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Win PP, Hlaing T, Win HH. Factors influencing maternal death in Cambodia, Laos, Myanmar, and Vietnam countries: A systematic review. PLoS One 2024; 19:e0293197. [PMID: 38758946 PMCID: PMC11101123 DOI: 10.1371/journal.pone.0293197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/08/2023] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND A maternal mortality ratio is a sensitive indicator when comparing the overall maternal health between countries and its very high figure indicates the failure of maternal healthcare efforts. Cambodia, Laos, Myanmar, and Vietnam-CLMV countries are the low-income countries of the South-East Asia region where their maternal mortality ratios are disproportionately high. This systematic review aimed to summarize all possible factors influencing maternal mortality in CLMV countries. METHODS This systematic review applied "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist (2020)", Three key phrases: "Maternal Mortality and Health Outcome", "Maternal Healthcare Interventions" and "CLMV Countries" were used for the literature search. 75 full-text papers were systematically selected from three databases (PubMed, Google Scholar and Hinari). Two stages of data analysis were descriptive analysis of the general information of the included papers and qualitative analysis of key findings. RESULTS Poor family income, illiteracy, low education levels, living in poor households, and agricultural and unskilled manual job types of mothers contributed to insufficient antenatal care. Maternal factors like non-marital status and sex-associated work were highly associated with induced abortions while being rural women, ethnic minorities, poor maternal knowledge and attitudes, certain social and cultural beliefs and husbands' influences directly contributed to the limitations of maternal healthcare services. Maternal factors that made more contributions to poor maternal healthcare outcomes included lower quintiles of wealth index, maternal smoking and drinking behaviours, early and elderly age at marriage, over 35 years pregnancies, unfavourable birth history, gender-based violence experiences, multigravida and higher parity. Higher unmet needs and lower demands for maternal healthcare services occurred among women living far from healthcare facilities. Regarding the maternal healthcare workforce, the quality and number of healthcare providers, the development of healthcare infrastructures and human resource management policy appeared to be arguable. Concerning maternal healthcare service use, the provisions of mobile and outreach maternal healthcare services were inconvenient and limited. CONCLUSION Low utilization rates were due to several supply-side constraints. The results will advance knowledge about maternal healthcare and mortality and provide a valuable summary to policymakers for developing policies and strategies promoting high-quality maternal healthcare.
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Affiliation(s)
- Pyae Phyo Win
- Department of Public Health and Social Medicine, University of Medicine, Magwae, Myanmar
| | - Thein Hlaing
- District Public Health Department (Ministry of Health), Pyay District, Bago Region, Myanmar
| | - Hla Hla Win
- Department of Health and Social Sciences, STI Myanmar University, Yangon, Myanmar
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Babirye S, Michielsen K, Ssengooba F. The unwritten rules and HIV: a qualitative study of informal institutions and HIV vulnerability among workers at social venues in Uganda. Front Public Health 2023; 11:1288058. [PMID: 38155895 PMCID: PMC10752962 DOI: 10.3389/fpubh.2023.1288058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/14/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. The unwritten rules, also known as informal institutions or social norms, are increasingly recognized as important determinants of HIV transmission. Unfortunately, these informal institutions, especially among high-risk environments for HIV, such as social venues like bars, lodges, remain poorly understood. This study explored the informal institutions at social venues, and how these institutions influenced vulnerability for HIV for venue workers in Uganda. Methods We conducted a qualitative study in two districts of Kyotera and Rakai in Central Uganda. We purposively selected and interviewed 44 workers including, cleaners, waiters, and waitresses and 22 venue managers at 22 social venues to explore the informal institutions at these establishments and how the institutions shaped HIV vulnerabilities among the workers. 31.8% (14) of the participants were males, and 68.2% (30) females. Data were analyzed using thematic content analysis. Results We found that the informal institutions at the venues were both officially and socially created, communicated, and sanctioned. The most common institutions operated through; selective hiring, rigid reporting structures, and informal job contracting procedures. Meager salaries, varying and delayed payments as well as attractive benefits and bonuses from customers were also important forms of informal institutions at the venues. Drinking alcohol, and offering sexual services at the venues were acceptable, although excessive drinking, and committed sexual relationships with customers were disapproved. These informal institutions shaped a risk environment at the venues by creating risk exposure opportunities that influenced workers' engagement into sexual risk behaviors. Conclusion The risk environment at social venues is shaped by the informal institutions at these venues. Thus, the need for venue-based HIV programs that integrate social norms interventions to better address the contextual determinants of HIV risk behaviors at the venues.
