Condom use and risk factors for HIV-1 infection among female commercial sex workers in Thailand.

Previous research in Thailand has indicated that the prevalence of human immunodeficiency virus (HIV) is higher among commercial sex workers in brothels (direct services) than among those in bars clubs and massage parlors (indirect services); it is also higher in the northern provinces. To confirm these findings HIV prevalence and condom use were investigated among direct and indirect commercial sex workers in Chiangmai City in the North (n = 410) and in Sungaikolok District in the South (n = 390). In both locations the HIV prevalence rate was higher among direct commercial sex workers (40% in the North and 21% in the South) than indirect workers (6% in the North and 7% in the South). Consistent condom use was higher among indirect workers (88% in the North and 38% in the South) than direct workers (81% in the North and 14% in the South). Direct workers in both locations were significantly more likely to be illiterate and to have entered prostitution at an earlier age than their counterparts. The higher incidence of HIV infection in the North despite greater levels of condom use is hypothesized to reflect infections that occurred before condom use became widespread. These findings suggest an urgent need for HIV prevention programs in southern Thailand aimed at increasing the rate of consistent condom use among prostitutes to avert HIV-positivity rates of the magnitude of those in the North.