title: Multiple condom use in commercial sex in Lamphun Province, Thailand: a community-generated STD/HIV prevention strategy.
abstract: OBJECTIVE
  In an investigation of condom breakage in commercial sex, we found a high proportion of multiple condoms use. This study sought to ascertain the characteristics of brothel-based commercial sex workers (CSWs) and their clients; to identify the decision makers (clients and/or CSWs) active in choosing multiple condom use; and to determine whether there is an implicit hierarchy of condom use negotiation.
  
  
  OBJECTIVE
  To identify factors associated with multiple condom use in commercial sex and to provide an understanding of how this innovation developed in this setting.
  
  
  METHODS
  Sixty-seven brothel-based CSWs in Lamphun Province who participated in a study of condom breakage participated in a case-control study of multiple versus single condom use, which determined CSW and client characteristics for evidence of multiple condom use. Interviews and focus groups were used to determine decision making for condom use and the contexts for multiple use. Association between characteristics of CSWs/clients and multiple condom use was analyzed using X2 for trend.
  
  
  RESULTS
  No official program encouraged multiple condom use; this appeared to be a community-devised strategy to increase protection from human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). CSWs working in daytime brothels had significantly greater multiple condom use than those working in nighttime brothels; mean percentages + SD of multiple simultaneous use were 57.5% + 28.6 and 35.5% + 22.4, respectively (p < 0.001). Day CSWs were older, had more pregnancies, reported higher frequency of STD symptoms and history of pelvic inflammatory disease, and had more clients per day but had a lower number of sex acts per client than night CSWs. Among factors associated with multiple condoms, only age was significant. The decision to use single or multiple condoms for a sex act was primarily (78.2% in single and 79.3% in multiple) made by the CSW herself. The main reason given for multiple condom use was protection from HIV/STD.
  
  
  CONCLUSIONS
  There is high compliance between CSWs in Lamphun province and the Ministry of Public Health-sponsored 100% condom use campaign, and CSWs are attempting to further reduce their risks of HIV/STD exposure by using multiple condoms for sex with their clients.
authors.affiliation: Faculty of Medicine, Chiang Mai University, Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Rugpao
authors.forename: S
authors.initials: S
authors.lastname: Tovanabutra
authors.forename: C
authors.initials: C
authors.lastname: Beyrer
authors.forename: D
authors.initials: D
authors.lastname: Nuntakuang
authors.forename: Y
authors.initials: Y
authors.lastname: Yutabootr
authors.forename: T
authors.initials: T
authors.lastname: Vongchak
authors.forename: M A
authors.initials: MA
authors.lastname: de Boer
authors.forename: D D
authors.initials: DD
authors.lastname: Celentano
authors.forename: K E
authors.initials: KE
authors.lastname: Nelson
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003256:Community Participation; D017280:Condoms; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D017008:Negotiating; D011477:Sex Work / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013785:Thailand