Explosive spread of HIV-1 and sexually transmitted diseases in Cambodia

A cross-sectional study conducted in 5 locations in Cambodia (Phnom Penh, Svay Pak, Sihanoukville, Battambang, and Sisophon) in 1996, compared prevalences of HIV and other sexually transmitted diseases (STDs) in 314 women seeking reproductive health services, 322 male police and military personnel, and 437 brothel-based sex workers (SWs). Among SWs, 38.7% had chlamydial and/or gonococcal infection and 13.8% were syphilis seroreactive. Among police and military personnel, 2.1% had chlamydial infection, 5.0% had gonorrhea, and 6.6% were syphilis seroreactive. 5.3% of reproductive health care clients had chlamydial and/or gonococcal infection and 4.0% were syphilis seroreactive. HIV prevalence was 40.6% among SWs (range by site, 19-51%), 12.5% among police and military personnel (range, 6-16%), and 4.5% in the reproductive health client group (range, 3-7%). Assays of serum specimens from 9 HIV-1-seropositive individuals revealed subtype E, suggesting that Cambodia's HIV epidemic is a result of regional spread from Thailand rather than importation by UN peacekeeping troops. 56% of police and military personnel acknowledged having sex with a prostitute in the month preceding the survey and 88.5% reported such an encounter in the past year; only 38% reported consistent condom use with commercial SWs. The high rates of HIV and other STDs identified in this study indicate an urgent need for preventive interventions, particularly ones focused on the commercial sex industry.