Cambodia Last Update: August 2018

CONTENT Basic socio-demographic indicators HIV prevalence and epidemiological status Risk behaviors Vulnerability and HIV knowledge HIV expenditure National response

BASIC SOCIO-DEMOGRAPHIC INDICATORS Total population (in thousands) 15,578 (2015) 1 Population aged 15-49 (thousands) 8,425(2015) 1 Maternal mortality ratio (per 100 000 live births) 161 (2015) 5 Percentage of population in urban areas 21 (2015) 2 Antenatal care coverage - At least one visit (%) 95.3 (2014) 7 Crude birth rate (births per 1,000 population) 24.1 (2014) 2 Under-5 mortality rate (per 1,000 live births) 29 (2015) 2 Human development index (HDI) - Rank/Value 143/0.555 (2014) 4 Life expectancy at birth (years) - Male/Female 67/71 (2015) 5 Adult literacy rate (%) 74 (2009) 2 Ratio of girls to boys enrolled at primary level in public and private school (%) 0.95 (2014) 2 GDP per capita (PPP, current international $) 3,483 (2015) 2 Per capita total expenditure on health (PPP int. $) 183 (2014) 3 Sources: Prepared by www.aidsdatahub.org based on 1. UN Population Division. (2015). World Population Prospects: The 2015 Revision - Extended Dataset; 2. World Bank. World Data Bank: World Development Indicators & Global Development Finance. Retrieved July 2016, from http://data.worldbank.org/; 3. WHO. Global Health Observatory Indicator Views: Per Capita Total Expenditure on Health (PPP int. $) (Health Systems), Retrieved July 2016, from http://apps.who.int/gho/data/node.imr.WHS7_105?lang=en; 4. Palanivel, T., Mirza, T., Tiwari, B. N., Standley, S., & Nigam, A. (2016). Asia-Pacific Human Development Report - Shaping the Future: How Changing Demographics Can Power Human Development; 5. WHO. (2016). World Health Statistics 2016: Monitoring health for the SDGs; 6. World Bank Group. (2016). World Development Indicators 2016 and 7. UNSD. Millennium Development Goals Database - Antenatal Care Coverage Retrieved May 2016, from http://data.un.org/Data.aspx?q=Antenatal+care+coverage&d=MDG&f=seriesRowID%3a762.

HIV prevalence and epidemiology

Estimated people living with HIV, new HIV infections and AIDS-related deaths, 1990-2017 Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates

Estimated number of adults (15+) living with HIV and women (15+) living with HIV, 1990-2017 Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates

Towards 2020 Fast-Track targets and ending AIDS in Cambodia Estimated new HIV infections in Cambodia Fast-track outlook zoom-in Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates

Key population size estimates, 2012-2015 Year of estimate People who inject drugs (PWID) 1300 2012 Female sex workers * (FSW) 34 000 2014 Men who have sex with men (MSM) 20 000 2015 Transgender (TG) 3000 * Female entertainment workers Source: Prepared by www.aidsdatahub.org based on Global AIDS Monitoring (GAM) reporting 2018

HIV prevalence among key populations, 2014 - 2017 Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance Reports, Integrated Biological and Behavioral Surveillance Reports, other serological survey reports and Global AIDS Monitoring (GAM) reporting

HIV epidemic: location and population snapshot National versus location specific HIV prevalence among key populations, 2014 - 2017 National Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance Reports, Integrated Biological and Behavioral Surveillance Reports and other serological survey reports

HIV prevalence trends among key populations, 2002-2017 Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance Reports, Integrated Biological and Behavioral Survey Reports, other serological survey reports and Global AIDS Monitoring 2017 and 2018

HIV prevalence among MSM by sexual practice, 2014 Source: Prepared by www.aidsdatahub.org based on National Center for HIV/AIDS, Dermatology and STD (NCHADS). (2015). National HSS among ANC and MSM 2014

HIV prevalence among MSM by city, 2010 and 2014 Source: Prepared by www.aidsdatahub.org based on 1) Liu, K.-L., & Chhorvann, C. (2010). Behavioral Risks On-site Serosurvey among at-risk Urban Men in Cambodia. Bros Khmer 2010; and 2) National Center for HIV/AIDS, Dermatology and STD (NCHADS). (2015). National HSS among ANC and MSM 2014

HIV prevalence among female entertainment workers (FEW), 2011 Source: Prepared by www.aidsdatahub.org based on NCHADS. (2013). 2011 Cambodia STI Survey: Female Entertainment Workers. Presentation by Mun Phalkun.

