The Cambodian government's crackdown on human trafficking and sexual exploitation could reverse the progress made in curbing the spread of HIV/AIDS, as sex workers fleeing the police have been unable to access health services.
Legislation against human trafficking, introduced in March 2008, also covers formal locations such as brothels, so police implementing the new laws have also targeted sex workers, who are now forced to ply their trade on the street, in bars and informal karaoke bars.
"It's had unintended consequences that have interrupted HIV prevention services in the sex industry," said UNAIDS Cambodia country coordinator Tony Lisle. NGOs were having "significant" difficulty reaching sex workers to provide them with HIV/AIDS education and prevention, Lisle told IRIN/PlusNews.
Cambodia's HIV prevalence declined from 3.7 percent in 1997 to 0.9 percent in 2005, but this progress is now being threatened.
Sex workers called the crackdown a "moral crusade" in protests during June, after reports revealed that the police were detaining sex workers as traffickers and sometimes demanding sexual favours and bribes.
Srey Pov*, a sex worker in the Cambodian capital, Phnom Penh, claimed the police had detained her for 18 days and demanded oral sex from her. "They stripped me of my clothing. We were powerless, because if we refused they could throw us in prison like we were traffickers," she told IRIN/PlusNews.
The Ministry of Interior, which oversees law enforcement, could not be reached for comment.
Police abuse of brothels mirrored government policies in the 1990s, when HIV prevalence was at its highest, Lisle added. This situation changed in 2001, when Prime Minister Hun Sen endorsed a 100 percent condom policy for sex workers over traditional law enforcement, leading to a decline in HIV prevalence among sex workers from a peak of 45.8 percent in 1998 to 12.7 percent in 2006.
"They [the government] realised they needed a more pragmatic approach. The brothels weren't going away, and they still won't after the recent anti-trafficking legislation. Many women [who] choose this work are not trafficked," Lisle commented.
"Legislation is a necessary component to stop HIV/AIDS, but now we need to make sure police understand the intent of the law, and that the laws criminalise traffickers, not consenting sex workers."
Sweethearts and karaokes
With the shift from brothels to bars, karaoke bars and beer gardens, new sexual behaviours are gaining momentum in Cambodia. "People in Cambodia say HIV/AIDS is a done story, a fight we've already finished," Lisle said. "But behaviours change - HIV has a way of finding new hosts and spreading."
The "sweetheart" phenomenon is also becoming common. This is a recent trend in which Cambodian men engage in long-term sexual relations - often without condom use - with hostesses working in karaoke bars and beer gardens.
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In earlier outreach programmes promoting condom usage, NGOs and the government emphasised traditional, brothel-based sex work, but men in long-term relationships tend to trust their partners more, and see condoms as unnecessary for their "sweethearts".
According to a survey conducted between 2005 and 2006 by Population Services International (PSI), karaoke hostesses reported receiving money from 14.6 paying sex partners a year on average, yet only 42 percent of hostesses said they used condoms regularly.
Won Sopheap, a university student, said he had taken on two sweethearts in the past six months. "A few years ago, people went to the brothels - it was just a fun weekend thing to do - but now a lot of my friends pick up sweethearts at the karaokes. We can trust them more; they don't have diseases because they're long-term."
Brothel-based sex workers
Despite the trend in the sex trade to leave brothels, Lisle said sex workers in brothels still faced an "unacceptable" high risk of contracting HIV. This was aggravated by high HIV prevalence among sex workers at coastal and border provinces, where the infection rate is as high as 30.7 percent.
According to the survey report, clients in these regions are more mobile, making the spread of the virus more likely, while sex workers in these provinces tend to be more inexperienced and have lower levels of formal education, so they are less able to negotiate condom use.
"We need to target this group more," Lisle said. "A demographic that enters sex work already infected, and without proper HIV education, could spread HIV very quickly."