Entertainment Workers Research Articles

The impact of violence on sex risk and drug use behaviors among women engaged in sex work in Phnom Penh, Cambodia

BackgroundViolence, substance use, and HIV disproportionately impact female entertainment and sex workers (FESW), but causal pathways remain unclear. MethodsWe examined data from an observational cohort of FESW age 15–29 in Phnom Penh, Cambodia for associations between violence exposure and sexual risk and drug use. Validated measures of physical and sexual violence were assessed at baseline. Self-reported outcomes measured quarterly over the next 12-months included past month sexual partners, consistent condom use by partner type, sex while high, and amphetamine type stimulant (ATS) use. Biomarkers measured quarterly included prostate specific antigen (PSA) and urine toxicology. Generalized estimating equations were fit adjusting for age, education, marital status and sex work venue. ResultsOf 220 women, 48% reported physical or sexual violence in the preceding 12-months. Physical violence was associated with increased number of sex partners (adjusted incidence rate ratio [aIRR] 1.33; 95% CI: 1.04–1.71), greater odds of sex while high (adjusted odds ratio [aOR] 2.42; 95% CI: 1.10–5.33), increased days of ATS use (aIRR 2.74; 95% CI: 1.29–5.84) and increased odds of an ATS+ urine screen (aOR 2.80, 95%CI: 1.38–5.66). Sexual violence predicted decreased odds of consistent condom use with non-paying partners (aOR 0.24; 95% CI: 0.10–0.59) and greater odds of a PSA+ vaginal swab (aOR 1.83; 95% CI: 1.13–2.93). ConclusionsPhysical and sexual violence are prevalent among Cambodian FESW and associated with subsequent sexual risk and drug use behaviors. Clinical research examining interventions targeting structural and interpersonal factors impacting violence is needed to optimize HIV/AIDS prevention among FESW.

Behavioral interventions for Cambodian female entertainment and sex workers who use amphetamine-type stimulants.

Conditional cash transfer (CCT) and cognitive-behavioral treatments are evidence-based approaches to reduce stimulant use and sexual risk taking. We describe the adaptation and implementation of sequential behavioral interventions for Cambodian female entertainment and sex workers (FESW) who use amphetamine-type stimulants (ATS): (1) a 12-week CCT intervention; and (2) a 4-week cognitive-behavioral aftercare (AC) group. An ongoing cluster randomized stepped wedge trial in 10 Cambodian provinces is enrolling FESW with confirmed recent ATS use to examine the effectiveness of CCT+AC. In the first six provinces, 138 of the 183 eligible FESW (75%) enrolled in CCT and completed a median of 25 (interquartile range 9-32) of the 36 urine screening visits. Of the 84 participants who were eligible for AC, 79 completed at least one session (94%) and 57 completed three or more sessions (68%). Culturally tailored behavioral interventions to reduce ATS use and optimize HIV prevention are feasible in resource-limited settings.

Qualitative research and implementation science: Informing the acceptability and implementation of a trial of a conditional cash transfer intervention designed to reduce drug use and HIV risk.

HIV risk remains high among Cambodian female entertainment and sex workers, driven by amphetamine-type substance use and sexual risk. Conditional cash transfer is an evidence-based approach to reduce stimulant use and optimize HIV/AIDS prevention, but questions remain regarding implementation in resource-limited settings. We conducted formative qualitative research to enhance acceptability of a conditional cash transfer intervention aimed at reducing amphetamine-type substance use and HIV risk among female entertainment/sex workers and inform implementation as part of a large cluster randomized trial. We conducted in-depth interviews with 30 female entertainment/sex workers. Interviews were digitally recorded and conducted and transcribed in Khmer. English transcripts were read for emerging themes and an initial coding scheme was developed. Data were coded using open and axial coding to clarify and consolidate initial themes. While most participants expressed enthusiasm for the intervention, financial and transportation issues emerged as key barriers to participation. The proposed incentive of USD$1 per screen was regarded as unacceptable and participants identified a need for transportation assistance. Participants also expressed concerns about directly observed urine specimen collection. Finally, while most participants found the 4-week aftercare program acceptable, the need for enjoyable as well as educational content was emphasized. Revisions to the protocol taking these data into account were made to optimize the acceptability of the intervention and the implementation of the trial. Findings identified key concerns and preferences that were taken into account in the final trial protocol. In particular, financial and transportation issues were identified as critical barriers to participation, with the potential to impact both intervention uptake and trial feasibility. Results demonstrate the value of formative qualitative research for clinical trial planning and implementation, particularly in settings where little is known about acceptability of interventions or willingness to participate.

