Bars, clubs and pubs oh my!
Actually you could be right, was forgetting about the large influx of Chinese.
The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern.
The syphilis incidence rates have increased three-fold from 2005 to 2012.
Time Series Modelling of Syphilis Incidence in China from 2005 to 2012 Xingyu Zhang et al 2006 http://journals.plos.org/plosone/articl ... ne.0149401
China's syphilis epidemic: epidemiology, proximate determinants of spread, and control responses. Joseph D Tucker; Myron S Cohen, Current Opinion in Infectious Diseases. 24(1):50–55, FEB 2011 https://insights.ovid.com/pubmed?pmid=21150594
As an ambulance officer in remote Australia I was often called on to attend a nearby indigenous community. It was known that no girl over the age of 8 in the community was a virgin, and that more than 90% of the sexually-active members of the community had HIV and/or (mostly and) Hep C. We triple-gloved and used hibitane solution excessively when called to the village.Kuroneko wrote: ↑Fri Jun 15, 2018 1:56 pmDont forget I worked here from 1996 with the MOH and also on HIV and STI related issues. There were high rates of Syphilis when I worked in Southern Africa in the "80's and also in Aboriginal communities in Australia, but not here.
Interestingly, in my lived experience exactly NONE of the screechy social justice women who hate on white men in Asian countries (because, like, they're all perverts and child molesters) make a single comment about this known issue, or even want to know about it, in the same way they don't want to know that 95% of commercialised sex in Asia is purchased by Asians.
I don't for a moment condone sex by force or coercion for any nationalities, or sex with minors in any circumstance - I just find these screechers to be an interesting subset of humanity.
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As khmers put it.
If i drink i die , if i dont drink i die.
Same goes with AIDS i guess.
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https://www.phnompenhpost.com/national/ ... ms-kingdomPhnom Penh Post wrote: 'Sweethearts', sex and condoms in the Kingdom
Bill Bainbridge | Publication date 21 June 2002 | 07:00 ICT
While the battle over condom use in commercial sex has seen major victories, the battle to introduce condoms to "sweetheart" relationships has only just begun. PSI's traveling puppet show. The performers illustrate to crowds of up to 20,000 around the country the importance of safe sex. Cambodian men are going to prostitutes less often and using condoms more frequently when they do. That news has put a smile on the face of the health officials and NGOs working to counter the Kingdom's HIV/AIDS epidemic.
In 1997 around 75 percent of the police and military surveyed reported having sex with a direct sex worker in the previous year, yet the most recent Behavioral Surveillance Survey (BSS), conducted by the National Center for HIV/AIDS (NCHADS), showed that figure had dropped to 32 percent. But, while the use of commercial sex workers has diminished, 'sweetheart relationships' which involve sex have increased.
Romantic relationships are evolving from chaste encounters to sexual, and often semi-commercial, relationships. Fewer than 40 percent of the men surveyed for the 1997 BSS had sex with their sweethearts, but by 2001 that figure had reached 73 percent. Worryingly, only 20 percent of those men reported consistently using condoms with their partners. The women surveyed showed a similar pattern. For both direct and indirect sex workers condom use with sweethearts is far lower than with clients. Direct sex workers use condoms with almost 90 percent of their clients but only half use condoms with their sweethearts. Beer girls, who are considered "indirect" sex workers, reported 56 percent and 37 percent respectively.
It is a problem that has been worrying Population Services International (PSI). The social marketing NGO and their Number One condom have become synonymous with condoms in Cambodia. Sales of PSI's Number One condom increased from just over 5 million in 1995 to more than 16 million in 2001, around 80 percent of the market share. PSI's success is viewed as a significant factor in arresting the spread of HIV in Cambodia, but it has come with an unwanted side effect. The condom retains a
strong association with commercial sex, hence the 'sweethearts study'.
PSI's report, Sweetheart Relationships and Condom Use in Phnom Penh, was commissioned to examine non-commercial sexual relationships. It is an in-depth qualitative study of eight categories of vulnerable groups. Two groups of eight volunteers were recruited from direct and indirect sex workers, students, moto drivers, police, military and garment factory workers. Through focus groups and 'participatory learning in action techniques' the researchers tried to elicit the different meanings of sweetheart relationships and discern successful methods for introducing condoms into those relationships. "There's nothing new about sweetheart relationships," says Gillian Fletcher, who co-authored the report. "I think they've always existed
but people haven't been able to speak about them before."
