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HIV in Cambodia

Amphetamine-type stimulant use increases HIV risk among young women engaged in sex work in Phnom Penh, Cambodia. M-C Couture, N Sansothy, ES Stein, J Evans, K Sichan, L Maher, and K Page (Young Women’s Health Study). HIV in Cambodia. Cambodia: one of the Asia’s most severe epidemic.

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HIV in Cambodia

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  1. Amphetamine-type stimulant use increases HIV risk among young women engaged in sex work in Phnom Penh, Cambodia M-C Couture, N Sansothy, ES Stein, J Evans, K Sichan, L Maher, and K Page (Young Women’s Health Study)

  2. HIV in Cambodia • Cambodia: one of the Asia’s most severe epidemic • Contributing factors: • Poverty • High levels of STI • Highly mobile workforce • Patronage of female sex workers (FSWs) • HIV prevalence (general population): • 2.7% (2001) to 0.9% (2007) • FSWs: a high risk population • Brothel-based sex workers (direct) • Entertainment/drinking establishments (indirect) • Freelancers: parks, streets, private apartments

  3. HIV prevalence in Cambodian FSWs

  4. Amphetamine-Type Stimulants • ATS use has been increasing dramatically throughout Southeast Asia, and Cambodia. • Associated with increased risk behaviors and incidence of STI/HIV • Main ATS observed in Cambodia: • Methamphetamine in pills (yama) • Methamphetamine in crystalline form (ice/crystal) • ATS use may lead to a reversal of the downward trend in HIV rates in Cambodia • No studies have examined the prevalence of ATS and its effect on sexual behaviors and HIV/STI infection in this population

  5. Objective Examine the prevalence of ATS use and its effect on sexual behaviors and STI infection among young FSWs in Phnom Penh, Cambodia • Institute of Global Health- UCSF • Cambodia National Center for HIV, AIDS, Dermatology and STDs (NCHADS) • Cambodian Women’s Development Agency (CWDA) • National Centre for HIV Epidemiology and Clinical Research (NCHECR), UNSW Australia

  6. Young Women’s Health Study 1 • Design: One year prospective cohort study • Population: young at-risk women working in the sex and entertainment industry in Phnom Penh Inclusion criteria: • Aged 15-29 years • Reporting >2 different sexual partners in the last month OR engaging in transactional sex within the last 3 months • Both HIV positive and negative women are enrolled • Recruitment: Convenience sample recruited in brothels, entertainment/drinking establishments, streets, parks and private apartments

  7. YWHS-1(June 2007-2008) Quarterly visits Structured questionnaire Blood samples: HIV Urine samples: Chlamydia and Gonorrhea(3 and 12-month visits) HIV referral and tracking Data collection

  8. Statistical analysis Effect of recent ATS use (last 3 months) - Bivariate analyses and multivariate models - Outcomes: 1. Number of partners • -Negative binomial regression models (data from all visits) • -Stratified by type of sex work venue 2. Inconsistent condom use • -Generalized estimating equations (data from all visits) • -Stratified by type of sex work venue 3. Incident STI (Chlamydia and Gonorrhea) -Logistic regression (data from 6-month visit for ATS use and 12-month visit for incident STI)

  9. Results

  10. Results Number of sex partners (last month) ** p≤0.01; * p≤0.05 † Adjusted for age, education, condom use, # days drunk, HIV status

  11. Results Inconsistent condom use (with last partner) * p≤0.05 † Adjusted for age, education, # of sex partners, # days drunk, HIV status

  12. Results Incident STI * p≤0.05 † Adjusted for age, education, # of sex partners, condom use, # days drunk, and working as freelance

  13. Conclusions • ATS use is prevalent among young women engaged in sex work in Phnom Penh • Recent ATS use was higher among women working in brothels and as freelance FSWs • Associations with risky sexual behaviors and STI infection = urgency of addressing drug use issues among these young women • Integration of drug use prevention interventions into HIV/STI programs

  14. Acknowledgments • UCSF • Kimberly Page • Ellen Stein • Jennifer Evans • Joel Palefsky • NCHADS • Vonthanak Sapphon • Mean Chi Vun • Neth San Sothy • TSP clinic staffs • CWDA • Serey Phal • Keo Sichan • Outreach workers • UNSW • Lisa Maher • John Kaldor • All participants • Public Health Institute • - Tooru Nemoto Couture MC, et al.. Young women engaged in sex work in Phnom Penh, Cambodia have high incidence of HIV and STI, and amphetamine-type stimulant use: new challenges to HIV prevention and risk. In Press in STD journal Maher L et al. “it makes us dare to do what we did not dare to do before”: amphetamine-type stimulants use and HIV/STI risk behaviors among young female sex workers in Phnom Penh Cambodia. Wednesday July 21st 16:30 SR 5. Sansothy N et al: Poster TUPE0354 Tuesday July 20th Keo s. et al. : Poster TPHE1004 Thursday July 22nd

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