Evaluation of a targeted HIV prevention programme among female commercial sex workers in the south of Thailand

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Abstract
OBJECTIVE: To evaluate a targeted HIV prevention programme among female commercial sex workers (CSWs) in the south of Thailand. SUBJECTS AND METHODS: A pretest-post-test comparison group study was carried out in Sungai Kolok and Betong between June and December 1994. In June 408 CSWs were entered in Sungai Kolok (the intervention area) and 343 CSWs were enrolled in Betong (the comparison area). In December 1994, 416 women were enrolled in Sungai Kolok and 342 in Betong. Of these women 37% (n = 283) also participated in the June survey. All women completed an oral interview and blood samples were collected for HIV serology. The intervention programme consisted of an informational and educational campaign and peer educator training. RESULTS: Increase in knowledge and perceived vulnerability was more pronounced in the intervention area but did not translate into a greater increase in condom use. Refusal of customers unwilling to use a condom and manager support in doing so were the only factors independently related to positive changes in condom use. HIV prevalence (approximately 20%) and incidence (approximately 4.2 per 100 women years) were the same in both study locations. Women in the intervention area reported significantly fewer customers and income from sex work, possibly as a result of a coincidental police campaign to suppress (child) prostitution. CONCLUSIONS: HIV incidence among CSWs in the south of Thailand is still high. Prevention programmes should focus on improvement of negotiation and refusal skills and manager support in using condoms.