Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Camb

[CEOCambodiaNews]

Long to read, but this is a serious study on HIV from July 2018 that may be of interest to readers here:
Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study
Published online 2018 Jul 2. doi: 10.1371/journal.pone.0198095

In Cambodian context, female entertainment workers (FEWs) are young women working at establishments such as karaoke bars, restaurants, beer gardens or massage parlors. FEWs may sell sex to male patrons and are considered a high-risk group for HIV. This study aimed to identify factors associated with recent HIV testing among FEWs in Cambodia to inform future prevention activities.

Methods
Data were collected in 2014 as part of the evaluation of a larger HIV prevention project. A two-stage cluster sampling method was used to select participants from Phnom Penh and Siem Reap for face-to-face interviews using a structured questionnaire. A logistic regression model was constructed to identify independent factors associated with recent HIV testing.

Results
Data were collected from 667 FEWs with a mean age of 25.6 (SD = 5.5). Of total, 81.7% reported ever having had an HIV test, and 52.8% had at least one test in the past six months. After adjustment for other covariates, factors independently associated with recent HIV testing included living in Phnom Penh (AOR = 2.17, 95% CI = 1.43–3.28), having received HIV education in the past six months (AOR = 3.48, 95% CI = 2.35–5.15), disagreeing with a statement that ‘I would rather not know if I have HIV’ (AOR = 2.15, 95% CI = 1.41–3.30), agreeing with a statement that ‘getting tested for HIV helps people feel better’ (AOR = 0.32, 95% CI = 0.13–0.81) and not using a condom in the last sexual intercourse with a non-commercial partner (AOR = 0.48, 95% CI = 0.26–0.88).

Conclusions
FEWs with greater knowledge and positive attitudes towards HIV testing got tested for HIV more frequently than those with lesser knowledge and less positive attitudes. These findings suggest that future interventions should focus on disseminating tailored health messages around testing practices as well as specific topics such as condom use with non-commercial partners.

In 2014, the HIV prevalence among the general adult population in Cambodia was 0.3%, reflecting a significant decline from the peak of 2.0% in 1998 [1,2]. Now, the HIV epidemic is confined mainly to high-risk groups such as sex workers, men who have sex with men (MSM), people who inject drugs and transgender women [3,4,5]. The reduction in HIV prevalence in the general population was attributed to the 100% condom use program that led to an increase in condom use, multi-sector programming that involved health workers, law enforcement officers, brothel owners and peer educators and increased access to voluntary confidential counseling and testing (VCCT) and antiretroviral therapy (ART) [6,7,8]. Cambodia was presented with a Millennium Development Goals (MDG) Award at the MDG Summit in 2010 for these efforts [9].

The passage and implementation of the 2008 ‘Law on Suppression of Human Trafficking and Sexual Exploitation,’ which banned brothel-based sex work has serious implications for HIV prevention [10]. The ‘brothel ban’ may have unintentionally created barriers to identifying and providing services to women who engage in commercial sex [11,12]. Cambodia has seen a significant decrease in brothel-based sex workers but an increase in sex workers at all types of entertainment venues, including karaoke bars, massage parlors and beer gardens [10,13].

Female entertainment workers (FEWs), with an estimated number of approximately 40,000 in the whole country, are now considered a high-risk group for HIV [14]. FEWs are young women who work at entertainment establishments, such as karaoke bars, beer gardens or massage parlors. FEWs may also sell sex to male patrons to supplement their income [15,16]. The prevalence of HIV among this group is estimated to be between 9.2%-13.9% [10, 11]. Reaching this population with prevention services, such as HIV testing, is a high priority in Cambodia. The Strategic Plan from 2016–2020 of the National Center for HIV/AIDS, Dermatology and STD (NCHADS) set a goal to reach at least 90% of HIV key populations, including FEWs, with an HIV test in every six months [17].

