While the battle over condom use in commercial sex has seen major victories, the
battle to introduce condoms to "sweetheart" relationships has only just
PSI's traveling puppet show. The performers illustrate to crowds of up to 20,000 around the country the importance of safe sex.
Cambodian men are going to
prostitutes less often and using condoms more frequently when they do. That news
has put a smile on the face of the health officials and NGOs working to counter
the Kingdom's HIV/AIDS epidemic.
In 1997 around 75 percent of the police
and military surveyed reported having sex with a direct sex worker in the
previous year, yet the most recent Behavioral Surveillance Survey (BSS),
conducted by the National Center for HIV/AIDS (NCHADS), showed that figure had
dropped to 32 percent.
But, while the use of commercial sex workers has
diminished, 'sweetheart relationships' which involve sex have increased.
Romantic relationships are evolving from chaste encounters to sexual, and often
Fewer than 40 percent of the men surveyed
for the 1997 BSS had sex with their sweethearts, but by 2001 that figure had
reached 73 percent. Worryingly, only 20 percent of those men reported
consistently using condoms with their partners.
The women surveyed showed
a similar pattern. For both direct and indirect sex workers condom use with
sweethearts is far lower than with clients. Direct sex workers use condoms with
almost 90 percent of their clients but only half use condoms with their
sweethearts. Beer girls, who are considered "indirect" sex workers, reported 56
percent and 37 percent respectively.
It is a problem that has been
worrying Population Services International (PSI). The social marketing NGO and
their Number One condom have become synonymous with condoms in Cambodia. Sales
of PSI's Number One condom increased from just over 5 million in 1995 to more
than 16 million in 2001, around 80 percent of the market share.
success is viewed as a significant factor in arresting the spread of HIV in
Cambodia, but it has come with an unwanted side effect. The condom retains a
strong association with commercial sex, hence the 'sweethearts
A PSI poster with the message "Safety with No. 1" greets clients who visit one of Phnom Penh's numerous 'massage' hotels.
PSI's report, Sweetheart Relationships and Condom Use in Phnom
Penh, was commissioned to examine non-commercial sexual relationships. It is an
in-depth qualitative study of eight categories of vulnerable groups.
groups of eight volunteers were recruited from direct and indirect sex workers,
students, moto drivers, police, military and garment factory
Through focus groups and 'participatory learning in action
techniques' the researchers tried to elicit the different meanings of sweetheart
relationships and discern successful methods for introducing condoms into those
"There's nothing new about sweetheart relationships," says
Gillian Fletcher, who co-authored the report. "I think they've always existed
but people haven't been able to speak about them before."
where many aspects of sexuality are cloaked by traditional culture, the study
has peeked under the covers to reveal sexuality in transition.
term songsah or 'sweetheart' does not automatically denote a sexual
relationship. Rather it covers a range of relationships from hand-holding, to
lovers, pimps and sugardaddies.
The male participants in the study came
up with a staggering 45 terms for women they might have unpaid sex with, while
the women had 64 terms for their songsahs.
It is a lexicon of love that
defines a range of subtle variations on the types of sweetheart relationships
between men and women.
"They're a bit like Eskimos and snow," says
co-author David Wilkinson of the vast array of terms. "You name what's important
Some of the terms are designed to tease men about their amorous
behavior. The 'bee-hearted man' flits from one girl to another pollinating but
never staying, while the 'crocodile man' has more smarm than charm. Researchers
were initially mystified by the 'four-kneed relative', whom they later
discovered denoted a man who spends half his time on his knees for sex and the
other half on his knees begging for money.
Most terms, however, are not
quite so cynical, says Wilkinson.
"The heart features strongly in all the
sweetheart terms. They certainly perceive the relationships as romantic," he
Among the most popular terms are 'favorite of my heart', 'male
friend', 'man held in my heart', and 'older man at the center of my heart'. Each
is imbued with varied degrees of trust by the research participants.
"They place great emphasis on the importance of loung lorm or 'sweet
talk'," Wilkinson says.
Asking participants how they reached that stage
revealed some interesting answers.
"It begins with comforting, touching a
woman's body and telling lies by saying we don't have any wife," one moto driver
told the researchers.
The report found that there are two main categories
of relationship for men: casual, in which sex occurs within an hour of meeting
and money often changes hands, and longer term affairs where a lengthy courtship
precedes sex and trust must be won.
"It takes three months before
becoming sexual," said one student. "We begin touching, comforting her,
flattering her that 'you are very pretty, my dear' and saying 'I won't leave you
even after I've had sex with you'. Often, women say nothing, which means they
agree with us."
Women's reticence is understandable. Traditional Khmer morality frowns on
women who engage in sex prior to or outside of marriage.
According to the 2001 Demographic Health Survey (DHS) half of all Cambodian
women are married by 20 and 81 percent by 25.
