When Siyan Yi was a medical student in Cambodia 12 years ago, he volunteered with a collaborative government-NGO project to provide young women at high risk for HIV/AIDS—the victims of sexual exploitation—with housing, vocational training, medical care, and psychological support. Cambodia at that time had one of Asia’s highest HIV-infection rates.

That rate has dropped by half, thanks to government policy measures, international NGO support, and the efforts of medical professionals like Yi. Cambodia’s government must now find ways to curb HIV infection in new segments of the population, says Yi, who is the Shorenstein Asia-Pacific Research Center’s inaugural Developing Asia Health Policy Fellow. Sustaining funding for the long-term care of HIV-infected individuals also poses a future challenge, he explains, and new health issues associated with development are beginning to crop up.

Cambodia’s first HIV case was detected in 1991 in a blood donor, and the rate of HIV/AIDS increased dramatically throughout the decade. HIV/AIDS hit Thailand slightly earlier, and was spread through the commercial sex trade. The epidemic reached an even greater scale there than it ever did in Cambodia.

Thailand’s government struck back with a 100-percent condom use promotion program, which Cambodia successfully adopted in the late 1990s. Brothels are illegal in Cambodia, but the government worked cooperatively with owners to provide basic HIV/AIDS education to sex workers. These efforts significantly reduced the transmission of HIV.

Since then, a more indirect form of prostitution has sprung up in places such as karaoke halls, massage parlors, restaurants, and even in factories. HIV prevalence remains high among some sentinel groups such as female sex workers, beer promoters, men who have sex with men (MSM), injected-drug users, and migrant workers.

Yi advocates that the government expand the scope of its HIV/AIDS prevention programs to encompass these new at-risk populations. He even suggests that the government consider creating a system of licensed brothels such as previously existed in Hong Kong and Taiwan. “It would provide the government with an easier means of controlling prostitution, and allow it to work with brothel owners to control HIV-infection rates,” states Yi.

HIV increases the risk of contracting or developing symptoms of tuberculosis; a large proportion of Cambodia’s population carries the disease but shows no signs of it. Tuberculosis went largely undetected during the decades of the Khmer Rouge regime, but with the advent of HIV/AIDS it has become more prevalent. Yi has been involved in government-NGO projects to provide tuberculosis screening for HIV patients, including a tuberculosis control project with the Japan International Cooperation Agency.

Tuberculosis screening and HIV treatment advances may greatly prolong the life—and even improve the health—of patients. But heartening as Cambodia’s success against HIV/AIDS has proven in the past decade, the government largely bears the responsibility for funding the expensive treatment and care for the low-income individuals most affected by it. A critical portion of government funding for its HIV/AIDS prevention programs comes from external organizations. 

“I think that the main issue for the government of Cambodia in the battle against HIV and AIDS is financial sustainability,” says Yi, who worries that donor agencies will withdraw support as the HIV-infection rate continues to improve. Prevention is less expensive, he explains, but long-term care is costly to a developing country such as Cambodia.

Yi, however, feels less concerned now about the HIV/AIDS epidemic and speaks hopefully of working to help the government find ways to measure and treat non-communicable diseases associated with economic development, such as diabetes and hypertension. While he is at Stanford, he will collaborate with Asia Health Policy Program researchers to move his work toward solving Cambodia’s new health challenges.

Blaming leaders in America and abroad for not doing enough to combat climate change, former United Nations Secretary-General Kofi Annan said continued failure to tackle the problem will result in worldwide hunger, social unrest and political turmoil.

“Without action at the global level to address climate change, we will see farmers across Africa – and in many other parts of the world including here in America – forced to leave their land,” the 2001 Nobel Peace Prize winner told a crowd of about 1,400 people at Stanford’s Memorial Auditorium on Thursday. “The result will be mass migration, growing food shortages, loss of social cohesion and even political instability.”

