100% Condom Use Programs

• Pages: 112-114

Contenidos

• The Issue.
• Legal and Policy Considerations.
• Practice Examples.
• References.

Page 112

The Issue

In the early years of the HIV pandemic, Thailand's sex industry was a significant source of infection in the country. Though sex work has been illegal in Thailand since 1960, in practice the government has adopted harm reduction strategies to control rather than eradicate it. In 1989, the "100% condom use program" was piloted in Thailand's Ratchaburi province. The program combined free, easily accessible condoms with a requirement that sex workers and clients use condoms for all sexual acts that could result in HIV transmission. Sex workers who sought treatment at government clinics were offered free, unlimited access to condoms, and health officials who visited commercial sex establishments brought condoms with them. A "No Condom-No Sex" policy was implemented, and enforced through sanctions against noncooperative establishments, which could be shut down for a period of time or closed permanently. This policy gave establishment managers the incentive to support sex workers in negotiating condom use. Men seeking treatment for sexually transmitted infections at government clinics would be asked if they had visited a commercial sex establishment, and whether or not condoms were used. (Contact tracing was an already-established part of sexually transmitted infection control in Thailand.) In this way, establishments not enforcing the 100% condom use program were discovered. Because most establishments then required condom use, there was a decrease in market pressure for condom-free sex.

After success in Ratchaburi, in 1991, the program was implemented nationally with the endorsement of the Prime Minister, and it has been successful in dampening the transmission of HIV. By 2000, 96% of sex workers used condoms and Thailand saw a 90% reduction in sexually transmitted infections among men treated at government clinics. However, in recent years, government support for the program may have flagged. Messages about condom use appear to be less prevalent, as is funding for condoms. Fewer people are reached by the program, and some may falsely assume that with the messages about AIDS disappearing, the disease is no longer a threat.

Legal and Policy Considerations

The WHO identifies six strategies essential to a successful 100% condom use program (CUP). The first is high-level political commitment. Even where prostitution is illegal, a...