Young Cambodians – those aged between 10-24 – make up one third of their country’s population. Some of them, particularly those who migrate from rural to urban areas and those practicing high risk behaviours, are among what UNICEF’s country office in Cambodia terms the ‘Most at Risk Young People’ (MARYP), who are vulnerable because they have moved away from their families and support networks at home.
UNICEF Cambodia, in partnership with the Inter-departmental Committee on HIV/AIDS and Drugs of the Ministry of Education, Youth and Sports, completed a survey in 2010 that identified the circumstances and motivations of young people “whose behaviors put them at greater risk of HIV infection, including multiple unprotected sexual partnerships, unprotected anal sex with multiple partners, and injecting drugs with non-sterile equipment.” The subsequent survey report put forward policy and programming recommendations to improve support for at-risk young people, recommendations that the office has been working to implement.
The young people surveyed by UNICEF came from eight provinces in Cambodia: Battambang, Banteay Mean Chey, Kampong Cham, Siem Reap, Phnom Penh, Preah Sihanouk, Koh Kong, and Svay Rieng. Most of those polled lived in urban areas: 71.6 percent, as opposed to 28.4 percent from rural areas. The urban focus was deliberate, says UNICEF HIV Specialist Ulrike Gilbert, as HIV prevalence is higher in urban areas of the country.
The survey used time-location sampling, a method used to recruit members of a target population at specific times in set venues; to that end, the interviewers targeted so-called local hotspots, which they found mostly located in urban areas. Local hotspots identified included karaoke parlors, massage parlors, bars, street corners, public parks, snooker clubs and computer game shops. The interviewers found that the best time to go to these places to talk to MARYP was late in the evening, when the bars and parlors were at their most active.
Some interesting differences between rural and urban MARYP were unearthed by the survey. For example, rates of involvement in so-called “sweetheart” (boyfriend/ girlfriend) relationships were highest among urban youths aged between
20-24. The report noted that the absence of family support and guidance amongst MARYP meant that there was a program opportunity to develop skills and vocational training for them, as well as a referral service to guide them to health services.
Ulrike Gilbert points out that “the survey confirmed the multiple risks young women and men face in hot spot locations in urban areas and that many were not reached with effective interventions. In the concentrated epidemiological context of Cambodia, it is important to ensure that high impact interventions reach young cohorts of key affected populations, such as young sex workers, young people who use drugs and young men who have sex with other men”.
In the years following the survey, UNICEF has made use of the results in a variety of projects. The findings were used to inform the development of the National AIDS Strategic Plan, and ensured that young key populations and their multiple vulnerabilities were included. The Ministry of Education used the survey results in 2011 in the process of revising the national education and HIV plan. The results were also used to inform the development of new Standard Operating Procedures for HIV prevention by the Minister of Health.
Another outcome of the MARYP survey was a 2012 follow up qualitative study, ‘Examining life experiences and HIV risks of young entertainment workers in four Cambodian cities.’ The qualitative study took place in Phnom Penh, Siem Reap, Poi Pet and Sihanoukville. It was based on a sample of 82 young women, young men and young transgendered persons who were in the entertainment industry (i.e. worked in bars, karaoke parlors, etc.) and reported having sex for money. The operational study provided in depth insights into the triggers, motivations and context of sex work. Although a number of factors influenced entry into transactional sex, the primary driver, which was shared by all study populations, was financial.
A key difference between the participant groups was that young women were working to support their parental families or their children and were more likely to have had experienced sexual violence, while male and transgendered entertainment workers were primarily working to support themselves and sexual violence was not a significant concern.
The UNICEF regional office, along with UNESCO, has used the 2010 study for regional training on MARYP. The results of the survey were used by the Cambodia country office to inform the development of a wealth of new guide programming priorities, including the expansion of support to local harm reduction efforts among young drug users, particularly women with young children, in Phnom Penh.