MULTIPLE CONDOM USE IN COMMERCIAL SEX IN LAMPHUN PROVINCE, THAILAND -A COMMUNITY-GENERATED STD HIV PREVENTION STRATEGY/

Background and Objective: In an investigation of condom breakage in co mmercial sex, we found a high proportion of multiple condoms use. This study sought to ascertain the characteristics of brothel-based commer cial sex workers (CSWs) and their clients; to identify the decision ma kers (clients and/or CSWs) active in choosing multiple condom use; and to determine whether there is an implicit hierarchy of condom use neg otiation, Goals: To identify factors associated with multiple condom u se in commercial sex and to provide an understanding of how this innov ation developed in this setting, Study Design: Sixty-seven brothel-bas ed CSWs in Lamphun Province who participated in a study of condom brea kage participated in a case-control study of multiple versus single co ndom use, which determined CSW and client characteristics for evidence of multiple condom use, Interviews and focus groups were used to dete rmine decision making for condom use and the contexts for multiple use , Association between characteristics of CSWs/clients and multiple con dom use was analyzed using X-2 for trend, Results: No official program encouraged multiple condom use; this appeared to be a community-devis ed strategy to increase protection from human immunodeficiency virus ( HIV) and other sexually transmitted diseases (STDs), CSWs working in d aytime brothels had significantly greater multiple condom use than tho se working in nighttime brothels; mean percentages + SD of multiple si multaneous use were 57.5 % + 28.6 and 35.5 % + 22.4, respectively (p < 0.001), Day CSWs were older, had more pregnancies, reported higher fr equency of STD symptoms and history of pelvic inflammatory disease, an d had more clients per day but had a lower number of sex acts per clie nt than night CSWs, Among factors associated with multiple condoms, on ly 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 us e was protection from HIV/STD. Conclusions: There is high compliance b etween CSWs in Lamphun province and the Ministry of Public Health-spon sored 100 % condom use campaign, and CSWs are attempting to further re duce their risks of HIV/STD exposure by using multiple condoms for sex with their clients.