AIDS Threat From Prostitution Drops In Thailand And Cambodia
Prostitution is no longer the major driving force of the AIDS epidemics in Thailand and Cambodia because of widespread condom use.
The sex industry now accounts for only a minority of all new HIV infections - 16% in Thailand and 21% in Cambodia last year. At one time, the vast majority of new cases in both countries - 80% to 90% - were directly attributable to commercial sex.
New HIV infections have also nose-dived by more than 80% since the peak of the epidemics in both countries. The World Health Organization's Western Pacific Regional Director, Dr Shigeru Omi, said these figures were the result of condom promotion programmes in the sex industry. ""There has been amazing success with these strategies. We need to make sure they continue. Any gains can be undone quickly,"" he said.
Most new HIV infections are now contracted through marital and casual sex, where condom use is low. Mothers also transmit the infection to their children.
Throughout Asia, commercial sex has driven the spread of HIV. It takes only a small pool of infected sex workers for an epidemic to explode, as seen in Thailand and Cambodia, both of which have well-established sex industries. At one time, roughly half of sex workers were infected in some areas, such as Chiang Mai, in Thailand, and Sihanoukville, in Cambodia.
A policy that made it very difficult to have commercial sex without using a condom led to a dramatic turnaround. In 1989, sensing the urgency of the situation, the Thai government decided to work with sex establishments to ensure condom use. Their success with the ""100% condom use programme"" led to Cambodia adopting it in 1998. Now, in both countries, condom use rates are more than 90%.
HIV rates have dropped, as have the numbers of sexually transmitted infections (STIs). Chancroid - the cause of genital ulcers which can raise the risk of HIV transmission by 10-fold or more - was once common but is now rarely found.
The 100% condom use programme is currently being piloted in China, Myanmar, Mongolia and Viet Nam. Pilot projects were initiated recently in Lao People's Democratic Republic and the Philippines.
To maintain the momentum, WHO is holding a meeting from 18 to 21 August in Vientiane, Lao People's Democratic Republic, to discuss the experiences of these countries about the programme which has been adapted in some areas to suit local needs.
There is an urgent need in these countries to address growing HIV epidemics in the sex industry. Studies show nearly a quarter of sex workers in Ho Chi Minh City are infected with HIV, while the rate among sex workers in Guangxi, China is about 10%.
""We need to protect people from infection. The sex industry is widespread and expanding,"" says Dr Bernard Fabre-Teste, who heads the HIV and sexually transmitted infections (STI) unit at WHO's Western Pacific Regional Office.
Studies have indicated more men are visiting sex workers and in a wider variety of settings and areas in Asia. In China, for example, commercial sex services exist in hotels, massage parlours, karaoke halls, bars and along transportation routes. Condoms are not easily accessible in many areas, which is fuelling the spread of the epidemic.
Thailand and Cambodia are the only two Asian countries where HIV is declining. However, a considerable number of people still get infected daily, mostly among the families of men previously infected from commercial sex encounters.
Although HIV rates among sex workers have fallen dramatically in Thailand and Cambodia, dropping by more than half in some areas, they are still high. This underscores the need to maintain high rates of condom use.
Issues to be discussed at the conference include the challenges in setting up the programme, condom accessibility, monitoring condom use and the sex industry situation.
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