Behavioral interventions for Cambodian female entertainment and sex workers who use amphetamine-type stimulants

Abstract

Conditional cash transfer (CCT) and cognitive-behavioral treatments are evidence-based approaches to reduce stimulant use and sexual risk taking. We describe the adaptation and implementation of sequential behavioral interventions for Cambodian female entertainment and sex workers (FESW) who use amphetamine-type stimulants (ATS): 1) a 12-week CCT intervention; and 2) a 4-week cognitive-behavioral aftercare (AC) group. An ongoing cluster randomized stepped wedge trial in 10 Cambodian provinces is enrolling FESW with confirmed recent ATS use to examine the effectiveness of CCT+AC. In the first six provinces, 138 of the 183 eligible FESW (75%) enrolled in CCT and completed a median of 25 (Interquartile Range: 9–32) of the 36 urine screening visits. Of the 84 participants who were eligible for AC, 79 completed at least one session (94%) and 57 completed three or more sessions (68%). Culturally tailored behavioral interventions to reduce ATS use and optimize HIV prevention are feasible in resource-limited settings.

Social support and amphetamine-type stimulant use among female sex workers in China

“…Due to the particularity of their work and living environment, exploring different types of social support from different sources can help deepen the understanding of correlates or factors for their ATS use and formulate corresponding interventions. Interventions targeting this population should be geared towards correcting misperceptions regarding ATS use, promoting emotional self-reliance and effective communication with friends, strengthening their ties with drug-free friends, and providing them with sustainable income-generating alternatives, which is proven effective in reducing ATS use and facilitating HIV prevention by some study in a resource-limited setting (Carrico, et al, 2016). …”

“…ATS can enable FSWs to engage in sex work longer and have larger number of sex partners in order to earn more income (Carrico et al, 2016; Dixon et al, 2015; Maher et al, 2011b); meanwhile, ATS use can have a disinhibiting effect on sexual decision-making (Halkitis & Jerome, 2008), and be associated with unprotected sex, which might lead to an increase in HIV infection and other STIs (Couture et al, 2011, 2012; Ho, Le, & Dinh, 2013). …”

HIV treatment cascade among female entertainment and sex workers in Cambodia: impact of amphetamine use and an HIV prevention program

“…Women with HIV infection who use stimulants in the U.S. are also more likely to report engaging in HIV transmission risk behavior [ 23 , 24 ], resulting in increased odds of onward HIV transmission where viral load is greater than 200 copies/mL [ 25 ]. We examine CoC outcomes among a sample of HIV-positive FESW participating in the Cambodia Integrated HIV and Drug Prevention Implementation (CIPI) Study being implemented in ten provinces in Cambodia [ 26 , 27 ].…”

“…The CIPI Study was implemented within the SMARTgirl HIV prevention platform [ 26 , 27 ], a widely disseminated ‘standard of care’ program launched nationally in 2008 to reduce HIV risk in women working in the high-risk entertainment sector [ 28 ]. SMARTgirl clubs exist in most provinces, and local community-based organizations maintain them and provide outreach to local women.…”

“…The SMARTgirl program uses targeted communication tools and club events to disseminate health information, conduct and promote HIV testing, and referrals to health services including HIV care, sexually transmitted infection and reproductive health services. The CIPI Study integrated an ATS intervention and microenterprise opportunity within the existing SMARTgirl platform (described in [ 26 , 27 ]).…”