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

Couture, Marie-Claude PhD*; Sansothy, Neth MD†; Sapphon, Vonthanak MD, PhD†; Phal, Serey‡; Sichan, Keo‡; Stein, Ellen MPH*; Evans, Jennifer MSc*; Maher, Lisa PhD§; Kaldor, John PhD§; Vun, Mean Chhi MD, PhD†; Page, Kimberly PhD, MPH*

Sexually Transmitted Diseases:
doi: 10.1097/OLQ.0b013e3182000e47
Original Study

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.

In Brief

Young female sex workers in Phnom Penh, Cambodia have high HIV and STI rates. New challenges to prevention are posed by widespread use of amphetamine-type stimulants which contribute to risk.

Author Information

From the *University of California San Francisco, San Francisco, CA; †National Institute for HIV, AIDS, Dermatology and STDs, Phnom Penh, Cambodia; ‡Cambodian Women's Development Agency, Phnom Penh, Cambodia; and §National Centre for HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia

The authors acknowledge the coordinated efforts and dedication of the research teams at the National Center for HIV/AIDS, Dermatology, and STDs, and the Cambodian Women's Development Agency. The authors are indebted to all the Cambodian women who agreed to participate in this study and grateful for the privilege to work with them.

Supported by NIH grants: U01AI0154241, 1R21 DA025441, and 1R01NR010995; Canadian Institutes of Health Research (postdoctoral fellowship award) (to M.C.C.); and Pangaea Global AIDS Foundation for this study.

Correspondence: Kimberly Page, PhD, MPH, Department of Epidemiology and Biostatistics, University of California, San Francisco, 50 Beale St, Ste 1200, San Francisco, CA 94105. E-mail:

Received for publication January 29, 2010, and accepted June 6, 2010.

© Copyright 2011 American Sexually Transmitted Diseases Association