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Affiliation(s)
- Susan Babirye
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Health Policy, Planning, and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Research and Evaluation, Afrislum Uganda, Kampala, Uganda
| | - Kristien Michielsen
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Freddie Ssengooba
- Department of Health Policy, Planning, and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Center for Policy and Management Science, Kampala, Uganda
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Khezri M, Tavakoli F, Schwartz S, Karamouzian M, Sharifi H, McKnight CA, Jarlais DD, Baral S, Shokoohi M. Global epidemiology of abortion among female sex workers: a systematic review, meta-analysis, and meta-regression. Ann Epidemiol 2023; 85:13-37. [PMID: 37356778 DOI: 10.1016/j.annepidem.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/11/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Despite the evidence of a high rate of unintended pregnancy, there remains limited information about the prevalence and experiences of abortion among female sex workers (FSWs). In response, we aimed to summarize the available evidence on abortion among FSWs. METHODS We searched Medline, Embase, PsycINFO, CINAHL, Scopus, and Web of Science from inception to January 29, 2023 . We pooled data from the included studies using random-effects meta-analyses. We also grouped countries for the legality of elective abortion stratified by the United Nations database on abortion laws and policies. RESULTS We identified 60 eligible studies from 2031 potentially eligible records. The pooled lifetime prevalence of at least one and multiple induced abortions was 37.7% (95% confidence interval, 31.8-43.7) and 21.7% (14.9-29.2), respectively. Among FSWs recruited in countries where elective abortion is illegal, at least one induced abortion prevalence was 35.1% (28.1-42.4), and multiple induced abortion prevalence was 23.1% (12.4-35.9). In countries where elective abortion is legal, at least one induced abortion prevalence was 44.6% (34.8-54.6), and multiple induced abortion prevalence was 19.9% (11.9-29.3). Among FSWs experiencing abortion, self-managed abortion prevalence was estimated at 32.8% (23.6-42.7) overall, 42.8% (37.2-48.5) for countries where elective abortion is illegal, and 15.6% (3.9-32.7) for countries that legally allow elective abortion. CONCLUSIONS Induced abortion is prevalent among FSWs, highlighting the need for interventions to increase access to effective contraception and safe abortion care. While induced abortion prevalence did not significantly differ across the legal grounds for abortion, self-managed abortion prevalence was higher in countries where elective abortion was illegal, highlighting the urgent need for accessible abortion services for FSWs in criminalized settings. Moving forward necessitates implementing and evaluating culturally acceptable models of safe abortion and post-abortion care for FSWs to increase access to the full spectrum of sexual and reproductive health services.
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Affiliation(s)
- Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Courtney A McKnight
- Department of Epidemiology, New York University School of Global Public Health, New York; Center for Drug Use and HIV/HCV Research, New York, NY
| | - Don Des Jarlais
- Department of Epidemiology, New York University School of Global Public Health, New York; Center for Drug Use and HIV/HCV Research, New York, NY
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada.
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Babirye S, Ssengooba F, Weir SS, Michielsen K. Social venues and HIV vulnerability of young venue workers: a cluster analysis of data from a national-level cross-sectional survey of social venues in Uganda. BMJ Open 2023; 13:e065239. [PMID: 37247965 PMCID: PMC10230894 DOI: 10.1136/bmjopen-2022-065239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Venues where people socialize, such as bars, play a significant role in HIV transmission risk. However, little research has been done that identifies characteristics of high-risk venues, to inform HIV prevention efforts. This study identified clusters of social venues in Uganda and their relationship with HIV vulnerability of young venue workers (15-24 years). We also assessed availability of HIV prevention services at the venues. DESIGN AND SETTING This was a secondary analysis of data from a larger cross-sectional survey of social venues in 25 districts of Uganda. PARTICIPANTS A total of 480 venues that employed young workers were included in this study. ANALYSIS Hierarchical cluster and mixed-effects regression analyses were conducted. RESULTS Four clusters were adopted: cluster 1 represented 127 venues (mainly alcohol-serving sex work venues with a provision of on-site sex); cluster 2 represented 80 venues (mainly alcohol-serving sex work venues without a provision of on-site sex); cluster 3 represented 113 venues (mainly alcohol-serving venues without sex work or on-site sex); and cluster 4 represented 160 venues (non-alcohol-serving venues). We found a positive correlation between venue clusters and HIV vulnerability. Workers who belonged to cluster 1 (alcohol-serving sex work venues with a provision of on-site sex) had a 0.15 increase in HIV vulnerability compared with those in alcohol-serving venues without sex work or a provision of on-site sex (cluster 3) (coefficient: 0.15, 95% CI: 0.030 to 0.287) after adjusting for age, sex and marital status. Thirty-seven per cent of cluster 1 venues reported any HIV prevention services in the past 12 months. CONCLUSION Alcohol-serving sex work venues with a provision of on-site sex (cluster 1) appeared to reinforce vulnerability to HIV in this study and should be targeted with HIV prevention interventions. Such venues can amplify HIV transmission by facilitating sexual partner coupling and on-site sex.
