GLOBALIZATION AND INCREASING BEER SALES, SEXUAL TOURISM AND HIV/AIDS. MULTI- SECTORAL AND GRASS-ROOT COMMUNITY RESPONSES IN SIEM REAP, CAMBODIA
Lubek, I. and McCourt, M., University of Guelph, Canada, Chhit, M., Mondol Moi Health Centre, Kros, S., HIV/STD Program of the Provincial AIDS Department in Siem Reap, Chhem, D.B., Siem Reap Province and Pen, S., Siem Reap and Mondol Moi Health Centre Cambodia, Wong, M.L., National University of Singapore, Singapore
With 240,000 tourists coming to the Angkor Wat temples this year (22% as "sexual tourists"), the 116,000 citizens of nearby Siem Reap experienced an HIV/AIDS epidemic with 10,000 estimated sero-positive cases, compared to the national average <3%. In-depth interviews pinpointed excessive beer- drinking by tourists and local men leading to inconsistent condom use with sex- workers. Most of the 400+ non-brothel-based "indirect sex workers" are "beer girls", who exclusively market one international brand. Paid about $2/day by distributors for Labatt, Budweiser, Heineken, Stella Artois, Fosters, ABC, San Miguel, Tiger, Alain Delon, Beck, etc., they sometimes drink with customers to reach sales-quotas and agree to after-hours sex- for-money. Increasing sero-positivity rates for sex-workers (19-44% ) are parallelled by increases for pregnant/ married women ( from 5% in 2000 to 9.7%-19%, per sample during 2001, against the 1.9% national rate). Strategies to obtain 100% condom compliance from male partners are being introduced through a peer-educational intervention project. Condom-use reports from 2001 indicated 78% use by sex-workers with clients (but 20% with "boyfriends" and non-paying men), but only 10% for pregnant wives. Alongside input from beer-girl focus groups and medical advisors, the collected reasons for condom resistance are being incorporated into Khmer booklets and audio-cassettes. Supported by the Elton John AIDS Foundation, materials for these non-reading women-at-risk will be available for peer- education through local/international NGOs, government agencies and medical practitioners. Local and international businesses are simultaneously being solicited to sustain further proactive community health initiatives.