Summary of the impact

Dr Helen Lee works with an international team on research identifying workplace risks and implementing changes to improve the well-being of a beer sellers` community in the developing country of Cambodia. Research identifying risks from HIV/AIDS (21.7%) and alcohol overuse (1.2 litres of beer nightly) has had different forms of impact: the implementation of i) an educational and industry skills training programme — Hotel Apprenticeship Program (HAP) reaching 30 women who reported changes in awareness of health risks (how HIV/AIDS is transmitted and the effect of alcohol overuse on health) and behaviour change (zero alcohol consumption and no longer engaging in indirect sex work), ii) a peer educator outreach programme reaching over 10,600 people in the Siem Reap community and iii) raising public and brewers awareness of beer sellers` health risks through websites (over 51,900 visits). In 2013 a near zero prevalence for HIV/AIDS in the target group is reported.

Underpinning research

Underpinning research
Dr Helen Lee at Staffordshire University has led on design, analysis and interpretation of qualitative data on this project which is part of a longitudinal programme of participatory action research. The work was informed by Kurt Lewin`s (1946, 1947) and Chataway`s (1997) work in social and health psychology, and was conducted in collaboration with SiRCHESI (NGO), Siem Reap Citizens for Health, Education & Social Issues) in Cambodia. The research identifies the risk to beer sellers, the causes of the beer sellers` situation and works to bring about change for them and others in the local community.

Names of key researchers, dates and roles
Dr Lee has been involved (since 2003) as a senior researcher bringing expertise in qualitative research methods and as international advisor to SiRCHESI. She works in collaboration with: Prof Ian Lubek (University of Guelph, Canada, involved since 2000 — present as project Director and international advisor to SiRCHESI); Dr Mee Lian Wong (Associate Professor in Public Health, National University of Singapore, 2001 — present); and Sarath Kros (Director of Siem Reap Provincial AIDS Office, Director of SiRCHESI — NGO, Siem Reap Citizens for Health, Education & Social Issues, 2000-2012).

Context
Beer sellers are at risk — 21.7% prevalence rate for HIV/AIDS, and from alcohol related illness as they drink on average 1.2 litres of beer each night, every night (Lubek et al., 2005; SiRCHESI newsletter 2005). Due to their low earning — 50% the amount needed to support their families, drinking with customers to reach sales targets was commonplace, and around 50% became indirect sex workers to supplement their income meaning condom use was low and the risk of alcohol-related illness was high (Lubek et al, 2005; Lubek et al., in press). The project aimed to reduce beer sellers` workplace health risks — HIV/AIDS, alcohol overuse, violence and sexual coercion (Lee et al., 2010). Interviews with beer sellers identified their initial preference for working in the hotel industry and that illiteracy and lack of English were reasons why they were not recruited and instead, became beer sellers (Lee et al, 2010). A two-year Hotel Apprenticeship Programme (HAP) was set up to provide education on health risks, literacy, and industry training for former beer sellers. The project also set up and run a peer education programme targeting the local Siem Reap community; it raises public and brewer awareness about the beer sellers` situation in order to encourage brewers to implement safer work practices and a fairer wage (SiRCHESI newsletter 2007).

Findings
Around 350 beer sellers had become indirect sex workers to supplement their income. They drank on average 1.2 litres of beer per night to meet sales quotas. Qualitative interviews suggested that beer drinking was related to low condom use. Interviews with beer sellers indicated a preference for hotel work but that women are underrepresented in the hotel industry due to illiteracy. Aside from identifying these health risks, this research demonstrates i) the importance of cultural and economic context in understanding health-risk behaviour and ii) the interrelationship between different health risks.

References to the research

Details of the impact

Process of Dissemination
Presentation of initial study at Universiteit van Leiden, Jan. 26, 2005.
The HAP and the Lee et al., (2010) paper were included in SiRCHESI newsletters (2010, 2011, 2013) disseminated via their website, office and www.fairtradebeer.com and www.beergirls.org. Research also disseminated at SiRCHESI`s annual conferences and international academic conferences. The research detailing the beer sellers` situation and health risks have informed two SOMO (Centre for Research on Multinational Corporations, Amsterdam) reports. Two websites www.beergirls.org and www.fairtradebeer.com are informed by this research project and provide information about the beer sellers` situation. In addition, www.beergirls.org provides a memorial list and a page on the HAP including quotations from former beer sellers who have undertaken the programme; www.fairtradebeer.com aims to encourage brewers to take more responsibility for the beer sellers.

