Marseille 2007
| Abstract #275 - HIV/AIDS and Alcohol in Cambodia: Adding Primary Prevention to Secondary Interventions in Siem Reap | ||||
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Session: 6.24: Posters A (Poster) on Monday in Chaired by Authors: Presenting Author: Prof Ian Lubek - University of Guelph, Canada |
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| Additional Authors: | ||||
| Aim: Authors: Ian Lubek1, Sarath Kros2, Mee Lian Wong3, Sochua Mu4 , Jillian Schuster1, Trisha Pagnutti1, Lakshmi Ganapathi3, Jessica Cadesky5, Tiny van Merode6, Helen Lee7, Bun Chemm Dy8, Brett Dickson9, Pring Noeun10, Song Heng10, Savun Touch2, Maryan Chitt10, Tim Tra2, Sary Pen2, Bory Ou11, Phallamony Em12, Sochivy Khieng13, Sophea Paal10, Srei Neang10, Maggie Hall1, Alison Rothwell1, Roel Idema14 Affiliations: 1 Psychology Department, University of Guelph, Canada 2 Siem Reap Provincial AIDS Office and SiRCHESI NGO, Cambodia 3 Dept. of Occupational and Family Medicine, National University of Singapore 4 Cambodian Minister of Womens Affairs, 1997-2004; Khemara, NGO, Cambodia 5 Humanitarian Policy and Advocacy Unit, Office of Emergency Programs,UNICEF, New York, USA 6 School of General Practice, University of Maastricht, Netherlands 7 Health Psychology, University of Staffordshire, UK 8 Siem Reap Provincial Health Department, Cambodia 9 Australian Volunteers International, and SiRCHESI, NGO, Cambodia 10 SiRCHESI, NGO, Cambodia 11 Orphanage of Siem Reap, and SiRCHESI, NGO, Cambodia 12 Department of Womens Affairs; SiRCHESI, NGO, Cambodia 13 DFID, British Embassy, Phnom Penh and SiRCHESI, NGO, Cambodia 14 Maastricht, Netherlands | ||||
| Method / Issue: Issues: Using an international, multi-disciplinary, multi-sectoral response, primary and secondary prevention programs were initiated in Siem Reap, Cambodia to confront HIV/AIDS prevalence and alcohol overuse. | ||||
| Results / Comments: Project: Since 2000, secondary prevention programs by local Cambodian NGO SiRCHESI, employed: annual behavioural surveys monitoring 4 risk groups (N=560), Participatory Action Research framework, focus groups, skills-training workshops, and community-outreach peer educators (4160 contacts in 2006; 6000 planned, 2007). Women beer-sellers, working exclusively for international brands, showed HIV+ prevalence around 20.4% (1995-2003), partially due to insufficient wages (by 50%) and non-supply of HAART by employers. Heineken researchers argued that free HAART provision was an emulatable corporate practice in Africa; their refusal to provide HAART to female Cambodian beer-sellers was criticized (the Lancet, 2006). Surveys/interviews (2002-2006) by SiRCHESI and CARE/Heineken showed beer-selling workplaces were dangerous for beerservers and men drinking there: 79% of beersellers witnessed physical abuse of colleagues, 54% experienced it themselves (CARE, 2004-5), and 38% were coerced to perform workplace sexual acts. Schuster (2006) found 91.3% experienced pressure to drink alcohol and 71.7% drank on their last shift. Beer-sellers (2004-6) drank 27 days monthly, 1.33 litres of beer nightly ( 5.33 standard drinks/units, where 5.00 defines W.H.O.s harmful level). Breathalyzer readings in Siem Reap restaurants (Pagnutti, 2006), outliers removed, found 33 servers had Blood Alcohol Content (BAC) =.048, while 44 male drinkers averaged BAC=.058 (with BAC=.05 considered impaired in many jurisdictions); 68.2% of those men intended driving home. Servers (N=48) drank 5.54 standard drinks while male customers (N= 51), drank 6.76 standard drinks (ns). In 2003, two brewers created the Selling Beer Safely program; their servers still drank 1.24 litres nightly. Despite correspondence and presentations to corporate headquarters (Heineken, Inbev/Interbrew and Carlsberg), press debates, and formation (2006) of a professional beer-selling association with code of conduct, no brewer agreed to increase salaries from US$55 to $110 (evidence-based fair wage). (www.ethicalbeer.com , www.fairtradebeer.com). SiRCHESI supports beer-servers preliminary unionization attempts, provides them HIV/AIDS/Alcohol prevention workshops and outreach (N= 565, in 2006), and offers an active voice and memorial website (www.beergirls.org). With beer industry recalcitrance on fair wages and HAART provision, SiRCHESI enlisted the Hotel industry to launch a primary-prevention program, transfering beer-sellers from high-risk workplaces (HIV/AIDS, alcohol, violence) into safer, alternative career pathways. Sponsored by M.A.C. Aids Fund, 14 women (Cohort 1, 2006-7) receive morning literacy-, language-, health/social skills- training from SiRCHESI staff, then complete mentored full shifts in 3 partner hotels, with systematic performance evaluations and fair wages (minimum $110, guaranteed for 24 months). | ||||
| Discussion: Lessons learned: Despite multi-sectoral cooperation between NGOs, Provincial AIDS Office and Provincial Health Department on secondary-prevention activities, an additional evidence-driven primary-prevention approach is needed to further reduce HIV/AIDS risks compounded by alcohol. Health risk-reduction involves research evidence, industry initiatives, and full stakeholder participation-- brewers, beersellers and drinkers. With Hotel industry cooperating, but beer industry less obliging, Cambodian beer-sellers began public demonstrations and unionization activities. Gendered attitudes of brewers, distributors, drinkers and beer-sellers require further change (e.g., the governments "Women are Precious Gems" program). | ||||
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