InterPress News Service (IPS); Thursday, 4 September 1997.
Prangtip Daorueng

In the anti-AIDS campaign, researchers say they are coming up against deeply rooted attitudes in Thai society, such as those that view women as the submissive sex and believe men should take the initiative and make the decisions in sexual matters.

Recent studies conducted among groups of women, wives and commercial sex workers confirm that decisions on the use of contraceptives or other forms of protection are often up to male partners, who in many cases refuse it for varied reasons.

Similar trends are evident among married couples and the consequences can be seen in the growing numbers of infected women. Due to biological and other reasons, the risk of HIV transmission to women are much higher compare to men.

A study on the impact of HIV on Thai children conducted by the Thai Red Cross society says that transmission of the virus that causes AIDS has indeed been slowed down by the government's national programme.

But female HIV infection in marital settings continues to grow steadily, because condom use between married partners is still uncommon and hovers at less than five percent.

Estimated HIV prevalence in Thailand, a country of 60 million people, is a little over 2 percent among those aged 15 to 49 years, according to the World Health Organisation (WHO).

This year's World Health Report says HIV infection rates among Thai men are declining, but prevalence continues to rise among women attending antenatal clinics. HIV prevalence among such women has climbed from 0 percent in 1989 to 2.3 percent in 1995.

In many cases, men are unaware they are carrying HIV and pass it on to their wives or partners during unprotected sex.

But it is not just commercial sex workers, but married women as well, who do not have full control over their sexual activity, says Pimwal Boonmongol of Mahidol University.

"Many husbands and wives believe that using condoms means lack of trust between each other. Also, majority of husbands refuse to use condoms with their wives because they say it is unnatural," she explained. "That's why it becomes difficult for wives to demand it."

She says proof of this unequal situation can be seen in the results of a study she conducted in six northern provinces of Thailand among pregnant women, who showed abmorally high rates of HIV infections.

The percentage of HIV-infected pregnant women in those provinces was from 5.5 to 7.8 percent, the study showed. Each year about 30,000 pregnant women there get infected, which means a third of newborn babies or 10,000 of them have a high chance of getting the virus from their mothers.

Pimwal says a factor that perpetuates the unequal partnership between men and women is the still prevalent attitude that thinks nothing of men, both single and married, to have many sexual affairs at the same time.

It comes as no surprise that in majority of families, male partners have control over the couple's sexual relationship, leaving women partners with little power to negotiate within those confines.

While wives are at significant risk of getting HIV, commercial sex workers say condom use is far from easy to impose on clients.

Penchan Prdubmook of the Public Health Department says advocating the use of condoms will not work unless the social factors that go into situations affecting its use are considered.

"Although condom use is a mainstay strategy for HIV/AIDS prevention and control efforts in Thailand and everywhere else in the world, it is not all of the answers," Penchan concluded in her study on the 'Social Dimensions of Condom Use Among Commercial Sex Workers'.

Getting and reporting percentage use of condoms "is not sufficient to indicate success or failure of the programme", she added. Experts say percentage of condom use in brothels is reported by their owners, who often inflate the figures.

"The social dimensions of condom use must and should be understood well enough before a successful and more realistic condom promotion programme for commercial sex workers can be launched, taking into consideration the issues of human rights and personal responsibility to protect one's own and others' health," Penchan added.

Her study was conducted in Chiang Mai province in northern Thailand, which has more than 1,000 brothels in its central district alone. During the early phase of the HIV epidemic in 1988, up to 44 percent of commercial sex workers there were HIV positive.

As the epidemic spread, the provincial public health office urge all brothels in the area to service only clients who agree to use condoms. The same approach spread to other parts of Thailand, where the "100 percent condom use" scheme became national policy.

But this policy does not always work on the ground.

From in-depth interviews and discussions with 25 commercial sex workers in Kampangdin in central Chiang Mai, Penchan found that few customers agree to use condoms even if doing so is good for their own health.

The sex workers she interviewed said most customers do not pay attention to their feelings, and most women have to compromise if they do not want to lose customers.

One sex worker recalled she had once asked a client to use a condom. He replied that he had spent money to 'buy' her services -- so he would not be getting his money's worth if he used a condom.

And in cases where condoms are used at the start of the sex act, Penchan says there is no guarantee this would continue to the end because many clients decide to remove them. The sex workers can do little in such situations, she explained.

Drug use among sex workers complicates the HIV problem. Many use marijuana and hallucinogens are heavily into liquor, known as "off drugs" that sex workers say make them "feel happy and euphoric, forget everything and not care much about condom use", Penchan added.

Most commercial sex workers are in also deep debt to brothel owners, which means many are keen to pay off the amount as soon as possible in order to leave sex trade.

There are other realities to deal with. Many say they are scared of getting HIV and know condom use would help them, but end up compromising because they say condom use prolongs sex and results in fewer number of clients a day.

One sex worker says her goal is to make as much money as possible to get rid of her debt. "I know how many clients I have to sleep with in a day so I can pay back my debt. If I cannot achieve that, I feel very anxious and depressed. I have to think about how to get enough clients for the next day," she said.

Penchan says that while condoms are a main method for HIV/AIDS prevention, their use is not always accepted because there are personal, sexual and human relationships to consider.

While sexual ties are supposed to be a joint decision between partners, "the issue becomes much more complicated when sex becomes a business and one side of the partners -- the commercial sex workers -- cannot make her own decision and has to serve the other or the clients," she concluded. (END/IPS/AP-HE-PR/PD/JS/97)

970904
IP970903

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1997. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .