Selling sex in unsafe spaces: sex work risk environments in Phnom Penh, Cambodia

Harm Reduction Journal

Kimberly Page³  Tooro Nemoto⁶  Neth Sansothy⁷  Melissa Cockroft⁵  Jennifer Evans³  Ellen Stein³  Marie-Claude Couture³  Pisith Phlong⁴  Julie Mooney-Somers¹  Lisa Maher² 

[1]The Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, Australia

[2]The Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia

[3]University of California San Francisco, San Francisco, CA, USA

[4]Royal University of Fine Arts, Phnom Penh, Cambodia

[5]Cambodian Women's Development Agency, Phnom Penh, Cambodia

[6]Tooru Nemoto, Public Health Institute, San Francisco, CA, USA

[7]National Centre for HIV/AIDS, Dermatology and STDs (NCHADS), Ministry of Health, Cambodia

关键词: Cambodia;    entertainment;    young women;    STI;    HIV;    vulnerability;    environment;    risk;    sex work;   

Others  :  810095
DOI  :  10.1186/1477-7517-8-30

 received in 2011-08-18, accepted in 2011-11-20,  发布年份 2011

【 摘 要 】

Background

The risk environment framework provides a valuable but under-utilised heuristic for understanding environmental vulnerability to HIV and other sexually transmitted infections among female sex workers. Brothels have been shown to be safer than street-based sex work, with higher rates of consistent condom use and lower HIV prevalence. While entertainment venues are also assumed to be safer than street-based sex work, few studies have examined environmental influences on vulnerability to HIV in this context.

Methods

As part of the Young Women's Health Study, a prospective observational study of young women (15-29 years) engaged in sex work in Phnom Penh, we conducted in-depth interviews (n = 33) to explore vulnerability to HIV/STI and related harms. Interviews were conducted in Khmer by trained interviewers, transcribed and translated into English and analysed for thematic content.

Results

The intensification of anti-prostitution and anti-trafficking efforts in Cambodia has increased the number of women working in entertainment venues and on the street. Our results confirm that street-based sex work places women at risk of HIV/STI infection and identify significant environmental risks related to entertainment-based sex work, including limited access to condoms and alcohol-related intoxication. Our data also indicate that exposure to violence and interactions with the police are mediated by the settings in which sex is sold. In particular, transacting sex in environments such as guest houses where there is little or no oversight in the form of peer or managerial support or protection, may increase vulnerability to HIV/STI.

Conclusions

Entertainment venues may also provide a high risk environment for sex work. Our results indicate that strategies designed to address HIV prevention among brothel-based FSWs in Cambodia have not translated well to street and entertainment-based sex work venues in which increasing numbers of women are working. There is an urgent need for targeted interventions, supported by legal and policy reforms, designed to reduce the environmental risks of sex work in these settings. Future research should seek to investigate sex work venues as risk environments, explore the role of different business models in mediating these environments, and identify and quantify exposure to risk in different occupational settings.

【 授权许可】

   
2011 Maher et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Church S, Henderson M, Barnard M, Hart G: Violence by clients towards female prostitutes in different work settings: Questionnaire survey. BMJ 2001, 322:524-525.
• [2]Remple V, Patrick D, Johnston C, Tyndall M, Jolly A: Clients of indoor commercial sex workers: heterogeneity in patronage patterns and implications for HIV and STI propagation through sexual networks. Sexually Transmitted Diseases 2007, 34:754-760.
• [3]McKeganey N, Barnard M: Sex Work on the Streets, Prostitutes and their Clients. Buckingham: Open University Press; 1996.
• [4]Pyett P, Warr D: Vulnerability on the streets: female sex workers and HIV risk. AIDS Care 1997, 9:539-547.
• [5]Dandona R, Dandona L, Gutierrez JP, Kumar AG, McPherson S, Samuels F, Bertozzi SM: High risk of HIV in non-brothel based female sex workers in India. BMC Public Health 2005, 5:87. BioMed Central Full Text
• [6]Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall M: Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Social Science and Medicine 2008, 66:911-921.
• [7]Shannon K, Strathdee S, Shoveller J, Rusch M, Kerr T, Tyndall M: Structural and Environmental Barriers to Condom Use Negotiation With Clients Among Female Sex Workers: Implications for HIV-Prevention Strategies and Policy. American Journal of Public Health 2009, 99:659-665.
• [8]Johnston C, Callon C, Li K, Wood E, Kerr T: Offer of financial incentives for unprotected sex in the context of sex work. Drug and Alcohol Review 2010, 29:144-149.
• [9]Couture M, Sansothy N, Sapphon V, Phal S, Sichan K, Stein ES, Evans J, Maher L, Kaldor J, Vun MC, Page K: 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. Sexually Transmitted Diseases 2011, 38:33-39.
• [10]Sherman S, Reuben J, Chapman C, Lilleston P: Risks associated with crack cocaine smoking among exotic dancers in Baltimore MD. Drug and Alcohol Dependence 2010, 114:249-252.
• [11]Rhodes T: Risk environments and drug harms: a social science for harm reduction approach. International Journal of Drug Policy 2009, 20:193-201.
• [12]Rhodes T: The 'risk environment': a framework for understanding and reducing drug-related harm. International Journal of Drug Policy 2002, 13:85-94.
• [13]Strauss A, Corbin J: Basics of Qualitative Research: Grounded Theory Procedures and Techniques. London: Sage; 1990.
• [14]Ezzy D: Qualitative Analysis: Practice and Innovation. Sydney: Allen & Unwin; 2002.
• [15]Marten L: Commercial sex workers: Victims, vectors or fighters of the HIV epidemic in Cambodia? Asia Pacific Viewpoint 2005, 46:21-34.
• [16]Maher L, Curtis R: Womenon the edge of crime: Crack cocaine and the changing contexts of street-level sex work in New York City. Crime, Law and Social Change 1992, 18:221-258.
• [17]Ministry of Health: Standard Operating Procedures (SOP) for continuum of prevention to care and treatment for women entertainment workers in Cambodia. Phnom Penh: Ministry of Health; 2009.
• [18]Plummer R: The sex industry in Cambodia: The traffic police. The Economist 2009.
• [19]UNIAP: United Nations Inter-Agency Project on Human Trafficking (Phase III). Cambodia: Exodus to the sex trade? Effects of the global financial crisis on women's working conditions and opportunities. 2009.
• [20]Maher L, Phlong P, Mooney-Somers J, Keo S, Stein E, Couture M, Page K: Amphetamine-type stimulant use and HIV/STI risk behaviour among young female sex workers in Phnom Penh, Cambodia. International Journal of Drug Policy 2011, 22:203-209.
• [21]Li Q, Li X, Stanton B: Alcohol Use Among Female Sex Workers and Male Clients: An Integrative Review of Global Literature. Alcohol & Alcoholism 2010, 45:188-199.
• [22]Agha S, Nchima M: Life-circumstances, working conditions and HIV risk among street and nightclub-based sex workers in Lusaka, Zambia. Culture, Health & Sexuality 2004, 6:283-299.
• [23]Halkitis P, Jerome R: A comparative analysis of methamphetamine use: black gay and bisexual men in relation to men of other races. Addictive Behaviors 2008, 33:83-93.
• [24]Molitor F, Truax S, Ruiz J, Sun R: Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. Western Journal of Medicine 1998, 168:93-97.
• [25]Couture M, Evans J, Stein E, Sansothy N, Sichan K, Maher LPK: Correlates of amphetamine-type stimulant use and associations with HIV-related risks among young women engaged in sex work in Phnom Penh, Cambodia. Drug and Alcohol Dependence Online First 2011.
• [26]Strathdee S, Philbin M, Semple S, Pu M, Orozovich P, Martinez G, Lozada R, Fraga M, de la Torre A, Staines H, et al.: Correlates of injection drug use among female sex workers in two Mexico-U.S. border cities. Drug and Alcohol Dependence 2008, 92:132-140.
• [27]Shannon K, Kerr T, Strathdee S, Shoveller J, Montaner J, Tyndall M: Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ 2009, 339:442-445.
• [28]Zhang C, Li X, Hong Y, Chen Y, Liu W, Zhou Y: Partner Violence and HIV Risk Among Female Sex Workers in China. AIDS and Behavior Online First 2011, 1-11.
• [29]USAID: Violence and exposure to HIV among sex workers in Phnom Penh, Cambodia. Washington DC: USAID; 2006.
• [30]Human Rights Watch: Off the streets: Arbitrary detention and other abuses against sex workers in Cambodia. New York: Human Rights Watch; 2010.
• [31]National AIDS Authority: Cambodia Country Progress Report. Monitoring the progress towards the implementation of the Declaration of Commitment on HIV and AIDS. Phnom Penh: National AIDS Authority; 2010.
• [32]National Center for HIV/AIDS Dermatology and STD: Updated data of Entertainment Workers in Cambodia (Q1 & Q4/2009). Phnom Penh: Ministry of Health; 2009.
• [33]Francis C: HIV prevention and anti-trafficking in conflict? The public health consequences of Cambodia's fight against trafficking. Phnom Penh; 2008.
• [34]Rhodes T, Simic M, Baros S, Platt L, Zikic B: Police violence and sexual risk among female and transvestite sex workers in Serbia: qualitative study. BMJ 2008, 337:560-563.
• [35]Shannon K, Csete J: Violence, condom negotiation, and HIV/STI risk among sex workers. JAMA 2010, 304:573-574.
• [36]Decker MR, McCauley HL, Phuengsamran D, Janyam S, Seage GR, Silverman JG: Violence victimisation, sexual risk and sexually transmitted infection symptoms among female sex workers in Thailand. Sexually Transmitted Infections 2010, 86:236-240.
• [37]Human Rights Watch: Abusing the user. Police misconduct, harm reduction and HIV/AIDS in Vancouver. New York; 2003.
• [38]Open Society Institute, Sex Workers Action Network: Arrest the violence: human rights abuses against sex workers in Central and Eastern Europe and Central Asia. 2009.
• [39]Blankenship K, Koester S: Criminal law, policing policy, and HIV risk in female street sex workers and injection drug users. Journal of Law Medicine and Ethics 2002, 30:548-559.
• [40]Maher L, Dixon D: Policing and public health: Law enforcement and harm minimization in a street-level drug market. British Journal of Criminology 1999, 39:488-512.
• [41]Wood E, Spittal P, Smallm W, Kerr T, Li K, Hogg R, Tyndall M, Montaner J, Schechter M: Displacement of canada's largest public illicit drug market in response to a police crackdow. Canadian Medical Association Journal 2004, 170:1551-1556.
• [42]Cooper H, Moore L, Gruskin S, Krieger N: Characterizing perceived police violence: implications for public health. American Journal of Public Health 2004, 94:1109-1118.
• [43]Davis C, Burris S, Kraut-Becher J, Lynch K, Metzger D: Effects of an intensive street-level police intervention on syringe exchange program use in Philadelphia. American Journal of Public Health 2005, 9:233-236.
• [44]Pollini R, Brouwer K, Lozada R, Ramos R, Cruz M, Magis-Rodriguez C, Case P, Burris S, Pu M, Frost S, et al.: Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities. Addiction 2008, 103:101-108.
• [45]Werb D, Wood E, Small W, Strathdee S, Li K, Montaner J, Kerr T: Effects of police confiscation of illicit drugs and syringes among injection drug users in Vancouver. International Journal of Drug Policy 2008, 9:332-338.