'Superstar' and 'model brothel': developing and evaluating a condom promotion program for sex establishments in Chiang Mai, Thailand.

OBJECTIVES

We developed and evaluated a multifaceted AIDS prevention program to increase condom use among sex workers in the city of Chiang Mai, Northern Thailand.

SUBJECTS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.