In Cambodia, where many aspects of sexuality are cloaked by traditional culture, the study has peeked under the covers to reveal sexuality in transition. The Khmer term songsah or 'sweetheart' does not automatically denote a sexual relationship. Rather it covers a range of relationships from hand-holding, to lovers, pimps and sugardaddies. The male participants in the study came up with a staggering 45 terms for women they might have unpaid sex with, while the women had 64 terms for their songsahs. It is a lexicon of love that defines a range of subtle variations on the types of sweetheart relationships between men and women. "They're a bit like Eskimos and snow," says co-author David Wilkinson of the vast array of terms. "You name what's important to you." Some of the terms are designed to tease men about their amorous behavior.
The 'bee-hearted man' flits from one girl to another pollinating but never staying, while the 'crocodile man' has more smarm than charm. Researchers were initially mystified by the 'four-kneed relative', whom they later discovered denoted a man who spends half his time on his knees for sex and the other half on his knees begging for money. Most terms, however, are not quite so cynical, says Wilkinson. "The heart features strongly in all the sweetheart terms. They certainly perceive the relationships as romantic," he says. Among the most popular terms are 'favorite of my heart', 'male friend', 'man held in my heart', and 'older man at the center of my heart'. Each is imbued with varied degrees of trust by the research participants.
"They place great emphasis on the importance of loung lorm or 'sweet talk'," Wilkinson says.
Asking participants how they reached that stage revealed some interesting answers. "It begins with comforting, touching a woman's body and telling lies by saying we don't have any wife," one moto driver told the researchers. The report found that there are two main categories of relationship for men: casual, in which sex occurs within an hour of meeting and money often changes hands, and longer term affairs where a lengthy courtship precedes sex and trust must be won. "It takes three months before becoming sexual," said one student. "We begin touching, comforting her, flattering her that 'you are very pretty, my dear' and saying 'I won't leave you even after I've had sex with you'. Often, women say nothing, which means they
agree with us."
Women's reticence is understandable. Traditional Khmer morality frowns on women who engage in sex prior to or outside of marriage. According to the 2001 Demographic Health Survey (DHS) half of all Cambodian women are married by 20 and 81 percent by 25. Once married the overwhelming majority of women are faithful to their husbands. Married women were more likely to report having had no sex at all in the past 12 months (3 percent) compared with women who had had sex with someone other than their husband (zero percent). In Cambodia an unmarried woman without her virginity is indelibly stained and frequently marginalized by village and family. Men are said to be gold, which can be washed clean, while women are cloth according to a popular Khmer saying. The family tightly regulates marriage.
According to the DHS around half of all women met their husband less than one month before getting married; 43 percent only met their husband on their wedding day. Chanthol Oung, executive director of the Cambodian Women's Crisis Center, sees many women whose lives have been damaged by the double standard that confines women to marriage and fidelity. "If women have sex before marriage then we are condemned, but for men it's seen as OK," she says. "In the cities right now women have more freedom, and more freedom to choose their own spouse," she adds, but argues it will be at least 20 years before women are not judged for exercising 'too much' freedom.
"The woman who is 'easy' is not seen as the 'good' woman so the men just play with them but never marry them. They have them just for the game," says Chanthol. In a changing society women are tending toward more sexual freedom, although still in very small numbers. The DHS found that women rarely engage in sexual activity outside of marriage. Only 5 percent never marry, and the percentage of single women who reported having had sex was a tiny 0.4 percent of all women. However among more mobile groups, such as garment workers, women have been reporting having a songsah or sweetheart in greater numbers over the past five years. "I think sweetheart relationships are extremely widespread, and increasing as men's use of brothel-based sex workers decreases," says Wilkinson. While he emphasizes that the sweethearts report did not try to quantify non-marital sex, the researchers had little trouble finding willing and experienced research subjects, both male and female. Wilkinson's impression is backed by NCHADS research. The BSS surveyed high and medium risk men and women such as direct sex workers, karaoke hostesses and beer girls.
Almost half of the beer girls surveyed in the BSS also had a sweetheart, most commonly a businessman, government official, policeman or member of the military. In 1997 less than half of beer girls who had sweethearts also had sex with their sweetheart. Now virtually all do. "It's becoming more common to have a sweetheart and I'm afraid that it will become a norm," says NCHADS deputy director Dr Hor Bunleng. "In my generation it was not acceptable but now it's becoming more acceptable to have sweethearts in school and then, or later, they may have sex, but it is still a minority."
