A new report on sex work in Phnom Penh has found that workers under less supervision are increasingly at risk for HIV and sexually transmitted infection, raising concerns over the shifting nature of sex work since the enactment of the 2008 Law on the Suppression of Human Trafficking and Sexual Exploitation.

The study, published in this month’s edition of Sexually Transmitted Diseases and which evaluates new HIV prevention challenges, finds the risk for both HIV and STI is higher for women working as freelancers or in multiple venues, as well as for women who use amphetamine-type substances on the job.

“Women who worked as freelance sex workers had higher odds of HIV infection compared with entertainment-based sex workers, and those who reported having a boss or manager had lower odds of HIV than those who did not,” the report states.

Researchers conducted a 12-month study of 160 sex workers, aged between 15 and 29, in Phnom Penh between 2007 and 2008.

The risk of STI was highest among freelance sex workers, women with a longer length of employment as sex workers, women without a boss or manager, and recent yama, or amphetamine, use.

The researchers express concern about the 2008 human trafficking law since it changed the typology for sex worker venues by outlawing brothels and pushing women further towards arenas where researchers found they are most at risk for HIV and STIs.

Cambodia country manager for Population Services International Chris Jones said prevention should take account of work venues and drug prevention, but noted implementation would be difficult.

“The shift of sex work from brothels to entertainment establishments has greatly complicated HIV prevention efforts, which rely on regular, unfettered access to women at risk of HIV to deliver information, products and referral to services such as STI and HIV testing and access to family planning services,” he said.

He added that prevention also requires access to male clients who play a key role in the use of condoms. “Scaling up condom availability at or near non-traditional outlets” ... has also proven effective.

Jones said partner organisations have adapted their approaches to reach women at risk, but the new environment is much more complicated and poses greater challenges than the model of the past.