HIV risk and psychological distress among female entertainment workers in Cambodia: a cross-sectional study.

BackgroundIn Cambodia, there has been an increase in entertainment work as a result of the breakdown of the traditional brothel-based sex industry, presenting new challenges to addressing the health issues and needs of people working in the entertainment industry. This study aims to identify factors associated with psychological distress among female entertainment workers (FEWs) in Cambodia.MethodsA two-stage cluster sampling method was used to randomly select 657 FEWs from entertainment establishments in Phnom Penh and Siem Reap in April and May 2014 for interviews using a structured questionnaire. Psychological distress was measured using the General Health Questionnaire (GHQ-12), and multivariate logistic regression analysis was conducted.ResultsAlmost half of FEWs (43.2 %) had a higher level of psychological distress (GHQ-12 > 3), while 19.5 % reported having suicidal thoughts, and 7.3 % reported having attempted to commit suicide in the past 3 months. Controlling for confounding factors, women with a higher level of psychological distress were significantly more likely to rate their overall health (AOR = 1.88, 95 % CI 1.20 to 2.94) and quality of life (AOR = 2.39, 95 % CI 1.47 to 3.87) as poor. They were also significantly more likely to have suicidal ideation (AOR = 2.41, 95 % CI 1.45 to 3.76), rate their HIV risk as higher than the general population (AOR = 0.48, 95 % CI 0.31 to 0.74), have been forced to drink at work (AOR = 1.77, 95 % CI 1.19 to 2.62), have had clients requesting not to use a condom (AOR = 3.48, 95 % CI 1.14 to 10.62), be not able to find condoms when they needed it (AOR = 0.64, 95 % CI 0.45 to 0.93), have had a family member who said hurtful things to them during childhood (AOR = 1.84, 95 % CI 1.24 to 2.75), and have had a parent or guardian who had been physically abused (AOR = 1.93, 95 % CI 1.34 to 2.82).ConclusionsFEWs in Cambodia experience high levels of psychological distress, which likely stems from both past negative experiences and current working conditions. For women that are experiencing psychological distress, intervention programs aimed at improving mental health should specifically address substance use, condom availability and negotiation skills, and suicide risk.

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

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.

Micro­microcelebrity: Branding Babies on the Internet

Micro­microcelebrity: Branding Babies on the Internet

Effectiveness of a Peer-Assisted Multicomponent Behavioral Intervention in HIV Risk Reduction Among Female Entertainment Workers in China.

This study examined the effectiveness of a behavioral intervention that combined cognitive and social influence approaches. The intervention consisted of small group sessions targeting HIV knowledge, protection motivation, behavioral skills, and social influences of risk reduction. The control was an attention-controlled HIV/STI health education and counseling. Two-group comparisons were conducted to assess the effectiveness of the intervention; risk reduction over time was analyzed to determine the sustainability of the effectiveness. The analyses revealed that the intervention was effective in reducing/increasing HIV risk/protective behaviors and the effect was sustainable. While participants in the control reported a greater reduction/increase in risk/protective behaviors 3-month post-intervention, the initial strong effect quickly faded and completely disappeared 12-month post-intervention. By contrast, the moderate initial effect of the intervention was not only sustained but actually strengthened over time. The intervention was well received by participants and holds promise for HIV risk reduction behavior change among female entertainment workers in China.

Characteristics, risk behaviors and factors associated with abortion among female entertainment workers in Cambodia.