HIV prevalence among female entertainment workers (FEW) in selected geographical locations, 2011 Source: Prepared by www.aidsdatahub.org based on Phalkun Mun, Navy Chann, Perry Killam, Jeff Mutuc, Sodara Chan. (2013). 2011 Cambodia STI Prevalence Survey - Integrated Biological and Behavioral Survey for Sexually Transmitted Infections and Risk Behaviors among Female Entertainment Workers. NCHADS.

HIV prevalence among female entertainment workers (FEW) in selected geographical locations, 2010 Source: Prepared by www.aidsdatahub.org based on National Center for HIV/AIDS Dermatology and STDs and Ministry of Health (2012). HIV sentinel surveys 2010: Female entertainment workers (FEWs); Antenatal care clinic (ANC) attendees.

STI prevalence among female entertainment workers who sold sex in the last 12 months, 2011 Source: Prepared by www.aidsdatahub.org based on NCHADS. (2013). 2011 Cambodia STI Survey: Female Entertainment Workers. Presentation by Mun Phalkun.

STI prevalence among female entertainment workers (FEW) in selected geographical locations, 2011 Source: Prepared by www.aidsdatahub.org based on Phalkun Mun, Navy Chann, Perry Killam, Jeff Mutuc, Sodara Chan. (2013). 2011 Cambodia STI Prevalence Survey - Integrated Biological and Behavioral Survey for Sexually Transmitted Infections and Risk Behaviors among Female Entertainment Workers. NCHADS.

Chlamydia prevalence among female entertainment workers (FEW) in selected geographical locations, 2011 Source: Prepared by www.aidsdatahub.org based on Phalkun Mun, Navy Chann, Perry Killam, Jeff Mutuc, Sodara Chan. (2013). 2011 Cambodia STI Prevalence Survey - Integrated Biological and Behavioral Survey for Sexually Transmitted Infections and Risk Behaviors among Female Entertainment Workers. NCHADS.

Gonorrhea prevalence among female entertainment workers (FEW) in selected geographical locations, 2011 Source: Prepared by www.aidsdatahub.org based on Phalkun Mun, Navy Chann, Perry Killam, Jeff Mutuc, Sodara Chan. (2013). 2011 Cambodia STI Prevalence Survey - Integrated Biological and Behavioral Survey for Sexually Transmitted Infections and Risk Behaviors among Female Entertainment Workers. NCHADS.

Hepatitis B prevalence among female entertainment workers (FEWs) in selected geographical locations, 2011 Source: Prepared by www.aidsdatahub.org based on Phalkun Mun, Navy Chann, Perry Killam, Jeff Mutuc, Sodara Chan. (2013). 2011 Cambodia STI Prevalence Survey - Integrated Biological and Behavioral Survey for Sexually Transmitted Infections and Risk Behaviors among Female Entertainment Workers. NCHADS.

Trends of HIV prevalence among ANC attendees (15-24 yr) by province, 2000-2010 Source: Prepared by www.aidsdatahub.org based on National Center for HIV/AIDS Dermatology and STDs and Ministry of Health (2012). HIV sentinel surveys 2010: Female entertainment workers (FEWs); Antenatal care clinic (ANC) attendees.

Trends of HIV prevalence among ANC attendees (25+ yr) by province, 2000-2010 Source: Prepared by www.aidsdatahub.org based on National Center for HIV/AIDS Dermatology and STDs and Ministry of Health (2012). HIV sentinel surveys 2010: Female entertainment workers (FEWs); Antenatal care clinic (ANC) attendees.

HIV prevalence among pregnant women, 1996-2014 Source: Prepared by www.aidsdatahub.org based on National Center for HIV/AIDS, Dermatology and STD (NCHADS). (2015). National HSS among ANC and MSM 2014 (Dissemination Presentation by Dr. Mun Phalkun, Surveillance Unit, NCHADS, 04 August, 2015).

HIV prevalence among pregnant women by province, 2014 Source: Prepared by www.aidsdatahub.org based on National Center for HIV/AIDS, Dermatology and STD (NCHADS). (2015). National HSS among ANC and MSM 2014 (Dissemination Presentation by Dr. Mun Phalkun, Surveillance Unit, NCHADS, 04 August, 2015).

