Life in the big city: Understanding the context of HIV prevention for rural-to-urban migrant Cambodian garment factory workers.

摘要

Objectives. The purpose of this two phase research study was to better understand the socio-ecologic context of HIV prevention for rural-to-urban migrant female garment factory workers in Cambodia.;Methods. The research used a mixed methods exploratory sequential design. Phase one consisted of interviews with migrant garment factory workers and key informants, and focus group interviews with health care providers about the women's migration experience and factors affecting HIV prevention. Phase two was a cross-sectional survey of health care providers (doctors, nurses, midwives, and pharmacists) about their HIV knowledge and attitudes, and their intentions to take a sexual history from migrant garment workers using constructs from the Theory of Planned Behaviour (TPB). The qualitative data were analyzed by comparison of the key themes discussed by the participant groups, while the quantitative survey data were analyzed using descriptive statistics, bivariate analysis, and multiple linear regression of the TPB constructs.;Results. Migrant women garment factory workers were at risk of HIV infection because of both economic and social vulnerability. These women migrated in order to support their poor families financially. They worked long hours in factories, sending a large proportion of their income home. Despite overall good knowledge about HIV transmission, there was a spectrum of discourses on condom use in relationships: many women maintained that their partners refused to wear condoms, or the women did not discuss the issue of condom use with their partner.;Cambodian health care providers were generally knowledgeable about HIV transmission, although attitudes about people with HIV were not always positive. The TPB constructs explained 55.5% of the variance in generalized intention to take a sexual history; the construct of perceived behavioural controls was the strongest contributor at 50.6%, subjective norms contributed 2.8%, and attitudes construct was non-significant.;Conclusions. There were multiple, contextual factors that put migrant women garment factory workers in Cambodia at risk for HIV: gender norms promoting a sexual double standard, AIDS stigma limiting condom use, and limitations in access to health care were predominant themes. These important issues should be considered in the development of interventions to improve HIV prevention for these migrant garment factory workers.