The Kirby Institute for Infection and Immunity, Faculty of Medicine, Level 6, Wallace Wurth Building, UNSW, Sydney, Australia; Drug Health Services, Sydney Local Health District & Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Centre, Albuquerque, NM, USA.
Int J Drug Policy. 2019 Feb;64:70-78. doi: 10.1016/j.drugpo.2018.12.002. Epub 2018 Dec 21.
In Cambodia, HIV infection remains high among female entertainment and sex workers (FESW) and the use of amphetamine-type stimulants (ATS) is an independent risk factor for unprotected sex and sexually transmitted infections among this group. For decades public health approaches to HIV prevention in low and middle income countries (LMIC) have attempted to target the macro-power relations that shape risk behaviour with structural interventions. Recent research has highlighted that interventions that combine ATS risk reduction, in the form of financial incentives for abstinence, with existing HIV prevention programmes, may also play an important role. However, whether this approach goes far enough as a response to structural drivers of risk requires further examination.
Semi-structured in-depth interviews were conducted with 30 FESW (mean age 25 years) from five provinces in Cambodia, as part of formative research for the implementation of the Cambodia Integrated HIV and Drug Prevention (CIPI) trial. The aim was to explore the contexts and drivers of ATS use. Data were analysed using grounded theory.
In addition to increasing occupational functionality, ATS were used to control pervasive feelings of 'sadness' in relation to the lived experience of poverty, family and relationship problems. Feeling sad could be viewed as an expression of social suffering, in response to competing priorities and seemingly inescapable constraints imposed by a lack of options for income generation, gender inequalities and stigma. Participants expressed interest in microenterprise (ME) opportunities, particularly vocational training, that could create new work opportunities beyond sex work and ATS use.
In addition to reducing ATS use, HIV prevention interventions need to target sources of sadness and social suffering as drivers of risk among FESW in this context. The inclusion of ME opportunities in HIV prevention, to alleviate social suffering, warrants further investigation through qualitative and ethnographic research.
在柬埔寨，艾滋病毒感染在女性娱乐和性工作者（FESW）中仍然居高不下，而安非他命类兴奋剂（ATS）的使用是该人群中无保护性行为和性传播感染的独立风险因素。几十年来，中低收入国家（LMIC）的艾滋病毒预防公共卫生方法一直试图针对塑造风险行为的宏观权力关系，采取结构性干预措施。最近的研究强调，以财务激励形式减少 ATS 风险的干预措施，结合现有的艾滋病毒预防方案，也可能发挥重要作用。然而，这种方法作为对风险结构驱动因素的反应是否足够，还需要进一步研究。
在柬埔寨五个省进行了 30 名 FESW（平均年龄 25 岁）的半结构式深入访谈，作为柬埔寨综合艾滋病毒和毒品预防（CIPI）试验实施的形成性研究的一部分。目的是探讨 ATS 使用的背景和驱动因素。使用扎根理论对数据进行分析。
除了增加职业功能外，ATS 还被用于控制与贫困、家庭和关系问题的生活经历有关的普遍的“悲伤”感。感到悲伤可以被视为社会痛苦的一种表达，是对竞争优先事项和似乎不可避免的缺乏创造收入、性别不平等和耻辱感的选择所造成的限制的回应。参与者对微企业（ME）机会表现出兴趣，特别是职业培训，可以创造超越性工作和 ATS 使用的新工作机会。
除了减少 ATS 的使用外，艾滋病毒预防干预措施还需要针对导致该地区 FESW 风险的悲伤和社会痛苦的根源。在缓解社会痛苦方面，将 ME 机会纳入艾滋病毒预防工作值得通过定性和民族志研究进一步调查。
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