TY - JOUR
T1 - Structural interventions and social suffering
T2 - Responding to amphetamine-type stimulant use among female entertainment and sex workers in Cambodia
AU - Coupland, Heidi
AU - Page, Kimberly
AU - Stein, Ellen
AU - Carrico, Adam
AU - Evans, Jennifer
AU - Dixon, Thomas
AU - Sokunny, Muth
AU - Phou, Maly
AU - Maher, Lisa
N1 - Funding Information:
We are grateful to the women who participated in the study, the FH1360 team in Phnom Penh, and the SMARTgirl programme staff in each province. We also acknowledge the support of our CIPI partners, the Department of Mental Health and Substance Abuse, Cambodian Ministry of Health , especially Dr Chhit Sophal and General Neak Yuthea and the Cambodian National Authority for Combating Drugs. The study was funded by the National Institute on Drug Abuse of the the National Institutes of Health under Award Number R01-DA033672 . Lisa Maher is supported by the award of an Australian National Health and Medical Research Council Senior Research Fellowship .
Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2019/2
Y1 - 2019/2
N2 - Background: In Cambodia, HIV infection remains high among female entertainment and sex workers (FESW) and the use of amphetamine-type stimulants (ATS) is an independent risk factor for unprotected sex and sexually transmitted infections among this group. For decades public health approaches to HIV prevention in low and middle income countries (LMIC) have attempted to target the macro-power relations that shape risk behaviour with structural interventions. Recent research has highlighted that interventions that combine ATS risk reduction, in the form of financial incentives for abstinence, with existing HIV prevention programmes, may also play an important role. However, whether this approach goes far enough as a response to structural drivers of risk requires further examination. Methods: Semi-structured in-depth interviews were conducted with 30 FESW (mean age 25 years) from five provinces in Cambodia, as part of formative research for the implementation of the Cambodia Integrated HIV and Drug Prevention (CIPI) trial. The aim was to explore the contexts and drivers of ATS use. Data were analysed using grounded theory. Results: In addition to increasing occupational functionality, ATS were used to control pervasive feelings of ‘sadness’ in relation to the lived experience of poverty, family and relationship problems. Feeling sad could be viewed as an expression of social suffering, in response to competing priorities and seemingly inescapable constraints imposed by a lack of options for income generation, gender inequalities and stigma. Participants expressed interest in microenterprise (ME) opportunities, particularly vocational training, that could create new work opportunities beyond sex work and ATS use. Conclusion: In addition to reducing ATS use, HIV prevention interventions need to target sources of sadness and social suffering as drivers of risk among FESW in this context. The inclusion of ME opportunities in HIV prevention, to alleviate social suffering, warrants further investigation through qualitative and ethnographic research.
AB - Background: In Cambodia, HIV infection remains high among female entertainment and sex workers (FESW) and the use of amphetamine-type stimulants (ATS) is an independent risk factor for unprotected sex and sexually transmitted infections among this group. For decades public health approaches to HIV prevention in low and middle income countries (LMIC) have attempted to target the macro-power relations that shape risk behaviour with structural interventions. Recent research has highlighted that interventions that combine ATS risk reduction, in the form of financial incentives for abstinence, with existing HIV prevention programmes, may also play an important role. However, whether this approach goes far enough as a response to structural drivers of risk requires further examination. Methods: Semi-structured in-depth interviews were conducted with 30 FESW (mean age 25 years) from five provinces in Cambodia, as part of formative research for the implementation of the Cambodia Integrated HIV and Drug Prevention (CIPI) trial. The aim was to explore the contexts and drivers of ATS use. Data were analysed using grounded theory. Results: In addition to increasing occupational functionality, ATS were used to control pervasive feelings of ‘sadness’ in relation to the lived experience of poverty, family and relationship problems. Feeling sad could be viewed as an expression of social suffering, in response to competing priorities and seemingly inescapable constraints imposed by a lack of options for income generation, gender inequalities and stigma. Participants expressed interest in microenterprise (ME) opportunities, particularly vocational training, that could create new work opportunities beyond sex work and ATS use. Conclusion: In addition to reducing ATS use, HIV prevention interventions need to target sources of sadness and social suffering as drivers of risk among FESW in this context. The inclusion of ME opportunities in HIV prevention, to alleviate social suffering, warrants further investigation through qualitative and ethnographic research.
KW - Amphetamine-type substances
KW - HIV
KW - Microenterprise
KW - Sex work
KW - Social suffering
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U2 - 10.1016/j.drugpo.2018.12.002
DO - 10.1016/j.drugpo.2018.12.002
M3 - Article
C2 - 30583088
AN - SCOPUS:85058810775
VL - 64
SP - 70
EP - 78
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
SN - 0955-3959
ER -
