The impact of a community-based HIV and sexual reproductive health program on sexual and healthcare-seeking behaviors of female entertainment workers in Cambodia.

Siyan Yi,Pheak Chhoun,Sopheap Oum,Khimuy Tith,Sovannary Tuot,Carinne Brody

doi:10.1186/s12879-015-0954-4

Abstract

BackgroundIn Cambodia, despite great successes in the fight against HIV, challenges remain to eliminating new HIV infections and addressing sexual reproductive health (SRH) issues in key populations including female entertainment workers (FEWs). To address these issues, the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project has been implemented since late 2009 using a community-based approach to integrate HIV and SRH services. This study evaluates the impact of the SAHACOM on sexual and healthcare-seeking behaviors among FEWs in Cambodia.MethodsA midterm and endpoint comparison design was utilized. Midterm data were collected in early 2012, and endpoint data were collected in early 2014. A two-stage cluster sampling method was used to randomly select 450 women at midterm and 556 women at endpoint for face-to-face interviews.ResultsCompared to women at midterm, women at endpoint were significantly less likely to report having sexual intercourse in exchange for money or gifts in the past three months (OR = 2.1, 95 % CI = 1.6-2.7). The average number of commercial sexual partners in the past three months also decreased significantly from 5.5 (SD = 13.3) at midterm to 3.6 (SD = 13.9) at endpoint (p = 0.03). However, women at endpoint were significantly less likely to report always using condom when having sexual intercourse with clients in exchange for money or gifts (OR = 2.6, 95 % CI = 1.5-4.5). Regarding sexually transmitted infections (STIs), women at endpoint were significantly less likely to report having an STI symptom in the past three months (OR = 1.8, 95 % CI = 1.4-2.3) and more likely to seek treatment for the most recent STI symptom (OR = 1.6, 95 % CI = 1.1-1.9). Furthermore, women at endpoint were significantly more likely to be currently using a contraceptive method (OR = 1.4, 95 % CI = 1.1-1.8) and less likely to report having an induced abortion (OR = 1.4, 95 % CI = 1.1-1.7) during the time working as a FEW.ConclusionsThe overall findings of the study indicate that the SAHACOM is effective in reducing sexual risk behaviors and improving the access to SRH care services among FEWs in Cambodia. However, several unfavorable findings merit attention.

Highlights

In Cambodia, despite great successes in the fight against Human immunodeficiency virus (HIV), challenges remain to eliminating new HIV infections and addressing sexual reproductive health (SRH) issues in key populations including female entertainment workers (FEWs)
In 2013, the National Center for HIV/Acquired immunodeficiency syndrome (AIDS), Dermatology, and STD (NCHADS) estimated that HIV prevalence among general adult population aged 15 to 49 was 0.6 %, reflecting a significant decline from the peak of 2.0 % in 1998 [2]. This success was widely attributed to the 100 % condom use program that led to a significant increase in condom use as well as a decline in the frequency of commercial sex and an increase in access to HIV voluntary confidential counseling and testing (VCCT) and antiretroviral therapy (ART) [3, 4]
Regarding SRH, 70 % of FEWs reported currently using a contraceptive method, and 77 % reported having at least one abortion during the time working as a FEW [11]

Summary

Introduction

In Cambodia, despite great successes in the fight against HIV, challenges remain to eliminating new HIV infections and addressing sexual reproductive health (SRH) issues in key populations including female entertainment workers (FEWs). Cambodia was presented with a Millennium Development Goals (MDG) Award at the MDG Summit in 2010 [5] This award represents a global recognition of the outstanding national leadership, commitment, and progress towards achievement of Goal 6 – halting and reversing the spread of HIV [5]. Despite these great achievements, eliminating new HIV infections remains a challenge. These women are considered at risk regardless of their involvement in direct or indirect sex work [6]

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