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Affiliation(s)
- Susan Babirye
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center for Policy and Management Science, Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Sharon Stucker Weir
- Carolina Population Center, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristien Michielsen
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Moradi G, Gouya MM, Ezzati Amini E, Ghorbani SS, Akbarpour S, Zareie B, Izadi N, Kashefi F, Moradi Y. Intentional abortion and its associated factors among female sex workers in Iran: Results from national bio-behavioral surveillance-2020. PLoS One 2022; 17:e0273732. [PMID: 36037196 PMCID: PMC9423624 DOI: 10.1371/journal.pone.0273732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
In addition to estimating the prevalence of intentional abortion in Iranian female sex workers (FSWs), this study identified related factors using the data of a national study.
Methods
This cross-sectional study utilizes the third round of integrated bio-behavioral surveillance-III data in Iranian FSWs in December 2019 and August 2020, and 1515 Participants were selected in 8 geographically diverse cities in Iran. Logistic regression was performed using unweighted analysis to identify factors associated with intentional abortion. Stata software (version 14), respondent-driven sampling analyses, and R (version 4.1.2) was used for data analysis.
Results
From 1390 participants with valid responses to the abortion question, 598 (37.3%; 95% CI: 32.43, 42.11%) reported intentional abortion during their life. According to the age groups, the highest prevalence of abortion was in the age group of 31 to 40 years (42.60%). In the multivariate logistic regression model, the marital status (divorced women (AOR = 2.05, 95% CI: 1.29, 3.27), concubines (AOR = 1.78, 95% CI: 1.02, 3.11)), work experience in brothels (AOR = 1.39, 95% CI: 1.04, 1.84), the type of sex (AOR = 2.75, 95% CI: 1.35, 5.58), the history of sexual violence (AOR = 1.54, 95% CI: 1.19, 2.01), and alcohol consumption (AOR = 1.53, 95% CI: 1.18, 2.01) were significantly associated with a history of intentional abortion.
Conclusion
Intentional abortion’s prevalence among Iranian FSWs has been much higher than that of the general female population in Iran, which is an alarming issue in the public health of this group and needs more effective interventions. In addition, alcohol consumption, working in a brothel, and being divorced are essential factors in increasing abortions among sex workers.
