Areport into the effectiveness of the 100% Condom Campaign - the national strategy

to prevent HIV transmission through sex workers - found it has achieved mixed results.

One serious finding was that localized corruption has extensively undermined the

program.

Perceptions of the Cambodian 100% Condom Use Program: Documenting the Experiences

of Sex Workers was drafted by the POLICY Project, an HIV/AIDS civil society group.

Under the 100% campaign, brothel owners are meant to provide all sex workers with

condoms for every client. Owners who fail to comply face sanctions such as warnings

and closure.

One of the strengths of the program, said study author David Lowe, was its endorsement

by Prime Minister Hun Sen and the government. Putting the responsibility for compliance

on brothel owners, not just sex workers, was also a benefit.

Another key provision was the regular attendance of sex workers at sexually transmitted

infection (STI) clinics. That had helped ensure they had access to health services.

"Previously, bonded sex workers would not have been allowed out of a brothel

to attend a health clinic," Lowe said.

But the report, which Lowe said was meant as constructive criticism, contained far

more recommendations than praise. The study discovered there was a lack of sex-worker-friendly

STI clinics, and that a number of sex workers paid bribes to health centers to avoid

attending.

"Corruption is also undermining the project very extensively," said Lowe.

A key recommendation was that the campaign be redesigned to ensure less hindrance

by corruption, particularly in the form of police harassment. Lowe said police did

not want to close brothels that failed to comply with the program because that meant

they could no longer extort bribes.

"Cooperation among police, brothel management, and sex workers is an essential

element of successful implementation of the 100% CUP at the local level," the

report stated. "However, in all sites visited, it was reported that police either

owned some brothels and/or were taking bribes from brothels.

"All of the sex workers appeared to be frightened of the police. While this

was partly because of claims of bribery, many reported incidents of violence when

police visited brothels and demanded free sexual services."

At his March 26 presentation of the report's findings, Lowe said the police should

not collect program data. Instead he recommended using health workers, who would

assign codes to the sex workers rather than use their names.

Kim Green, HIV/AIDS coordinator at CARE, told the meeting that one aspect missing

from the report was that sex workers often could not obtain condoms because brothel

owners charged fees for them.

Lowe told attendees that he did not doubt that was the case, and said it was also

quite significant that sex workers had no input into the program and were totally

dependent on unreliable brothel owners.

"The program currently ignores the fact that there are strong incentives for

condoms not to be used in brothels," he said, adding that the program had been

undermined by greedy owners making more money off clients seeking unprotected sex.

Also, the program's assumption that clients would follow brothel owners' instructions

was flawed.

More controversially, Lowe called for the creation of a local NGO of sex workers

to advocate their own rights. Such a partnership, he said, would benefit the program

as the sex workers would be effective peer educators, and could lobby for rights,

HIV education and social needs.

Some representatives from local HIV organizations expressed doubt that sex workers

could attend to their own needs. But Lowe said experiences in other countries had

resulted in a higher rate of condom use and improved self-esteem.

Lowe added that a broader approach was needed to promote safe sex, including establishing

sex-worker consultation groups in the provinces. Finally, the program needed to include

indirect sex workers, such as beer girls, who were also at great risk.

"At the moment it's estimated 50 percent of HIV infections occur from husbands

to their wives, so it's clearly important to target men," said Lowe. "In

addition to looking at the environment, we need to look at changing people's behavior."