title: Sex work and HIV in Cambodia: trajectories of risk and disease in two cohorts of high-risk young women in Phnom Penh, Cambodia.
abstract: OBJECTIVE
  HIV prevalence among Cambodian female sex workers (FSW) is among the highest in Southeast Asia. We describe HIV prevalence and associated risk exposures in FSW sampled serially in Phnom Penh, Cambodia (Young Women's Health Study (YWHS)), before and after the implementation of a new law designed to combat human trafficking and sexual exploitation.
  
  
  METHODS
  Cross-sectional analysis of baseline data from two prospective cohorts.
  
  
  METHODS
  Community-based study in Phnom Penh, Cambodia.
  
  
  METHODS
  Women aged 15-29 years, reporting ≥2 sexual partners in the last month and/or engaged in transactional sex in the last 3 months, were enrolled in the studies in 2007 (N=161; YWHS-1), and 2009 (N=220; YWHS-2) following information sessions where 285 and 345 women attended.
  
  
  METHODS
  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.
  
  
  RESULTS
  Participants in the two cohorts were similar in age (median 25 years), but YWHS-2 women reported fewer sex partners, more alcohol use and less ATS use. A higher proportion of YWHS-2 compared with YWHS-1 women worked in entertainment-based venues (68% vs 31%, respectively). HIV prevalence was significantly lower in the more recently sampled women: 9.2% (95% CI 4.5% to 13.8%) vs 23% (95% CI 16.5% to 29.7%).
  