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Affiliation(s)
- Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Mehdi Gouya
- Iranian Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Elnaz Ezzati Amini
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sahar Sotoodeh Ghorbani
- Department of Epidemiology School of Public health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Bushra Zareie
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Neda Izadi
- Department of Epidemiology School of Public health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Kashefi
- Reproductive health, Population, Family and School Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- * E-mail:
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Tuot S, Teo AKJ, Chhoun P, Mun P, Prem K, Yi S. Risk factors of HIV infection among female entertainment workers in Cambodia: Findings of a national survey. PLoS One 2020; 15:e0244357. [PMID: 33347494 PMCID: PMC7751854 DOI: 10.1371/journal.pone.0244357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cambodia has been well recognized for its success in the fight against the HIV epidemic. However, challenges remain in eliminating HIV infections in key populations, including women working in entertainment establishments, such as massage parlors, karaoke bars, or beer gardens. This study explored the prevalence of HIV and identified factors associated with HIV infection among female entertainment workers (FEWs) in Cambodia. Methods This national biological and behavioral survey was conducted in 2016 in Phnom Penh and 17 provinces. We used a two-stage cluster sampling method to recruit FEWs for HIV testing performed on-site and face-to-face interviews using a structured questionnaire. We investigated factors associated with HIV infection using multiple logistic regression. Results This study included 3149 FEWs with a mean age of 26.2 years (SD 5.7). The adjusted prevalence of HIV was 3.2% (95% CI 1.76–5.75). In the multiple logistic regression model, the odds of HIV infection were significantly higher among FEWs in the age group of 31 to 35 (AOR 2.72, 95% CI 1.36–8.25) and 36 or older (AOR 3.62, 95% CI 1.89–10.55); FEWs who were not married but living with a sexual partner (AOR 3.00, 95% CI 1.16–7.79); FEWs who had at least ten years of formal education (AOR 0.32, 95% CI 0.17–0.83); FEWs who reported having abnormal vaginal discharge (AOR 3.51, 95% CI 1.12–9.01), genital ulcers or sores (AOR 2.06, 95% CI 1.09–3.17), and genital warts (AOR 2.89, 95% CI 1.44–6.33) in the past three months; and FEWs who reported using illicit drugs (AOR 3.28, 95% CI 1.20–4.27) than their respective reference group. The odds of HIV infection were significantly lower among FEWs working in karaoke bars (AOR 0.26, 95% CI 0.14–0.50) and beer gardens (AOR 0.17, 95% CI 0.09–0.54) than among freelance FEWs. Conclusions The prevalence of HIV among FEWs in Cambodia remains much higher than that in the general population. These findings indicate that differentiated strategies to address HIV and other sexually transmitted infections should be geared towards FEWs working as freelancers or in veiled entertainment venues such as massage parlors and freelance sex workers. Prevention efforts among venue-based FEWs should be sustained.
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Affiliation(s)
- Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Center for Global Health Research, Touro University California, Vallejo, California, United States of America
- * E-mail:
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Faini D, Munseri P, Bakari M, Sandström E, Faxelid E, Hanson C. "I did not plan to have a baby. This is the outcome of our work": a qualitative study exploring unintended pregnancy among female sex workers. BMC Womens Health 2020; 20:267. [PMID: 33261591 PMCID: PMC7709442 DOI: 10.1186/s12905-020-01137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND High number of unintended pregnancies-often leading to induced abortions-are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW's pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW's pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. METHODS We conducted in-depth interviews with 11 FSWs (January-June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. RESULTS FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs' commitment to good contraceptive practices. CONCLUSION Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.
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Affiliation(s)
- Diana Faini
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), 9 United Nations Road, Dar es Salaam, Tanzania.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Muhammad Bakari
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Eric Sandström
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Perrault Sullivan G, Guédou FA, Batona G, Kintin F, Béhanzin L, Avery L, Bédard E, Gagnon MP, Zannou DM, Kpatchavi A, Alary M. Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin. BMC WOMENS HEALTH 2020; 20:248. [PMID: 33167931 PMCID: PMC7650197 DOI: 10.1186/s12905-020-01091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
Background Behavioural and structural factors related to sex work, place female sex workers (FSWs) at high risk of maternal mortality and morbidity (MMM), with a large portion due to unintended pregnancies and abortions. In the African context where MMM is the highest in the world, understanding the frequency and determinants of pregnancy and abortion among FSWs is important in order to meet their sexual and reproductive health needs. Methods Data from two Beninese cross-sectional surveys among FSWs aged 18+ (2013, N = 450; 2016, N = 504) were merged. We first performed exploratory univariate analyses to identify factors associated with pregnancy and abortion (p < 0.20) using Generalized Estimating Equations with Poisson regression and robust variance. Multivariate analyses first included all variables identified in the univariate models and backward selection (p ≤ 0.05) was used to generate the final models. Results Median age was 39 years (N = 866). The proportion of FSWs reporting at least one pregnancy during sex work practice was 16.4%, of whom 42.3% had more than one. Most pregnancies ended with an abortion (67.6%). In multivariate analyses, younger age, longer duration in sex work, previous HIV testing, having a boyfriend and not using condoms with him were significantly (p < 0.05) associated with more pregnancies. Conclusion One FSW out of five had at least one pregnancy during her sex work practice. Most of those pregnancies, regardless of their origin, ended with an abortion. Improving access to various forms of contraception and safe abortion is the key to reducing unintended pregnancies and consequently, MMM among FSWs in Benin.
