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New Mexico State University

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HIV/AIDS and condom use research in Thailand could benefit the U.S.-Mexico border

After spending a year researching condom use and the spread of HIV/AIDS among female sex workers in Thailand, Robert Buckingham has hopes for applying the knowledge obtained from that research to the U.S.-Mexico border area.


ham, a professor of health science at New Mexico State University, spent one year on sabbatical in Thailand as a professor of medicine at Mahidol University School of Medicine researching this topic. The research sought to determine the actual levels of condom use by female sex workers in Thai brothels located in Bangkok, Mae Hong Son, Chang Mai and other villages. He said he chose Thailand because of its heavy economic reliance on the commercial sex industry and also because the AIDS epidemic has been "absolutely exploding" throughout Southeast Asia.

"By conducting this public health study in Thailand, I was able to come back to New Mexico with a new perspective," Buckingham said. "I am hoping to be able to apply the lessons learned in Thailand to our region along the U.S.-Mexico border in an effort to benefit the well-being and better serve the health needs of our local communities."

The study will be published in the journal AIDS Care this month. Buckingham said he hopes to spark interest among public health advocates and regional funding agencies in support of a similar study to address condom usage and other practices of female sex workers in the southern New Mexico and El Paso-Juarez region.

John Moraros, an assistant college professor in the College of Health and Social Services at NMSU, co-authored the study with Buckingham.

"The timing could not be better for us to pursue a study that will determine the actual condom utilization rates among the female sex workers in the border region," Moraros said. "We believe that along the U.S.-Mexico border, many of the same public health principles that proved to be highly effective in Thailand would be applicable in our region as well."

Four years ago, Thailand, which has legalized prostitution, passed a law requiring 100 percent condom utilization by female sex workers and initiated a national educational campaign on the benefits of condom use and the adverse health effects of sexually transmitted diseases. Condom utilization rates by female sex workers went from 20 percent in 2000 to 60 percent by 2004. The number of new HIV cases declined from 143,000 in 1991 to 29,000 in 2001.

Buckingham and Moraros surveyed 150 Thai female sex workers, ranging in age from 20 to 32 years. The average number of years the women were employed as sex workers was 3.8. The participants averaged 5.1 customers per day, but used on average only 3.52 condoms.

The study found that condom use was significantly higher among western customers at 76 percent, when compared with foreign Asians at 52 percent and native Thai at 27 percent. Buckingham attributed these differences to the fact that westerners tended to be more educated and consequently more aware of the health risks associated with not using a condom.

The study determined that the overall condom use by participating female sex workers was 51 percent. Despite the failure to meet the 100 percent condom utilization mandate, the study corroborated evidence reported by other investigators, that there has been a substantial increase in condom use rates in the past five years.

"The reason there was so much success with this public health initiative in Thailand may be attributed to the fact that the Thai authorities did not try to polarize their audience and politicize their campaign with moral or legal undertones," Moraros said. "Their intent was not to stigmatize, arrest, or even attempt to curb the female sex industry. Rather they focused on educating and empowering their population on the issues of how condom use may help reduce the devastation caused to human life by the HIV/AIDS epidemic."

Moraros said one anticipated major difference between a study conducted here compared with the one conducted in Thailand would be the different roles religion plays in the two societies. He said in the primarily Buddhist population of Thailand, people have a higher propensity to engage in risky behaviors and lifestyles because of the belief that their fate is pre-ordained. On the other hand and for the same reason, people who contract the HIV/AIDS virus are not stigmatized or ostracized by the Thai society.

Addressing issues such as condom use and AIDS in the U.S.-Mexico border region could be different because the major religion is Catholicism, which forbids the use of condoms and condemns engaging in sex with someone other than a spouse. Buckingham and Moraros believe any public health campaign addressing the sex workers on the U.S.-Mexico border should "steer clear from religious, moral or legal undertones."

"When trying to combat catastrophic diseases, like the AIDS epidemic, it is important to leave morals at the door and enter in these public health initiatives from a more humanistic perspective," said Moraros.