Entertainment venues have become important locations for prevention activities, including HIV education and community-based testing [13]. Still, the prevalence of lifetime HIV testing among FEWs in Cambodia has been found to be between 60–80% [11,18], and recent testing has been shown to be much lower, ranging from as low as 20.0% (in the past three months) [11] to 63.9% (in the past six months) [18]. Factors associated with HIV testing among sex workers in Asia include older age [18,19], higher educational attainment [19,20], longer duration working in entertainment venues [21], working in higher-income commercial sex venues [19], greater self-rated HIV knowledge [19,21], high perception of HIV risk [20], having a regular sexual partner [21], inconsistent condom use with husbands or lovers [22] and illegal drug use history [20,22].
There is currently no published information on whether or not these factors are associated with recent HIV testing for FEWs in Cambodia. In order to improve regular HIV testing rates among FEWs through tailored services, it is critically important to know factors affecting testing practices. This study aims to identify factors associated with recent HIV testing among FEWs in Cambodia including socio-demographic characteristics, sexual behaviors, HIV testing attitudes and HIV knowledge.

Ethical statement

The National Ethics Committee for Health Research of the Ministry of Health, Cambodia approved this study (Reference no. 082NECHR). A written informed consent was obtained from each participant after they were made clear that participation in this study was voluntary, and they could refuse or discontinue their participation at any time. We protected privacy of the respondents by conducting the interviews at a private place, and no personal identifiers were collected in the questionnaires or field notes.

This cross-sectional study was conducted in 2014 as part of the end-line survey to evaluate the impact of the Sustainable Action against HIV and AIDS in Communities (SAHACOM) Project. The five-year intervention was implemented by KHANA, the largest national non-governmental organization providing HIV prevention, care and support services in Cambodia. Reports related to the main survey have been published elsewhere [18, 23]. Venues from which study participants were selected for face-to-face interviews were randomly selected from a list of entertainment venues obtained from KHANA’s partners in Phnom Penh and Siem Reap. The number of FEWs in Phnom Penh and Siem Reap represents approximately 70% of the total FEW population in Cambodia [6]. The sample size was proportionally allocated to the number of FEWs in the two study sites.
And much more here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028079/

[Kuroneko]

Information from when I was working in this area about 18 years ago, are we finding anything new?

Sex workers help control spread of HIV/AIDS Caroline Green | Publication date 07 June 2002

As the National Assembly debated the HIV/AIDS law last week, the Khmer HIV/AIDS NGO Alliance (KHANA) kicked off a $2.7 million prevention program focused on educating and mobilizing sex workers.

Conclusions: These findings suggest that future interventions should focus on disseminating tailored health messages around testing practices as well as specific topics such as condom use with non-commercial partners.

Cambodia HIV/AIDS Strategic Plan 2002-2005
Numerous challenges persist. Recent data suggest a general shift in HIV transmission from female sex workers and their male clients to transmission between husbands and their wives. This epidemiologic transition has resulted in the transmission of HIV to a greater number of infants. While the majority of people infected with HIV current ly live in urban areas and in border provinces, especially those provinces bordering Thailand, this concentrated geographic pattern is expected to change in coming years due to a high degree of population mobility. Newly impacted populations and increasing demands for quality care services are among the issues donors and the government must address. Greater emphasis needs to be placed on proving the quality of,and access to, home-, community- and in stitutional-based care for people living with HIV/AIDS. Critical services include the diagnosis and treatment of tuberculosis and other opportunistic infections. All of these demands are placing an increasing burden on a relatively new and fragile health system. http://www.hivpolicy.org/Library/HPP000433.pdf

[Foreigner]

"Female entertainment workers (FEWs), with an estimated number of approximately 40,000 in the whole country, are now considered a high-risk group for HIV...The prevalence of HIV among this group is estimated to be between 9.2%-13.9%"

FUCK ING HELL

[Big Daikon]

"Female entertainment workers (FEWs), with an estimated number of approximately 40,000 in the whole country, are now considered a high-risk group for HIV...The prevalence of HIV among this group is estimated to be between 9.2%-13.9%"

FUCK ING HELL

On the bright side:

The authors found that, overall, female-to-male (.04% per act or, in theory, about 4 cases of HIV transmission per every 10,000 acts of vaginal sex with a woman who is HIV positive) and male-to-female (.08% per act or 8 cases of HIV transmission per every 10,000 acts of vaginal sex with a man who is HIV positive) transmission

https://www.hivlawandpolicy.org/resourc ... a-analysis

[Foreigner]

"Female entertainment workers (FEWs), with an estimated number of approximately 40,000 in the whole country, are now considered a high-risk group for HIV...The prevalence of HIV among this group is estimated to be between 9.2%-13.9%"

FUCK ING HELL

On the bright side:

The authors found that, overall, female-to-male (.04% per act or, in theory, about 4 cases of HIV transmission per every 10,000 acts of vaginal sex with a woman who is HIV positive) and male-to-female (.08% per act or 8 cases of HIV transmission per every 10,000 acts of vaginal sex with a man who is HIV positive) transmission

https://www.hivlawandpolicy.org/resourc ... a-analysis

true but still a shocking stat.

