Sustained Progress and Remaining Inequities: Residual HIV Transmission in Cambodia toward the Controlled Epidemic
While Cambodia has achieved substantial national progress toward HIV epidemic control with high treatment coverage and declining incidence, significant residual transmission persists due to inequities affecting key populations, children, and specific provinces, necessitating targeted, equity-focused strategies to ensure fully equitable control by 2030.
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In the fight against HIV, the goal is not just to treat those who are sick, but to stop the virus from spreading at all. This happens when a country reaches a point where the number of new infections drops so low that the epidemic is effectively under control. To get there, health systems must ensure that anyone living with the virus knows their status, receives medication to suppress the virus, and stays healthy. This medication, known as antiretroviral therapy, works so well that it prevents the virus from being passed to others. However, even when a nation sees great success overall, the benefits are not always shared equally. Some groups of people or specific regions may be left behind, creating pockets where the virus continues to spread. Understanding where these gaps exist is crucial for finishing the job and protecting everyone.
A recent review of Cambodia's HIV response offers a clear picture of how a country can nearly reach this goal of control, while also highlighting the specific hurdles that remain. Researchers from the World Health Organization and Cambodia's National Center for HIV/AIDS, Dermatology and STD analyzed data from 2010 through 2024. They looked at the entire journey of care: how many people were infected, how many were tested, how many received treatment, and how well the treatment worked. The findings show that Cambodia has made extraordinary progress. The number of new infections has fallen by nearly half since 2010, and deaths related to the virus have dropped significantly. Today, an estimated 92 percent of all people living with HIV in the country are on life-saving medication, and almost all of them have achieved a level of viral suppression that stops the virus from spreading.
Despite these national triumphs, the virus has not disappeared. It has retreated into specific corners of the population. The study found that the vast majority of new infections now occur among key populations—groups of people who face higher risks due to their circumstances or social barriers. This includes men who have sex with men, transgender people, and sex workers. In fact, nearly 90 percent of new infections happen within these groups and their partners. While the country has successfully expanded prevention services to reach most of these communities, the virus persists in hidden subgroups. For instance, while testing coverage has grown, the researchers noted that young men and transgender individuals who are harder to reach may still be missing out on testing and prevention tools like pre-exposure prophylaxis, a daily pill that prevents infection.
The data also revealed a stark difference between how adults and children are faring. While the treatment system works remarkably well for adults, children living with HIV are not receiving the same level of care. The study showed that fewer children know their status, and those who do are less likely to start treatment immediately or stay in care compared to adults. Consequently, the rate at which children achieve viral suppression is lower. This gap suggests that the systems designed to find and treat infected infants and children are not keeping pace with the systems that serve adults. Furthermore, the quality of care is not uniform across the country. While the capital city and some provinces perform well, other regions struggle with lower rates of same-day treatment starts and fewer tests to monitor how well the medication is working.
The researchers conclude that Cambodia is standing on the brink of fully controlling the epidemic, but it cannot stop now. The path forward requires shifting focus from broad national averages to the specific inequities that remain. To truly end the threat of HIV, the country must intensify efforts to reach the young and hidden members of key populations, improve the detection and care of children, and strengthen health services in the provinces that are currently lagging. By addressing these specific gaps, Cambodia has the opportunity to turn its near-success into a fully equitable victory, ensuring that no one is left behind as the nation moves toward ending the AIDS epidemic.
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