Determining barriers to creating an enabling environment in Cambodia: results from a baseline study with key populations and police

Schneiders, Mira Leonie; Weissman, Amy

doi:10.7448/ias.19.4.20878

Cited by 18 publications

(19 citation statements)

References 17 publications

(24 reference statements)

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“…This is particularly the case with law enforcement. As a recent study surmised, “Fear of accessing harm reduction and health services and police’s negative attitudes and practices towards key populations present major barriers to HIV prevention efforts in Cambodia” [ 19 , 38 ]. Efforts to reduce the fear of retaliation and/or stigma may help improve the effectiveness of broader intervention programs.…”

Section: Discussionmentioning

confidence: 99%

HIV prevalence, related risk behaviors, and correlates of HIV infection among people who use drugs in Cambodia

Sopheab

Chhea

Tuot³

et al. 2018

BMC Infect Dis

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BackgroundAlthough HIV prevalence in Cambodia has declined to 0.6% among the general population, the prevalence remains high among female sex workers (14.0%) and men who have sex with men (2.3%). Over the past 10 years, the number of people who use drugs (PWUDs) has increased considerably. PWUDs, especially people who inject drugs (PWIDs), who have multiple sex partners or unprotected sex contribute to a higher HIV prevalence. This paper aims to estimate the prevalence of HIV across PWUD groups and to identify factors associated with HIV infection.MethodsRespondent-driven sampling (RDS) was used to recruit 1626 consenting PWUDs in 9 provinces in 2012. Questionnaires and blood specimens were collected. HIV prevalence estimates were calculated using RDSAT 7.1. Individual weightings for HIV were generated with RDSAT and used for a weighted analysis in STATA 13. Multivariate logistic regression was used to identify the independent factors associated with HIV prevalence.ResultsMost of the PWUDs were men (82.0%), and 7.3% were PWIDs. Non-PWIDs, especially users of amphetamine-type stimulants (ATS), represented the larger proportion of the participants (81.5%). The median age for of the PWUDs was 24.0 years (IQR: 20–29). The HIV prevalence among the PWUDs was 5.1% (95% CI: 4.1–6.2), 24.8%, among PWIDs and 4.0% among non-PWIDs. The HIV prevalence among female PWIDs was 37.5, and 22.5% among male PWIDs. Four factors were independently associated with HIV infection: female sex, with AOR = 7.8 (95% CI: 3.00–20.35); age groups 21–29 and older (AOR = 10.3, 95% CI: 1.2–20.4); and using drugs for ≥12 months (AOR = 4.0, 95% CI: 1.38–11.35). Finally, injecting drugs remained a strong predictor of HIV infection, with an AOR = 4.1 (95% CI: 1.53–10.96).ConclusionHIV prevalence remains high among PWIDs. Harm reduction efforts, such as needle and syringe provision programs, must improve their coverage. Innovative strategies are needed to reach sub-groups of PWUDs, especially women who inject drugs. Furthermore, the large proportion of non-PWIDs, especially ATS users, should not be ignored. Therefore, combined HIV prevention and harm reduction programs should integrate ATS users.

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Section: Discussionmentioning

confidence: 99%

HIV prevalence, related risk behaviors, and correlates of HIV infection among people who use drugs in Cambodia

Sopheab

Chhea

Tuot³

et al. 2018

BMC Infect Dis

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“…This occurred since PWID/PWUD engaged in more risky behaviors, such as not carrying clean syringes/needles from NSP out of fear of getting caught with them and then punished by law enforcement officers [14]. This is also true in Cambodia because our study and an earlier study in Cambodia [15] unveil that PWID/PWUD were fearful of sanctions from law enforcement, thus not accessing harm reduction and health services.…”

