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JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. AbstractWhile repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced antitrafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers' human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia's AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers.

BackgroundIn Cambodia, HIV prevalence among female entertainment and sex workers (FESW) is up to twenty times higher than in the general population. Use of amphetamine-type stimulants (ATS) has been associated with increased risk of HIV and other sexually transmitted infections in key populations, including FESW. While one in four Cambodian FESW report recent ATS use, little attention has been paid to how the occupational contexts of sex work shape patterns of use. Currently, no HIV prevention interventions target ATS use in this population.MethodsWe conducted in-depth interviews with FESW (n = 30) with the goal of exploring experiences and motivations for ATS use and informing the development of a conditional cash transfer (CCT) intervention designed to reduce ATS use and HIV risk. Interviews were conducted and transcribed in Khmer and translated into English. Interview narratives were read and re-read and emerging themes reviewed and refined to develop an initial coding scheme. Data were formally coded using both open and axial coding to clarify and consolidate initial themes.ResultsThe most common driver of ATS use among FESW was increased functionality. ATS was seen as a performance enhancer, acting as an appetite suppressant and enabling women to meet the physiological demands of sex work, including long working hours, multiple clients and extended sexual transactions. While our results are consistent with studies linking ATS use to heightened sexual risk, via unprotected and/or prolonged sex, for women in the current study, the negative consequences of ATS use were outweighed by perceived functional benefits.ConclusionsFESW in Cambodia harness the pharmacological properties of ATS to meet the physiological demands of sex work in a context of limited economic opportunities. There is an urgent need to both provide Cambodian women with options for income generation that do not risk their health and to better regulate the conditions of sex work to provide safer working environments. Structural and economic interventions, including CCT programmes, combined with awareness and enforcement of sex workers’ rights, are also necessary to facilitate harm reduction and occupational health and work safety within the Cambodian sex and entertainment industry.

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HIV risk remains high among Cambodian female entertainment and sex workers, driven by amphetamine-type substance use and sexual risk. Conditional cash transfer is an evidence-based approach to reduce stimulant use and optimize HIV/AIDS prevention, but questions remain regarding implementation in resource-limited settings. We conducted formative qualitative research to enhance acceptability of a conditional cash transfer intervention aimed at reducing amphetamine-type substance use and HIV risk among female entertainment/sex workers and inform implementation as part of a large cluster randomized trial. We conducted in-depth interviews with 30 female entertainment/sex workers. Interviews were digitally recorded and conducted and transcribed in Khmer. English transcripts were read for emerging themes and an initial coding scheme was developed. Data were coded using open and axial coding to clarify and consolidate initial themes. While most participants expressed enthusiasm for the intervention, financial and transportation issues emerged as key barriers to participation. The proposed incentive of USD$1 per screen was regarded as unacceptable and participants identified a need for transportation assistance. Participants also expressed concerns about directly observed urine specimen collection. Finally, while most participants found the 4-week aftercare program acceptable, the need for enjoyable as well as educational content was emphasized. Revisions to the protocol taking these data into account were made to optimize the acceptability of the intervention and the implementation of the trial. Findings identified key concerns and preferences that were taken into account in the final trial protocol. In particular, financial and transportation issues were identified as critical barriers to participation, with the potential to impact both intervention uptake and trial feasibility. Results demonstrate the value of formative qualitative research for clinical trial planning and implementation, particularly in settings where little is known about acceptability of interventions or willingness to participate.