Context is king: sex education in the slums of Phnom Penh

I’ve decided to spend a good part of my day off (Sunday) working on a workshop I’m to facilitate to some local teenagers in about a week. It’s a four-day workshop (three hours a day) on HIV/AIDS, domestic violence, drug awareness, and life skills. The curriculum was provided to me, so I’m merely working on creating a PowerPoint to guide the lectures, discussion, and exercises.

Never one to leave well enough alone, though, I started making minor revisions to the curriculum. However, in doing so, I’ve begun to realize that I know very little about low-income, urban Cambodian teenagers. So, while I think the curriculum in general is quite good, I’m unclear how well tailored it is to meet the needs and concerns of this group. As a starting point, I’m wondering about the epidemiology of HIV in Cambodia and related risk behaviors of its youth.

What I’ve found is that the core of HIV infection in Cambodia resides within the female sex worker industry. An estimated 35% of all sex industry workers are HIV-infected. Female sex worker industry clients tend to be military and police personnel and to a somewhat lesser extent, truck and taxi drivers. These individuals are the bridge to infection in the general population. Little is mentioned about HIV incidence and prevalence among men who have sex with men or injecting drug users, but it is highly likely that significant transmission is occurring within these groups as well. Having said that, the public health focus appears to be on encouraging condom use among men frequenting female sex workers and thereby interrupting the chain of HIV transmission into the general population.

The other piece of useful information is that premarital sex is relatively rare among Cambodians and, relatedly, first intercourse tends to occur at a later age – in the early 20s. Extramarital sex is also relatively rare. So, it would appear that a good number of Cambodians wait until marriage to have sex and are mutually monogamous thereafter – therefore at low or zero risk for HIV and other STDs. This is good news in terms of disease risk, and combined with an increase in use of condoms among sex workers, may explain why government officials cite considerable progress in the war against HIV in Cambodia.

In light of this information, what are the key messages to my teenage students next week? I think that reinforcing messages of abstinence until marriage and mutual monogamy makes sense within the context of the current sexual culture in Cambodia. In addition, consistent use of condoms outside these circumstances is a critically important complementary message. Beyond that, expanded advocacy efforts to address the root causes of sex trafficking and prostitution and the abject poverty that feeds this exploitation are desperately needed. I hope to build discussion of this issue into the workshop as well.

On a completely different note, I was offered the soup dish pictured below for lunch today. While I did document my willingness to try the caterpillar larva yesterday, I must admit to having little interest in trying these little guys (minnows?) today. I did manage to pop a small piece into my mouth, but was put off by its crunchiness (bones?). It didn’t make it down the hatch. I’ll keep you posted about other Cambodian delicacies that are finding their way into my home-cooked meals.

Fish soup