Angkor all to yourself!

The international airport had also been significantly damaged by the fighting, and was closed for several days. Until repairs could be completed, it was prudent to schedule morning flights to Phnom Penh when the weather was more likely to be clear, because pilots had to rely on visual navigation only, to land at the international airport. When I eventually got my passports back, I had new visas that allowed me to stay in Cambodia for another year – a comforting thought!

The Mekong Region STD/HIV/AIDS Project

On top of all this Cambodia had the most serious and rapidly progressing HIV/AIDS epidemic in Asia, and was on the brink of becoming one of the worst affected countries in the world.  HIV infection rates among sex workers, their clients and pregnant women were the highest in Asia. Nearly half of all brothel workers were infected, and the HIV infection rate among pregnant women had doubled since the previous year.

Commercial sex was cheap and widespread – an estimated 50,000 commercial sex contacts occurred each day in Phnom Penh, and with inconsistent condom use.

Under its humanitarian mandate, UNICEF was able to continue working for the benefit of women and children in Cambodia, including the training of over 10,000 primary and secondary school teachers and curriculum writers on Life Skills approaches for HIV/AIDS prevention, along with a learning package for foreign language schools.

UNICEF supported multi-sector prevention activities at provincial and local levels, as well as community-based care and counseling for people living with HIV/AIDS. One such activity, designated a UNAIDS “Best Practice” model, successfully brought together a dozen NGOs and the Buddhist temples in Phnom Penh in coordinated support of the municipal health services.

UNICEF also played a leading role in the first ever National Strategic Planning effort to identify priorities and key strategies to guide the response to the spread of HIV/AIDS in Cambodia.

Don’t Bring AIDS Back Home

UNICEF’s mass media social marketing campaign “Don’t Bring AIDS Back Home” had become the most popular HIV/AIDS prevention theme in Cambodia.

Cambodian women are especially vulnerable to HIV, in part due to cultural norms that tolerate men who seek sex outside of marriage and return home to have unprotected sex with their wives. Although the country’s epidemic was largely male-driven, it was increasingly infecting more women, with more than half of the new infections among women, and with implications for increased mother-to-child transmission of the virus. 

Based on recent studies of sexuality among young people in Cambodia as well as our own participatory research with key target audiences, UNICEF worked closely with young people to produce appropriate IEC (Information, Education and Communication) media, including a series of interactive teaching video packages which presented real-life scenarios and modeled practical strategies for dealing successfully with a variety of risk situations.

Some of the videos were so popular, they were pirated and distributed even before being completed. These video packages were also adapted for use in Thailand, Laos and Vietnam.

Behavior modelling and Life Skills educational programs aimed to empower young people to deal effectively with their problems, make informed choices, act on their decisions and protect their health when pressured to take illegal drugs, engage in unprotected sex or participate in dangerous activities.

For example, working with adolescent boys hanging out at snooker clubs, and who also visit brothels, UNICEF staff helped them to identify a typical risk scenario, draft some basic scripting and even act in the video – which featured the peer group leader clearly modelling safer behavior at the brothel – in this case, insisting that they all use condoms.

Another scenario targets adolescent girls with example dialogue and behavior modelling to effectively and amicably delay the onset of sex, when pressured by their boyfriends. 

Popular TV spots featuring famous Khmer actors also demonstrated safer behaviors. For example, married men who go out with their friends to drinking establishments where many of the waitresses or ‘beer girls’ also sell sex, are reminded to remain faithful to their wives or otherwise use a condom every time.

On one occasion, our popular film star ‘model citizen’ disappeared with the ‘beer girl’ actress after the TV spot filming was over. We could only hope they were using condoms!

Stay tuned for Part Three, coming soon!

You can read more about Jim’s backstory,  here and here.

December 1996:“A weekend retreat — traveling three hours by convoy for safety, radios in each of the three cars and along a good, tar-sealed road (which passes through Pol Pot territory – and a popular kidnapping area lined on either side with mine fields) brings us to some very pleasant beaches along Cambodia’s southern coast. Then, during a morning jog along the beach, someone discovered a freshly killed, bloody corpse (probably a smuggler) the day we left the resort town Kompong Som. A stark reminder that we are still in Cambodia – where at times life can seem cheap, and security must be taken seriously.”

In May 1996, I moved to Phnom Penh, Cambodia to set up and manage UNICEF’s country program assistance to government, NGOs and international organizations as part of the Mekong Region STD/HIV/AIDS Project, a new regional project implemented in six countries bordering the Mekong River: Cambodia, China, Laos, Myanmar, Thailand and Vietnam.

