Date Published: July 2, 2018
Publisher: Public Library of Science
Author(s): Siyan Yi, Sovannary Tuot, Pheak Chhoun, Khuondyla Pal, Kolab Chhim, Chanrith Ngin, Carinne Brody, Kimberly A. Page.
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.
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.
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).
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.
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 .
About half of FEWs (52.3%) in our study had been tested for HIV in the past six months, and 81.7% had been tested in lifetime. Compared to past studies with similar populations, these rates may represent an improvement. In 2009, a study in Cambodia found that sex workers had a lifetime prevalence of HIV testing of 79.7%, and three months testing prevalence of 22.2% . A situational analysis of FEWs in Cambodia in 2012 found that four out of 41 participants had ever been tested for HIV, although this study was not designed to be representative of FEWs in the cities where the study was conducted . In China, a study of female sex workers in the southeast found that 48% had ever been tested for HIV . It is difficult to compare HIV testing rates of FEWs in Cambodia to other studies because many focus exclusively on female sex workers or measure testing rates at different time intervals. Nevertheless, our findings suggest that the recent testing rate for FEWs is much lower than the 90% goal of recent HIV testing (in every six months) that the nation sets for key populations such as FEWs. This may explain HIV testing fatigue among the women. FEWs may not want to get tested for HIV frequently if they are not aware of the recommendation of testing frequency for individuals who engage in high-risk behaviors. Moreover, despite their engagement in HIV risks, a large proportion of FEWs in this study did not perceive themselves as being at elevated risks.
FEWs with greater knowledge about 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 increasing outreach to groups that have not yet been reached with HIV education. In particular, supporting changes in beliefs and norms around healthy sexual practices could have an important role to play in getting to 90% coverage for recent testing. Some methods may include behavioral models that offer tailored health behavior messages around HIV testing practices as well as specific topics such as condom use with non-commercial partners. In addition, efforts to reduce stigma around HIV testing and knowing one’s HIV status may improve attitudes towards HIV testing and, therefore, may be important areas for future programming for FEWs in Cambodia.