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Affiliation(s)
- Gentiane Perrault Sullivan
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Fernand Aimé Guédou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Georges Batona
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Frédéric Kintin
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Luc Béhanzin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Lisa Avery
- Medical Microbiology, College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Emmanuelle Bédard
- Département des sciences infirmières, Université du Québec à Rimouski, Lévis, Québec, Canada
| | - Marie-Pierre Gagnon
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département des sciences infirmières, Université Laval, Québec, Canada
| | - Djimon Marcel Zannou
- Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Bénin.,Centre national hospitalier universitaire HMK de Cotonou, Cotonou, Bénin
| | - Adolphe Kpatchavi
- Département de Sociologie - Anthropologie, Faculté des Lettres, Arts et Sciences Humaines, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Michel Alary
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada. .,Département de médecine sociale et préventive, Université Laval, Québec, Canada.
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Khezri M, Shokoohi M, Karamouzian M, Mirzazadeh A, Ghalekhani N, Gholamypour Z, Valipour A, Haghdoost AA, Sharifi H. Induced abortion and associated factors among female sex workers in Iran. EUR J CONTRACEP REPR 2020; 25:434-438. [PMID: 32938240 DOI: 10.1080/13625187.2020.1815007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Induced abortion is an occupational hazard for female sex workers (FSWs). This study aimed to examine the prevalence and factors associated with induced abortion among FSWs in Iran. METHODS 1337 FSWs aged ≥18 years who reported selling sex to more than one male client in the past 12 months were recruited in 13 major cities in Iran between January and August 2015. Bivariable and multivariable modified Poisson regression models were constructed to examine the correlates of induced abortion. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported. RESULTS Lifetime induced abortion was reported by 621 of 1335 participants (46.5%; 95% CI 43.8, 49.2). Older age (APR for ≥ 35 vs. < 25 years, 1.46; 95% CI: 1.03, 2.07), having ever been married (APR 1.58; 95% CI 1.05, 2.39), having ever worked in a brothel (APR 1.19; 95% CI 1.02, 1.38) and a lifetime history of being raped (APR 1.19; 95% CI 1.03, 1.38) were significantly associated with lifetime induced abortion (all p < 0.05). CONCLUSION The high prevalence of induced abortion among FSWs in Iran is concerning. Evidence-informed programmes targeting FSWs in Iran would improve their knowledge and encourage contraceptive use as well as promote pregnancy prevention and post-abortion care.
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Affiliation(s)
- Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Gholamypour
- Centre for Disease Control and Prevention, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Valipour
- Centre for Communicable Diseases, Ministry of Health, Tehran, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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10
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Bowring AL, Schwartz S, Lyons C, Rao A, Olawore O, Njindam IM, Nzau J, Fouda G, Fako GH, Turpin G, Levitt D, Georges S, Tamoufe U, Billong SC, Njoya O, Zoung-Kanyi AC, Baral S. Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:82-99. [PMID: 32234842 PMCID: PMC7108938 DOI: 10.9745/ghsp-d-19-00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
Female sex workers (FSWs) in Cameroon have unmet need for effective contraception, and experience of unintended pregnancy and pregnancy termination is common. Reducing barriers to accessing high-quality, voluntary family planning services in FSW-focused community services is a key strategy to promote client-centered care, promote informed choice, reduce unintended pregnancies, and improve quality of life for FSWs. Background: Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. Methods: From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Results: Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]=1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Conclusions: Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.
