2nd Australian Forum on Sexuality, Education & Health

I had the pleasure of attending the second meeting of the Australia Forum on Sexuality, Education and Health at UNSW today. It was organised by Peter Aggleton at the National Centre in HIV and Social Research. The forum was a series of short provocations from 4 people on the theme Learning about sex—what, when, where and how? It was a great spread of speakers – an academic, a clinician form Family Planning, a youth worker from Twenty10, and a high school principal.

I experimented with live tweeting for the first time and then with storify to bring together the (admittedly not very extensive) twitter conversation… you can read it here:

[View the story “Aust Forum on Sexuality, Education & Health ” on Storify]

Condom negotiation and young women in Cambodia

A new paper from the research project I am involved with in Cambodia about young female sex workers and HIV. Drawing on the qualitative data from young women sex workers we’ve explored condom use. Originally a paper broadly about the determinants of condom use (incl alcohol and drug use by women and their clients, violence) it now focuses on the use of condoms across the relationships that young women are involved in – commercial, not commercial and those of ambiguous status.  We look at how the young women thought about their relationships – conceptualizing them as risky or not – and how that shaped their desire to use condoms as well as the strategies they employed to use them (or not).

Email me for a copy of the paper or find it here: Maher L, Mooney-Somers J, Phlong P, Couture MC, Phal S, Bates A, Sansothy N, Page K. (2013) Condom negotiation across different relationship types by young women engaged in sex work in Phnom Penh, Cambodia. Global Public Health [Epub ahead of print]

Abstract: Cambodia’s 100% Condom Use Programme is credited with an increase in
consistent condom use in commercial sexual interactions and a decrease in HIV
prevalence among female sex workers (FSWs). There has been little improvement
in condom use between FSWs and non-commercial partners, prompting calls for
more innovative approaches to increasing condom use in these relationships. To
understand why condoms are used or not used in sexual interactions involving
FSWs, we examined condom negotiation across different types of relationships.
We conducted 33 in-depth interviews with young (15 to 29 years) women engaged
in sex work in Phnom Penh. There was an important interplay between the
meanings of condom use and the meanings of women’s relationships. Commercial
relationships were characterised as inherently risky and necessitated condom use.
Despite a similar lack of sexual fidelity, sweetheart relationships were rarely
construed as risky and typically did not involve condom use. Husbands and wives
constructed their sexual interactions with each other differently, making agreement
on condom use difficult. The lack of improvement in condom use in FSWs’
non-commercial sexual relationships needs to be understood in relation to both
sex work and the broader Cambodian sexual culture within which these
relationships are embedded.

Young Women’s Health Study Cambodia article

Our latest paper from the Young Women’s Health Study (YHWS) in Cambodia, has just been accepted by the Harm Reduction Journal. It’s open access so the provisional PDf is up – just click on the paper title.

Maher, L, Mooney-Somers, J, Phlong, P,  Couture, MC, Stein, E, Evans, J, Cockroft, Sansothy, NC, Nemoto T, and Page, K.(2011) Selling sex in unsafe spaces: Sex work risk environments in Phnom Penh, Cambodia. Harm Reduction Journal.

Abstract:
Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Young Women’s Health Study Cambodia article

Our paper on the Young Women’s Health Study (YHWS), in Cambodia, has just been accepted by the International Journal of Drug Policy. The qualitative anaysis explores amphetamine-type substance use and vulnerability to HIV/STI among young female sex workers.

Maher, L, Phlong, P, Mooney-Somers, J, Keo, S, Stein, E, Page, K. Amphetamine-type stimulant use and HIV/STI risk behaviour among young female sex workers in Phnom Penh, Cambodia. International Journal of Drug Policy.

“Background: Use of amphetamine-type substances (ATS) has been linked to increased risk of HIV and other sexually transmitted infections (STI) worldwide. In Cambodia, recent ATS use is independently associated with incident STI infection among young female sex workers (FSW). Methods: We conducted 33 in-depth interviews with women (15-29 years old) engaged in sex work to explore ATS use and vulnerability to HIV/STI. Results: Participants reported that ATS, primarily methamphetamine in pill and crystalline forms (yama), were cheap, widely available and commonly used. Yama was described as a “power drug” (thnam kamlang) which enabled women to work long hours and serve more customers. Use of ATS by clients was also common, with some providing drugs for women and/or encouraging their use, often resulting in prolonged sexual activity. Requests for unprotected sex were also more common among intoxicated clients and strategies typically employed to negotiate condom use were less effective. Conclusion: ATS use was highly functional for young women engaged in sex work, facilitating a sense of power and agency and highlighting the occupational significance and normalization of ATS in this setting. This highly gendered dynamic supports the limited but emerging literature on women’s use of ATS, which to date has been heavily focused on men. Results indicate an urgent need to increase awareness of the risks associated with ATS use, to provide women with alternative and sustainable options for income generation, to better regulate the conditions of sex work, and to work with FSWs and their clients to develop and promote culturally appropriate harm reduction interventions.”

Background on the study from the project leaders at the University of California, San Fransisco and the Cambodian research partners, National Centre for HIV, Dermatology and STI (NCHADS).

Other publications from the YWHS
Couture, M.-C., Sansothy, N., Sapphon, V., Phal, S., Sichan, K., Stein, E., et al. (2011). Young Women Engaged in Sex Work in Phnom Penh, Cambodia, Have High Incidence of HIV and Sexually Transmitted Infections, and Amphetamine-Type Stimulant Use: New Challenges to HIV Prevention and Risk.. Sexually Transmitted Diseases, 38(1), 33-39.

Indigenous Resilience article

Our paper on understanding Indigenous young people’s past experiences of sexually transmitted diseases as resilience narratives has just been published by Culture, Health and Sexuality. Here’s the abstract:

“The Indigenous Resilience Project is an Australian community-based participatory research project using qualitative methods to explore young Aboriginal and Torres Strait Islander people’s views of blood-borne viral and sexually transmitted infections (BBV/STI) affecting their communities. In this paper we present an analysis of narratives from young people who had a previous BBV/STI diagnosis to explore how they actively negotiate the experience of BBV/STI infection to construct a classic resilience narrative. We examine two overarching themes: first, the context of infection and diagnosis, including ignorance of STI/BBV prior to infection/diagnosis and, second, turning points and transformations in the form of insights, behaviours, roles and agency. Responding to critical writing on resilience theory, we argue that providing situated accounts of adversity from the perspectives of young Indigenous people prioritises their subjective understandings and challenges normative definitions of resilience.”

Mooney-Somers, J., Olsen, A., Erick, W., Scott, R., Akee, A., Kaldor, J., & Maher, L. (on behalf of the Indigenous Resiliency Project). (2010) Learning from the past: Indigenous young people’s accounts of BBV/STI infection as resilience narratives. Culture, Health & Sexuality, 13(2): 173-186.

Our conference presentation at Making Sense of: Health, Illness & Disease, based on the article, will appear in the conference eBook shortly.

Papua New Guinea 2

A very successful few day in a beautiful report on the east coast of PNG (Tawali Resort). The training was a great success, and the feedback from participants very positive. I was delighted to hear they have so much qualitative research happening, and there is much interest in participatory methods. I learnt a lot about PNG from the participants, and about bioethics in HIV research from my colleagues Bridget, John and Rob. Hoping for a return visit! 

The VELiM/NCHECR team and the training participants