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
- 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
- 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
- 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
id21 Research Highlight: 29 January 2001
Nicholas J. Ford
Department of Geography
University of Exeter
Tel: +44 (0)1392 263339
Fax: +44 (0)1392 263342
Contact the contributor:
University of Exeter
Institute for Population and Social Research
Tel: +66 2 441 0201/4 ext 302
Fax: +66 2 441 9333
Other related links:
the UNAIDS site for epidemiological data and other information.
UNDP also has
information on HIV/AIDS.
Resources has information relating to HIV/AIDS in the region.
Check the AVSC International
website for research and publications related to reproductive
International covers a range of reproductive health resources.