The risk environment framework provides a valuable but under-utilised heuristic for understanding environmental vulnerability to HIV and other sexually transmitted infections among female sex workers. Brothels have been shown to be safer than street-based sex work, with higher rates of consistent condom use and lower HIV prevalence. While entertainment venues are also assumed to be safer than street-based sex work, few studies have examined environmental influences on vulnerability to HIV in this context.
As part of the Young Women’s Health Study, a prospective observational study of young women (15-29 years) engaged in sex work in Phnom Penh, we conducted in-depth interviews (n=33) to explore vulnerability to HIV/STI and related harms. Interviews were conducted in Khmer by trained interviewers, transcribed and translated into English and analysed for thematic content.
The intensification of anti-prostitution and anti-trafficking efforts in Cambodia has increased the number of women working in entertainment venues and on the street. Our results confirm that street-based sex work places women at
risk of HIV/STI infection and identify significant environmental risks related to entertainment-based sex work, including limited access to condoms and alcohol intoxication.
Our data also indicate that exposure to violence and interaction with the police are mediated by the settings in which sex is sold. In particular, transacting sex in environments such as guest houses where there is little or nooversight in the form of peer or managerial support or protection, may increase
vulnerability to HIV/STI.
Entertainment venues may also provide a high risk environment for sex work. Our results indicate that strategies designed to address HIV prevention among brothel-based FSWs in Cambodia have not translated well to street and entertainment-based sex work venues in which increasing numbers of women are working.
There is an urgent need for targeted interventions, supported by legal and policy reforms, designed to reduce the environmental risks of sex work in these settings. Future research should seek to investigate sex work venues as risk environments, explore the role of different business models in mediating these environments, and identify and quantify exposure to risk in different occupational settings.
Comment.
The conclusion of the study is that there is ‘a need for targeted interventions…that attempt to reduce the occupational risks of sex work in specific settings’.
It is difficult to understand why this article does not acknowledged the achievements of existing sex worker group. For example when the law against sexual exploitation and trafficking was introduced in 2009 ‘rescued’ sex workers were put in detention centres where their human rights were systematically violated and rape was common. Now, as a direct result of sex worker advocacy, sex workers who do not want to be treated as trafficking victims ( 95% of them) are released into the custody of Phnom Penh’s only sex worker group. The same group, WNU, reaches most of Phnom Penh’s street sex workers with condoms and information.
Another surprising aspect of this study is that it classifies sexually abused young people of 15 years in the same category as consenting adults. That this was accepted by various ethics commitees and the local agencies involved is very worrying .
