A second wave of HIV epidemic among young people in Cambodia?

By Siyan Yi

Siyan Yi, Director of the KHANA, the Alliance’s Linking Organisation in Cambodia, on rising HIV rates among young people from key populations.

<p>Young women who work in a brothel in Battambang, Cambodia attend an HIV prevention discussion group &copy; Eugenie Dolberg for the Alliance</p>Young women who work in a brothel in Battambang, Cambodia attend an HIV prevention discussion group © Eugenie Dolberg for the Alliance

Cambodia has been recognised for its successful HIV prevention and control efforts, having reduced HIV prevalence among adults by more than half, from 1.7% in 1998 to 0.6% in 2016.

Today, HIV in Cambodia is concentrated among people from certain populations such as female entertainment workers, men who have sex with men, transgender women and people who use drugs. A large proportion of the individuals who make up these key populations are under 25, yet HIV programmes designed to address the needs of at-risk young people remain limited. Moreover, HIV education, particularly for young people, has not been a priority. According to the most recent Cambodian Demographic and Health Survey, only 37% of youth aged 15 to 24 have comprehensive knowledge about HIV and AIDS.

In recent years, KHANA’s Center for Population Health Research has conducted several studies to explore the links between HIV and at-risk young people in Cambodia, collaborating with the National Center for HIV/AIDS, Dermatology and STD (NCHADS), several national and international institutions, and young people themselves.

One of the major studies, the Most-at-Risk Young People Survey, was designed and implemented with the active involvement of different youth-led communities and networks. The survey included approximately 2,500 people aged 10-24, recruited from bars, karaoke parlours, massage parlours, street corners, public parks, snooker clubs, computer game shops, and places where adolescents and youths often congregate such as football or skating clubs.

Condom use and transactional sex 

Analysing data from sub-samples of the larger study, we found that 70% of boys and 53% of girls questioned were involved in transactional sex, with approximately half (48% of boys and 52% of girls) having more than one sexual partner in the past three months.

For those engaged in transactional sex, the rate of condom use with commercial partners was high (88% among boys and 90% among girls), but the rate in non-commercial relationships was very low at 43% among boys and just 6% among girls. The increased HIV prevalence among these young people may be explained by this low rate of consistent condom use.

Surprisingly, 82% of young men (aged 16 to 24) reported paying for sex. The majority of HIV prevention efforts relating to sex work in Cambodia are currently aimed at female sex workers, but targeting young men from key populations in ways that are relevant to them and their lifestyles may prove an effective step towards more sustainable HIV prevention.

Rising rates

KHANA has also conducted several national surveys and found HIV prevalence to be high and rising among all key populations, at 3.2% among female entertainment workers, 2.3% among men who have sex with men and 5.9% among transgender women. The data for people who use drugs are being analysed, and the results are coming soon.

In addition to their heightened risk of acquiring HIV, many of these young people are experiencing social and sexual and reproductive health issues such as sexually transmitted infections, unwanted pregnancy, unsafe abortions, substance abuse, stigma and discrimination and gender-based violence.

Collective efforts are needed from national and international partners to address the complex situations these young people face. What we need are tailor-made intervention programmes informed by young people’s experiences that are age-specific, more effective, and cost efficient.

Without this we risk seeing HIV prevalence continue to rise, as a second wave of HIV epidemic among young key populations in Cambodia unfolds.

Further reading

Further details of KHANA’s recent studies on young people in Cambodia can be found below.

Youth paying for sex: what are the associated factors? Findings from a cross-sectional study in Cambodia.

Youth paying for sex: what are the associated factors? Findings from a cross-sectional study in Cambodia.

HIV prevalence and factors associated with HIV infection among transgender women in Cambodia: results from a national Integrated Biological and Behavioral Survey.

Sex with sweethearts: Exploring factors associated with inconsistent condom use among unmarried female entertainment workers in Cambodia.

Improving prevention and care for HIV and sexually transmitted infections among men who have sex with men in Cambodia: the sustainable action against HIV and AIDS in communities (SAHACOM).

For more information on KHANA and HIV in Cambodia, click here.