Citing numbers from the World Bank, Annan said rapidly rising food prices since 2010 have “pushed an additional 70 million people into extreme poverty.” He called a lack of food security for nearly 1 billion of the world’s population “an unconscionable moral failing” that is also a stumbling block to a strong international economy.

“It affects everything from the health of an unborn child to economic growth,” he said.

Annan’s talk, “Food Security Is a Global Challenge,” was delivered as part of a daylong conference on global underdevelopment sponsored by Stanford’s Freeman Spogli Institute for International Studies. The event drew the world’s leading experts in the field and featured panel discussions that explored the connections between global security and food supplies, health care and governance. Keynote speeches were delivered by Annan and Jeff Raikes, CEO of the Bill & Melinda Gates Foundation. Former Secretary of Defense Robert Gates also planned to deliver a talk to a private audience.

The conference marked the launch of FSI’s Center on Food Security and the Environment.

“With this facility, and the creative thinkers and inquisitive minds for which Stanford is famous, you are well-equipped to undertake research which advances our knowledge and helps to shape our response to the many global challenges we face,” Annan said. “And with the resources at your disposal, you also have the capacity to actively engage to influence policy, implement solutions and thus improve the lives of the most vulnerable people on the planet.”

Annan also lauded government initiatives such as America’s Feed the Future program that focus on alleviating global hunger. He recently met with Secretary of State Hillary Clinton, Secretary of Agriculture Tom Vilsack and Raj Shah, head of the U.S. Agency for International Development, to discuss ways to address food insecurity.

“If we pool our efforts and resources, we can finally break the back of this problem,” he said.

But he challenged wealthier nations to do more than pay lip service to the problem.

“We need to make sure that promises of extra support from richer countries are kept and involve fresh funds rather than the repackaging of existing financial commitments,” he said.

Annan, who is the chair of the Kofi Annan Foundation, the Africa Progress Panel, and the Alliance for a Green Revolution in Africa, said Africa represents both the greatest problem and the greatest promise when it comes to food security.

The continent is home to 60 percent of the world’s uncultivated arable land, but cannot produce enough food to feed its own people, he said. But if Africa can grow just half the world’s average yield of staple crops like wheat, corn and rice, it would end up with a food surplus.

Transforming Africa into one of the world’s biggest crop producers will take more than supporting farmers, he said. It entails sound environmental stewardship.

 “I hope this is an area where the Center on Food Security and the Environment can make a major contribution to finding solutions,” Annan said.

Without those solutions, the future is bleak.

In Sub-Saharan Africa, where global warming brings the threat of persistent drought, current crop production is expected to be cut in half by the end of the century and 8 percent of the region’s fertile land is expected to dry up.

“Those arguing, here and elsewhere, for urgent action and a focus on opportunities to green our economies still find themselves drowned out by those with short-term and vested interests,” Annan said. “This lack of long-term collective vision and leadership is inexcusable. It has global repercussions, and it will be those least responsible for climate change – the poorest and most vulnerable – that will pay the highest price.”

Annan's speech was sponsored by FSI, Stanford in Government and the Stanford University Speakers Bureau.

In a Q&A for Stanford Lawyer magazine, CISAC Co-Director Mariano-Florentino Cuéllar discusses with U.S. Rep. Xavier Becerra (D-CA) immigration, national security, and how the Congressional panel on deficit reduction will address the country's long-term fiscal challenges.

The Center on Democracy, Development, and the Rule of Law (CDDRL) is currently accepting applications from pre-doctoral students at the write-up stage and from new postdoctoral scholars working in any of the four program areas of democracy, development, evaluating the efficacy of democracy promotion, and rule of law. Applicants working at the intersection of two or more of these issue areas will receive preferential consideration. The Center expects to award three to four fellowships for the 2012-13 academic year.

For additional information about the program and application procedures, please visit our fellowship page at: http://cddrl.stanford.edu/fellowships/cddrl_fellowships

Applications are due by January 31, 2012.