THE RELATIONAL DETERMINANTS OF CONDOM USE WITH COMMERCIAL SEX PARTNERS IN THAILAND

Objective: To analyze the extent and determinants of condom use with c ommercial sex partners among lower socioeconomic status groups in the Thai population.Design: Respondents were sampled in Udon Thani, Sarabu ri and Bangkok in 1992. Completed sample size was 678 women in brothel s, 330 male truck drivers and 1075 men aged 17-45 years. Behavioral da ta and local sexual network information were collected using structure d questionnaires (face-to-face interviews), focus groups and in-depth unstructured interviews. Methods: Data were analyzed using univariate and multivariate logistic regression. Results: Condom use with commerc ial partners remains inconsistent. Consistent use was reported by 61% of women in brothels, 25% of truck drivers, and 29% of men in the low- income population. The single strongest predictor of consistent condom use for all groups is type of partnership. Consistent use drops signi ficantly with regular (multivisit) commercial sex partners compared wi th casual (single visit) commercial partners; adjusted odds of consist ent use are 0.22 for women and 0.25 for men. Brothel women report that one in five of their commercial partners is a 'regular', and 20% of t he young men who report a commercial partner report a 'regular'. Discu ssion: The strongest determinant of consistent condom use is the natur e of the relational bond between the partners, rather than their indiv idual characteristics, knowledge or attitudes. To raise condom use fur ther, programs will have to move beyond the standard knowledge-attitud es-practices paradigm focus on individual attributes to address the co ntextual determinants of behavior.