It has long been advocated that scarce public health resources should be used for interventions that are most likely to have a significant impact on the HIV epidemic. This operational research project aims to validate a specific protocol for the management of gonococcal and/or chlamydia cervicitis in female sex workers that has been piloted in Cambodia since 1998, and has been officially adopted by the Ministry of Health in Cambodia for use in all services providing STI care to sex workers in the country. The Cambodian component of the research project also aims to document the context of sex work in Cambodia, in particular the aspects and determinants of the mobility of sex workers in space and time across the country. The Thai component of the project similarly aims to document the aspects and determinants of the mobility of vulnerable women (not only sex workers, but also domestic servants and factory workers) as well as their particular reproductive health needs. The overall objective is to help the National HIV/AIDS Control Programme in both countries to implement high quality and cost-effective targeted interventions for vulnerable women who are particularly at risk of STI/HIV infection and related reproductive health problems. The project consists of three related yet distinctive studies, two in Cambodia and one in Thailand, each one with its own specificity.
The main objective is to conduct high-quality operational research in order to help the National HIV/AIDS Control Programme in both Cambodia and Thailand to implement high-quality and cost-effective interventions targeted at vulnerable women who are at particular risk of STI/HIV infection and related reproductive health problems.
Three closely related, yet distinctive studies, will aim to achieve the following specific objectives:
1. to evaluate pilot STI services for female sex workers in Cambodia
2. to document the aspects and determinants of mobility among female sex workers in Cambodia
3. to document the aspects and determinants of mobility as well reproductive health needs among vulnerable women in Thailand
4. to build up sound scientific thinking among government and NGO staff through their involvement in this research project.
Tackling the spread of HIV in Cambodia and Thailand must address the issue of sexual transmission of HIV as a priority. In the context of HIV/AIDS prevention, it is important to focus STI and related reproductive health services on the population groups with the highest prevalence of STIs and/or the greatest vulnerability to infection and reproductive health problems because of their occupational situation. In Cambodia particularly, and still to a significant extent in Thailand, the main priority groups for STI Care in HVI/AIDS prevention are female sex workers (and their clients). STI care and related health services targeted at vulnerable women need to be customised to meet their special needs. This operational research proposal consists of inter-related yet distinctive studies. One study will evaluate a specific STI management protocol for sex workers in Cambodia. The other two studies (one in Cambodia and one in Thailand) will seek to understand better the context in which sex workers enter/re-enter into sex work, move across the country, and leave sex work. In Thailand, the study will also seek to document the mobility of vulnerable women across occupational sectors (sex workers, domestic servants and factory workers) and assess the reproductive health needs of these women (not only in terms of STIs but also in terms of contraception and safe abortion). The purpose of this research project will be to maximise the cost-effectiveness of STI care for sex workers (study 1). It will also provide the Thai and Cambodian governments with the necessary information to make sound policy and strategy decisions related with STI/HIV and reproductive health interventions for vulnerable women (studies 2 and 3). This research consortium consists of four partners, two from EU Member States, one from Cambodia and one from Thailand. The Institute of Tropical Medicine (ITM) of Antwerp, which will be the coordinator, has accumulated vast experience, both in research and in technical assistance related with HIV epidemiology and STI interventions for high-risk populations. In Cambodia, through Dr. Crabbe, ITM has been providing technical advice for the past four years to the National HIV/AIDS Programme. The Municipality Health Service of Amsterdam has a vast experience of work with marginalised populations in both The Netherlands and elsewhere. They also have a keen interest in the social aspects of health. The Centre for Advanced Study is a Cambodian non-governmental organisation with vast experience in social science research in Cambodia. Finally, the raison d'être of Global Alliance Against Trafficking in Women (GAATW) is to ensure that the human rights – are respected.
Each one of the three studies has several milestones, deliverables, and work packages. Each study aims to result in conclusions and practical recommendations for the appropriate policy and strategy decisions by the Thai and/or the Cambodian National HIV/AIDS Control Programme.
‘Prince Leopold’ Institute of Tropical Medicine
Department of Microbiology,
STI/HIV Research and Intervention Unit 155 Nationalestraat
Tel: +32 3 2476320
Fax: +32 3 2476333