Field Note

Challenging Cambodian Sexual Norms

By Jennifer Hyman
Managing Editor, Global AIDSLink
Global Health Council

Many guys think I'm crazy, because I'm 23-years-old, and refuse to lose my virginity to a sex worker," my waiter explained to me, as I interviewed him after dinner. "But the really crazy guys are the ones who are willing to engage in bauk, and don't feel bad because they can get away with it."

In fact, the knowledge that few victims of Cambodia's prevalent bauk — or gang rape — phenomenon ever dare talk about it has bred a feeling of impunity among its perpetrators.

Although the Khmer word bauk traditionally refers to the plus sign (+) used in mathematics, some young Cambodian men would translate the word to mean 'added value'. And to women, it describes a far more pernicious and looming threat. Bauk happens when one or two young men secure the services of a commercial sex worker (CSW), and then as many as a dozen youth hiding nearby ambush and gang rape her. If she refuses to submit, she most likely will be beaten as she is forced into sex. Although indirect and direct sex workers are rampant in Cambodia — and police are among their primary clientele — no one will listen to them if they report the rapes.

While some link the emergence of bauk with the closure of Cambodian brothels and karaoke bars in 2001, which forced most CSWs to move to the streets, sex workers are not its sole victims. Any young woman perceived to be breaking the country's conservative sexual and social norms is also a target, and even less likely than the CSWs to speak out, or fight against the practice. Some young men also organize and participate in gang rapes against girlfriends they percieve as pressuring them into marriage or commitment, an unconventionally brutal means of breaking things off.

In this atmosphere of silence and shame, although it is hard to know the exact statistics of how many women contract sexually transmitted infections like HIV or have unintended pregnancies from bauk, there is no doubt about the acute intrinsic risks. Cambodia has the highest adult HIV-prevalence rate in Asia, at 2.6 percent of its population of 11.4 million (albeit down from 4 percent two years ago), and the main route of transmission has long been bound to sex workers and their clients. But, increasingly, as is true elsewhere in the world, those at highest risk are the women married to the clients of CSWs, as well as their children. Violent, multiple rapes also greatly increase the chances of a woman's delicate tissues tearing, making her even more prone to contracting a disease.

Cambodia is a country ravaged by poverty, and it still bears the visceral physical and psychological scars borne from the years of genocide and other atrocities committed by Pol Pot's Khmer Rouge regime. With 42.8 percent of the population under age 15, society remains cleft in two by the power of a few against the powerlessness of the many; between the haves and have-nots. Although it is often viewed as a means of maximizing economic resources by paying for only one sex worker, many of bauk's perpetrators hail from the middle- and upper-class echelons of society, and others are the sons of well placed parents. While bauk is acutely prevalent in the capital of Phnom Penh, it has become a regular occurrence all around the country.

"The vast majority of men here lose their virginity to sex workers, and it affects the way that they view relations with women," explained Luke Bearup, project advisor for the Play Safe project run by CARE Cambodia, in conjunction with the local nongovernmental organization Gender and Development in Cambodia. Bearup is spearheading initiatives to provide the young men demographically most prone towards engaging in bauk an education about reproductive health and human rights. After undergoing three days of counseling, some of the young men are then trained to become peer educators in their communities. So far, 110 have been trained.

"We have to make it cool, and we attract groups like teams of football players, by inviting them to our recreation center to sing karaoke and play games like ping pong," said Bearup. "But once there, our staff begins frank dialogues with the young men about reproductive health and rights." Bearup says the young men are extremely responsive to this unique opportunity to speak openly about sex and relationships with women, and he is devising a training curriculum he hopes will be replicated around the country.

For women, however, such as young garment factory workers, they need to learn sexual empowerment and safer sex negotiation skills.

"Most of the women who become garment workers have left their parents' homes and rural life for the very first time, and they have newfound personal and sexual freedom," notes Claire Christie, CARE Cambodia's reproductive and sexual health advisor.

Christie is the technical advisor for a large reproductive rights program called Sewing for a Healthy Future in 25 of Phnom Penh's approximately 250 garment factories. Each factory typically employs thousands of workers, 90 percent of whom are female. Although most of the women meet the legally required age of 18, many appear far younger, and almost all are sexually naïve. Away from their families, living with few rules in close proximity to young male workers, they are vulnerable to unsafe sexual encounters that can lead to unintended pregnancy, the acquisition of STIs like HIV/AIDS, and rape.

"A young man will promise his love with a token in order for sexual relations to ensue," Christie explains. "He never actually intends to marry her, and she can't negotiate condom use, because having them signifies that she's a 'bad girl.'" Christie says that after he inevitably breaks up with her following sex, she is now viewed as a 'used girl' by male peers, and often becomes more vulnerable to sexual advances and sexual violence. Then, although she is not a sex worker, her options become increasingly limited, and she will be more easily lured into indirect sexual services with young men that offer her trinkets.

Sewing for a Healthy Future uses numerous methods to educate women about their rights, and to help destigmatize the use of condoms for dual protection against STIs and pregnancy.

CARE Cambodia was able to initiate Sewing for a Healthy Future by applying a cost-benefit analysis in their appeals to the general managers and human resource directors of garment factories. "We explain that it will affect their productivity if they have workers infected with HIV, and that workers need a top-down holistic approach that will provide them with the necessary prevention messages," says Christie.

She is typically able to convince factories to join both because the program is free and, as Christie admits, "I don't take no for an answer." But, moreover, CARE works to promote the advantages of corporate social responsibility in the factories, and they work with the Garment Manufacturers Association in Cambodia to highlight to potential international business partners companies that are investing in the wellbeing of their workers.

All of the participating factory human resource directors are part of an advocacy group called "Strengthening Activities for Factory Education" (SAFE), and work with CARE to implement the International Labor Organization's HIV/AIDS workplace policies.

Sewing for a Healthy Future also promotes educational and behavior communications change programs with the garment workers, training about 15 workers every three months to become peer educators. They learn about gender violence, condom negotiation skills and how to delay the onset of sex, and are then are required to speak to 10 other garment workers about the skills that they've learned.

In an effort to make learning about sexual and reproductive health fun, the project has set up youth libraries in the garment factories and, three times a month, factory workers are encouraged to participate in structured games about reproductive health and HIV/AIDS, which offer prizes such as soap, toothbrushes and condoms. The project also makes use of radio broadcast systems in the factories, to air programs that include questions and answers about sexual health, and songs about preventing sexually transmitted infections.

And, in conjunction with Population Services International, CARE's Sewing for a Healthy Future program is also offering socially marketed condoms and birth control pills.

"The girls love the program," remarks Christie, but she acknowledges that it's difficult to quantitatively measure behavior change. "Ultimately, young women working in garment factories now feel much better about carrying condoms, and they're much more open about talking about reproductive rights."

"Some of the attitudes we're trying to change run so deep, it won't work if you knock people over the head," notes Bearup, about the behavior change he is witnessing among the young men he works with. "Just as bauk often stems from peer pressure, we are trying to make our own movement of cool, where aligning human rights and gender awareness is considered socially-acceptable, modern behavior."

For more information, please visit www.playsafe.info or www.care.org.