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Affiliation(s)
- Anna L Bowring
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Burnet Institute, Melbourne, Australia
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oluwasolape Olawore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iliassou Mfochive Njindam
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Metabiota, Yaounde, Cameroon
| | | | | | | | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Ubald Tamoufe
- Metabiota, Yaounde, Cameroon.,Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Serge C Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Oudou Njoya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Anne-Cécile Zoung-Kanyi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon.,Division of Operations Research, Ministry of Health, Yaounde, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Ong KKX, Ng JS, Om C, Chhoun P, Tuot S, Yi S. Perceived barriers and facilitators in using text and voice messaging for improving HIV and sexual and reproductive health of female entertainment workers in Cambodia: a qualitative study. Mhealth 2020; 6:38. [PMID: 33209915 PMCID: PMC7656103 DOI: 10.21037/mhealth.2020.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Female entertainment workers (FEWs) in Cambodia are one of the hard-to-reach populations at risk of human immunodeficiency virus (HIV) and poor sexual and reproductive health (SRH). Due to the stigmatizing nature of their work, it is difficult to reach them with prevention and treatment services. The Mobile Link project is a mobile health (mHealth) intervention that aims to deliver health messages to FEWs and link them up to health services. This study aims to explore the perspectives of stakeholders on the Mobile Link and identify barriers and facilitators to the project implementation, in order to determine areas for improvement of future mHealth interventions. METHODS This study was conducted between November to December 2018 in the capital city and other three provinces where the Mobile Link was implemented. We employed a qualitative research design using an interpretative approach. A purposive sampling method was used to recruit participants across four project sites. All participants were stakeholders involved directly or indirectly with the Mobile Link. Nine different groups of stakeholders at the national, non-governmental organizations, community, and individual levels were recruited. Seventeen semi-structured in-depth interviews (IDIs) and five focus group discussions (FGDs) were conducted and transcribed. Data were managed using NVivo 12 and analysed using thematic analysis with an inductive approach. RESULTS We derived four major themes: (I) perceived benefits, (II) attitudes, (III) access, and (IV) enabling environment. Different levels of stakeholders reported on the perceived benefits of the Mobile Link, including ease of use, knowledge gained, link to services, and cost-effectiveness. Perceived benefits and enabling environment were identified as facilitators to implementation of the project. Barriers included technological issues, operational challenges, poor rapport with entertainment establishment owners, and low motivation to participate in the Mobile Link among FEWs. CONCLUSIONS The Mobile Link has many advantages and is well-accepted by stakeholders from the national and community levels. We discussed the implications of the perceived facilitators and barriers identified on the project and mHealth interventions. Implications discussed should be taken into consideration by organizations implementing mHealth interventions for HIV key populations in Cambodia as well as in other resource-limited settings.
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Affiliation(s)
- Kiyoko Kai Xuan Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Janelle Shaina Ng
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Chhorvoin Om
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, CA, USA
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
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12
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Abstract
Purpose
The purpose of this paper is to determine the sexual risk behavior and sexual harassment among female beer promoters in Chiang Mai, Thailand and analyze the associations among demographic data, sexual activities, sexual orientation, attitudes and working conditions based on the level of sexual harassment.
Design/methodology/approach
This study is a cross-sectional study that approached 184 Thai female beer promoters in Chiang Mai by a snowball sampling technique. Data were collected through a self-administrative questionnaire to find demographic data, sexual activities, sexual orientation, attitudes, sexual risk behavior and sexual harassment while working as a beer promoter. Descriptive, Pearson’s χ2 and Fisher exact tests were performed to describe and determine the associations.
Findings
The findings highlight that sexual risk behaviors and sexual harassment are found among female beer promoters. In total, 62.5 percent of them ever had sexual intercourse and 25.2 percent did not use condom. For sexual harassment, most of respondents had experienced a medium level harassment especially verbal harassment (73.9 percent). It associated with currently student status (p=0.038), having sexual intercourse experience (p=0.024), and type of job (p=0.002).
Originality/value
This paper explores the sexual risk behaviors and sexual harassment among female beer promoters in the northern part of Thailand, containing the information on how common are the types of sexual risk behavior and sexual harassment experiences among a specific and hard-to-reach population.
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13
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Yam EA, Sultana N, Hossain T, Zieman B, Roy S, Yasmin R, Sadiq N, Hossain SMI. Reproductive health and desire for children among young female sex workers in Bangladesh brothels. Health Care Women Int 2019; 40:981-994. [PMID: 31161893 DOI: 10.1080/07399332.2019.1623801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Globally, reproductive health research among female sex workers (FSWs) often focuses on pregnancy prevention, but many women who sell sex aspire to have children in the future. In Bangladesh, where early marriage and parenthood is the norm, we examine reproductive histories and childbearing desires of young women who sell sex in brothels. We interviewed 1061 FSWs aged 18 to 24 in eight brothels in three Bangladesh divisions. Interviewers elicited information on sociodemographic characteristics, contraceptive use, pregnancy history, and childbearing desire. Bivariate and multivariate analyses were conducted to examine correlates of wanting to have a child within 24 months.
