In a blow to Cambodia’s 100 percent condom use program, use of the prophylactic sheath by the country’s sex workers has dropped from 94 percent to 85 percent in the past two years, according to numbers gathered by Population Services International.
The data, collected in December from interviews with 1,021 men in Phnom Penh, Battambang, Siem Reap and Sihanoukville, also showed that condom use in so-called sweetheart relationships rose from 48 percent in 2006 to 59 percent in 2008, PSI country manager Chris Jones said Tuesday.
“It’s a mixed message,” he said by telephone, adding that it was too early to give concrete reasons for the drop in condom use.
“What we know is that condom use in brothels is very high. There’s a very supportive environment for condom use,” Mr Jones said. However, sex work has shifted from brothels to venues like karaoke bars and beer gardens, as brothels are closed in accordance with Cambodia’s new anti-human trafficking law.
Tim Vora, executive director of the HIV/AIDS Coordinating Committee, agreed that it has become harder for outreach workers to promote condom use with sex workers. However, he acknowledged that a highly publicized drop in Cambodia’s HIV/AIDS infection rate—estimated at 0.9 percent in 2006—might have caused some complacency when it comes to condom use.
“Maybe they think that HIV/ AIDS is not a priority issue anymore,” Mr Vora said. “We can assume that,” he added, “but we don’t have any proper studies.”
Dr Mean Chhi Vun, president of the National Center for HIV/AIDS, Dermatology and STDs, would not comment on the PSI study. “I don’t have any comment, because we don’t comment on other people’s studies,” he said.
Although condom use is rising for men involved in sweetheart relationships—loosely defined as non-marital, non-commercial and repeated sexual encounters involving at least some degree of affection—HIV/AIDS experts interviewed Tuesday said men should be more cautious about using protection with their wives and sweethearts.
Dr Anand Chaudhuri, officer in charge of the UN Office on Drugs and Crime for Cambodia, said condom use is critical to stem a possible epidemic of HIV/AIDS, originating from three high risk groups: men who have sex with men, entertainment sex workers and intravenous drug users.
About 45 percent of men who have sex with men in Phnom Penh, and 84 percent in the rest of the country, reported having unprotected anal sex in the past month, according to statistics presented last week by Dr Oum Sopheap, executive director of the Khmer HIV/AIDS NGO Alliance. An estimated 33.6 percent of Phnom Penh drug users shared needles the last time they injected, it added.
Because of what he called “the bisexual nature of men,” Dr Chaudhuri said that many men who have sex with men also have wives and sweethearts, whom they could expose to HIV/AIDS.
He also cautioned that the risky behaviors of intravenous drug users could expose members of the wider population to transmission of the virus.
“Visualize the spouse or the girlfriend when you are doing a harm reduction program,” he said. “Don’t only give needles, give condoms. But don’t only give condoms, give needles.”
Mr Chhi Vun said that NCHADS is working on a pilot project in Siem Reap, launched last week, that targets prevention and care to the three highest risk groups. That project will include continued promotion of condom use as a preventative measure.
“The 100 percent condom use program is a 100 percent condom use program,” Mr Chhi Vun said.