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The first, Young Women's Health Study (YWHS-1), was conducted in 2007–2008 and the second, YWHS-2, in 2009–2010.5 46 In this paper, we explore the changing HIV risk landscape by comparing and contrasting the two cohorts of FSW sampled prior to, and following, legislative changes designed to combat human trafficking and sexual exploitation in Cambodia.
We theorise that the demographic characteristics and HIV risk of FSW has shifted as a result of sociolegal change induced by the implementation of the new legislation.
In both studies, women were remunerated US at each study visit for their participation time.
All data collection occurred at the YWHS clinic, which was staffed by a physician, nurses, counsellors and a laboratory technician. STI treatment was provided at no cost, and women with HIV and HPV infection were referred to a local provider for free medical evaluation and treatment.
Future prevention research and programmes need to consider how new policies and demographic changes in FSW impact HIV transmission.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
CT and GC were assessed from urine samples using the BDProbe Tec strand displacement amplification assay (Becton Dickinson, Sparks, Maryland, USA) at the NCHADS STD laboratory.5 Cervical specimens for HPV testing were collected using a standard cytobrush.47 Client-centred risk reduction counselling was provided in association with all testing.
The study protocols were reviewed and approved by the Institutional Review Board of the Committee on Human Research at UCSF, the Cambodian National Ethics Committee and the UNSW Human Research Ethics Committee in accordance with ethical standards (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
Primary outcomes HIV prevalence, sexual risk behaviour, amphetamine-type stimulant (ATS) and alcohol use, and work-related factors were compared in the two groups, enrolled before and after implementation of the new law.With changes in sex work venues, this prevention approach is quite likely to be less effective, failing to reach the large number of women now engaged in transactional sex in entertainment establishments.Indeed, measures of self-reported condom use have declined according to the monitoring data reported by UNAIDS.10 New risk factors have also emerged, especially amphetamine-type stimulant (ATS) use, in the form of ‘yama’, (pills) and ‘ice’ (a crystalline form).28–38 ATS use is associated with increased sexual risk behaviour and STI incidence among these young women,5 39 similar to that seen in other populations and locales.40–44 We conducted two prospective studies of high-risk young women engaged in transactional sex in Phnom Penh, the principal research questions focused on estimating HIV and STI prevalence and incidence and associated risk factors.39 Both studies were led by a multidisciplinary collaborative prevention research group from NCHADS, the Cambodian Women's Development Association (CWDA), the University of California in San Francisco (UCSF) in the USA and the Kirby Institute at the University of New South Wales (UNSW) in Australia.The target population in both studies was young women engaged in transactional sex in Phnom Penh.
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NGOs working in HIV prevention reported that as transactional sex was displaced to a wider range of settings, women at highest risk became harder to reach for both prevention and service delivery.16 25 These factors pose significant challenges to HIV prevention and threaten to undermine progress achieved to date.