Commercial sex workers: Victims,vectors or fighters of the HIV epidemic in Cambodia?

Abstract: This paper looks at the knowledge, attitudes and behaviour of commercial sex workers (CSWs) in Cambodia regarding HIV/AIDS and condom use. The findings are based on semistructured interviews and focus groups with brothel‐based and self‐employed CSWs, and interviews with people who work with them. The respondents live in two towns near the Thai border served by Medecins Sans Frontiers sexually transmitted disease clinics set up to reduce the transmission of HIV. Most CSWs had attended the clinics. Knowledge of HIV and the ability of condoms to prevent infection was universal. The desire to use condoms with clients was also universal. Most CSWs were active and skilful in negotiating condom use with clients. However, many CSWs who wanted to use condoms failed to do so on occasion due to disparate power relationship with brothel owners and clients, and economic desperation. In addition, some exempted regular or special clients from condom use due to emotional isolation and misconceptions over susceptibility to HIV. The current 100% Condom Use Policy in place in Cambodia is not compatible with voluntary programmes such as the successful Medecins Sans Frontiers clinics. The government policy also fails to address the broader social and economic factors that make CSWs unable to enforce condom use when a client does not desire to do so.