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Sexual behavioural study of commercial sex workers and their clients in Cambodia

Morio, Shinsukea; Soda, Kenjib; Tajima, Kazuoc; Leng, Hor Bundother members of the Japan-Cambodia Collaborating Research Group


aKochi Prefectural Tosa-shimizu Health Center, 4-5 Nishi-machi, Tosa-shimizu-shi, Kochi Prefecture, 787-0333 Japan; bDepartment of Public Health, School of Medicine, Yokohama City University; Yokohama, Japan; cDepartment of Epidemiology, Aichi Cancer Center Research Institute, Aichi, Japan; dNational HIV/AIDS Programme, AIDS Office, Ministry of Health, Kingdom of Cambodia.

*The Japan-Cambodia Collaborating Research Group: Dr Kenji Soda (Chief), Drs Katsuhiro Kitamura, Shunsaku Mizushima, Kenji Ohshige (Yokohama City University, Japan), Dr Kazuo Tajima (Aichi Cancer Center Research Institute, Japan), Dr Shinsuke Morio, Ms Fen-zhu Tan, Dr Akihiko Suyama (Tottori University, Japan), Ms Keiko Namiki (System Science Consultants Inc., Japan), Drs Hor Bun Leng, Tia Phalla, Heng Sopeab, Sok Bunna, Mun Phallcun, and Ms Ek Someth (Ministry of Health, Cambodia).

Received: 11 March 1998; revised: 19 April 1999; accepted: 27 April 1999.

South-east Asia is one of the regions where HIV/AIDS is highly epidemic, with Thailand and Vietnam famous for epidemics of HIV among commercial sex workers (CSW). Myanmar and the southern part of China is famous for epidemics among intravenous drug users. Cambodia, which is surrounded by these countries, is no exception. Information relating to the HIV/AIDS epidemic in Cambodia is limited [1-3], although this limited information shows that there has been a rapid and prevalent HIV/AIDS epidemic among the Cambodian population.

The study sample consisted of three groups: direct commercial sex workers (DCSW); indirect commercial sex workers (IDCSW); and their clients in Phnom Penh, Cambodia. DCSW were female CSW who were living at brothels in the red light areas of Phnom Penh. The number of DCSW interviewed in the Toul Kork Dike, Trolauk Bek, and Chaum Chao areas was 200. IDCSW were women who were working for beer companies as beer promotion girls or for massage parlours as masseuses in Phnom Penh. The number of IDCSW interviewed who were beer promotion girls and masseuses was 220. Clients were men belonging to AIDS risk groups and were working in Phnom Penh, as soldiers, policemen, or were unemployed. The number of clients interviewed was 211.

The questions asked were about age, sex, nationality, home town, job (only for IDCSW and clients), marriage status, sexual activities, usage of condoms, knowledge of sexually transmitted diseases (STD) and AIDS, past history of STD, and social support (only for DCSW and IDCSW). The questionnaires were made in English and translated into Khmer. The number of questions asked was 32 for DCSW, 31 for IDCSW, and 29 for clients. All interviewers were staff from the National HIV/AIDS Programme, AIDS Office, Ministry of Health, Kingdom of Cambodia, and received lectures about this study and the questionnaires from a researcher of the study before the interviews. The interviews were performed from October 1996 to January 1997.

The mean ages of DCSW, IDCSW, and clients were 20 years (range: 15-34 years), 23 (range: 13-37 years), and 31 (range: 18-56 years), respectively. For DCSW, the frequency of sexual intercourse with clients per day was higher than the number for IDCSW. A total of 67 DCSW (34%) and no IDCSW (0%) answered that they had more than five clients a day. The mean personal incomes per day of DCSW and IDCSW were US$4.63 (range: US$1.00-20.00) and US$11.70 (range: US$18.50-85.00), respectively. A large difference was noted in the usage of condoms between DCSW and IDCSW. A total of 125 DCSW (63%) and 18 IDCSW (8%) answered that they used condoms every time. The main methods of getting condoms were being provided with them by the owners of brothels (75%), buying them themselves or being given them by friends (80%) in DCSW and IDCSW, respectively. Incidentally, 112 clients (53%) answered that they used condoms every time.

Many DCSW and also IDCSW had a past history of infection of STD (Table 1). A total of 164 DCSW (82%) and 70 IDCSW (32%) answered that they had had STD in the past. The three most prevalent STD were vaginal discharge, gonorrhoea, and genital warts. Many of them had been treated by physicians in public hospitals or private clinics. However, 69 DCSW (42%) and 19 IDCSW (12%) had treated themselves by purchasing drugs. Among the clients, 10 and 14% of them had had ulcers in the genital region and urination pain/discharge, respectively, in the past year. Half of them had treated themselves with drugs.

Table 1

Table 1

Advisers for many DCSW were the owners of their brothels (answer rate: 67%) or their girlfriends (answer rate: 26%), and only six (4%) answered: persons from a non-governmental organization. A total of 85 (51%), 65 (39%), and 18 (11%) IDCSW answered that they obtained advice from their parents, their husbands/boyfriends, and their girlfriends, respectively. Furthermore, a few IDCSW answered: relatives, medical assistants, or the owners of their place of work.

In Cambodia, prostitution is prohibited by law, but having sexual intercourse with CSW is commonly accepted among young men. Many young men (soldiers, policemen, and unemployed men) frequently have sexual intercourse with CSW. Condoms have seldom been used by CSW and young men, and not all STD-infected people are treated by physicians. Many CSW and young men suffer from STD. As a counter measure against this situation, government medical clinics for CSW, especially for DCSW, are required. Such clinics should be located at places near the red light areas and should provide preventative education, free laboratory tests, and free treatment of STD. It is also necessary that the activities of non-governmental organizations should be strengthened to support CSW in taking care of their health.

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1. Richner B, Laurent D, Sunnarat Y, Bee D, Nadal D. Spread of HIV-1 to children in Cambodia. Lancet 1997, 349:1451.
2. Soeprapto W, Ertono S, Hudoyo H, et al. HIV and peacekeeping operations in Cambodia. Lancet 1995, 346:1304-1305.
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© 1999 Lippincott Williams & Wilkins, Inc.