sexually transmitted infections among female sex workers in Cambodia

sexually transmitted infections among female sex workers in Cambodia: high turnover seriously challenges the 100% Condom Use Programme. BMC Infect Dis. 2008;8:167.

Cambodia ’s 100% Condom-Use Programme, implemented nationally in 2001, requires brothel-based female sex workers to use condoms with all clients. In 2005, Sopheab et al conducted a sexually transmitted infection survey among female sex workers. This paper presents sexually transmitted infection prevalence and related risk factors, and discusses prevalence trends in the context of the 100% Condom-Use Programme in Cambodia. From March-May, 1079 female sex workers from eight provinces consented to participate, provided specimens for syphilis, chlamydia, and gonorrhoea testing, and were interviewed. Univariate and multivariate logistic regression analysis was used to determine factors associated with sexually transmitted infections. The prevalence of sexually transmitted infection was compared with data from the 1996 and 2001 sexually transmitted infection surveys. Most female sex workers were young (55% aged 15-24) and new to sex work ( 60% had worked 12 . Consistent condom use with clients was reported by 80% of female sex workers, but only 38% of female sex workers always used condoms with sweethearts or casual partners. Being new to sex work was the only factor significantly associated with “any sexually transmitted infection” (OR = 2.1). Prevalence of syphilis was 2.3%; chlamydia, 14.4%; gonorrhoea, 13.0%; and any sexually transmitted infection, 24.4%. Prevalence of each sexually transmitted infection in 2005 was significantly lower than in 1996, but essentially the same as prevalence observed in 2001. New female sex workers were found to have substantially higher prevalence than those with longer experience. The percent of female sex workers who used condoms consistently was high with clients but remained low with non-paying sex partners. Because of the high turnover of female sex workers, the prevention needs of new female sex workers should be ascertained and addressed. Despite 100% Condom-Use Programme implementation, the prevalence of sexually transmitted infections among female sex workers was the same in 2005 as it was in 2001. Limited coverage and weak implementation capacity of the programme along with questionable quality of the sexually transmitted infection services are likely to have contributed to the sustained high prevalence. The programme should be carefully reviewed in terms of intensity, quality, and coverage.

Editors’ note: Successful 100% condom use programmes in Thailand in late 1989 and Cambodia in late 1998 were rigorously conducted with high coverage and intensity. Sustaining such results given the high turnover among sex workers requires regular evaluations of programme quality and impact. Using curable bacterial sexually transmitted infection prevalence makes sense as they are good biological markers reflecting recent risk behaviour but different data collection methods, specimen-sampling techniques, and laboratory methods can make comparison of survey results hazardous. One thing is clear – Cambodia’s 100% condom-use programme, implemented nationally in 2001, should focus attention on ascertaining and addressing the prevention needs of new sex workers.