Still reeling in the aftermath of the Khmer Rouge’s reign of terror (1975-1979) that resulted in the deaths of up to three million people or nearly a quarter of the 1975 population through execution, torture, starvation, and disease. Tragically, in the mid-1990’s Cambodia was experiencing the most serious and rapidly progressing HIV/AIDS epidemic in Asia, and was on the brink of becoming one of the worst affected countries in the world.

For the majority of Cambodians, HIV/AIDS was not considered a priority concern. Disruption and weakening of the family and community, as well as continued armed conflict and extensive poverty following years of turmoil had resulted in large numbers of young people, women and children living in especially difficult circumstances.

The rapid transition to a free market economy, increased population mobility, the opening of borders, and other liberalizing measures implemented with little apparent guidance or regulation were also contributing to the explosive spread of HIV in Cambodia.

The primary mode of HIV transmission was unprotected heterosexual intercourse. Women especially faced an enormous challenge from HIV. National HIV Sentinel Surveillance had found that over 40% of the commercial sex-workers tested and nearly 2% of pregnant women attending ante-natal clinics were HIV-infected.

Even among those who were not occupationally exposed in Cambodia’s growing commercial sex industry, women were increasingly at risk for infection from their husbands and boyfriends.

UNICEF’s chief strategy was to raise the capacity of counterpart organizations at local levels, working in collaboration with target populations assessed to be most vulnerable to sexually transmitted diseases (STDs) including HIV. 

These included students in primary, secondary and vocational schools, non-formal education participants, out-of-school youth, women of reproductive age, and women and children directly affected by HIV and AIDS – especially rural people and ethnic minorities who faced a higher risk for HIV infection because of their marginal status.

Because so many of the educated Khmer had either died, were badly traumatized, or had fled the country to escape the horrors carried out by the Khmer Rouge under Pol Pot, the few remaining qualified government counterparts UNICEF could work with were stretched to the limit and often unavailable as they faced enormous challenges of competing priorities in health, education, social welfare, and other sectors that UNICEF supported.

Project Officer for STD/HIV/AIDS

As UNICEF’s Project Officer for STD/HIV/AIDS, I was responsible for the planning, development and management of technical and financial assistance on all aspects of Project implementation to establish Cambodia’s component of UNICEF’s Mekong Region STD/HIV/AIDS Project.

Through on-going situation analysis, awareness-raising, human resource needs assessment and training, the Project raised the capacity of government agencies, NGOs, local communities and the UNICEF country office to design, test, implement, monitor and evaluate activities to reduce HIV/AIDS transmission and increase community acceptance and care for women, children and families affected by the illness.

As the leading multilateral agency supporting Cambodia’s National HIV/AIDS Program and its multiple implementing partners at national, provincial and community levels, a major challenge was coordinating these important and wide-ranging efforts for maximum impact.

A swim each evening at the International Youth Club pool was refreshing and helped ease the strain, followed by a bowl of noodle soup from my favorite street vendor and a loaf of hot, crispy French bread from the ‘Nom Pang’ (bread) vendor whose ‘Pang Pang’ cries echoed through the streets as he peddled his bike through the night.

Of course, it was prudent, especially after dark, to carry a readily accessible $20 bill to hand off in a hurry if confronted by armed robbers roaming the streets.

Once known as the “Pearl of Asia,” Phnom Penh was considered one of the loveliest French-built cities in Indochina in the 1920’s. Sadly, in the mid-90’s, the city was a stinking mudslide when it rained, and a heavily trashed dust bowl the rest of the time, especially because of the growing traffic on the largely unpaved roads.

Of course, a big challenge was simply managing the energy drain and overall depressing nature of the place. Rampant corruption, civil war and subsequent political purges, AIDS, poor illiterate peasants, beggars, amputees, child prostitution, orphans – it was going to take time to recover from such horrific trauma and suffering.

Strolling home from the pool each night under the stars, twinkling through the coconut palms – down the quiet, dusty back streets, a few fires burning in the darkness, migrant workers and their families huddled in ramshackle shelters.

A few guys shooting snooker, a scuttering rat or two in the rotting rubbish piles and stagnant pools of stinking water, past a small market area behind the crumbling hospital next to a temple. But as usual, there was not much worth buying or eating – except a roast banana or perhaps a blackened, rock-hard baguette from the mobile hot bread-seller.

Again, the positive and stimulating nature of my work at UNICEF is what saved me. Grateful for the pool, for quiet, walkable streets with (at that time) only limited motorized traffic, and the stamina to respond to the swarms of kids desperately seeking attention and love – and yet somehow, still bursting with boundless youthful exuberance.

Stay tuned for Part Two, coming soon!

You can read more about Jim’s backstory,  here and here.