Visrutaratna S, Lindan C P, Sirhorachai A, Mandel J S
Chiang Mai Provincial Public Health Office, Thailand.
AIDS. 1995 Jul;9 Suppl 1:S69-75.
We developed and evaluated a multifaceted AIDS prevention program to increase condom use among sex workers in the city of Chiang Mai, Northern Thailand.
A year-long intervention targeted sex workers, brothel owners and clients, promoted cooperation between these groups and the public health office and established a free condom supply for sex establishments. Nearly 500 women from 43 establishments took part in the program, encompassing nearly all direct sex workers in urban Chiang Mai. The intervention included repeated small-group training sessions for sex workers in which experienced women ('superstars') acted as peer educators. The 'model brothel' component encouraged all brothel owners in Chiang Mai to insist on mandatory use of condoms by sex workers and to encourage clients to use condoms. Before and after the intervention, specially trained volunteers posing as clients tested a subsample of sex workers to see whether they insisted on condom use.
The intervention was well received by sex workers and obtained strong support and cooperation from brothel owners. Before the intervention, only 42% (10/24) of women surveyed by volunteers posing as clients refused to have sex without a condom, even when the client insisted and offered to pay three times the usual fee. Following the program, 92% (72/78) refused; 1 year later, 78% (69/85) refused during the same scenario.
An innovative program directly involving sex workers as peer educators and enlisting the support of brothel owners and operators can result in improved condom use over time. Lessons learned from this program may be applicable elsewhere.
我们制定并评估了一项多方面的艾滋病预防计划，以增加泰国北部清迈市性工作者使用避孕套的比例。
一项为期一年的干预措施针对性工作者、妓院老板和嫖客，促进这些群体与公共卫生办公室之间的合作，并为性场所建立免费避孕套供应。来自43家场所的近500名女性参与了该计划，涵盖了清迈市几乎所有直接从事性工作的女性。干预措施包括为性工作者举办多次小组培训课程，由经验丰富的女性（“明星”）担任同伴教育者。“示范妓院”部分鼓励清迈所有妓院老板坚持要求性工作者强制使用避孕套，并鼓励嫖客使用避孕套。在干预前后，经过专门培训的志愿者假扮嫖客对一部分性工作者进行测试，看她们是否坚持要求使用避孕套。
该干预措施受到性工作者的欢迎，并得到了妓院老板的大力支持与合作。在干预前，假扮嫖客的志愿者调查的女性中，只有42%（10/24）即使在嫖客坚持并提出支付三倍通常费用的情况下，仍拒绝无避孕套性行为。在该计划实施后，92%（72/78）的女性拒绝；1年后，在相同场景下，78%（69/85）的女性拒绝。
一项直接让性工作者作为同伴教育者参与并获得妓院老板和经营者支持的创新计划，随着时间推移可提高避孕套的使用率。从该计划中吸取的经验教训可能适用于其他地方。
