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Self-esteem matters: condom use by Thai sex workers

Thailand's sex industry is of core importance for the country's serious HIV problem. There is a strong male tradition of using commercial sex workers (CSW) before and during marriage. What are the psychosocial factors that affect the use of condoms by CSW? How can interventions increase the rate of condom use?

To combat the HIV epidemic, the Thai government has launched a campaign to promote one hundred percent condom use in the sex industry. Researchers from the UK University of Exeter and Mahidol University, Thailand, are contributing to this campaign by developing sustainable programmes that address the attitudes and self-esteem factors that influence condom use.

It is estimated that there are more than 150,000 CSW in Thailand. Many come from the rural north or the diverse hill tribes that straddle the border with Burma. Many are illiterate. Poverty and marginalisation have long pushed women into commercial sex work. However, in some villages there is also a social expectation that young women will be 'dutiful daughters' and follow their siblings into sex work.

The pre-intervention research found that:

  • Two-thirds of commercial sex workers have no education or education only up to primary level.
  • Eight percent are married. 53 percent have previously been married. Marriage breakdown often leads to commercial sex work, due to loss of self-esteem and the need to support children.
  • Low knowledge about HIV, fatalistic attitudes and low self-esteem are related to inconsistent condom use.

Women are more likely to use condoms regularly if they have:

  • a sense of self-worth
  • self-esteem due to supporting a family
  • a desire for knowledge
  • a sense of being valued
  • self-efficacy to persuade customers to use condoms
  • good social adjustment.

The programme consists of three sessions with community health workers, involving videos, audio cassettes and discussion. The self-esteem of CSW is enhanced. Their knowledge about HIV is improved and they are keen to learn more. Most importantly, the intervention increases their consistent use of condoms with customers. Policy implications of this study include:

  • Stories related on video were particularly effective. The use of videos for CSW could be expanded to cover their future and financial planning.
  • This intervention can be performed by community health workers within their routine work and is therefore sustainable.
  • The illegality of the sex industry caused the biggest problems for the programme. This is a strong argument for official recognition of the sex sector under strict conditions (regular HIV prevention education, minimum age of 18 years, and elimination of forced involvement).

'Narrative explorations and self-esteem: research, intervention and policy for HIV prevention in the sex industry in Thailand' by N. Ford and S. Koetsawang, International Journal of Population Geography 5 (1999)

Funded by: European Community Programme on HIV/AIDS in Developing Countries

id21 Research Highlight: 29 January 2001

Further Information:
Nicholas J. Ford
Department of Geography
University of Exeter

Tel: +44 (0)1392 263339
Fax: +44 (0)1392 263342
Contact the contributor: n.j.ford@ex.ac.uk

University of Exeter

Suporn Koetsawang
Institute for Population and Social Research
Mahidol University
Salaya Campus
Nakhonpathom 73170

Tel: +66 2 441 0201/4 ext 302
Fax: +66 2 441 9333

Mahidol University, Thailand

Other related links:
Search the UNAIDS site for epidemiological data and other information.

UNDP also has information on HIV/AIDS.

Asian AIDS Resources has information relating to HIV/AIDS in the region.

Check the AVSC International website for research and publications related to reproductive health care.

Marie Stopes International covers a range of reproductive health resources.



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