Cambodian sex workers waiting for customers at a public park in Phnom Penh. Credit Chor Sokunthea/Reuters

H.I.V. Stalks Prostitutes and Their Children in Cambodia

New York Times | 20 February 2017

Abortion and AIDS are the two most common causes of death among Cambodian female sex workers, and AIDS is the most frequent cause of death among their children, according to a small new study.

Prostitution in poor countries with high H.I.V. rates has lethal consequences not just for women but for their infants, the study found. Mothers engage in riskier sex acts to feed their children, but because they are socially shunned or threatened with arrest, they often cannot get drugs that would prolong their lives or prevent them from infecting their babies.

The study, by investigators at Global Health Promise, a nonprofit based in Portland, Ore., that researches prostitution in poor countries, was an attempt to shed light on a little-studied corner of the AIDS epidemic. The group takes no position on whether prostitution should be legal, its director, Brian Willis, said.

Sex workers are about 12 times as likely to be infected with H.I.V. as other women in their communities. Estimates of how many women sell sex around the world vary, but range from 10 million to 40 million. Most are mothers.

They are often the focus of H.I.V.-prevention efforts, but that can also make them targets for discrimination, violence, police seizures of condoms as evidence, and other abuses.

The researchers adapted questions and techniques from standard demographic surveys to interview 271 sex workers in four Cambodian cities about the deaths of other sex workers and of their children. They were paid about $5 for one-hour interviews.

The mean age was 29, with seven years as a sex worker. Only women over 18 were interviewed. Despite crackdowns by Cambodian police and American immigration authorities, the country remains a destination for child sex tourism. Human Rights Watch has detailed abuse of sex workers by police even when they are released to social work agencies rather than imprisoned.

Of the 32 women’s deaths reported, 40 percent were from abortions, the report found. Abortion is legal in Cambodia, but there is widespread misunderstanding of that, according to a report by the Guttmacher Institute. Public clinics often do not offer the procedure, forcing women to find other providers. “Deep massage abortion” — a traditional practice — can cause fatal hemorrhages.

AIDS was the second-most-common cause of death among the women, and the most common cause among the 52 infants whose deaths were described, suggesting that access to even the brief course of drugs needed to prevent mother-child transmission was low.

Global Health Promise does not study highly paid escorts, said Mr. Willis, who paid for the research with a Fulbright grant. “This population works in bars, beer gardens and karaoke parlors, and is extremely poor,” he said. “If you have a hungry child at home, you can’t choose not to have unprotected sex. What I heard again and again was: ‘I’ll do anything to take care of my kids.’”