Risk behaviours

Proportion of key populations who reported condom use at last sex, 2003-2017 Source: Prepared by www.aidsdatahub.org based on Integrated Biological and Behavioral Surveys, Behavioral Surveillance Surveys, other behavioral survey reports and Global AIDS Monitoring 2017 and 2018.

Trends in consistent condom use among female sex workers, 1997- 2013 Source: Prepared by www.aidsdatahub.org based on 1. National Center for HIV/AIDS Dermatology and STD Cambodia, FHI, & USAID. (2007). Cambodia 2007 Behavioral Surveillance Survey: HIV/AIDS Related Sexual Behaviors among Sentinel Groups ; 2. Chhorvann, C. (2011). Behavioral Sentinel Surveillance 2010. Power Point Presentation. National Center for HIV/AIDS Dermatology and STD; and 3. National Center for HIV/AIDS Dermatology and STD Cambodia. (2013). Behavioral Sentinel Surveillance (BSS 2013): Presented by Mun Phalkun on 16 December 2013.

Proportion of PWID who reported having protective sexual behavior and safe injection practice, 2007 and 2012 Source: Prepared by www.aidsdatahub.org based on 1. National Center for HIV/AIDS Dermatology and STDs Cambodia. (2007) Cambodia HIV Surveillance Survey among Drug Users 2007; and 2. Chhorvann, C. Sopheab, H. Sovannary, T. (2014). National Population Size Estimation, HIV Related Risk Behaviors and HIV Prevalence among People Who Use Drugs in Cambodia in 2012.

Proportion of PWID who reported condom use by partner type, 2012 Source: Prepared by www.aidsdatahub.org based on Chhorvann, C. Sopheab, H. Sovannary, T. (2014). National Population Size Estimation, HIV Related Risk Behaviors and HIV Prevalence among People Who Use Drugs in Cambodia in 2012.

Proportion of MSM who reported condom use at last sex by partner type, 2007 and 2013 Source: Prepared by www.aidsdatahub.org based on Ministry of Health, National Center for HIV/AIDS Dermatology and STDs. (2013). Behavioral Sentinel Surveillance (BSS 2013). Presentation by Mun Phalkun.

Proportion of MSM who reported consistent condom use in the last month by partner type, 2007 and 2013 Source: Prepared by www.aidsdatahub.org based on Ministry of Health, National Center for HIV/AIDS Dermatology and STDs. (2013). Behavioral Sentinel Surveillance (BSS 2013). Presentation by Mun Phalkun.

Proportion of transgender people who reported condom use at last sex by partner type, 2007 and 2013 Source: Prepared by www.aidsdatahub.org based on Ministry of Health, National Center for HIV/AIDS Dermatology and STDs. (2013). Behavioral Sentinel Surveillance (BSS 2013). Presentation by Mun Phalkun.

Proportion of transgender people who reported consistent condom use in the last month by partner type, 2007 and 2013 Source: Prepared by www.aidsdatahub.org based on Ministry of Health, National Center for HIV/AIDS Dermatology and STDs. (2013). Behavioral Sentinel Surveillance (BSS 2013). Presentation by Mun Phalkun.

Mean number of clients/sexual partners among FEW, MSM and transgender people, 2013 Source: Prepared by www.aidsdatahub.org based on Ministry of Health, National Center for HIV/AIDS Dermatology and STDs. (2013). Behavioral Sentinel Surveillance (BSS 2013). Presentation by Mun Phalkun.

Overlapping risk behaviors among MSM and transgender people, 2013 Source: Prepared by www.aidsdatahub.org based on Ministry of Health, National Center for HIV/AIDS Dermatology and STDs. (2013). Behavioral Sentinel Surveillance (BSS 2013). Presentation by Mun Phalkun.

Proportion of male PLHIV with reported risk behaviors, 2010 and 2013 Source: Prepared by www.aidsdatahub.org based on Ministry of Health, National Center for HIV/AIDS Dermatology and STDs. (2013). Behavioral Sentinel Surveillance (BSS 2013). Presentation by Mun Phalkun.