The sweetheart relationship is not thought of as a commercial one by either the men or women involved, according to the BSS findings. Only 4.4 percent of women reported never receiving money from their sweetheart, while two-thirds said it was "not likely" they would ever marry their sweetheart. PSI's sweethearts study found both commercial and non-commercial versions of the relationship. "Sex workers is a very loosely defined term," says Wilkinson. "There's a great spectrum of women, like beer girls, who don't necessarily consider themselves sex workers." Money was a motivation for many of the women surveyed for the sweethearts
study. "The men who take us out to have sex are not faithful with us. We know this in advance and thus what we need is only pleasure or money," said one indirect sex worker.
While some sweetheart relationships are pre-marital many others are extra-marital. The male participants in the sweethearts survey showed little interest in marital fidelity, says Wilkinson. "Traditionally Cambodian men are expected to be sexually
aggressive and women passive. There is a tacit acknowledgment that Cambodian men need many partners for sexual satisfaction. "Many men have a cadre of partners, with a wife, sex workers and one or more sweetheart also. It's quite clear that men are the major vectors of transmission for HIV and there needs to be a much greater emphasis on programs targeted at changing the behavior of men," he says.
Researchers found that a high percentage of military and police said they engaged in occasional homosexual sex acts, but none identified themselves as homosexual. Women bear the brunt of the blame for the spread of HIV/AIDS, answers to other questions showed. When male students were asked for their recommendations they bluntly told the researchers to "educate the women". The men interviewed typically indicated that no matter how many other partners they had, they saw no need to use condoms with their wives because "we trust each other". To maintain the appearance of trust other men also refuse to use condoms with their sweethearts. "If I use condoms she will not believe in me and will no longer allow me to have sex with her," one soldier told researchers, who say this link between trust and lack of condom use is a cause for concern. PSI's study also found that men almost always initiate sex, even when the female sweetheart is also a sex worker.
"Though we are sex workers, we are still shy, never using sweet talk," one participant said. Sex workers and other sexually active women are forced to conform to a passive role. "The 'woman's code' still totally dominates women's behavior," says CWCC's Chanthol Oung. "The code was taught at school everyday. Girls were told 'don't speak loudly, don't walk fast, don't glance at men'. It was in the curriculum." For condom use the researchers found that it was considered acceptable for women to suggest condom use. However for most, but not all research subjects, women were frowned upon if they carried condoms with them.
"That is why we usually have sex with songsah without a condom. How can a condom be found when having sexual desire by chance? [If we give our partner a condom] they will look down on us saying that we have already been with a number of men," said one garment worker. In an affectionate relationship it is also usually unacceptable to mention disease prevention when negotiating condom use, even though most participants agreed that that was the main reason for using them. To raise the subject of HIV is viewed as a betrayal of trust. "Trust is the key factor," says PSI's behavioral change campaign coordinator Natacha Bobin. "Where trust is absent, that's when condoms are introduced."
Men and women talk instead about preventing pregnancy and preserving their family's honor. "We tell them we want to prevent pregnancy ... not prevent infection, because we fear they may get angry with us," said one soldier. The good news from the report, says Bobin, is that Number One condoms received favorable feedback as Cambodia's condom of choice. Social marketing NGOs in other countries have differentiated between condoms marketed for paid sex and those for romantic liaisons. Bobin said PSI is considering launching a second condom marketed to sweethearts as a dual prophylactic against both pregnancy and disease.
In a trusting relationship condoms aren't considered necessary. But that trust may well be misplaced. The students interviewed typically had an 'official' sweetheart, often a female student or someone of the same social status. That relationship might or might not be sexual, but they would also have a range of other sexual encounters. "Most of the young women are aware that their boyfriends sleep with other women, but hope that, because their boyfriend cares about them, they will use condoms with their other partners," says Bobin. The study found that the risk assessment of male students was poor. Most decide they will not use condoms if a girl has pale skin, is from a good family, or has only recently moved to Phnom Penh. "Sweetheart
relationships are largely driven by men," says Wilkinson, "but the issue of sexual pleasure for women is getting on the agenda, and there's a growing awareness that satisfaction might be desirable."
"The reason we have sex with different partners is that we want to know the techniques of having sex from one man to another, or it is because we want to satisfy our passion," a garment worker said. Chanthol believes women should have the right to sexual relationships but worries that the rapidly changing sexual mores open women up to exploitation. "Many women are cheated by traffickers. If the man just pretends to be the boyfriend then it's very dangerous," she says. "To prohibit youth from knowing each other is not really useful but maybe they shouldn't sleep together before marriage. This is a transition period and it should be taken slowly." For NCHAD's Hor Bunleng the key to changing behavior lies in education. "They don't learn anything about sex in the school system. Some girls even get very shocked and frightened when they begin to menstruate," he says.
