Abstract
Introduction
Cambodia has made notable progress in controlling the HIV epidemic, with new infections declining by 50% between 2010 and 2021. Despite this, HIV remains concentrated among key populations (KPs), particularly female entertainment workers (FEWs), who face high risks related to illicit substance abuse and unsafe sexual behaviors. This study aimed to assess the associations between behavioral risk factors, specifically illicit drug use and binge drinking, and sexual risk behaviors among FEWs in Cambodia.
Methods
Using data from the 2016 Integrated Biological and Behavioral Surveillance (IBBS), a total of 3,151 FEWs were analyzed. The key outcome variables were having paid sex partners in the past 12 months and inconsistent condom use in the past three months. The independent variables included illicit drug use and binge drinking. Descriptive statistics and bivariate analysis using chi-square tests were performed using STATA 14 SE to determine the association between behavioral risk factors and sexual risk behaviors.
Results
Most of the FEWs were karaoke women (70.6%), with an average age of 26.2 years (SD = 5.7). Over half (54%) reported having paid sex partners in the past 12 months, and close to 20% reported inconsistent condom use in the past three months. Illicit drug use was reported by 7.6% of participants, and most of them used amphetamine-type stimulants (ATSs). Additionally, 57.6% of FEWs reported binge drinking over the past week, especially among karaoke women. About 70% of the FEWs reported having HIV testing in the past 12 months. Factors significantly associated with sexual risk behavior included illicit drug use in the past 12 months (80.4% vs. 50.9%, p < 0.001) and binge drinking in the past week (55.9% vs. 49.9%, p = 0.003). Also, being a freelancer or former brothel-based sex worker and karaoke worker; younger age at first sexual intercourse; a younger FEW; never-married FSW, having a low level of education; and having HIV testing were associated with sexual risk behaviours, with p values < 0.05.
Conclusion
Our study revealed high-risk sexual behavior among FEWs, especially among binge drinkers and illicit drug users. This study highlights the urgent need for targeted interventions addressing substance use and risky sexual behaviors among FEWs, especially karaoke workers. Interventions should include health promotion, safe work environments, and structural changes to reduce exploitation and improve access to care. Further research is needed to determine the contributing factors related to workplace conditions and environments that contribute to high risk for substance use and sexual risk behaviors.