AIDS pandemic gives way to a world epidemic of orphans
By Karen J. Coates
Milwaukee Journal Sentinel, Dec. 3, 2005

It's a small golden urn, stashed in the way back of a dusty cabinet beneath 10 little Buddhas.

There, in a Phnom Penh pagoda, rest the bones of David's mother, dead at 24. And just up the dirt road, in 3-year-old David's home, is a story that depicts the future of AIDS in Cambodia.

It's pandemic: 40 million people living with HIV worldwide; five people dying every minute. Cambodia has Asia's highest prevalence of HIV, at 2.6% of the adult population.

Every year on Dec. 1, millions gather to mark this tragedy, in a tradition known as World AIDS Day. Activists march through city streets; documentaries portray the lives of the dying. Little red ribbons honor the people who live with HIV/AIDS.

But another scourge grows among the millions left behind.

So far, worldwide, AIDS has left more than 15 million orphans. Most of those kids live in sub-Saharan Africa. There are no precise numbers in Cambodia, a country for decades devastated by war, but some sources estimate at least 300,000 or more kids have lost parents to AIDS-related diseases.

David was 2 years old when my husband, Jerry, first met him in the one-room apartment where his mother, Phala, spent her last months. Jerry was assigned to photograph the young mother in conjunction with World AIDS Day 2004.

I never met Phala, but I saw the photos of a stick figure, nothing but skin and bones and heart. Phala had been chosen for antiretroviral treatments and was undergoing preparations for the drugs.

But she didn't last. Phala died on Feb. 26.

Now, a year later, when Jerry and I visit Phala's neighborhood, we find David and his grandmother living with relatives in a different house. This rough home, in Stung Meanchey Commune, is their fourth in a year.

Grandmother Phaly is 64 and gray, with the robust cough of a Cambodian who has lived long in troubled times. She misses Phala.

"It is very difficult now," she says. But she vows to care for David until she, too, passes on.

No one knows whether David is HIV positive, but he appears healthy. Just a few sniffles, just the normal bites and scratches of a kid living in tropical squalor. His dad, Narith, lives nearby, though he leaves his fatherhood responsibilities to Phaly.

Narith has his own worries. He knows his estranged wife died of AIDS. And lately, he's acquired a serious cough.

He's thin; his skin is blotched. He doesn't want to be tested; he's too scared. He asserts, a little too adamantly, "I never touch the women."

In this country, with a dedicated tradition of prostitution, it's a difficult statement to believe. It is this brothel culture that easily spreads AIDS from husband to wife and often child.

Jerry and I meet Narith at 11 a.m. on the ground floor of a home on stilts, just around the corner from David and Phaly. On this day, like many, the young man skips work at a garment factory and gets drunk instead.

A rainstorm pummeled Phnom Penh the night before, and the home's rocky floor has turned to mud. The only clean, shiny item in this house is a TV. Narith grabs a karaoke microphone and sings a sappy Khmer tune, with whiffs of whiskey riding his breath.

By late afternoon, Narith sleeps soundly. Jerry and I walk with Phaly and David to the nearby temple, to see Phala's remains.

It takes some searching, through dozens of dusty glass cases surrounding vase-like urns. Phaly finally finds the container and offers it to David.

He clutches it between his tiny hands. He knows what it is.

When relatives ask David where his mother went, he says, "She died at Kossamak Hospital."

On the opposite wall hangs a U.N. AIDS poster, "a global view of HIV infection," with color-coded countries indicating the severity of AIDS.

Cambodia is orange, darker than its northern neighbors, meaning 1% to 5% of the population is HIV-infected. Darkest of all is sub-Saharan Africa, painted in a deep blood-red.

I stare at the poster while David plays hide-and-seek with the back door.

The story of AIDS doesn't end with Phala's death. Her son lives; so does her mother, an old woman with no money but a heart to do the right thing. And so does her husband, the probable origin of her disease, a child himself in mind and behavior.

All through the neighborhood - and all through Cambodia - this story repeats itself.

When the Venerable Luy Bora, a monk at the Stung Meanchey Pagoda, started working with AIDS orphans in 2002, there were 47 in his community. Three years later, there are 127, just like David.

Year after year, World AIDS Day passes like any other in Stung Meanchey, in the close and stuffy quarters of a Phnom Penh commune.

The neighbors sing karaoke. The dust and garbage blow through mucky streets. Mosquitoes bite, dogs bark, chickens roam. The heat parches a medley of concrete, wood and metal shacks. It all goes on, day after day - until death.

But even then, it still goes on. In Cambodia, as in many countries, death merely signals the start of another epidemic.

Dec. 1, 2005, marked the 18th annual World AIDS Day. That week, Jerry and I visited a three-year-old boy named David, the son of a young woman who died of AIDS earlier in the year. Jerry had photographed the mother, Phala, in conjunction with the 17th annual World AIDS Day. This year, Phala’s mother struggles to raise David on the little money she has. It’s an all-too-typical scenario in Cambodia, where AIDS has left hundreds of thousands of orphans.

A note on statistics used in the story: The Cambodian government recently reported that the country’s HIV infection rate has dropped from 2.6 percent to 1.9 percent. The new number is based on a government study. Meanwhile, UNAIDS still uses 2.6 percent, as I have in my story. UNAIDS's next Cambodia assessment is due this year.