Young Women Engaged in Sex Work in Phnom Penh, Cambodia, Have High Incidence of HIV and Sexually Transmitted Infections, and Amphetamine-Type Stimulant Use: New Challenges to HIV Prevention and Risk

Abstract

Objectives To estimate prevalence and incidence of HIV and sexually transmitted infections (STI) and associated risk factors among young women working as sex workers (SWs) in Phnom Penh, Cambodia. Methods A prospective study of young (<29 years) women working as SWs in brothels, entertainment establishments, and freelance. Sociodemographics, sexual risk, and use of amphetamine-type stimulants (ATS) (“yama” and “crystal”) were assessed by self-report. HIV and STI (Chlamydia trachomatis and Neisseria gonorrhoeae) testing were conducted on blood and urine specimens, respectively. Results Baseline prevalences of HIV, C. trachomatis, and N. gonorrhoeae were 23%, 11.5%, and 7.8%, respectively. HIV incidence was 3.6 per 100 person-years (95% confidence interval [CI], 1.2%– 11.1%); STI incidence was 21.2 per 100 person-years (95% CI, 12.6%– 35.8%). At baseline, 26.5% reported recent ATS use. HIV infection was associated with freelance SW (adjusted odds ratio, 5.85; 95% CI, 1.59–21.58) and younger age of first sex (≤15 years; adjusted odds ratio, 3.06; 95% CI, 1.01–8.46). Incident STI was associated with duration (per year) of SW (adjusted hazard ratio, 1.1; 95% CI, 1.1–1.2) and recent yama use (adjusted hazard ratio, 3.9; 95% CI, 1.5–10.3). Conclusions HIV and STI infection rates were high among SWs working in various settings; freelancers had highest risk. ATS use was associated with incident STI. Venue of sex work and drug prevention should be considered in prevention programs.

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.…”

“…Heterosexual contact is the major route of HIV transmission, and female sex workers (FSW) remain the group at highest risk [2]. Although crucial progress has been made in reducing risky sexual behavior, including widespread condom use and promotion of reduced number of sexual partners, HIV prevalence among FSW remains high, ranging from 11% to 26% [2][3][4][5]. Poverty [6], low literacy [7], a high prevalence of sexually transmitted infections (STI) [4], and a highly mobile workforce [8] are contributing factors to the epidemic.…”

“…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].…”

Drugs, sex, and the geographies of sexual health in Thailand, Southeast Asia

“…The results were new networks of a more mobile and less placespecific production system that was locally situated and consumed. The most logical place to consume those products has been in one of the wealthiest countries in Southeast Asia, Thailand, although the methamphetamine trade, which produces relatively inexpensive drugs in comparison to heroin, is found throughout the region and among some of the highest risk populations, including, for example, commercial sex workers in Cambodia (e.g., Couture et al 2011). It is not that heroin production has been eliminated from the region, far from it.…”