Trends in consistent condom use (in last three months) among moto-taxi drivers by type of partner, 1997-2010 Source: Prepared by www.aidsdatahub.org based on National Center for HIV/AIDS Dermatology and STD Cambodia. (2010). Behavioral Sentinel Surveillance (Dissemination Presentation at Naga World Hotel 30th December), 2010.

Proportion of males (15-49) years who reported having more than one sexual partner in the last 12 months and reported condom use at last paid sex, 2005-2010 Source: Prepared by www.aidsdatahub.org based on National Institute of Statistics Ministry of Planning, Directorate General for Health Ministry of Health, & MEASURE DHS ICF Macro. (2011). Cambodia Demographic and Health Survey 2010; National Institute of Public Health and National Institute of Statistics. Cambodia Demographic and Health Survey 2005, December 2006; and UNAIDS. (2010). UNAIDS Report on the Global AIDS Epidemic 2010.

Vulnerability and HIV knowledge

People who inject drugs who knew where to get clean needles and syringes, 2012 Source: Prepared by www.aidsdatahub.org based on Chhorvann, C. Sopheab, H. Sovannary, T. (2014). National Population Size Estimation, HIV Related Risk Behaviors and HIV Prevalence among People Who Use Drugs in Cambodia in 2012.

Proportion of MSM and transgender who perceive themselves at risk of HIV, and who know that condom use can reduce HIV transmission, 2013 Source: Prepared by www.aidsdatahub.org based on National Center for HIV/AIDS Dermatology and STD Cambodia. (2013). Behavioral Sentinel Surveillance (BSS 2013). Dissemination Presentation, 2013.

Comprehensive knowledge of HIV among adults (15 - 49 yr) by age group, gender and area of residence, 2014 Source: Prepared by www.aidsdatahub.org based on National Institute of Statistics, Directorate General for Health, and ICF International, 2015. Cambodia Demographic and Health Survey 2014.Phnom Penh, Cambodia, and Rockville, Maryland, USA: National Institute of Statistics, Directorate General for Health, and ICF International.

HIV expenditure

AIDS spending by financing source AIDS spending by service category AIDS financing, 2015 46.9 million US$ AIDS spending by financing source AIDS spending by service category Key populations prevention 11% Other prevention 14% Care and treatment 37% Other AIDS expenditure Prepared by www.aidsdatahub.org based on Cambodia NASA 2014-15

Total AIDS spending and a quarter for prevention Less than 50% of total prevention expenditure was spent for key populations HIV prevention programmes Total AIDS spending and a quarter for prevention Amount and proportion of key populations prevention spending in Cambodia, 2015 Prevention spending 24% 9% 16% of total prevention spending* 44% 4% 46.9 million US$ Total AIDS spending * additional 1.7 million USD was spent for key population prevention but breakdown data by key population for 1.7 million USD is not available Source: Prepared by www.aidsdatahub.org based on Cambodia NASA 2014-15

AIDS spending by financing source, 2006-2012 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

AIDS spending by financing source, 2006-2012 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

AIDS spending by category, 2006-2012 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of total prevention programme spending on key populations at higher risk, 2006-2012 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of spending on HIV prevention programmes by funding source, 2006-2012 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of spending on care and treatment by funding source, 2006 - 2012 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

National response

Proportion of key populations who received an HIV test in the last 12 months and know their results, 2007-2016 Source: Prepared by www.aidsdatahub.org based on 1.National Center for HIV/AIDS Dermatology and STD Cambodia, FHI, & USAID. (2007). Cambodia 2007 Behavioral Surveillance Survey: HIV/AIDS Related Sexual Behaviors among Sentinel Groups ; . 2.Chhorvann, C. (2011). Behavioral Sentinel Surveillance 2010. Power Point Presentation. National Center for HIV/AIDS Dermatology and STD; 3.Liu, K.-L., & Chhorvann, C. (2010). Behavioral Risks On-site Serosurvey among At-risk Urban Men in Cambodia; 4.Drug User HIV Prevalence and Behavioral Survey 2007 cited in National AIDS Authority Cambodia. (2010). UNGASS Country Progress Report: Cambodia; 4. NCHADS. (2013). 2011 Cambodia STI Survey: Female Entertainment Workers. Presentation by Mun Phalkun; 5. Cambodia Global AIDS Response Progress Report (Country narrative report) and 5. Global AIDS Monitoring Reports