Wilkinson concludes that in addition to changing male behavior, the portrayal of women in Khmer society also needs to change. PSI plans a ' positive role model' campaign to encourage women to carry condoms. "We need to make condoms acceptable in affectionate relationships, and need to portray women who carry condoms as responsible, respected and intelligent," he says. Lexicon of love PSI researchers have rated the levels of affection and respectability that adhere to the different sweetheart terms. Each term had a different status. A kou kamnann chet (partner who is held by my heart) for instance was suitable to be introduced to a man's family. For women on the other hand a kampoul sneih (top of love) received a low "introduce to the family" rating. He is "the man we heartily love, the place they take us to have sex is good like a hotel," one woman told researchers. Bong samlang (lovely brother) received the highest affection rating out of all 64 terms used
by women. A man simply referred to as bong was more likely to be asked to use a condom, one sex worker said. "This is used to please the men so they will have sex with us and, in return, give us money and buy us presents."
For men, the term srey kalibe is literally a high caliber woman. Usually young, attractive, well dressed and riding a nice moto the srey kalibe is favored by wealthy men and very well compensated for her affections. One of the most disturbing aspects of the research was the matter-of-fact approach young men have to gang rape "We found a very high incidence of gang rape and the students were able to relate stories of rape in great detail," says PSI's Natacha Bobin. "When they talked about it they saw absolutely nothing wrong with it." The stories came to light in the second part of the research where male students and female waitresses and beer girls were asked to discuss issues of AIDS, condoms and sexuality with their peers.
"Every single male student had stories about gang rape,"Bobin says. "The women said they felt much more vulnerable since the closure of the karaoke bars and they rated fear of gang rape as their second greatest fear."
Students both described and role-played typical gang rape scenarios. Usually one member of the group goes to areas where non-brothel based sex workers can be found, such as HE Park. He then negotiates a fee and takes the girl to a guesthouse where several of his friends are already waiting. Once there the girl is powerless to refuse sex with all the men, sometimes without condoms, without payment and accompanied by violence. "They were very matter of fact about it," says Bobin. "They justified it in terms of it being less expensive and as a bonding experience for the group." "What's disturbing is the cynical attitude of men and young people towards 'bad' women to the point of abuse," says the report's co-author
David Wilkinson. "[That is] particularly [a problem] among the emerging affluent middle class." PSI plans to address the issue of violence against women in its response to the report and will share the findings with government and other organizations working in the field. "We're hoping to work with government and other NGOs to influence some sort of national campaign to address violence," says Bobin. "HIV, gender, sexuality, power and poverty are all interlinked."
Cambodia Daily wrote:Condom use among prostitutes in the entertainment industry remains high with clients but low in more affectionate relationships, data show.
About 82 percent of women working in karaoke bars, massage parlors and beer gardens reported that they consistently used condoms with commercial clients over the past three months, according to a 2010 survey, said Chhea Chhorvann, deputy director of the National Authority for HIV/AIDS, Dermatology and STD.
However, only 40.5 percent of the female workers said that they always used condoms with sweethearts, according to data across five provinces from the 2010 Behavioral Sentinel Survey. “It is always a concern for us to see low condom use,” Mr Chhorvann said on the sidelines of the third Phnom Penh Symposium on HIV/AIDS. “Our first priority is clients, then if we have a budget we can work more on sweethearts.”
The crackdown on brothels after the anti-human trafficking law approved in 2008, which pushed sex workers into entertainment venues and underground, had not significantly reduced condom use with clients, he added.
High-risk sexual behavior among entertainment workers in Cambodia has evolved to include semi-transactional “sweetheart” relationships characterized by affection and trust, said a study by NGO Population Services International dated October 2009.
About half of the 1,000 women surveyed from karaoke bars, beer gardens and massage parlors in Phnom Penh reported consistent condom use with sweethearts over the last three months, according to the survey, which noted that 93 percent of respondents said they always used condoms with clients.
“We know low condom use between entertainment workers and sweethearts is a driver of the epidemic,” said Long Dianna, director of strategic information at PSI Cambodia, noting that most workers have relationships with multiple clients and sweethearts at the same time.
The level of trust and length of the relationship were associated with decisions to use condoms or not, she said. “They see if it is safe or not safe based on behavior, background and trust.”
Thanks for taking the time to format this - insightful reading.
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