Abstract: HIV, Amphetamine-Type Stimulant (ATS), and Alcohol Use in Cambodian Sex and Entertainment Workers: Results From Two Prospective Cohorts (Society for Prevention Research 21st Annual Meeting)
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390 HIV, Amphetamine-Type Stimulant (ATS), and Alcohol Use in Cambodian Sex and Entertainment Workers: Results From Two Prospective Cohorts

Schedule:
Thursday, May 30, 2013
Pacific D-O (Hyatt Regency San Francisco)
* noted as presenting author
Kimberly Page, PhD, Professor in Residence, University of California, San Francisco, San Francisco, CA
Ellen Stein, MPH, Academic Coordinator, University of California, San Francisco, San Francisco, CA
Jennifer Evans, MS, Senior Statistician, University of California, San Francisco, San Francisco, CA
Neth San Sothy, MD, Program Director, National Centre for HIV/AIDS, Dermatology, and STI, Phnom Penh, Cambodia
Keo Sichan, BA, Project Director, Cambodia Women's Development Association, Phnom Penh, Cambodia
Marie-Claude Couture, PhD, Researcher, University of California, San Francisco, San Francisco, CA
Lisa Maher, PhD, Program Head and NHMRC Senior Research Fellow, University of New South Wales, Sydney, Australia
Background: HIV rates among Cambodian women are among the highest in Southeast Asia, and women engaged in sex work (SW) are the most impacted. The number of women engaged in sex work (SW), including those working as Entertainment Workers (EW) increased by 300% between 2002 and 2009. We investigated HIV, STI and substance use risk in two prospective cohorts: Young Women’s Health Study-1 & -2 (YWHS).

Methods:  Female SWs aged 15-29 years, were enrolled in 2007 (YWHS-1) and 2009 (YWHS-2), and followed quarterly for 1 year. We assessed HIV, STI, pregnancy, sexual risk, amphetamine-type stimulant (ATS), and alcohol use. Prevalence and incidence of HIV/STI (per 100 person-years observation [PYO]) were estimated. Bivariate and multivariate analyses were conducted.

Results: 160 and 220 women were enrolled in YWHS-1 and YWHS-2, respectively. Median age was 25 years, time working as a SW was 3.9 years. HIV prevalence and incidence in YWHS-1 was 23% (95% CI, 16.5-29.7) and 3.6/100 PYO (95% CI, 1.2-11.1), and in YWHS-2, 15.5% (95% CI,10.6-20.3), and 1.2/100 PYO (95%CI, 0.3,4.8). Chlamydia and Gonorrhoea incidence was 18.2/100 PYO and 6.1/100 PYO, respectively (YWHS01). 41% of YWHS-2 women were HPV positive. In both groups, recent (past 3 months) ATS use was high, 25%; and ATS was independently associated with more sex partners and STIs.  Reported consistent condom use was high (88%) with paying partners, but not non-paying (18%). Pregnancy incidence was 22/100 PYO. The proportion of women working as EW increased significantly in YWHS-2 (68% vs. 31% in YWHS-1). Freelance SWs reported more ATS use, and EWs more alcohol and inconsistent condom use.  

Conclusions: While HIV prevalence and incidence declined between the two cohorts, prevalence of recent ATS and alcohol use remained high. Recent ATS use among brothel/street-based SWs increased from 36% in 2007 (YWHS-1) to 58% in 2009 (YWHS-2). HIV prevention efforts for SW in Cambodia, largely focused on condom use and HIV testing, need to be bolstered with interventions to mitigate drug and alcohol use and increase access to reproductive health care. Shifts in SW venues may contribute to new risks for HIV among young women.

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