Amphetamine-Type Stimulant (ATS) Use HIV among Young Female Sex and Entertainment Workers in Cambodia
We propose an exploratory developmental study investigating amphetamine-type substance (ATS) use among young women working in the entertainment and female sex work (FSW) industries in Phnom Penh, Cambodia. ATS use has increased tremendously in Cambodia, and although acknowledged to be a significant potential problem, little is known about ATS use among women. We will research current drugs being used, assess and develop measures of ATS use, and investigate associations between ATS with HIV infection, sexual risk behavior, and access to HIV care in HIV negative and positive women working in the entertainment/FSW industry. In recent work we conducted in Cambodia, 42.5% of entertainment/FSWs reported using ATS, including yama (40%) and,or crystal (23%). No studies have been conducted to qualify the various substances used, to quantify its use, or ATS' impact on sexual risk and health-seeking behaviors among this population. ATS use has been shown to be associated with elevated risk of HIV infection in many groups and locales; thus we hypothesize the same will be true among women in Cambodia. We also hypothesize that ATS use may be associated with negative outcomes relative to HIV care: HIV positive ATS users may access HIV care, and initiate antiretroviral therapy (ART) at lower rates than their non-ATS using counterparts due to poor patient follow up or provider bias. ATS may increase risk of medication related toxicities, for instance hepatotoxicities, poor adherence, contributing to sub-therapeutic drug levels and resistance. The proposed study will be conducted within the framework of an pilot cohort of HIV-negative and positive young entertainment/ FSWs: the Young Women's Health Study (YWHS), affording us an extraordinary opportunity to better understand the entwined epidemics of ATS use and HIV infection in a high-risk population To explore ATS use and assess associations between ATS use and HIV, sexual risk, and utilization of HIV care/treatment, we will collect both qualitative and quantitative data. In depth interviews and focus groups will be conducted initially, to explore ATS issues, views, and knowledge among the target population and to inform a quantitative survey. We will recruit 100 women from the YWHS cohort, to participate in a survey and HIV testing. We will measure ATS use, and other risk exposures by self-report and urine-based toxicology testing. HIV antibody status will be determined by serologic testing. Associations between ATS use and sexual risk (principally condom use, and number and type of sex partners) will be assessed for both HIV-positive and negative women, and access to HIV care including initiation of anti-retroviral therapy (ART) use) will be evaluated among those who are HIV-positive. Finally, we will gather information from governmental, clinical and other (NGO) sources in Cambodia regarding known pharmacological and forensic data, to inform an evaluation of potential interactions between ATS and antiretroviral treatment. The results of this study will be used to lay the groundwork for a future R01 proposal examining ATS substances in more detail, and ART use, including potential drug-drug interactions, and will guide recommendations for the provision of HIV prevention and care services among ATS-using women in Cambodia and Southeast Asia. Project Narrative We propose to conduct an exploratory developmental study investigating amphetamine-type substance (ATS) use among young women working in the entertainment and female sex work (FSW) industries in Phnom Penh, Cambodia. ATS use has increased tremendously in Cambodia, and although acknowledged to be a significant potential problem, little is known about ATS use and HIV among young high risk women. We will research which current drugs are being used, assess and develop measures of ATS use, and investigate associations between ATS with HIV infection, sexual risk behavior, and access to HIV care and treatment in HIV negative and positive women working in the entertainment/FSW industry. The research will be conducted by a multi-disciplinary collaborative research group that includes academic, governmental and community partners.