Sex Work and HIV in Cambodia: Trajectories of Risk and Disease in Two Cohorts of High-Risk Young Women in Phnom Penh, Cambodia

October 2013 - Structural Prevention

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Page, K., Stein, E., Sansothy, N., et al. BMJ Open (September 2013), Vol. 3 No. 9, pp. e003095.

In 2008, the Cambodian government implemented laws to combat human trafficking and sexual exploitation, including banning brothel-based sex work and labeling female sex workers (FSWs) "entertainment workers” (EWs). The authors conducted two prospective studies on high-risk FSWs, aged 15-29, in Phnom Penh (cohort 1: 2007-2008, n=160 and cohort 2: 2009-2010, n=153) to explore changes in the HIV risk environment. Women in cohort 2 had higher education, fewer sexual partners, less time working as FSWs, and significantly lower HIV prevalence compared to those in cohort 1 (9.2 versus 23 percent). More women from cohort 2 had worked in entertainment establishments during the previous 30 days. Women in cohort 2 reported more alcohol use but fewer days drunk during the previous 30 days, and fewer reported ever using amphetamine-type stimulants (ATS). Cohort 2 EWs reported less alcohol and ATS use, but brothel-based or street FSWs reported significantly more ATS use. The protective effects of entertainment-based venues may include having a manager; the odds of having HIV were lower among women who reported having a manager than among those who did not. The authors noted that HIV incidence may increase among FSWs at the population level because of the increase of women engaging in sex work; hence a possible increase in occupational HIV risk among FSWs. While more research is needed, the need for combination HIV prevention services for Cambodian FSWs is evident.

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