BackgroundLinkages between HIV and reproductive health (RH) among female entertainment workers (EWs) have not been addressed well in most developing countries. In Cambodia, there has been considerable research on HIV epidemiology among EWs. However, there have been limited studies on RH and specifically factors related to abortion. We examine socio-behavioral characteristics, and RH practices as determinants of abortion among Cambodian EWs.MethodsA survey was conducted in Siem Reap and Battambang and Phnom Penh provinces/city among EWs in September 2012. Trained female interviewers administered the survey to 595 EWs. Two-stage cluster sampling was used to select EWs. Bivariate associations were examined using chi-squares; univariate and multivariate logistic regression were used to assess factors independently associated with reporting having at least one abortion while working as an EW.ResultsThree-quarters (75 %) of EWs were sexually active, of which nearly one third reported at least one abortion while working as an EW. About 40 % of EWs reported recent an abortion in the past six months. Contraceptive use in the past year was low. Factors found to be independently associated with reporting a recent abortion included: ages 25–29 (OR = 2.2, 95 % CI: 1.2–4.0), living with spouse/cohabitated partner (OR = 2.2, 95 % CI: 1.1–4.2), longer duration of entertainment work (OR = 4.8, 95 % CI: 2.5–9.2), higher number of partners (OR = 4.4, 95 % CI: 2.2–8.7) and being a karaoke worker (OR = 2.2, 95 % CI: 1.1–4.4).ConclusionThis study highlights a high proportion of EWs reporting abortion. While HIV vulnerability of EWs has been clearly established, broader RH needs have gone largely unrecognized and not prioritized. Though HIV/RH integrated initiatives have been introduced by the HIV program, challenges for EWs with multiple risks from professional and partners are profound. Therefore, there is an urgent need for practical programmatic approaches to help address their RH needs.

Factors associated with induced abortion among female entertainment workers: a cross-sectional study in Cambodia.

ObjectiveTo explore risk factors associated with induced abortion among sexually active female entertainment workers (FEWs) in Cambodia.DesignCross-sectional study.SettingPhnom Penh and Siem Reap, Cambodia.ParticipantsThis study included 556 FEWs aged 18–47 years randomly selected from entertainment establishments in the two cities in 2014 using a two-stage cluster sampling method. Data were collected through face-to-face interviews using a structured questionnaire.Primary outcome measureHistory of induced abortion during the time working as a FEW.ResultsOf the total sample, 45.6% reported currently using a contraceptive method with condom (42.4%) being the most common method, followed by pills (25.6%). One-fourth (25%) of the respondents reported having been pregnant at least once, and 21.4% reported having at least one induced abortion during the time working as a FEW. After controlling for other covariates in a multivariate logistic regression model, FEWs with a history of induced abortion remained significantly more likely to be currently working in a karaoke bar (AOR=1.75, 95% CI 1.10 to 2.78), to have worked longer as a FEW (AOR=1.42, 95% CI 1.06 to 1.43), to have had a greater number of sexual partners in the past 12 months (AOR=1.86, 95% CI 1.02 to 1.54), to be currently using a contraceptive method (AOR=1.52, 95% CI 1.01 to 2.29), to be able to find condoms when they needed them (AOR=2.03, 95% CI 1.09 to 3.82), and to report inconsistent condom use with non-commercial partners in the past 3 months (AOR=1.62, 95% CI 1.06 to 3.44).ConclusionsThis study highlights the high rates of unwanted pregnancies that ended in induced abortions among FEWs in Cambodia. Access of FEWs to quality sexual and reproductive healthcare services is deemed a high priority. Integrated interventions to improve sexual and reproductive health among these vulnerable women should be tailored to reach the most-at-risk groups.

Dançarinos de quadrilha junina: um divertimento que é trabalho?

