Not far from the ancient ruins of Angkor Wat in north-central Cambodia, 7,000 people gathered in the town of Siem Reap to watch one of the oldest traditional art forms of this culture—a puppet show. It was not an ordinary performance, however; the audience was riveted by Fish Story, a modern drama about lives being uprooted by the scourge of AIDS, a story written by a young Cambodian student and produced by Population Services International (PSI).

Puppets are just one of the many creative ways in which PSI spreads the word about AIDS prevention in Cambodia, a country that has one of the fastest growing HIV rates in the world. Five years ago, AIDS did not officially exist in Cambodia. Today, there are an estimated 120,000 people who are infected with the deadly HIV virus.

In 1994, PSI launched the Cambodia Condom Social Marketing Project in the face of a myriad of challenges—including an extremely poor population, low awareness of AIDS and condoms, poor infrastructure and a difficult security situation. As with other PSI projects, the Cambodia effort both creates the demand for healthy lifestyles and behavior change and supplies the product. In 1993, before PSI started its project, the total condom market in Cambodia was 2-3 million per year. Project sales are projected to be 14 million in 2000. In the words of an independent evaluator: "PSI's intervention is widely regarded as the most effective HIV prevention effort to date in Cambodia."

That intervention includes the targeting of sales directly to brothels so that it can reach a high-risk population. Other communications programs include a popular radio soap-opera called Sopheap and Her Family, collaboration with CARE on an AIDS prevention video, Suzi's Story, AIDS education programs for young schoolchildren and a teacher's guide titled "When My Students Ask about AIDS." PSI/Cambodia also works with Buddhist religious leaders on AIDS awareness programs and plays an active role in both the annual World AIDS Day events and the Cambodian Water Festival celebration.

The principal funder of PSI's Cambodia project is the United States Agency for International Development (USAID). Additional significant support has come from the governments of the United Kingdom, Australia, Japan and the Netherlands.

Fish Story, produced by the PSI Puppet Players, is a 20-minute cautionary tale in which myths about HIV infection—that it can be contracted by eating fish, for example—are debunked in a dramatic and even humorous way. The script originated through a PSI-sponsored play-writing competition which a young Cambodian student won. It was produced for puppets, rather than for human actors, because puppets can be much more outspoken about sensitive issues such as sexually transmitted diseases. The National AIDS Program helped pre-test Fish Story and approved it for distribution.

Fish Story is performed in schools, factories, adult education centers and public gathering places in Phnom Penh and in rural areas throughout much of the country. Since its premiere in November 1995, more than 30,000 Cambodians have seen the AIDS drama. It features four characters, portrayed by large puppets with moveable mouths and arms. The two puppet operators, Ly Thavy and Heng Srieng, dressed and adapted the puppets to look more like Cambodians. The voices of the actors combined with music and sound effects are pre-recorded. The sound is played back during the performance on a public address system, which allows the dialogue to be heard clearly by large audiences. The puppet operators do not need to memorize lines, but merely pantomime in time to the soundtrack, which allows them to concentrate on synchronizing puppet movement and sound.

To attract a crowd, the puppeteers broadcast popular music interspersed with teaser announcements for the show. After the performance, the Master of Ceremonies summarizes the main lessons of the play, then invites audience members to answer questions about HIV/AIDS. Those who answer correctly are given colorful T-shirts with AIDS messages. Literature about HIV/AIDS is distributed between the play's three acts. In some cases PSI salespersons sell condoms or distribute free samples at the end of the program. The play is performed several times a day at public events such as village markets and fairs.

The PSI Puppet Players are adding more plays to its repertoire, including those dealing with birth spacing and other family health issues. Because of the great popularity of Fish Story, plans are underway to videotape it for television and to expanded it so that it can be performed by live actors. PSI Cambodia plans to begin training other groups in puppetry so that this popular and traditional form of entertainment can play a growing role in improving the health of Cambodian families throughout the country.

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