Cambodia: Inexperienced prostitutes most at risk of sexual infections

Less experienced prostitutes are more likely to have sexually transmitted infections (STIs). A study of more than a thousand female sex workers in Cambodia, reported in the open access journal BMC Infectious Diseases, has shown that girls who were new to the sex industry were twice as likely to have gonorrhoea or chlamydia.

Heng Sopheab from the University of Bergen, Norway, and the National Center for HIV/AIDS, Dermatology and STDs, Cambodia, led a team of researchers who investigated the prevalence of STIs and the health behaviour of female sex workers in the popular tourist destination of Cambodia. He said, "Of the women we studied, 60% were new workers, having been selling sex for less than a year. Prevalence of gonorrhoea, chlamydia, or any STI was higher among these new workers; overall they were 2.1 times more likely to be infected than more experienced women".

The overall STI prevalence in the Cambodian workers was 2.3% for syphillis, 13.0% for gonorrhoea and 14.4% for chlamydia. This is the first time that the association between STI prevalence and recent entry into the sex trade has been studied in Cambodia. The obvious explanation is that newer workers are more likely to engage in high-risk behaviour because they lack prevention information, are unaware of STI services and are less skilled and experienced in negotiating safer sex with clients. However, according to Sopheab, "Our analysis did not reveal any significant differences between new and longer-working women in terms of socio-demographic characteristics and risk behaviours that might explain the significant difference in prevalence of STIs. Therefore, a biological difference between new and more experienced sex workers is one possible explanation".

In 2001, a nationwide government programme was implemented to encourage 100% condom usage within the Cambodian sex industry. The authors found that despite the implementation this programme, STI prevalence remains comparable to the 2001 estimates. As well as a large proportion of women who reported having unprotected sex with non-commercial partners, there was limited coverage and weaknesses in implementation of the policy. The authors conclude, "This is likely to have contributed to the sustained high prevalence of STIs among sex workers in Cambodia. The 100% condom-use policy should be carefully evaluated, particularly in terms of human resource capacity, sustainable intensity, quality, and coverage".

1. "Sustained high prevalence of sexually transmitted infections among female sex workers in Cambodia: high turnover seriously challenges the 100% condom use programme", Heng Sopheab, Guy Morineau, Joyce J Neal, Vonthanak Saphonn and Knut Fylkesnes, BMC Infectious Diseases (in press)