Section: Discussionmentioning

confidence: 69%

How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

Tuot

Ngin

Pal³

et al. 2017

Harm Reduct J

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BackgroundHarm reduction interventions in Cambodia face numerous obstacles because of conflicting understanding and interests and inconsistencies in the implementation by law enforcement officials. This study aims to examine how understanding and application of Drug Control Law (DCL) and Village/Commune Safety Policy (VCSP) affects harm reduction interventions in Cambodia from the standpoints of law enforcement officials, people who inject drugs and people who use drugs (PWID/PWUD), as well as other key stakeholders.MethodsThis qualitative study was conducted in the capital city of Phnom Penh in 2015. We held five focus group discussions (FGDs) with groups of PWID/PWUD, police officers, Sangkat/commune officers, and local non-governmental organization (NGO) field staff. We also conducted ten key informant interviews (KIIs) with representatives from government agencies, donor agencies, and NGOs. FGDs and KIIs with Cambodian participants were transcribed in Khmer and translated into English. KIIs with foreign participants were transcribed in English. Transcripts were read and re-read to identify emerging themes, which were reviewed and refined to develop common and divergent patterns.ResultsThere was a huge gap between what the DCL and VCSP say and how law enforcement officers and PWID/PWUD understood them. The gap was also evident in how law enforcement officers implemented the DCL and VCSP. Harm reduction services, including health- and non-health-related interventions, were limited and challenged by unsupportive attitudes, misinterpretation of the DCL and VCSP, and the lack of full engagement with NGOs in the development of these instruments. The needs of PWID/PWUD in accessing health care services were not met due to misconduct of authorities while practicing the DCL and VCSP. Further, the misconduct and enforcement of the law and policy lead to increased social discrimination and physical abuses against PWID/PWUD.ConclusionsThere is a lack of common understanding of the drug-related law and policy and their implications to harm reduction services among both law enforcement officers and PWID/PWUD. Thus, there is a need to mainstream and simplify the law and policy for better comprehension among these actors. To improve the quality and coverage of harm reduction interventions, the gap of understanding and enforcement of laws and policies should be narrowed, and coordination between the government and NGOs and other key stakeholders should be strengthened.

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“…Previous research in different settings suggests that transgender women are exposed to high levels of stigma and discrimination due to their transgender identity [ 3 , 4 ]. In addition, legal marginalization of transgender women provides contexts that aid arbitrary arrests, stigma, and abuse of transgender women in different countries [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Exposure to gender-based violence and depressive symptoms among transgender women in Cambodia: findings from the National Integrated Biological and Behavioral Survey 2016

Tuot²,

Chhim³

et al. 2018

Int J Ment Health Syst

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BackgroundTransgender women are at significant risk of HIV, and they face intersecting barriers to health, social, and legal services. However, data regarding the unique needs and experiences of transgender women are globally scant. This study examined the relationship between gender-based violence and depressive symptoms among transgender women in Cambodia.MethodsThis cross-sectional study included 1375 sexually active transgender women recruited by using the respondent-driven sampling method in the capital city of Phnom Penh and 12 provinces between December 2015 and February 2016. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Multivariate regression analysis was conducted to explore factors independently associated with depressive symptoms.ResultsOf total, 45.0% of the participants had depressive symptoms, and 21.8% had severe depressive symptoms. After controlling for potential confounders, transgender women with depressive symptoms remained significantly more likely to report several negative experiences of gender-based violence such as a feeling that co-workers or classmates were not supportive regarding their transgender identity (AOR = 2.00, 95% CI = 1.22–3.28), having difficulties in getting a job (AOR = 1.67, 95% CI = 1.29–2.16), having been denied or thrown out of housing (AOR = 1.53, 95% CI = 1.02–2.26), having difficulties in getting health services (AOR = 2.40, 95% CI = 1.50–3.82), having been physically abused (AOR = 1.54, 95% CI = 1.15–2.08), and having been fearful of being arrested by police or authorities (AOR = 2.18, 95% CI = 1.64–2.91) because of their transgender identity. Regarding their childhood experiences, transgender women with depressive symptoms remained significantly more likely to report that someone had tried to touch them or make them touch in a sexual way when they were growing up (AOR = 2.08, 95% CI = 1.61–2.68).ConclusionsTransgender women in Cambodia experience high levels of gender-based violence and depressive symptoms. To address these concerns, a combination of service and policy interventions are required. These may include training and sensitization of trained and lay health providers in screening for depressive symptoms and integration of mental health services into facility- and community-based HIV services with enforcement of policies and laws that protect the rights of transgender women against gender-based violence.

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Determining barriers to creating an enabling environment in Cambodia: results from a baseline study with key populations and police

Cited by 18 publications

References 17 publications

HIV prevalence, related risk behaviors, and correlates of HIV infection among people who use drugs in Cambodia

HIV prevalence, related risk behaviors, and correlates of HIV infection among people who use drugs in Cambodia

How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

Exposure to gender-based violence and depressive symptoms among transgender women in Cambodia: findings from the National Integrated Biological and Behavioral Survey 2016

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