Correlates of amphetamine-type stimulant use and associations with HIV-related risks among young women engaged in sex work in Phnom Penh, Cambodia

Abstract

Background Amphetamine-type stimulant (ATS) use has increased in Cambodia and emerged as a significant problem among female sex workers (FSWs), potentially contributing to increased risk of HIV. We examined the prevalence of ATS use and its effect on sexual risk behaviors, and sexually transmitted infections (STI) among FSWs in Phnom Penh, Cambodia. Methods A one-year prospective study among young women engaged in sex work in brothels, entertainment establishments and on a freelance basis. Socio-demographics, sexual risks, and recent ATS use were assessed by self-report. Blood and urine samples were collected to detect HIV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Bivariate and multivariate longitudinal analyses were conducted to assess the effects of ATS use on number of sex partners, inconsistent condom use with paying partners and incident STI. Results ATS use was higher among women working freelance (35.6%) and in brothels (34.8%) compared to women working in entertainment establishments (17.7%) or in multiple venues (14.8%). ATS users reported more sex partners and days drunk in the previous month. In multivariate longitudinal analysis, ATS use was associated with having a higher number of sex partners (Adjusted Risk Ratio 1.49; 95% CI: 1.00–2.21) and incident STI (Adjusted Odds Ratio 5.41; 95% CI: 1.15–25.48), but not inconsistent condom use with paying partner. Conclusion ATS users had more sex partners, high level of alcohol use, and were at increased risk of STI. Our findings underscore ATS use as an important emerging risk exposure that should be integrated into HIV prevention interventions targeting this population.

Integration of Methamphetamine Harm Reduction into Opioid Harm Reduction Services in Iran: Preliminary Results of a Pilot Study

“…This might have been due to the fact that females were recruited from DICs that provided services for female drug users who were involved in sex exchange drug or money. This pattern was consistent with international studies, showing instrumental use of methamphetamine among females who are involved in commercial sex work (4,26).…”

“…During 2010 and 2011, Iran was among the countries with highest amount of methamphetamine seizure in the word (1). Methamphetamine users are highly involved with HIV related risky behaviors such as methamphetamine injection (2,3) and unsafe sexual activities (3)(4)(5). International studies also found a link between unprotected sex among female sex workers and methamphetamine use (4,5).…”

Testing for amphetamine-type stimulant (ATS) use to ascertain validity of self-reported ATS use among young female sex workers in Cambodia

“…Despite these limitations, our results suggest a high level of concordance between self-reported ATS use and urine toxicology results in this group of women. Results indicate high prevalence (14%) of ATS use among FSW, who are also at elevated risk of HIV and other sexually transmitted infections [3,9]. There are few, if any, community-based options for ATS users in Cambodia.…”

“…Recent research has also identified drug use and, in particular, amphetamine-type stimulant (ATS) use as a serious emerging problem associated with HIV risk among FSW [3,9,10], which threatens to reverse downward trends in HIV infection rates in the region.…”

“…Although yama pills are swallowed, both forms are usually melted and the vapors inhaled, resulting in rapid neurologic effects [11,12]. Use of ATS has been associated with elevated HIV risk behavior in many countries and in several population subgroups [3,9,[13][14][15][16][17][18][19]. The United Nations Office on Drugs and Crime (UNODC) reports that use of these drugs is widespread in Asia and increasing rapidly in Cambodia [20].…”