Condom negotiation across different relationship types by young women engaged in sex work in Phnom Penh, Cambodia

Abstract

Cambodia's 100% Condom Use Programme is credited with an increase in consistent condom use in commercial sexual interactions and a decrease in HIV prevalence among female sex workers (FSWs). There has been little improvement in condom use between FSWs and non-commercial partners, prompting calls for more innovative approaches to increasing condom use in these relationships. To understand why condoms are used or not used in sexual interactions involving FSWs, we examined condom negotiation across different types of relationships. We conducted 33 in-depth interviews with young (15 to 29 years) women engaged in sex work in Phnom Penh. There was an important interplay between the meanings of condom use and the meanings of women's relationships. Commercial relationships were characterised as inherently risky and necessitated condom use. Despite a similar lack of sexual fidelity, sweetheart relationships were rarely construed as risky and typically did not involve condom use. Husbands and wives constructed their sexual interactions with each other differently, making agreement on condom use difficult. The lack of improvement in condom use in FSWs' non-commercial sexual relationships needs to be understood in relation to both sex work and the broader Cambodian sexual culture within which these relationships are embedded.

Keywords:

• female sex workers
• condoms
• sexually transmitted infections
• HIV
• Cambodia

Acknowledgements

We are indebted to the women who participated in the study and grateful for the privilege of working with them. We acknowledge the efforts of the CWDA research team, especially Chan Dyna, Tony Masy, Serey Mealy, Ly Vina, Chhuon Minea, Keo Sichan, Hun Phanna, Sok Phearum, Prak Saban, Khun Saveth, Ni Say, Sok Sreyleak and A Tyna. This study received financial support from the following National Institutes of Health (NIH) grants: U01AI0154241, 1R21 DA025441 and 1R01NR010995. Lisa Maher is supported by a National Health and Medical Research Council Senior Research Fellowship, and Marie-Claude Couture is supported by a Canadian Institutes of Health Research Postdoctoral Fellowship. The Kirby Institute is affiliated with the Faculty of Medicine, University of New South Wales, and is funded by the Australian Government Department of Health and Ageing. The views expressed here do not necessarily represent the position of the Australian Government or the Cambodian Ministry of Health.

Notes

John Kaldor, Serey Phal Kien, Lisa Maher, Tooru Nemoto, Kimberly Page, Joel Palefsky, Vonthanak Saphonn and Mean Chhi Vun are the members of Young Women's Health Study Collaborative.