Nos festejos juninos de Campina Grande, PB, conhecidos como “O maior São João do mundo”, as quadrilhas juninas são consideradas um grande ícone da festa. A partir de uma pesquisa realizada com dançarinos de quadrilha dessa cidade, nos ocuparemos, neste artigo, das representações sociais que são construídas sobre essa atividade. Foram realizadas, além da observação participante, vinte entrevistas semiestruturadas com dançarinos de ambos os sexos, das quadrilhas Arraial da Felicidade e Mistura Gostosa. A análise dos dados, operada pelo método hermenêutico-dialético, evidenciou que os dançarinos de quadrilhas juninas constroem diferentes representações sobre essa atividade: divertimento, lazer, prazer, responsabilidade e trabalho. Por fim, observou-se que os entrevistados constroem um discurso que enfatiza os efeitos positivos dessa atividade, o reconhecimento social, o entrosamento coletivo e a realização pessoal.

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

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.

Fostering absolute reductions in resource use: the potential role and feasibility of practice-oriented design

This article explores the potential role of design in fostering absolute reductions in everyday consumption. It links ambitions to achieve absolute reductions to concepts from social theories of practice and design. Practice theory directs attention towards expectation levels, opening up questions about sufficiency. Design activity is often pointed out as a potential key instrument for creating change in sustainable directions, and the social practice as a relevant starting point for such work. Little attention is however paid to what may help and hinder practice-oriented initiatives. Consequently, this article asks what the role of design may be in fostering actual reductions in resource use when social practices continuously are in flux, and, what the space for action is, given societal arrangements rooted in ideas about boundless consumption.This is done on a theoretical and empirical basis, by drawing on practice theory and system innovation theory, and a case study on television entertainment practices and work by related actors. This is relevant given the increasing contribution of electronics to the environmental impact of households. The analysis shows how standardisation and predominantly technical experience and value definitions have consequences for resulting resource use levels and the feasibility of creating change. The lack of policy attention to the relationship between resource use and practical value may prevent actors from making use of the theoretical space for practice-oriented action. The article concludes by presenting recommendations for policy and practice on how to foster further exploration of it.

Sexuality, Gender, and US Imperialism after Philippine Independence: An Examination of Gender and Sexual Stereotypes of Pilpina Entertainment Workers and US Servicemen

Submitted to the Undergraduate Library Research Award scholarship competition: 2015-2016. 28 pages

Spectacle of excess: The passion work of professional wrestlers, fans and anti-fans

This article examines how professional wrestlers, promoters and audiences perform the passion work of sports entertainment. Rather than celebrate professional wrestling as a popular phenomenon, this articles seeks to use empirical research on live wrestling events to understand the meaning of passion work in sports entertainment. In Roland Barthes’ seminal article on professional wrestling in Mythologies, he describes wrestling as a spectacle of excess, where passions such as love and hate are exaggerated through the expressions of wrestlers and audience members. A key research question concerns how the passion work in professional wrestling involves different types of labour, the physical and emotional work of wrestlers and event organisers, and the work of audiences, fans and anti-fans interacting with professional performers. The article uses ethnographic research of professional wrestling to explore how different types of passionate labour re-enforce and legitimate each other, shaping an emotional structure to a spectacle of excess. The overall argument in this article is that the meaning of passion work in sports entertainment highlights what Stephen Coleman calls a public performance of power relations, where the particularities of power are made visible through the collective labour of wrestlers and audience members. Power is neither industry led nor in the hands of audience members; rather, it is made visible through the work of promoters, wrestlers and audiences as a collective performance in a high-energy, adrenalin-fuelled live event.

Human papillomavirus knowledge, vaccine acceptance, and vaccine series completion among female entertainment and sex workers in Phnom Penh, Cambodia: the Young Women's Health Study.

Human papillomavirus is a common sexually transmitted infection and the causative agent for cervical cancer, a frequently occurring malignant disease among women in developing countries. We assessed human papillomavirus awareness prior to the delivery of a brief information and education intervention, and human papillomavirus vaccine provision to female entertainment and sex workers (N = 220). At baseline, only 23.6% of women had heard of human papillomavirus. Following the educational intervention, 90% answered all the human papillomavirus knowledge questions correctly. Of 192 participants attending the first quarterly cohort visit where vaccine was offered, 149 (78%) were eligible for vaccination; HIV-positive (n = 32) and pregnant (n = 11) women were excluded. Acceptance of vaccine among eligible women was universal, and 79.2% completed the three-dose vaccination series. Women who reported use of amphetamine-type stimulants had significantly and independently lower odds of vaccine completion (adjusted odds ratio [AOR] 0.24; 95% confidence interval [CI] 0.08, 0.69). New pregnancies also had an impact on vaccine completion: 5.4% (8/149 5.4%) who started the series had to stop due to new pregnancy. Results demonstrate the effectiveness of a simple education intervention designed to increase human papillomavirus knowledge and the feasibility of successful human papillomavirus vaccine in a population that is often difficult to engage in preventive health care.

