Improving the health and life choices of women beer sellers in Cambodia

Staffordshire University Senior Lecturer in Critical Psychology, Dr Helen Lee, has been working as part of an international team of social science researchers, health workers, educators and journalists, to reduce workplace health risks and improve the quality of life of women beer sellers in Siem Reap, Cambodia.

21.7% prevalence of HIV/AIDS

"In Cambodia, women beer sellers work in bars and restaurants, promoting particular brands of beer," comments Dr Lee. "Back in 2003, when my involvement in the beer sellers project began, the prevalence of HIV/AIDS among beer sellers was an astonishing 21.7%. This was largely due to the fact that, as their earnings equated to about half the amount needed to support their families, around 50% became sex workers to supplement their income."

Compelled to get involved

"The practice of drinking with customers to reach beer sales quotas was also commonplace," she adds. "Inevitably, condom use was low and the risk of alcohol-related illness was high. As a further complication, unlike people testing HIV Positive in the UK, beer sellers did not have access to anti-viral medication and often died within months of contracting HIV."

Collaborative working

Since joining the beer sellers project, Dr Lee has worked in elaboration with Cambodian NGO, SiRCHESI (Siem Reap, Citizens for Health, Education and Social Issues) and Professor Ian Lubek, of the University of Guelph, Toronto, on a project to improve the health and wellbeing of the Siem Reap beer sellers, as well as the wider Siem Reap community.

Journal of Health Psychology report

In 2010, she took the lead role in producing a co-authored report for publication in the Journal of Health Psychology, entitled: ‘Creating new career pathways to reduce poverty, illiteracy and health risks, while transforming and empowering Cambodian women's lives.' The report centres on the evaluation of a two-year Hotel Apprenticeship Programme (HAP) that was introduced to help provide beer sellers with safer, secure career opportunities.

Impacting change

Although the beer sellers project initially set out to examine the high incidence of HIV/AIDS among the female beer-selling community in Siem Reap, over the years it has grown to bring about change at a number of levels.

Around 10,600 people in the Siem Reap community, for example, have benefited from attending health promotion peer-education workshops centred on HIV/AIDS prevention.

Considerable efforts have also been made to raise both public and brewer awareness of the workplace health risks faced by beer sellers. This has been achieved in part by websites such as ‘', which has had in excess of 90,000 visits since it was launched.

Hotel Apprenticeship Programme

Finally, through the introduction of the Hotel Apprenticeship Programme (HAP) – the focus of Dr Lee's 2010 co-authored report and a scheme providing education on health risks and related behaviours, Khmer literacy, English and hotel industry skills training - beer sellers are being given the opportunity to aspire to better, healthier futures. To-date, 30 former beer sellers have benefited from HAP training.

"Good knowledge, good skill and a stable income"

As one former beer seller and HAP trainee comments: "In the beer garden is no good job. I have many problems when I drink a lot of beer and I have no empowerment. Look down on me from guests. Not safe, not secure and no respect. In the hotel I have good knowledge and good skill and stable income, supported by society. In the future I want to work for an NGO and help women in Cambodia."

The value of Participatory Action Research

Adds Dr Lee: "The beer sellers project illustrates the need for researchers to adapt techniques to the specific cultural context in which they are working. Participatory Action Research (PAR) is an approach that is ideal for this kind of task, as it involves working from the perspective and values of the people in the community".

This is an approach that Dr Lee is passionate about. Indeed, a co-authored paper which gives an overview of this Participatory Action Research project, and argues for the importance of adapting techniques according to the specific cultural context, has just been accepted for publication in the Journal of Health Psychology, special edition ‘Community health psychology for the 21st century: Pathways to health-enabling social change'.

New Cultures and Communities Research Group

Dr Lee has brought her background in critical psychology and her experience on the Cambodian beer sellers project to help develop a new Cultures and Communities Research Group (CCRG) at Staffordshire University. The group was inspired partly by the community focus of the beer sellers project and the importance it placed on impacting change. Other influences included the research carried out by Dr Anca Roberts into ethical production among manufacturers in the Midlands, and Dr Jennifer Cole's research on gossip as well as her interest in women and video gaming. The new group is looking forward to bringing together other researchers from both within and outside the psychology team, and collaborating with external partners.

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