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
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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)