I know this is hardly the main issue here, but does that also mean that the average bar girl has had sex approx 10,000 times ?

* say 10% have HIV, transmission say 0.1%, say 1% of men have it (100*100).

[John Bingham]

I don't believe that bar girls wouldn't be in the top rates. Street walkers, women working in low rent "massage"/KTVs and ladyboys are much more likely to be indulging in unsafe sex and drugs like crystal meth which increase the risk.

[hunter8]

Having sex is not for the faint-hearted.

[Big Daikon]

"Female entertainment workers (FEWs), with an estimated number of approximately 40,000 in the whole country, are now considered a high-risk group for HIV...The prevalence of HIV among this group is estimated to be between 9.2%-13.9%"

FUCK ING HELL

On the bright side:

The authors found that, overall, female-to-male (.04% per act or, in theory, about 4 cases of HIV transmission per every 10,000 acts of vaginal sex with a woman who is HIV positive) and male-to-female (.08% per act or 8 cases of HIV transmission per every 10,000 acts of vaginal sex with a man who is HIV positive) transmission

https://www.hivlawandpolicy.org/resourc ... a-analysis

true but still a shocking stat.

I know this is hardly the main issue here, but does that also mean that the average bar girl has had sex approx 10,000 times ?

* say 10% have HIV, transmission say 0.1%, say 1% of men have it (100*100).

First, determine average times per week. (Honestly curious.)

[Foreigner]

"Female entertainment workers (FEWs), with an estimated number of approximately 40,000 in the whole country, are now considered a high-risk group for HIV...The prevalence of HIV among this group is estimated to be between 9.2%-13.9%"

FUCK ING HELL

On the bright side:

The authors found that, overall, female-to-male (.04% per act or, in theory, about 4 cases of HIV transmission per every 10,000 acts of vaginal sex with a woman who is HIV positive) and male-to-female (.08% per act or 8 cases of HIV transmission per every 10,000 acts of vaginal sex with a man who is HIV positive) transmission

https://www.hivlawandpolicy.org/resourc ... a-analysis

true but still a shocking stat.

I know this is hardly the main issue here, but does that also mean that the average bar girl has had sex approx 10,000 times ?

* say 10% have HIV, transmission say 0.1%, say 1% of men have it (100*100).

First, determine average times per week. (Honestly curious.)

well if we say our average F.E.W. has been working for 4 years, then that's 50 times a week. seems excessive to me tbh even if there might be some who have done that in a record week. we might need to get a proper statistician in tbh.

[Big Daikon]

"Female entertainment workers (FEWs), with an estimated number of approximately 40,000 in the whole country, are now considered a high-risk group for HIV...The prevalence of HIV among this group is estimated to be between 9.2%-13.9%"

FUCK ING HELL

On the bright side:

The authors found that, overall, female-to-male (.04% per act or, in theory, about 4 cases of HIV transmission per every 10,000 acts of vaginal sex with a woman who is HIV positive) and male-to-female (.08% per act or 8 cases of HIV transmission per every 10,000 acts of vaginal sex with a man who is HIV positive) transmission

https://www.hivlawandpolicy.org/resourc ... a-analysis

true but still a shocking stat.

I know this is hardly the main issue here, but does that also mean that the average bar girl has had sex approx 10,000 times ?

* say 10% have HIV, transmission say 0.1%, say 1% of men have it (100*100).

First, determine average times per week. (Honestly curious.)

well if we say our average F.E.W. has been working for 4 years, then that's 50 times a week. seems excessive to me tbh even if there might be some who have done that in a record week. we might need to get a proper statistician in tbh.

How about interviewing bar girls? Granted, self-reporting can be unreliable.