The Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia.
Harm Reduct J. 2011 Nov 20;8:30. doi: 10.1186/1477-7517-8-30.
The risk environment framework provides a valuable but under-utilised heuristic for understanding environmental vulnerability to HIV and other sexually transmitted infections among female sex workers. Brothels have been shown to be safer than street-based sex work, with higher rates of consistent condom use and lower HIV prevalence. While entertainment venues are also assumed to be safer than street-based sex work, few studies have examined environmental influences on vulnerability to HIV in this context.
As part of the Young Women's Health Study, a prospective observational study of young women (15-29 years) engaged in sex work in Phnom Penh, we conducted in-depth interviews (n = 33) to explore vulnerability to HIV/STI and related harms. Interviews were conducted in Khmer by trained interviewers, transcribed and translated into English and analysed for thematic content.
The intensification of anti-prostitution and anti-trafficking efforts in Cambodia has increased the number of women working in entertainment venues and on the street. Our results confirm that street-based sex work places women at risk of HIV/STI infection and identify significant environmental risks related to entertainment-based sex work, including limited access to condoms and alcohol-related intoxication. Our data also indicate that exposure to violence and interactions with the police are mediated by the settings in which sex is sold. In particular, transacting sex in environments such as guest houses where there is little or no oversight in the form of peer or managerial support or protection, may increase vulnerability to HIV/STI.
Entertainment venues may also provide a high risk environment for sex work. Our results indicate that strategies designed to address HIV prevention among brothel-based FSWs in Cambodia have not translated well to street and entertainment-based sex work venues in which increasing numbers of women are working. There is an urgent need for targeted interventions, supported by legal and policy reforms, designed to reduce the environmental risks of sex work in these settings. Future research should seek to investigate sex work venues as risk environments, explore the role of different business models in mediating these environments, and identify and quantify exposure to risk in different occupational settings.
风险环境框架为理解女性性工作者中艾滋病毒和其他性传播感染的环境脆弱性提供了一种有价值但未充分利用的启发式方法。妓院被证明比街头性工作更安全，因为那里有更高比例的人坚持使用安全套，艾滋病毒感染率也更低。虽然娱乐场所也被认为比街头性工作更安全，但很少有研究调查过这种环境对艾滋病毒易感性的影响。
作为金边年轻女性健康研究的一部分，这是一项针对从事性工作的年轻女性（15-29 岁）的前瞻性观察性研究，我们进行了深入访谈（n=33），以探讨艾滋病毒/性传播感染和相关伤害的易感性。访谈由受过培训的访谈者用高棉语进行，然后被转录并翻译成英语，并进行主题内容分析。
柬埔寨加强了打击卖淫和人口贩运的力度，这使得更多的女性从事娱乐场所和街头性工作。我们的研究结果证实，街头性工作使女性面临艾滋病毒/性传播感染的风险，并确定了与娱乐性工作相关的重大环境风险，包括有限获得安全套和与酒精有关的中毒。我们的数据还表明，接触暴力和与警察的互动受到性交易场所的影响。特别是，在没有同伴或管理层支持或保护的情况下，在宾馆等环境中进行性交易，可能会增加感染艾滋病毒/性传播感染的脆弱性。
娱乐场所也可能为性工作提供高风险环境。我们的研究结果表明，旨在解决柬埔寨妓院性工作者中艾滋病毒预防问题的战略并没有很好地转化为越来越多女性从事的街头和娱乐性工作场所。迫切需要有针对性的干预措施，同时还需要法律和政策改革的支持，以减少这些环境中的性工作风险。未来的研究应该寻求将性工作场所视为风险环境，探索不同商业模式在调解这些环境方面的作用，并确定和量化不同职业环境中的风险暴露。
