Current HIV/AIDS/STI Epidemic: Intervention Programs in Cambodia, 1993–2003

Saphonn, Vonthanak; Sopheab, Heng; Li-hua, Sun; Vun, Mean Chhi; Wantha, Seng Suth; Gorbach, Pamina M.; Detels, Roger

doi:10.1521/aeap.16.3.5.64.35522

Cited by 44 publications

(31 citation statements)

References 10 publications

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“…In comparison, the first HIV outbreak in nearby Thailand was reported among urban IDUs about one year earlier than in Yunnan; however, the virus spread rapidly into FSWs within just 1 year, with very high HIV prevalence noted (e.g., 44% in Chiang Mai FSWs in 1989) (Punpanich, Ungchusak, & Detels, 2004). Similarly, rapid and severe heterosexual HIV transmission was also observed in Cambodia (Saphonn et al, 2004) and neighboring Myanmar (Thwe, 2004).…”

Section: Discussionmentioning

confidence: 77%

Expansion of HIV/AIDS in China: Lessons from Yunnan Province

Xiao¹,

Kristensen

Sun³

et al. 2007

Social Science & Medicine

110

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In this article we systematically and critically review the Chinese and English language literature on human immunodeficiency virus (HIV)-related studies in Yunnan Province, Southwestern China. Yunnan Province had the first Chinese HIV outbreak and is still the worst affected area in the nation. Since 1989, HIV infection has extended from injecting drug users into the general population through sexual transmission. Since the economic reform of the 1980s, changed social norms and increased migration have spawned increases in HIV-related risk behaviors such as drug use and commercial sex work. A smaller size of "bridge" populations and lower sexual contact rates between persons in "bridge" and general populations may explain the slower expansion of the HIV epidemic in Yunnan compared to nearby Southeast Asian nations. In 2004, women in antenatal care had a 0.38% HIV prevalence province wide, although >1% infection rates are seen in those counties with high injection drug rates. Patterns of drug trafficking have spread the unusual recombinant HIV subtypes first seen in Yunnan to far-flung regions of China. Increased efforts of Yunnan's HIV control program are correlated with an improved general HIV awareness, but risk behaviors continue at worrisome rates. Future efforts should focus on changing risk behaviors, including harm reduction and condom promotion, especially among the "bridge" groups. The resurgence of commercial sex work in Yunnan, and the high frequency of workers migrating into provinces far from home and family are all sociocultural factors of considerable importance for future HIV and sexually transmitted disease control in China.

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Section: Discussionmentioning

confidence: 77%

Expansion of HIV/AIDS in China: Lessons from Yunnan Province

Xiao¹,

Kristensen

Sun³

et al. 2007

Social Science & Medicine

110

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“…However examples of continued high rates STIs and/or HIV among FSWs despite increased condom use have been also reported in Thailand and Cambodia [48-50]. This is likely due to factors such as high mobility and turnover of FSWs, factors such as violence and forced sex [50,51] and most importantly, the low level of condom use with non-commercial partners who are not effectively addressed by prevention programs and contribute to further HIV and STI transmission.…”

Section: Discussionmentioning

confidence: 99%

“…Assessment of interventions providing similar package of services in Cambodia have shown decline in prevalence of HIV among FSWs [48,49]. However examples of continued high rates STIs and/or HIV among FSWs despite increased condom use have been also reported in Thailand and Cambodia [48-50].…”

