The empowerment of commercial sex workers (CSWs) to claim their reproductive rights is an important strategy to halt the spread of HIV/STIs among the Cambodian population as a whole. Accordingly, the National Centre for HIV/AIDS, Dermatology and STIs (NCHADS) has given high priority to the prevention, early diagnosis and treatment of STIs as part of HIV prevention among CSWs, since their HIV/STI rates are especially high. Monitoring trends in HIV/STI prevalence and risk behaviours of CSW and studying STI drug resistance among CSWs are important priorities.

The commercial sex industry has existed in Cambodia for many centuries and, although illegal, is flourishing more than ever. In 1997, it was estimated that 14,000 women were involved in sex work in brothels --so-called direct CSWs-- throughout the country. Indirect CSWs are women working in massage salons, as beer-girls or karaoke singers. One of every six CSWs is younger than 18 years. A census report in three provinces (Phnom Penh, Kandal and Kampong Cham) canvassed 1302 establishments with both direct and indirect CSWs. The vast majority (75%) of the 7346 sex workers in this census was Khmer and not, contrary to what is generally reported, of Vietnamese origin. In view of the high HIV prevalence among this group --43% among direct sex workers (although the most recent data suggest 64%) and 19% among indirect sex workers-- sex workers are considered the highest priority group for the national HIV/AIDS/STI prevention and care programme in Cambodia. Research shows that most CSWs are aware of HIV/AIDS: the vast majority of CSWs has heard about HIV/AIDS (97%) and over three-quarters recognise HIV/AIDS as a serious problem in Cambodia today.

Access to STI services, however, is difficult for an important risk group like CSWs. A survey conducted in Phnom Penh among 100 CSWs of Vietnamese origin indicates that they have limited access to public health services for complaints such as amenorrhoea, vaginal discharge, painful intercourse and unwanted pregnancy: 75% first see the brothel owner, 61% visit a private clinic, and only 11% go to a government clinic. To better reach CSWs, STI prevention messages, providing general knowledge on HIV/STIs and condom negotiation skills with clients, as well as care seeking behaviours have been integrated into outreach and peer education programmes. Mobile STI clinics have been established for those CSWs who live far from public health facilities;

In addition to improving access to STI services, CSWs' self-empowerment is important for them to be able to claim their sexual and reproductive rights. Recently, the Cambodian Prostitutes Union (CPU) was established under the umbrella of the Cambodia Women's Development Association. Its main objectives are legalisation of sex work, empowerment of sex workers, elimination of violence and ensuring CSWs' rights to health, to education, to negotiate and to live. The CPU is run by 26 sex workers who meet regularly in their Phnom Penh office. Because sex work is illegal, it is difficult to implement activities and CPU's impact is limited. As a pressure group, CPU facilitates the future recognition of sex workers' existence and rights.