Changes in prostitution and the AIDS epidemic in Thailand

AIDS Care. 1998 Feb;10(1):69-79. doi: 10.1080/713612352.


The HIV/AIDS epidemic which broke out in Thailand 1988 was mainly caused by the widespread patronage of prostitutes. The Thai authorities responded with programmes which encouraged the use of condoms in commercial sex. These programmes were highly successful. However, prostitution has changed since the beginning of the epidemic, partly for economic and demographic reasons, but mainly because of the fear of AIDS. Fewer women practise prostitution, men patronize it less, and the price of commercial sex has risen. Prostitution is less likely to be practised in brothels and more likely to be practised in establishments like restaurants and bars. Moreover, as fewer native Thai women are willing to practise prostitution, foreign women are taking their place. In order to continue to control the epidemic, the authorities will have to adapt their programmes to the changing structure of commercial sex.

PIP: The Thai Government's HIV/AIDS Prevention and Control Program has promoted 100% condom use in commercial sex encounters. Condom use in sex establishments has risen from 14% of sex acts in 1989 to 94% in 1994, with concomitant declines in the prevalence of all sexually transmitted diseases. To maintain this trend of decline, Thai officials must attend to the changing structure of commercial sex work. These changes were analyzed through a review of official enumeration data sent to the Venereal Disease Division of the Ministry of Public Health in 1989-94. In January 1989, there were 86,201 female prostitutes working in 6095 commercial sex establishments (primarily brothels) for an average fee of US$10.60 per sex act. There was an inverse relationship between the price of sex and the level of HIV infection among sex workers in the province. By January 1994, there were only 66,035 prostitutes, centered primarily in indirect establishments such as massage parlors and restaurants and working for an average fee of $16.30. The decline in prostitution began after 1990, when the government launched its AIDS education campaign. It is presumed that, not only were women less willing to continue working as prostitutes because of fear of AIDS, fewer men were willing to patronize them. The decline in commercial sex activity also corresponded with improvements in the economy and expanded job opportunities. The recent shift from direct to indirect prostitution, where condom use is lower and beyond the control of authorities, is potentially problematic, however. Another concern is the recent influx into commercial sex work in Thailand of women from Myanmar who are hard for authorities to identify, counsel, and treat.

MeSH terms

  • Acquired Immunodeficiency Syndrome / epidemiology
  • Acquired Immunodeficiency Syndrome / prevention & control*
  • Condoms
  • Emigration and Immigration
  • Female
  • Humans
  • Male
  • Preventive Health Services*
  • Risk-Taking
  • Sex Work / psychology
  • Sex Work / statistics & numerical data*
  • Sexual Behavior
  • Thailand / epidemiology