Section: Discussionmentioning

confidence: 99%

Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

et al. 2011

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BackgroundAvahan, the India AIDS Initiative has been a partner supporting targeted interventions of high risk populations under India’s National AIDS Control Organisation (NACO) since 2004 in the state of Maharashtra. This paper presents an assessment of the Avahan program among female sex workers (FSWs) in Maharashtra, its coverage, outcomes achieved and their association with Avahan program.MethodsAn analytical framework based on the Avahan evaluation design was used, addressing assessment questions on program implementation, intermediate outcomes and association of outcomes with Avahan. Data from routine program monitoring, two rounds of cross-sectional Integrated Behavioural and Biological Assessments (IBBAs) conducted in 2006 (Round 1- R1) and 2009 (Round 2 – R2) and quality assessments of program clinics were used. Bi-variate and multivariate analysis were conducted using the complex samples module in SPSS 15® (IBM, Somers NY).ResultsThe Avahan program achieved coverage of over 66% of FSWs within four years of implementation. The IBBA data showed increased contact by peers in R2 compared to R1 (AOR:2.34; p=0.001). Reported condom use with clients increased in R2 and number of FSWs reporting zero unprotected sex acts increased from 76.2% (R1) to 94.6% (R2) [AOR: 5.1, p=0.001].Significant declines were observed in prevalence of syphilis (RPR) (15.8% to 10.8%; AOR:0.54; p=0.001), chlamydia (8% to 6.2%; AOR:.0.65; p=0.010) and gonorrohoea (7.4% to 3.9; AOR:.0.60; p=0.026) between R1 and R2. HIV prevalence increased (25.8% to 27.5%; AOR:1.29; p=0.04). District-wise analysis showed decline in three districts and increase in Mumbai and Thane districts.FSWs exposed to Avahan had higher consistent condom use with occasional (94.3% vs. 90.6%; AOR: 1.55; p=0.04) and regular clients (92.5% vs. 86.0%; AOR: 1.95, p=0.001) compared to FSWs unexposed to Avahan. Decline in high titre syphilis was associated with Avahan exposure.ConclusionThe Avahan program was scaled up and achieved high coverage of FSWs in Maharashtra amidst multiple intervention players. Avahan coverage of FSWs was associated with improved safe sexual practices and declines in STIs. Prevalence of HIV increased requiring more detailed understanding of the data and, if confirmed, new approaches for HIV control.

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“…[1][2][3] In 2010, the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) revised the national estimate of HIV prevalence to 0.8% (in 15-year-olds to 49-year-olds), reflecting a significant decline after the peak estimate of 2·4% in 1998. 4 However, HIV prevalence in Cambodian women, especially young women, is among the highest in Southeast Asia and heterosexual sex remains the main route of transmission.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Sex work and HIV in Cambodia: trajectories of risk and disease in two cohorts of high-risk young women in Phnom Penh, Cambodia

et al. 2013

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ObjectivesHIV prevalence among Cambodian female sex workers (FSW) is among the highest in Southeast Asia. We describe HIV prevalence and associated risk exposures in FSW sampled serially in Phnom Penh, Cambodia (Young Women's Health Study (YWHS)), before and after the implementation of a new law designed to combat human trafficking and sexual exploitation.DesignCross-sectional analysis of baseline data from two prospective cohorts.SettingCommunity-based study in Phnom Penh, Cambodia.ParticipantsWomen aged 15–29 years, reporting ≥2 sexual partners in the last month and/or engaged in transactional sex in the last 3 months, were enrolled in the studies in 2007 (N=161; YWHS-1), and 2009 (N=220; YWHS-2) following information sessions where 285 and 345 women attended.Primary outcomesHIV prevalence, sexual risk behaviour, amphetamine-type stimulant (ATS) and alcohol use, and work-related factors were compared in the two groups, enrolled before and after implementation of the new law.ResultsParticipants in the two cohorts were similar in age (median 25 years), but YWHS-2 women reported fewer sex partners, more alcohol use and less ATS use. A higher proportion of YWHS-2 compared with YWHS-1 women worked in entertainment-based venues (68% vs 31%, respectively). HIV prevalence was significantly lower in the more recently sampled women: 9.2% (95% CI 4.5% to 13.8%) vs 23% (95% CI 16.5% to 29.7%).ConclusionsSex work context and risk have shifted among young FSW in Phnom Penh, following implementation of anti-prostitution and anti-trafficking laws. While both cohorts were recruited using the same eligibility criteria, more recently sampled women had lower prevalence of sexual risk and HIV infection. Women engaging more directly in transactional sex have become harder to sample and access. Future prevention research and programmes need to consider how new policies and demographic changes in FSW impact HIV transmission.

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Current HIV/AIDS/STI Epidemic: Intervention Programs in Cambodia, 1993–2003

Cited by 44 publications

References 10 publications

Expansion of HIV/AIDS in China: Lessons from Yunnan Province

Expansion of HIV/AIDS in China: Lessons from Yunnan Province

Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

Sex work and HIV in Cambodia: trajectories of risk and disease in two cohorts of high-risk young women in Phnom Penh, Cambodia

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