Who has benefitted?
30 former beer sellers have benefitted from the Hotel Apprenticeship Programme (HAP). By end of 2011 over 10,600 people had taken part in the peer education outreach programme. Participants are beer sellers and members of the wider community in Siem Reap. Interns (3 in 2012, up to 12 planned for 2013). Interns receive a 14 day intensive programme of hands-on field work.

How have they benefitted?
The HAP delivers Khmer literacy, conversational English, education on health risks and related behaviours and training in hotel industry skills (with paid placements in a hotel). Lee et al., (2010) evidences quantitative and qualitative data showing that former beer sellers who have taken the HAP showed significant improvement in health-related knowledge, specifically, how condom use could prevent HIV/AIDS transmission and that drinking alcohol had adverse effects on their health. The drinking of, on average 1.2 litres of beer per night was reduced to zero and HAP trainees reported no longer engaging in sex work. In addition, they reported increased job aspirations. Interviews also demonstrated that the programme has provided the women with a sense of empowerment as they take up more valued positions within the local community. Quotes from interviews with trainees illustrate the positive impact HAP has had on their lives:
"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 the guests. Not safe, not secure and no respect. In the hotel is a good job. 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 the women in Cambodia." (HAP Trainee, 2008) (quoted in Lee et al., 2010, p. 988; and
www.beergirls.org/HotelApprenticeshipProgram.html)

Dates
This long-term participatory action research project (2001- present).
Development of peer-educator outreach programme (2002- present)
The two year Hotel Apprenticeship Programme ( cohort one 2006-2008; cohort two 2007-2009)
www.fairtradebeer.com (2004 - present)
www.beergirls.org (2005-present)
Internships (2012-2013)

Evidence of Impact
The SOMO 2010 report states "SiRCHESI has a long history of interviewing, and providing health education for beer promotion women in the Cambodian district Siem Reap. During the period 2004 - 2009 it interviewed more than 700 beer sellers. The SiRCHESI interviews with beer sellers were conducted either in the workplaces or during health workshops" (2010 p. 8), and Staffordshire University is mentioned in a footnote to the report. The SOMO 2012 report refers to SiRCHESI`s research in the 2010 report. SiRCHESI`s newsletters report that by the end of 2011 over 10,600 people had been part of this programme and about 12,000 by end of 2012. www.fairtradebeer.com received 280 and www.beergirls.org received 51,621 new visits (Jan 2009 to Dec 2012) evidencing that people are accessing this information. International impact is demonstrated via visitors to websites from countries including UK, Australia, China, Hungary, Canada, US, Singapore, Germany, Switzerland, Malaysia, India, Kuwait, Thailand, Ireland, Slovakia, Japan, Korea, South Africa, Sweden, and Indonesia). The project has also received international press coverage (including in Cambodia, US and Sweden). Between 2009 — March 2012 there have been several press reports published (see below) and two radio interviews associated with this project.

Sources to corroborate the impact

Hotel Apprenticeship Program www.beergirls.org/HotelApprenticeshipProgram.html SiRCHESI (NGO) newsletters are available via their website www.angkorwatngo.com and via www.fairtradebeer.com/FTBreports.html#sirchesinewsletters

SiRCHESI internships www.fairtradebeer.com/miscdocs/brochure2013.pdf SOMO (2010). Heineken an overview of controversial business practices in 2009.
http://somo.nl/publications-en/Publication_3536

SOMO (2012). Promoting decency? Report on the situation of beer promotion workers in Cambodia. Amsterdam. http://somo.nl/publications-en/Publication_3796

Project Director and international advisor to SiRCHESI, Professor at the University of Guelph, Canada, can also be contacted.
(last accessed 25/2/13)

A full list of press coverage is available at www.fairtradebeer.com/FTBreports.html#press though some of the links are no longer active.