While the battle over condom use in commercial sex has seen major victories, the

battle to introduce condoms to "sweetheart" relationships has only just

begun.

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

semi-commercial, relationships.

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.

PSI's

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

study'.

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.

Two

groups of eight volunteers were recruited from direct and indirect sex workers,

students, moto drivers, police, military and garment factory

workers.

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

relationships.

"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."

In Cambodia,

where many aspects of sexuality are cloaked by traditional culture, the study

has peeked under the covers to reveal sexuality in transition.

The Khmer

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

to you."

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

says.

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

regulates marriage.

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

fidelity.

"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

much' freedom.

"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

and female.

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

do.

"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

minority."

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

sweetheart.

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."

Money

was a motivation for many of the women surveyed for the sweethearts

study.

"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

Wilkinson.

"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 women".

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

worker.

"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

of trust.

"Trust is the key factor," says PSI's behavioral change

campaign coordinator Natacha Bobin. "Where trust is absent, that's when condoms

are introduced."

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

misplaced.

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

Bobin.

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.

"Sweetheart

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

condoms.

"We need to make condoms acceptable in affectionate

relationships, and need to portray women who carry condoms as responsible,

respected and intelligent," he says.

Lexicon of

love

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"

rating.

He is "the man we heartily love, the place they take us to have

sex is good like a hotel," one woman told researchers.

Bong samlang

(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."

For

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

"We found

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

their peers.

"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

fear."

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

violence.

"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

the group."

"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

middle class."

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

interlinked."