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Affiliation(s)
- Eileen A Yam
- Population Council , Washington , District of Columbia , USA
| | | | | | - Brady Zieman
- Population Council , Washington , District of Columbia , USA
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14
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Ippoliti NB, Nanda G, Wilcher R. Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low- and Middle-Income Countries: A Review of the Evidence. Stud Fam Plann 2017; 48:121-151. [PMID: 28422301 DOI: 10.1111/sifp.12020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Female sex workers and other women at high risk of acquiring HIV have the right to sexual and reproductive health, including the right to determine the number and timing of pregnancies. We conducted a literature review to examine the data that exist regarding the family planning and reproductive health needs of female key populations, the underlying determinants of these populations' vulnerability to poor reproductive health outcomes, and the obstacles they face in accessing high-quality reproductive health services. Findings indicate that female key populations experience high rates of unmet need for family planning and safer conception services, unintended pregnancies, sexual violence, and abortion, and that they practice inconsistent condom use. Restrictive policy environments, stigma and discrimination in health care settings, gender inequality, and economic marginalization restrict access to services and undermine the ability to safely achieve reproductive intentions. We offer recommendations for structural, health system, community, and individual-level interventions that can mitigate the effects of these barriers and improve reproductive health outcomes.
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15
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Yi S, Tuot S, Chhoun P, Pal K, Ngin C, Chhim K, Brody C. Sex with sweethearts: Exploring factors associated with inconsistent condom use among unmarried female entertainment workers in Cambodia. BMC Infect Dis 2017; 17:20. [PMID: 28056842 PMCID: PMC5217300 DOI: 10.1186/s12879-016-2101-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the success in promoting condom use in commercial relationships, condom use with regular, noncommercial partners remains low among key populations in Cambodia. This study explores factors associated inconsistent condom use with sweethearts among unmarried sexually active female entertainment workers (FEWs). METHODS In 2014, the probability proportional to size sampling method was used to randomly select 204 FEWs from entertainment venues in Phnom Penh and Siem Reap for face-to-face interviews. Multivariate logistic regression analysis was conducted to examine independent determinants of inconsistent condom use. RESULTS Of total, 31.4% of the respondents reported consistent condom use with sweethearts in the past three months. After adjustment, respondents who reported inconsistent condom use with sweethearts remained significantly less likely to report having received any form of sexual and reproductive health education (AOR = 0.49, 95% CI = 0.22-0.99), but more likely to report having been tested for HIV in the past six months (AOR = 2.19, 95% CI = 1.03-4.65). They were significantly more likely to report having used higher amount of alcohol in the past three months (AOR = 1.29, 95% CI = 1.01-1.99) and currently using a contraceptive method other than condoms such as pills (AOR = 4.46, 95% CI = 1.34-10.52) or other methods (AOR = 9.75, 95% CI = 2.07-9.86). CONCLUSIONS The rate of consistent condom use in romantic relationships among unmarried FEWs in this study is considerably low. The importance of consistent condom use with regular, non-commercial partners should be emphasized in the education sessions and materials, particularly for FEWs who use non-barrier contraceptive methods.
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Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia. .,Center for Global Health Research, Public Health Program, Touro University California, Vallejo, USA.
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Khuondyla Pal
- KHANA Center for Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Chanrith Ngin
- KHANA Center for Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Kolab Chhim
- HIV/AIDS Flagship Project, KHANA, Phnom Penh, Cambodia
| | - Carinne Brody
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, USA
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16
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Hsu LN, Howard R, Torriente AM, Por C. Promoting Occupational Safety and Health for Cambodian Entertainment Sector Workers. New Solut 2016; 26:301-13. [PMID: 27242184 DOI: 10.1177/1048291116652688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cambodia has developed booming textile, garment, tourism, and entertainment service industries since the mid-1990s. The 2007 global financial crisis pushed many garment workers, who lost their jobs, into the entertainment sector. Entertainment workers are typically engaged informally by their employers and are subjected to long working hours, sexual harassment, and violence. Many who sell beverages are forced into excessive alcohol consumption as part of their work. Many are also expected by their employers and clients to provide sexual services. To address unsafe and unhealthy working conditions for these workers, an innovative occupational safety and health regulation was adopted in 2014. This first-of-its-kind occupational safety and health regulation was developed jointly by the Cambodian Ministry of Labour and Vocational Training and employers' and workers' organizations in the entertainment sector. The implementation of this regulation can also be a viable contribution of occupational safety and health to HIV interventions for these workers.
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Affiliation(s)
- Lee-Nah Hsu
- International Labour Organization, Geneva, Switzerland
| | | | | | - Chuong Por
- International Labour Organization, Phnom Penh, Cambodia
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