title: The impact of a community-based HIV and sexual reproductive health program on sexual and healthcare-seeking behaviors of female entertainment workers in Cambodia.
abstract: BACKGROUND
  In Cambodia, despite great successes in the fight against HIV, challenges remain to eliminating new HIV infections and addressing sexual reproductive health (SRH) issues in key populations including female entertainment workers (FEWs). To address these issues, the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project has been implemented since late 2009 using a community-based approach to integrate HIV and SRH services. This study evaluates the impact of the SAHACOM on sexual and healthcare-seeking behaviors among FEWs in Cambodia.
  
  
  METHODS
  A midterm and endpoint comparison design was utilized. Midterm data were collected in early 2012, and endpoint data were collected in early 2014. A two-stage cluster sampling method was used to randomly select 450 women at midterm and 556 women at endpoint for face-to-face interviews.
  
  
  RESULTS
  Compared to women at midterm, women at endpoint were significantly less likely to report having sexual intercourse in exchange for money or gifts in the past three months (OR = 2.1, 95 % CI = 1.6-2.7). The average number of commercial sexual partners in the past three months also decreased significantly from 5.5 (SD = 13.3) at midterm to 3.6 (SD = 13.9) at endpoint (p = 0.03). However, women at endpoint were significantly less likely to report always using condom when having sexual intercourse with clients in exchange for money or gifts (OR = 2.6, 95 % CI = 1.5-4.5). Regarding sexually transmitted infections (STIs), women at endpoint were significantly less likely to report having an STI symptom in the past three months (OR = 1.8, 95 % CI = 1.4-2.3) and more likely to seek treatment for the most recent STI symptom (OR = 1.6, 95 % CI = 1.1-1.9). Furthermore, women at endpoint were significantly more likely to be currently using a contraceptive method (OR = 1.4, 95 % CI = 1.1-1.8) and less likely to report having an induced abortion (OR = 1.4, 95 % CI = 1.1-1.7) during the time working as a FEW.
  
  
  CONCLUSIONS
  The overall findings of the study indicate that the SAHACOM is effective in reducing sexual risk behaviors and improving the access to SRH care services among FEWs in Cambodia. However, several unfavorable findings merit attention.
authors.affiliation: Research Center, No. 33, Street 71, P.O Box 2311, Phnom Penh, Khana, Cambodia. siyan@doctor.com.|Public Health Program, College of Education and Health Sciences, Touro University-California, California, USA. siyan@doctor.com.
authors.forename: Siyan
authors.initials: S
authors.lastname: Yi
authors.affiliation: Research Center, No. 33, Street 71, P.O Box 2311, Phnom Penh, Khana, Cambodia. tsovannary@khana.org.kh.
authors.forename: Sovannary
authors.initials: S
authors.lastname: Tuot
authors.affiliation: Research Center, No. 33, Street 71, P.O Box 2311, Phnom Penh, Khana, Cambodia. cpheak@khana.org.kh.
authors.forename: Pheak
authors.initials: P
authors.lastname: Chhoun
authors.affiliation: Public Health Program, College of Education and Health Sciences, Touro University-California, California, USA. carinne.brody@tu.edu.
authors.forename: Carinne
authors.initials: C
authors.lastname: Brody
authors.affiliation: Research Center, No. 33, Street 71, P.O Box 2311, Phnom Penh, Khana, Cambodia. tkhimuy@khana.org.kh.
authors.forename: Khimuy
authors.initials: K
authors.lastname: Tith
authors.affiliation: Research Center, No. 33, Street 71, P.O Box 2311, Phnom Penh, Khana, Cambodia. osopheap@khana.org.kh.
authors.forename: Sopheap
authors.initials: S
authors.lastname: Oum
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D002160:Cambodia; D017280:Condoms; D003271:Contraceptive Agents, Female; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D007407:Interviews as Topic; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy; D016730:Program Development; D060728:Reproductive Health; D012725:Sexual Behavior / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female