CAMBODIA: "Sometimes I get regular women, sometimes I hire lady-boys"

Male commercial sex worker in Phnom Penh (Photo: David Swanson/IRIN)

PHNOM PENH, 11 November 2008 (PlusNews) - At the end of each day, Lux, a construction worker in the Cambodian capital, Phnom Penh, goes home for supper with his wife and young children. At the weekend he leads a different life, cruising the city's most notorious male brothels, where he regularly has group sex with men while watching pornographic videos.

"I think it's pretty common. A lot of men I know do this in secret without their wives knowing," he told IRIN/PlusNews. When asked about using condoms during sex, he said, "Sometimes, but never with my wife."

After police cracked down on the brothels he visited, Lux turned to the streets, taking nightly strolls through Hun Sen Park, where he pays transsexuals for sex at least once a month.

"Sometimes I get regular women, and sometimes I hire lady-boys," he said. He has never been tested for HIV and does not think it an issue, given Cambodia's falling HIV rate.

HIV prevalence dropped to just 0.9 percent in 2006 from 3.7 percent in 1997. But among men who have sex with men (MSMs), the rate remained an uncomfortably high 5.1 percent nationally, and 8.7 percent in Phnom Penh in 2006, the most recent year for which UNAIDS data is available.

Advocacy groups warn that the lack of outreach programmes to educate MSM about HIV risks could undo the progress that Cambodia as a whole has achieved.

"There are underestimated contributions of MSM to the overall environment of HIV," Tony Lisle, UNAIDS Cambodia country coordinator, told IRIN/PlusNews. "The HIV epidemic has been largely ignored among MSM."

Cambodian MSM see themselves as belonging to two distinct groups, which complicates outreach efforts. They define themselves as either "short-haired" - masculine-acting MSM who tend to have sex with each other - or "long-haired", transgender MSM, whose sexual partners can be from either group.

Half of long-haired MSM and 38 percent of short-haired MSM reported having unprotected sex in the past month, according to a UNAIDS survey in 2006. "We need to achieve an 80 percent condom-use rate to have an impact," Lisle noted.

Hidden MSMs

Long-haired MSMs had double the number of sexual partners as short-haired men (5.7 male partners in a month compared to 2.9 partners for short-haired MSM), and were far more likely to have sold sex (60 percent to 36 percent of short-haired men).

"These hidden MSM are difficult to reach because they're not self-identifying," Lisle said. "Many also engage in unsafe behaviours, like injecting drugs."

Lux does not consider himself homosexual, or at a heightened risk of HIV. "I'm not a gay person. I just do this for pleasure, like a lot of men," he told IRIN/PlusNews. "From the TV programmes I've seen that are run by NGOs, I think gay people spread AIDS, but not people who just do this on the side."

Makara, a male sex worker, is aware of the HIV risk and wears a condom, but does not panic if his condom breaks. "If it breaks for a second, that's fine," he said. "I just get a new one. I don't worry about HIV for that short amount of time it breaks."

Over a three-month period in 2006, according to UNAIDS, 20 percent of long-haired MSM who engaged in risky behaviour reported condom breakage, but nearly half said they had obtained their most recent condom from an NGO, showing that targeted prevention efforts have been making headway.

"If NGOs can get more prevention services to this vulnerable group, we could maintain the great progress we've seen for the last five years," Lisle said.

In Festivities Lurk Worries of HIV's Spread

By Chiep Mony, VOA Khmer
Original report from Phnom Penh
11 November 2008

With millions of spectators and hundreds of boat racers in the capital for this year’s Water Festival, health officials say they are worried about the spread of HIV and other diseases, as well as drug abuse.

A coalition of more than 100 health organizations, in collaboration with the national AIDS authority, has undertaken a three-day awareness campaign, distributing 250,000 free condoms to revelers and racers.

Authorities expect up to 5 million visitors to Phnom Penh for the three-day festival, which got underway Tuesday.

Health workers worry that festival-goers will use this opportunity to have unprotected sex with thousands of brothel workers, hostesses, beer girls and other prostitutes, or with “sweethearts” leading to the further spread of HIV.

“The people at risk for HIV are the youth, who like having sex outside [their homes],” said Choub Sok Chamreun, director of technical support and best practices department for the Khmer HIV/AIDS NGO Alliance. “If no measures are taken to educate them and promote HIV awareness, we think that more than 10,000 people would face HIV during these three days.”

Ly Po, vice president of the National Anti-AIDS Authority, echoed those concerns.

“During the festival, my authority provided about 2 million T-shirts throughout the country, so that people understand HIV education. The T-shirt says, ‘We must prevent ourselves from being infected with HIV/AIDS’ and ‘Don’t take HIV/AIDS home.’”

Meanwhile, authorities have hung a banner over Mao Tze Tung boulevard reading, “Condoms are a weapon to prevent HIV/AIDS infection.”

Sex workers at a brothel in Tuol Kork district who asked not to be named said they expect more clients during the festival, including boat racers.

“Whoever doesn’t use a condom, I don’t have sex with him,” said a 23-year-old woman, who said that during the 2007 Water Festival, she turned away several clients who didn’t want to use a condom.

Boat racers said Tuesday they had been educated about the spread of sexually transmitted diseases and how to protect themselves from falling into the water and drowning.

“I must take caution, even though I come from a far-away area,” said Kem Sophath, a racer from Kratie province. “If I feel sexual, I must use a condom properly.”