Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study

PLOS ONE, Nov 2019

Background 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.

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Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study

July Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study Siyan Yi 0 1 Sovannary Tuot 0 1 Pheak Chhoun 0 1 Khuondyla Pal 0 1 Kolab Chhim 0 1 Chanrith Ngin 0 1 Carinne Brody 0 0 Editor: Kimberly A. Page, University of New Mexico Health Sciences Center , UNITED STATES 1 KHANA Center for Population Health Research, Phnom Penh, Cambodia, 2 Public Health Program, College of Education and Health Sciences, Touro University California , Vallejo, CA , United States of America - 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). OPEN ACCESS Data Availability Statement: Data underlying the findings in this study are from an impact evaluation study of the Sustainable Action against HIV and AIDS in Communities (SAHACOM) Project. The data cannot be made available in the manuscript, the supplemental files, or a public repository due to the ethical restriction stated in the agreement with the National Ethics Committee for Health Research. However, all data are available upon request from KHANA at . Background Methods Results Funding: Data used for this study were collected as part of the impact evaluation of the Sustainable Action against HIV and AIDS in Communities that was funded by the United States Agency for International Development (USAID). The funding agency had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. 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. Introduction 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 (...truncated)


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Siyan Yi, Sovannary Tuot, Pheak Chhoun, Khuondyla Pal, Kolab Chhim, Chanrith Ngin, Carinne Brody. Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study, PLOS ONE, 2018, Volume 13, Issue 7, DOI: 10.1371/journal.pone.0198095