Number of needles/syringes distributed per person who inject drugs per year, 2008-2017 Medium coverage: >100–<200 syringes per PWID per year Low coverage: <100 syringes per PWID per year High coverage: >200 syringes per PWID per year Source: Prepared by www.aidsdatahub.org based on Global AIDS Monitoring Reporting and www.aidsinfo.unaids.org

Proportion of people who inject drugs with reported sources of new needles and syringes in the last 12 months, 2012 Source: Prepared by www.aidsdatahub.org based on Chhorvann, C. Sopheab, H. Sovannary, T. (2014). National Population Size Estimation, HIV Related Risk Behaviors and HIV Prevalence among People Who Use Drugs in Cambodia in 2012.

Number of Needle and Syringe Programme (NSP) and Opioid Substitution Therapy sites (OST), 2011-2014 Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting.

Scale-up HIV testing at VCCT services and percent tested positive, 2006 - Second Quarter 2014 Sources: Prepared by www.aidsdatahub.org based on Ministry of Health; National Centre for HIV/AIDS Dermatology and STD Cambodia (NCHADS). HIV/AIDS and STI Prevention, Care and Treatment Programme. Quarterly Comprehensive Reports: 2nd Quarter 2014; 4th Quarter 2011; and 4th Quarter 2009.

Number of ART sites and people on ART, 2004-2017 Source: Prepared by www.aidsdatahub.org based on 1. National Centre for HIV/AIDS Dermatology; STD Cambodia. Annual and Quarterly Reports; 2. Cambodia Global AIDS Monitoring (GAM) reporting; and 3. www.aidsinfoonline.org

ART scale up, 2000-2017 Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates and Global AIDS Monitoring 2018

HIV testing and treatment cascade, 2017 Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates and Global AIDS Monitoring 2018

Treatment cascade, 2017 n/a Estimated PLHIV PLHIV know their status PLHIV receiving care People on ART Tested for viral load Suppressed viral load* n/a * Number of people on ART who received a viral load test in the past year and have VL of <1000copies/ml Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates and Global AIDS Monitoring 2018

Estimated adults living with HIV, adults receiving ARVs, and adult ART coverage, 2017 Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates and Global AIDS Monitoring 2018

Estimated pregnant women living with HIV, pregnant women receiving ARVs, and PMTCT coverage, 2017 Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates and Global AIDS Monitoring 2018

PMTCT coverage in Cambodia is almost double the regional average in the past 7 years Prevention of mother-to-child transmission, Cambodia versus Asia and the Pacific, 2010-2017 95% Prepared by www.aidsdatahub.org based on UNAIDS 2018 HIV estimates, and Global AIDS Monitoring 2018

National data on stigma and discrimination Selected indicators of response from NCPI 2014 Access to justice: Legal services (legal aid or other) NHRI or other mechanisms Civil society perspectives/ratings: 2009 2011 2013 Trend Laws and policies in place to protect and promote HIV- related human rights 8/10  4/10   Efforts to implement human rights-related laws and policies 5/10  3/10 STIGMA INDEX (2010 Data) Percent of PLHIV respondents who avoided going to a local clinic when needed because of HIV status: 24% Source: Prepared by UNAIDS Regional Support Team Asia and the Pacific andwww.aidsdatahub.org based on information provided by UNAIDS country office and partners.

Human rights and legal environment Age of legal capacity to consent independently to an HIV test Harm reduction services for young PWID Yes, “under 18” if guardian consent cannot be obtained and in best interests of the child Yes, available Punitive laws Criminalization of same-sex sexual activities Compulsory detention centres for PWUD Criminalization of sex work Criminalization of HIV transmission or exposure HIV-related restrictions on entry, stay and residence Has punitive law Does not have punitive law Prepared by www.aidsdatahub.org based on UNAIDS, AIDS Data Hub, UNODC, UNFPA, & UNDP. Punitive Laws Hindering the HIV Response in Asia and the Pacific and World Health Organization - http://www.who.int/maternal_child_adolescent/epidemiology/policy-indicators/en/ (accessed Feb 10, 2017)

Punitive laws hindering the HIV response Sources: Prepared by www.aidsdatahub.org based on UNAIDS, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

slides compiled by www.aidsdatahub.org THANK YOU slides compiled by www.aidsdatahub.org Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge www.aidsdatahub.org if slides are lifted directly from this site.