Once married the overwhelming majority of women are faithful to their
husbands. Married women were more likely to report having had no sex at all in
the past 12 months (3 percent) compared with women who had had sex with someone
other than their husband (zero percent).
In Cambodia an unmarried woman
without her virginity is indelibly stained and frequently marginalized by
village and family. Men are said to be gold, which can be washed clean, while
women are cloth according to a popular Khmer saying. The family tightly
According to the DHS around half of all women met
their husband less than one month before getting married; 43 percent only met
their husband on their wedding day.
Chanthol Oung, executive director of
the Cambodian Women's Crisis Center, sees many women whose lives have been
damaged by the double standard that confines women to marriage and
"If women have sex before marriage then we are condemned, but
for men it's seen as OK," she says.
"In the cities right now women have
more freedom, and more freedom to choose their own spouse," she adds, but argues
it will be at least 20 years before women are not judged for exercising 'too
"The woman who is 'easy' is not seen as the 'good' woman
so the men just play with them but never marry them. They have them just for the
game," says Chanthol.
In a changing society women are tending toward more
sexual freedom, although still in very small numbers. The DHS found that women
rarely engage in sexual activity outside of marriage. Only 5 percent never
marry, and the percentage of single women who reported having had sex was a tiny
0.4 percent of all women.
However among more mobile groups, such as
garment workers, women have been reporting having a songsah or sweetheart in
greater numbers over the past five years.
"I think sweetheart
relationships are extremely widespread, and increasing as men's use of
brothel-based sex workers decreases," says Wilkinson. While he emphasizes that
the sweethearts report did not try to quantify non-marital sex, the researchers
had little trouble finding willing and experienced research subjects, both male
Wilkinson's impression is backed by NCHADS research. The BSS
surveyed high and medium risk men and women such as direct sex workers, karaoke
hostesses and beer girls.
Almost half of the beer girls surveyed in the
BSS also had a sweetheart, most commonly a businessman, government official,
policeman or member of the military. In 1997 less than half of beer girls who
had sweethearts also had sex with their sweetheart. Now virtually all
"It's becoming more common to have a sweetheart and I'm afraid that
it will become a norm," says NCHADS deputy director Dr Hor Bunleng. "In my
generation it was not acceptable but now it's becoming more acceptable to have
sweethearts in school and then, or later, they may have sex, but it is still a
The sweetheart relationship is not thought of as a commercial
one by either the men or women involved, according to the BSS findings. Only 4.4
percent of women reported never receiving money from their sweetheart, while
two-thirds said it was "not likely" they would ever marry their
PSI's sweethearts study found both commercial and
non-commercial versions of the relationship.
"Sex workers is a very
loosely defined term," says Wilkinson. "There's a great spectrum of women, like
beer girls, who don't necessarily consider themselves sex workers."
was a motivation for many of the women surveyed for the sweethearts
"The men who take us out to have sex are not faithful with us. We
know this in advance and thus what we need is only pleasure or money," said one
indirect sex worker.
While some sweetheart relationships are pre-marital
many others are extra-marital. The male participants in the sweethearts survey
showed little interest in marital fidelity, says
"Traditionally Cambodian men are expected to be sexually
aggressive and women passive. There is a tacit acknowledgment that Cambodian men
need many partners for sexual satisfaction.
"Many men have a cadre of
partners, with a wife, sex workers and one or more sweetheart also. It's quite
clear that men are the major vectors of transmission for HIV and there needs to
be a much greater emphasis on programs targeted at changing the behavior of
men," he says.
Researchers found that a high percentage of military and
police said they engaged in occasional homosexual sex acts, but none identified
themselves as homosexual.
Women bear the brunt of the blame for the
spread of HIV/AIDS, answers to other questions showed. When male students were
asked for their recommendations they bluntly told the researchers to "educate
The men interviewed typically indicated that no matter how
many other partners they had, they saw no need to use condoms with their wives
because "we trust each other". To maintain the appearance of trust other men
also refuse to use condoms with their sweethearts.
"If I use condoms she
will not believe in me and will no longer allow me to have sex with her," one
soldier told researchers, who say this link between trust and lack of condom use
is a cause for concern.
PSI's study also found that men almost always
initiate sex, even when the female sweetheart is also a sex
"Though we are sex workers, we are still shy, never using sweet
talk," one participant said. Sex workers and other sexually active women are
forced to conform to a passive role.
"The 'woman's code' still totally
dominates women's behavior," says CWCC's Chanthol Oung. "The code was taught at
school everyday. Girls were told 'don't speak loudly, don't walk fast, don't
glance at men'. It was in the curriculum."
For condom use the researchers
found that it was considered acceptable for women to suggest condom use. However
for most, but not all research subjects, women were frowned upon if they carried
condoms with them.
"That is why we usually have sex with songsah without
a condom. How can a condom be found when having sexual desire by chance? [If we
give our partner a condom] they will look down on us saying that we have already
been with a number of men," said one garment worker.
