Despite numerous initiatives to promote condom use among Cambodian sex workers, many unmarried entertainment industry workers who participate in sex work do not routinely use condoms when sleeping with regular partners, a new study in BioMed Central reveals.

After interviewing female entertainment workers in Phnom Penh and Siem Reap, researchers found that only 31.4 percent of respondents consistently used condoms with regular, non-commercial partners.

Transactional sex in Cambodia has changed radically since 2008 when the Law on Suppression of Human Trafficking and Sexual Exploitation closed many of the country’s brothels, the report found. Sex work now happens on the margins of other businesses, such as in karaoke bars, beer gardens and massage parlors.

As a result, the definition of sex work has become less clear, with many men blurring the lines between regular client, boyfriend and cohabitating partner. A 2015 study in the journal Reproductive Health revealed that 60 percent of female entertainment workers in Cambodia have one or more of these relationships each year.

“The lifestyle of [female entertainment workers] thus is unique to the Cambodian context, and their sexual activities are more complex than the lifestyles and behaviors of [female sex workers] in other countries,” the study notes.

Meanwhile, about 9.8 percent of female entertainment workers in Cambodia are HIV-positive, compared to just 0.6 percent of the general population, according to research by the US-based National Center for Biotechnology Information.

With this in mind, the study’s authors recommend that new outreach methods be used to increase the rate of condom use among female entertainment workers and curb the spread of HIV.

“We are trying to find effective models to reach these women through technology innovations such as Facebook pages, websites, hotline phone services, etc,” said Siyan Yi, director of the KHANA Center for Population Health Research and one of the study’s authors.

KHANA has also been working with community-based non-profits to provide sexual and reproductive health services through a large network of outreach workers. But numerous initiatives implemented over the past decade have failed to improve the rates of condom use among at-risk groups, including female entertainment workers, Yi noted.

“We would encourage the national HIV program to revisit their educational tools and update their content to reflect the current situation” of female entertainment workers, he added.