The Impact of Healthcare Access on Knowledge and Willingness for HIV Testing in Chinese Female Entertainment Workers.

Chinese female entertainment workers are at high risk for HIV. We assessed the impact of healthcare access on HIV knowledge, condom use, and their willingness to receive HIV testing. We surveyed 257 entertainment workers in a cross-sectional study. Demographic, knowledge, and behavioral risk factors were examined. Of 257 women, 107 (42.1%) reported inconsistent condom use. Only 9% had prior HIV testing. Their HIV knowledge was generally poor. Having access to healthcare, being able to obtain condoms, and managers providing health information were associated with consistent condom use (all P < 0.01). Having access to healthcare was related to previous HIV testing (P < 0.01). Our study showed that having a doctor and access to healthcare had positive effects on HIV knowledge and likelihood of condom use and previous HIV testing. Chinese medical providers can play a significant role in encouraging HIV testing and outreach in migrant women employed at entertainment venues.

‘Sorry mate, you're finishing tonight’: a historical perspective on employment flexibility in the UK film industry

This article considers the nature of employment in the UK Film Industry in the period 1927–1947 against a background of US domination of the global market for film. Drawing on archived interview material from 60 participants in the archive of the History Project of BECTU (the British trade union for Media and Entertainment workers) the article focusses on entry routes, working hours, training and pay grades to assess the degree of stability present in the labour market across a number of selected below-the-line film production occupations. This provides an historical context to debates surrounding the organisation of work in the sector, which is characterised by both continuity and change. The article argues that the UK film industry has never been a stable, ‘job-for-life’ sector, nor have its labour processes ever followed mass production lines. It supports assertions that assumptions of linear development from secure to casualised employment are inadequate for understanding work in this sector.

Financial Literacy Education as Public Pedagogy for the Capitalist Debt Economy

Financial literacy education often appears as part of a solution to the individualization of economic risk, growing indebtedness, financialization and ongoing austerity. Using concepts from Marx, Žižek and Foucault, this paper analyses a number of prominent debt and investment television shows, arguing that these forms of entertainment work with financial literacy curriculum documents, editorials and speeches to form a public pedagogic dispositif that supports the creation of subjects ethically disposed to recreate the debt economy’s hierarchical relations and practices. In contrast to those who see financial literacy education as a tool for reducing debt and ameliorating financial and economic insecurity, I argue that financial literacy education is better seen as a technology that supports the production of an economic system that produces debt and financial and economic insecurity. To challenge the capitalist debt economy, the paper ends by calling for a critical public pedagogy to create the conditions in which all can be secure and realize their human capacities free from the constraints imposed by capital–conditions we owe others and ourselves a debt to continually recreate.

O11.5 Risks For Sexually Transmitted Infections (STIs), HIV, and Pregnancy Among Women Working in Entertainment Establishments in Cambodia

BackgroundSince the 1990s, Cambodia successfully reduced HIV and STI prevalence among female sex workers. In 2008, brothels were outlawed, and non-brothel Entertainment Establishments (EEs) increased. Some women working in EEs...

P5.088 Chlamydia Trachomatis and Neisseria Gonorrhoea Diagnosis by Nucleic Acid Amplification Tests Among Female Entertainment Workers (FEWs) in Cambodia

BackgroundAccurate diagnosis of chlamydia and gonorrhoea infections followed by appropriate treatment are critical steps in preventing transmission and morbidity. Sex workers are a target population for lab-based screening. This study...