In an affectionate
relationship it is also usually unacceptable to mention disease prevention when
negotiating condom use, even though most participants agreed that that was the
main reason for using them. To raise the subject of HIV is viewed as a betrayal
"Trust is the key factor," says PSI's behavioral change
campaign coordinator Natacha Bobin. "Where trust is absent, that's when condoms
Men and women talk instead about preventing pregnancy
and preserving their family's honor.
"We tell them we want to prevent
pregnancy ... not prevent infection, because we fear they may get angry with
us," said one soldier.
The good news from the report, says Bobin, is that
Number One condoms received favorable feedback as Cambodia's condom of choice.
Social marketing NGOs in other countries have differentiated between condoms
marketed for paid sex and those for romantic liaisons. Bobin said PSI is
considering launching a second condom marketed to sweethearts as a dual
prophylactic against both pregnancy and disease.
In a trusting
relationship condoms aren't considered necessary. But that trust may well be
The students interviewed typically had an 'official'
sweetheart, often a female student or someone of the same social status. That
relationship might or might not be sexual, but they would also have a range of
other sexual encounters.
"Most of the young women are aware that their
boyfriends sleep with other women, but hope that, because their boyfriend cares
about them, they will use condoms with their other partners," says
The study found that the risk assessment of male students was
poor. Most decide they will not use condoms if a girl has pale skin, is from a
good family, or has only recently moved to Phnom Penh.
relationships are largely driven by men," says Wilkinson, "but the issue of
sexual pleasure for women is getting on the agenda, and there's a growing
awareness that satisfaction might be desirable."
"The reason we have sex
with different partners is that we want to know the techniques of having sex
from one man to another, or it is because we want to satisfy our passion," a
garment worker said.
Chanthol believes women should have the right to
sexual relationships but worries that the rapidly changing sexual mores open
women up to exploitation.
"Many women are cheated by traffickers. If the
man just pretends to be the boyfriend then it's very dangerous," she says. "To
prohibit youth from knowing each other is not really useful but maybe they
shouldn't sleep together before marriage. This is a transition period and it
should be taken slowly."
For NCHAD's Hor Bunleng the key to changing
behavior lies in education.
"They don't learn anything about sex in the
school system. Some girls even get very shocked and frightened when they begin
to menstruate," he says.
Wilkinson concludes that in addition to changing
male behavior, the portrayal of women in Khmer society also needs to change. PSI
plans a ' positive role model' campaign to encourage women to carry
"We need to make condoms acceptable in affectionate
relationships, and need to portray women who carry condoms as responsible,
respected and intelligent," he says.
PSI researchers have rated the levels of affection and respectability that
adhere to the different sweetheart terms.
Each term had a different
status. A kou kamnann chet (partner who is held by my heart) for instance was
suitable to be introduced to a man's family.
For women on the other hand
a kampoul sneih (top of love) received a low "introduce to the family"
He is "the man we heartily love, the place they take us to have
sex is good like a hotel," one woman told researchers.
(lovely brother) received the highest affection rating out of all 64 terms used
by women. A man simply referred to as bong was more likely to be asked to use a
condom, one sex worker said.
"This is used to please the men so they will
have sex with us and, in return, give us money and buy us presents."
men, the term srey kalibe is literally a high caliber woman. Usually young,
attractive, well dressed and riding a nice moto the srey kalibe is favored by
wealthy men and very well compensated for her affections.
One of the most disturbing aspects of the research was the
matter-of-fact approach young men have to gang rape
a very high incidence of gang rape and the students were able to relate stories
of rape in great detail," says PSI's Natacha Bobin. "When they talked about it
they saw absolutely nothing wrong with it."
The stories came to light in
the second part of the research where male students and female waitresses and
beer girls were asked to discuss issues of AIDS, condoms and sexuality with
"Every single male student had stories about gang rape,"
Bobin says. "The women said they felt much more vulnerable since the closure of
the karaoke bars and they rated fear of gang rape as their second greatest
Students both described and role-played typical gang rape
scenarios. Usually one member of the group goes to areas where non-brothel based
sex workers can be found, such as Hun Sen Park.
He then negotiates a fee
and takes the girl to a guesthouse where several of his friends are already
waiting. Once there the girl is powerless to refuse sex with all the men,
sometimes without condoms, without payment and accompanied by
"They were very matter of fact about it," says Bobin. "They
justified it in terms of it being less expensive and as a bonding experience for
"What's disturbing is the cynical attitude of men and young
people towards 'bad' women to the point of abuse," says the report's co-author
David Wilkinson. "[That is] particularly [a problem] among the emerging affluent
PSI plans to address the issue of violence against women
in its response to the report and will share the findings with government and
other organizations working in the field.
"We're hoping to work with
government and other NGOs to influence some sort of national campaign to address
violence," says Bobin. "HIV, gender, sexuality, power and poverty are all