<< Monks like Thorn Vandong have gotten involved in bringing key HIV services to rural Cambodians. / Credit:Irwin Loy/IPS

But despite these conditions at home, he and his wife were healthy; his three children had enough food to eat today. That was not always the case.

Just three years ago, Mon Hol’s world was spiralling out of control.

The results of a medical test came through: HIV-positive. His wife, Roun Ry, also tested positive. Mon could barely fathom what it meant.

Then there was his health. He would need to take medicine every day to manage his condition, doctors told him. But the nearest clinic was an hour away. He could barely afford to feed his family as it was, let alone the cost of a motorbike taxi to pick up his medicine. How would he cope?

"I was scared," Mon said. "I was afraid. I didn’t even know anyone who had HIV. Then I realised that I had it."

Mon’s situation underscores just one of the challenges authorities in this South-east Asian nation face in addressing HIV. Countries have pledged to reduce the prevalence of HIV and offer life-saving anti-retroviral (ARV) treatment to all those who need it as part of the United Nations’ Millennium Development Goals.

But in rural Cambodia, far from even basic medical care and a world away from city hospitals, the best intentions abruptly run up against the realities of daily life.

Three years ago, there were few options for Mon. He knew little about the virus that had taken control of his body. There was no care in his remote village, no counsellors, no one to talk to about the illness. Cambodia’s health system did not reach as far as his village and few non-governmental organisations operated in the area.

The hospital in the provincial capital was an hour away. For a poor farmer living hand to mouth, it might as well have been in another country.

In 2009, however, a non-government organisation led by monks, the Buddhism and Society Development Association (BSDA), stepped in with a programme that Mon says has changed his life.

It linked people living with HIV, like Mon and his wife, with counselling and offered health education to them and their neighbours. More vitally, they have also made it possible for Mon to get his medication on a regular basis. BSDA’s support includes a monthly stipend that allows him to make the trip to the nearest clinic to pick up his treatment.

"People who live in the village are very poor," said Pheaktra Lansamrith, a project coordinator with BSDA. "If they don’t have money, then some of them just won’t get the help they need."

Cambodia offers free ARV treatment to people like Mon – those who are least able to afford them. In remote rural areas like this, extra measures are crucial to ensuring people living with HIV can get the help they need.

"HIV and AIDS is the big issue, the big challenge in Cambodia, especially in rural areas like Kampong Cham," said Thorn Vandong, a monk and BSDA’s executive director.

Thorn said while authorities may embrace the importance of addressing HIV and AIDS, many villagers in poor rural areas have a poor understanding of it.

"They don’t think that HIV and AIDS is the biggest problem. They can have sex without condoms; they don’t care," Thorn said. "In Khmer, we say ‘they’re not afraid of AIDS; what they are afraid of is not having sex’."

Still, for a country still mired in poverty following decades of conflict, statistics suggest that HIV is one of the key areas in which Cambodia has taken significant strides. Cambodia committed to cutting the HIV prevalence rate among adults to 1.8 percent by 2015. Current estimates peg this at around 0.7 percent, ahead of target.

Cambodia has also seen a rapid scale-up in the proportion of people receiving ARV treatment. In 2002, only 3 percent of those who needed ARVs had access to them and only two health facilities even offered the treatment. The government says more than 40,000 people now have access to ARVs – representing roughly 86 percent coverage.

By end-2009, ARV treatment had reached clinics or hospitals in 20 out of 24 provinces, but this translated into only half of the country’s 78 health districts.

Kampong Cham itself is one of Cambodia’s most populous provinces and its capital is a relatively close 125- kilometre drive from the capital Phnom Penh. But there are still areas where HIV programmes have yet to reach.

"We just started our programme last year," said BSDA’s Thorn. "So you can imagine what happened here after 20 years with no HIV programmes in the community."

A couple of years ago, Mon Hol’s older brother, Hon, then living on the other side of the country, also tested positive for HIV. He moved back to Kampong Cham because his brother told him he could get help here.

Today, he is healthy and manages to take his medication regularly. "I’ve learned a lot from the counsellors. Not just about the virus, but they’ve also given me the motivation to continue," Mon Hon said. "There’s hope for the future. And there’s hope for the future of my children as well."