One hard-to-reach, high-risk group in Cambodia is the growing population of female entertainment workers (FEWs). FEWs are women working in venues such as karaoke bars, massage parlors, restaurants (as hostesses or singers) or beer gardens. FEWs frequently sell sex, directly or indirectly, to male patrons to supplement their income.
By 2013, there were approximately 40,000 FEWs in Cambodia, 24,000 of whom resided in the capital city of Phnom Penh. This group has been increasing since the 2008 passage and implementation of the ‘Law on Suppression of Human Trafficking and Sexual Exploitation,’ which banned brothel-based sex work, and more women have moved into indirect sex work based out of entertainment venues. The influx in the number of FEWs also follows the increase in garment factory jobs that attract young women from poor rural families to migrate to urban areas to earn and remit income to their families in their home villages. Today, the garment factories in Cambodia employ over 700,000 young women. Garment workers are typically not given fair wages, safe work environments or health insurance—a combination of factors that have resulted in worker unrest and mass fainting incidents at various factories. Claiming worker rights becomes a complicated challenge that involves risking their jobs, their livelihood and their ability to provide for family. As a result, more and more young migrant women become involved in alternative work opportunities in the entertainment industry. In addition, urban youth may also be at-risk of engaging in sex work. A recent study from Cambodia found that 48% of at-risk female youth across the country reported having been paid for sex in the past year.
FEWs in Cambodia are considered at high-risk for poor sexual and reproductive health (SRH) outcomes because of their involvement in direct or indirect sex work and limited access to SRH services. Indirect sex work is sex work that occurs through non-brothel based establishment such as pubs, karaoke bars and massage parlors. Recent studies indicate that HIV prevalence among women working in other entertainment establishments was 9.8%, which is lower than street-based sex workers (37.3%) and brothel-based sex workers (17.4%), but is still considered a national concern . Estimated HIV incidence among FEWs was 9.2% in 2009. In addition, in 2011/2012 incidences of C. trachomatis, HPV and N. gonorrhea among FEWs were 11.5%, 41.1%, and 7.8%, respectively.
The Mobile Link intervention is an operational mHealth research project that aims to engage FEWs, and link them to high quality prevention, care and treatment services provided by KHANA and its partner organizations. This intervention will consist of theory-based text, i.e. short message service (SMS), or voice messages (VM) that aim to increase the utilization of SRH services and reduce risky behaviors of FEWs in Cambodia. In addition, this intervention will determine if SMS/VM messaging can be a reliable source of monitoring and evaluation data. The initial operational research project will focus on FEWs as a proof of concept and if effective, the messaging program will be tailored for other key populations.
In partnership with KHANA, InSTEDD iLab SEA support this mHealth research project by providing the SMS and Voice technologies solutions.