Pharmacology, physiology and performance: occupational drug use and HIV risk among female entertainment and sex workers in Cambodia.

Thomas Crewe Dixon,Adam Carrico,Ellen Stein,Lisa Maher,Kimberly Page,Song Ngak

doi:10.1186/s12954-015-0068-8

Abstract

BackgroundIn Cambodia, HIV prevalence among female entertainment and sex workers (FESW) is up to twenty times higher than in the general population. Use of amphetamine-type stimulants (ATS) has been associated with increased risk of HIV and other sexually transmitted infections in key populations, including FESW. While one in four Cambodian FESW report recent ATS use, little attention has been paid to how the occupational contexts of sex work shape patterns of use. Currently, no HIV prevention interventions target ATS use in this population.MethodsWe conducted in-depth interviews with FESW (n = 30) with the goal of exploring experiences and motivations for ATS use and informing the development of a conditional cash transfer (CCT) intervention designed to reduce ATS use and HIV risk. Interviews were conducted and transcribed in Khmer and translated into English. Interview narratives were read and re-read and emerging themes reviewed and refined to develop an initial coding scheme. Data were formally coded using both open and axial coding to clarify and consolidate initial themes.ResultsThe most common driver of ATS use among FESW was increased functionality. ATS was seen as a performance enhancer, acting as an appetite suppressant and enabling women to meet the physiological demands of sex work, including long working hours, multiple clients and extended sexual transactions. While our results are consistent with studies linking ATS use to heightened sexual risk, via unprotected and/or prolonged sex, for women in the current study, the negative consequences of ATS use were outweighed by perceived functional benefits.ConclusionsFESW in Cambodia harness the pharmacological properties of ATS to meet the physiological demands of sex work in a context of limited economic opportunities. There is an urgent need to both provide Cambodian women with options for income generation that do not risk their health and to better regulate the conditions of sex work to provide safer working environments. Structural and economic interventions, including CCT programmes, combined with awareness and enforcement of sex workers’ rights, are also necessary to facilitate harm reduction and occupational health and work safety within the Cambodian sex and entertainment industry.

Highlights

In Cambodia, HIV prevalence among female entertainment and sex workers (FESW) is up to twenty times higher than in the general population
While approximately 0.8 % of the adult population in Cambodia is estimated to be living with HIV, prevalence is significantly higher among female sex workers, referred to here as female entertainment and sex workers (FESW), with 15–23 % of young women (15–29 years) testing positive in a recent study [14, 19]
Using a stepped wedge randomised cluster trial in ten provinces, Cambodia Integrated HIV/Drug Prevention Intervention (CIPI) will evaluate whether the intervention, consisting of a 16-week programme combining a 12-week conditional cash transfer (CCT) programme based on urine toxicology screening for amphetamine-type stimulants (ATS) and a 1month weekly aftercare component, results in larger decreases in HIV risk compared to SMARTgirl

Summary

Introduction

In Cambodia, HIV prevalence among female entertainment and sex workers (FESW) is up to twenty times higher than in the general population. Use of amphetamine-type stimulants (ATS) has been associated with increased risk of HIV and other sexually transmitted infections in key populations, including FESW. While approximately 0.8 % of the adult population in Cambodia is estimated to be living with HIV, prevalence is significantly higher among female sex workers, referred to here as female entertainment and sex workers (FESW), with 15–23 % of young women (15–29 years) testing positive in a recent study [14, 19]. Factors independently associated with incident STI included duration (per year) of sex work (adjusted hazard ratio (AHR) 1.1; 95 % CI 1.1–1.2) and recent use of yama (AHR 4.3; 95 % CI 1.7–11.0) [14]. Further analyses revealed independent associations between ATS use and higher number of sex partners (adjusted relative ratio 1.49; 95 % CI 1.00–2.21) and incident STI (adjusted odds ratio 5.41; 95 % CI 1.15–25.48) [19]

Methods

Results

Conclusion