Abstract
BackgroundAt-risk male youth in Cambodia who purchase sex are at greater risk for HIV compared to the general population. Factors associated with paying for sex among youth are poorly studied, both globally and in Cambodia. This study aimed to identify specific factors associated with transactional sex with women among most-at-risk male youth in Cambodia.MethodsThis cross-sectional questionnaire survey was conducted with 405 sexually active male youth aged 16–24 recruited at ‘hotspots’ in the capital city of Phnom Penh and seven provinces. We collected data on demographic factors, sexual behaviors, HIV testing and other potential factors. Multivariable logistic regression analysis was used to identify factors associated with transactional sex.ResultsIn total, this study included 405 male youth with a mean age of 21.3 (SD = 2.2). Of the total respondents, 82.5% (n = 334) have ever paid for sex. After controlling for potential confounding, participants who purchased sex in the last 12 months remained significantly more likely to be older than 18 (AOR = 3.60, 95% CI = 1.26–10.62), reside in an urban area (AOR = 2.29, 95% CI = 1.24–4.20), never have been married (AOR = 9.58, 95% CI = 4.34–21.12), spend less than 2.55 USD per day (AOR = 2.22, 95% CI = 1.12–4.40), and have had more than 4.6 sexual partners in the past year (AOR = 16.73, 95% CI = 4.71–59.36).ConclusionsThis study highlights the high proportion of Cambodian male youth who paid for sex and the potential challenges to addressing this issue. While the majority of HIV prevention interventions surrounding sex work are aimed at female sex workers themselves, targeting the demand side of sex work, particularly the local demand, may be an important next step towards a sustainable HIV prevention.
Highlights
At-risk male youth in Cambodia who purchase sex are at greater risk for Human immunodeficiency virus (HIV) compared to the general population
Compared to respondents who reported not having paid for sex, respondents who reported having paid for sex were significantly more likely to be older than 18 (97.0% vs. 90.1%, p = 0.009) and to live in an urban area (75.5% vs. 56.3%, p < 0.001), and were significantly less likely to be married (69.0% vs. 93.7%, p < 0.001)
Over 70% of both respondents who reported having paid for sex and respondents who reported not paying for sex completed at least 6 years of school (79.6% vs. 73.2%, p = 0.23)
Summary
At-risk male youth in Cambodia who purchase sex are at greater risk for HIV compared to the general population. Factors associated with paying for sex among youth are poorly studied, both globally and in Cambodia. In one analysis based on 21 studies from across the globe, Cambodia appears to be the country with the highest proportion of men from the local population who pay for sex [1]. From the limited studies that are available on demandside factors, there are several ethnographic studies and small survey-based research in Western countries which suggest that older age, lower educational attainment [5], being single, being on disability pension, having had an early sexual debut, reporting a high number of sexual partners [6] and reporting risky sexual practices such unprotected sex [7] were associated with paying for sex among men. Other studies from Western countries argue that men who purchase sex are a heterogeneous group of all ages, socioeconomic status levels, occupation and ethnic/racial groups [8, 9]
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