On best behaviour: men's attitudes to sexual health in Cambodia

The HIV epidemic in Cambodia is one of the most serious in Asia. The main cause of the rapid increase in infection is unprotected heterosexual sex. In Cambodia it is men who generally make the decisions about sex while women are expected not to talk, or even know, about sex.  In this situation it is essential to target men if infection rates are to be reduced.  But how can male sexual behaviour be altered?  How can men become more involved in supporting people infected with HIV?  The International HIV/AIDS Alliance, together with the Khmer HIV/AIDS NGO Alliance, looked at the experience of nine HIV/AIDS organisations working in Cambodia over a period of two years.

There is a great deal of fear and misinformation about AIDS in Cambodia.  Many people with HIV have been abandoned by their families and refused treatment by hospitals. Employees lose their jobs and small businesses collapse because people are afraid to purchase goods from someone who has AIDS. Women with HIV are accused of being immoral; in particular sex workers are blamed for spreading the virus rather than their male clients.  Yet it is male behaviour that is fuelling the epidemic.  Twice as many men as women are infected with the AIDS virus, and men have more sexual partners than women. It is the male culture of risk-taking, drinking and visiting sex workers that place many men most at risk of infection.

The review found that peer group discussions were effective in changing attitudes and behaviour. Groups of men, of similar age, occupation or marital status, met over a period of several months to discuss HIV and other issues.  Wives, girlfriends, sex workers, community and military leaders were also targetted to bring about change in the wider community.  Following the discussions:

• men began to use condoms more frequently with sex workers and with their regular partners
• men developed negotiating skills and were better able to resist peer pressure to drink and visit brothels
• more men were seeking treatment for sexually transmitted diseases
• women said they had benefited from men’s changing attitudes and behaviour.

The report recommends using the same strategy of peer group discussion in order to:

• raise awareness of discrimination towards and the rights of AIDS sufferers
• think about the role men can play in caring for and supporting AIDS victims
• mobilise community support for people with the infection and their families.
• While it is important to involve all sectors of the community in fighting the AIDS epidemic, the review found that peer group discussions with men were an effective way of changing men’s sexual behaviour.  Because of men’s dominant role in Cambodian society, altering their attitudes and behaviour can bring about change in the wider community.

Source(s):
‘Promoting the participation of men in community-based HIV/AIDS prevention and care in Cambodia’, in Realising rights: transforming approaches to sexual and reproductive well-being’, A. Cornwall and A. Welbourn (eds), pp154-166, by T. Sellers et al, 2002 Full document.

Funded by: Sida; Swiss Agency for Development and Co-operation (SDC); UK Department for International Development

id21 Research Highlight: 22 July 2003

Further Information:
Tilly Sellers
International HIV/AIDS Alliance
Queensberry House
104-106 Queens Road
Brighton
BN1 3XF
UK

Tel: +44 (0)1273 718 900
Fax: +44(0)1273 718 901
Contact the contributor: tsellers@aidsalliance.org

International HIV/AIDS Alliance

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