  
  CONCLUSIONS
  Sex work context and risk have shifted among young FSW in Phnom Penh, following implementation of anti-prostitution and anti-trafficking laws. While both cohorts were recruited using the same eligibility criteria, more recently sampled women had lower prevalence of sexual risk and HIV infection. Women engaging more directly in transactional sex have become harder to sample and access. Future prevention research and programmes need to consider how new policies and demographic changes in FSW impact HIV transmission.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, and Global Health Sciences, San Francisco, California, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Page
authors.forename: Ellen
authors.initials: E
authors.lastname: Stein
authors.forename: Neth
authors.initials: N
authors.lastname: Sansothy
authors.forename: Jennifer
authors.initials: J
authors.lastname: Evans
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Couture
authors.forename: Keo
authors.initials: K
authors.lastname: Sichan
authors.forename: Melissa
authors.initials: M
authors.lastname: Cockroft
authors.forename: Julie
authors.initials: J
authors.lastname: Mooney-Somers
authors.forename: Pisith
authors.initials: P
authors.lastname: Phlong
authors.forename: John
authors.initials: J
authors.lastname: Kaldor
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
keywords: EPIDEMIOLOGY
references.citation: Drug Alcohol Depend. 2012 Jan 1;120(1-3):119-26
references.pmid: 21820251
references.citation: AIDS Educ Prev. 2004 Jun;16(3 Suppl A):64-77
references.pmid: 15262566
references.citation: J Med Assoc Thai. 1988 Sep;71(9):471-4
references.pmid: 3249178
references.citation: BMJ. 2009 Aug 11;339:b2939
references.pmid: 19671935
references.citation: Lancet. 2003 May 31;361(9372):1878-9
references.pmid: 12788585
references.citation: Sex Transm Dis. 2011 Jan;38(1):33-9
references.pmid: 21085056
references.citation: Sex Transm Dis. 2013 Jun;40(6):462-8
references.pmid: 23680902
references.citation: J Urban Health. 2006 Nov;83(6 Suppl):i16-28
references.pmid: 17031567
references.citation: Lancet. 2002 Jun 1;359(9321):1927
references.pmid: 12057566
references.citation: N Engl J Med. 2010 Dec 30;363(27):2587-99
references.pmid: 21091279
references.citation: J Immunol. 2012 May 15;188(10):5177-88
references.pmid: 22508927
references.citation: J Acquir Immune Defic Syndr. 2003 Jun 1;33(2):259-66
references.pmid: 12794564
references.citation: J Prev Interv Community. 2010;38(2):118-31
references.pmid: 20391059
references.citation: AIDS. 2001 Apr;15 Suppl 3:S33-40
references.pmid: 11421180
references.citation: Sex Transm Dis. 2005 Dec;32(12):745-51
references.pmid: 16314771
references.citation: BMJ. 2002 Jan 26;324(7331):207-11
references.pmid: 11809643
references.citation: BMC Infect Dis. 2008 Dec 12;8:167
references.pmid: 19077261
references.citation: AIDS Behav. 2009 Jun;13(3):462-9
references.pmid: 19294500
references.citation: Harm Reduct J. 2011 Nov 20;8:30
references.pmid: 22099449
references.citation: AIDS. 2008 Aug 20;22(13):1659-65
references.pmid: 18670227
references.citation: Lancet Infect Dis. 2012 Jul;12(7):538-49
references.pmid: 22424777
references.citation: Soc Sci Med. 2008 Feb;66(4):911-21
references.pmid: 18155336
references.citation: AIDS. 2004 Jan 23;18(2):311-6
references.pmid: 15075550
references.citation: AIDS Care. 2011 Jan;23(1):69-74
references.pmid: 21218278
references.citation: Psychiatry Clin Neurosci. 2004 Apr;58(2):206-12
references.pmid: 15009828
references.citation: Int J STD AIDS. 2005 Feb;16(2):170-4
references.pmid: 15807948
references.citation: J Acquir Immune Defic Syndr. 2006 Jun;42(2):242-7
references.pmid: 16639348
references.citation: J Acquir Immune Defic Syndr. 2005 Aug 15;39(5):587-92
references.pmid: 16044012
references.citation: Addiction. 2002 Jul;97(7):771-2
references.pmid: 12133111
references.citation: AIDS Behav. 2011 Jul;15(5):911-8
references.pmid: 21153762
references.citation: J Infect Dis. 2011 Dec 1;204 Suppl 5:S1223-8
references.pmid: 22043036
references.citation: Addict Sci Clin Pract. 2012 Jun 28;7:11
references.pmid: 23186171
references.citation: J Med Assoc Thai. 2001 Sep;84(9):1263-7
references.pmid: 11800299
references.citation: Addiction. 2002 Jul;97(7):801-8
references.pmid: 12133118
references.citation: J Urban Health. 2010 Mar;87(2):292-303
references.pmid: 20143269
references.citation: HIV AIDS Policy Law Rev. 2005 Dec;10(3):31, 33
references.pmid: 16544410
references.citation: BMJ. 2003 Feb 8;326(7384):308
references.pmid: 12574043
references.citation: Prev Sci. 2007 Jun;8(2):141-51
references.pmid: 17265194
references.citation: Forensic Sci Int. 2003 Sep 9;136(1-3):47-51
references.pmid: 12969619
references.citation: Int J Drug Policy. 2011 May;22(3):203-9
references.pmid: 21316935
references.citation: AIDS. 2009 Jul 17;23(11):1389-95
references.pmid: 19487909
references.citation: Int J STD AIDS. 2004 Jul;15(7):479-83
references.pmid: 15228734
references.citation: Lancet. 2008 Nov 22;372(9652):1805-6
references.pmid: 19027478
references.citation: J Infect Dis. 2011 Dec 1;204 Suppl 5:S1206-10
references.pmid: 22043033
references.citation: Drug Alcohol Depend. 2002 Dec 1;68(3):245-53
references.pmid: 12393219
references.citation: J Infect Dis. 2011 Dec 1;204(11):1730-40
references.pmid: 21984735
references.citation: Science. 2010 Sep 3;329(5996):1168-74
references.pmid: 20643915
references.citation: Ann N Y Acad Sci. 2004 Oct;1025:446-57
references.pmid: 15542748
references.citation: AIDS. 2008 Dec;22 Suppl 5:S91-100
references.pmid: 19098483
references.citation: Women Health. 2002;35(4):27-42
references.pmid: 12216990
references.citation: Sex Transm Infect. 2003 Aug;79(4):e2
references.pmid: 12902610
references.citation: J Prev Interv Community. 2010;38(2):104-17
references.pmid: 20391058
references.citation: Int J STD AIDS. 2004 Oct;15(10):697-704
references.pmid: 15479508
references.citation: Forensic Sci Int. 2004 Aug 11;144(1):29-36
references.pmid: 15240018