Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2 #10-01, Singapore, 117549, Singapore.
Provincial Health Department, Siem Reap Province, Cambodia.
BMC Public Health. 2018 Mar 27;18(1):411. doi: 10.1186/s12889-018-5321-0.
Following Cambodia's implementation of the 100% condom use program with enforcement of condom use and STI treatment services for sex workers in 2001, sexually transmitted infection and HIV declined markedly. In 2008, Cambodia implemented a law to ban brothel-based sex work. We reported trends in unprotected vaginal intercourse with sex workers among heterosexual men buying sex before (2003-2008) and after (2009-2012) the brothel ban in Cambodia. We also determined the association of brothel ban with these men's reports of unprotected intercourse with sex workers.
In this serial cross-sectional study, we collected yearly behavioural data on random cross-sectional samples of heterosexual men buying sex who attended the only government health centre in Siem Reap for voluntary confidential counselling and testing (VCCT) between 2003 and 2012. We used multivariable Poisson regression analysis on the 10-year data of 976 men to obtain the adjusted prevalence ratio (aPR) of unprotected intercourse in the last 6 months by brothel closure.
Men buying sex from non-brothel-based sex workers increased almost 3-fold from 17% in 2007-2008 before brothel closure to 55% in 2011-2012 after brothel closure (p < 0.001). Unprotected intercourse with sex workers in the last week increased significantly from 37% (2003-2004) before brothel closure to 65% (2011-2012) after brothel closure. This increase corresponded closely with the increase in self-reported unprotected intercourse from 35% to 61% by the sex workers (n = 1805) attending the same clinic for VCCT. Brothel closure was associated with an increased risk (aPR: 1.65; 95% CI: 1.40-1.94) of unprotected intercourse with sex workers. HIV prevalence in the heterosexual men declined significantly from 26% in 2003-2004 to 4.8% in 2007-2008 and 0 case in 2009-2010 before increasing to 5.6% in 2011-2012.
Our findings suggest that the brothel ban had led to an increase in unprotected intercourse with all sex workers for men buying sex. This effect could be attributed to reduced condom access, a consequence of the lack of feasibility to implement the 100% condom use program following the brothel ban. The ban on brothels in Cambodia should be reviewed.
2001 年，柬埔寨实施了 100% condom use 项目，强制规定性工作者使用安全套并提供性传播感染和艾滋病治疗服务，此后性传播感染和艾滋病毒的发病率显著下降。2008 年，柬埔寨颁布法律禁止基于妓院的性工作。我们报告了在柬埔寨禁止妓院后，性工作者中异性恋男性在购买性服务时无保护阴道性交的趋势（2003-2008 年之前和 2009-2012 年之后）。我们还确定了禁止妓院与这些男性报告的与性工作者无保护性交之间的关联。
在这项连续的横断面研究中，我们收集了 2003 年至 2012 年间，每年在暹粒唯一的政府卫生中心接受自愿保密咨询和检测（VCCT）的异性恋男性购买性服务的随机横断面样本的行为数据。我们使用多变量泊松回归分析对 976 名男性的 10 年数据进行了分析，以获得在过去 6 个月内无保护性交的调整后患病率比（aPR），并根据妓院关闭情况进行了分析。
从非妓院性工作者那里购买性服务的男性数量几乎增加了两倍，从 2007-2008 年之前关闭妓院之前的 17%增加到 2011-2012 年之后关闭妓院的 55%（p<0.001）。在过去一周内与性工作者无保护性交的比例显著增加，从 2003-2004 年之前关闭妓院之前的 37%增加到 2011-2012 年之后关闭妓院的 65%（p<0.001）。这与自我报告的性工作者无保护性交的比例增加相吻合，从 35%增加到 61%（n=1805）参加同一诊所进行 VCCT。妓院关闭与无保护性交的风险增加相关（aPR：1.65；95%CI：1.40-1.94）。异性恋男性中的艾滋病毒流行率从 2003-2004 年的 26%显著下降到 2007-2008 年的 4.8%，2009-2010 年没有病例，然后在 2011-2012 年增加到 5.6%。
我们的研究结果表明，妓院的关闭导致了购买性服务的男性与所有性工作者发生无保护性交的比例增加。这种影响可能归因于避孕套获取减少，这是禁止妓院后 100% condom use 项目实施不可行的结果。柬埔寨应审查禁止妓院的规定。
