What is 100%What is 100%

condom use programme?condom use programme?

Components ofComponents of100% condom use programme100% condom use programme

• Based on Government Based on Government POLICIES:POLICIES:( Law, regulation, decrees, etc.) ( Law, regulation, decrees, etc.)

– Requiring use of condoms in sex relations negotiated through entertainment establishmentsRequiring use of condoms in sex relations negotiated through entertainment establishments– Imposing collaboration of establishment ownersImposing collaboration of establishment owners– Enforcing the policyEnforcing the policy : :

• sanctions sanctions • identifying and “screening” establishment workersidentifying and “screening” establishment workers

– Monitoring condom useMonitoring condom use

Activities ofActivities of100% condom use programme100% condom use programme

• SupportedSupported byby PROGRAMME ACTIVITIES:PROGRAMME ACTIVITIES:

– Advocacy (high level declaration)Advocacy (high level declaration)– Establishment of monitoring committees and Establishment of monitoring committees and

working groupsworking groups– Mapping of establishmentsMapping of establishments– IECIEC– Condom supplyCondom supply– Providing STI servicesProviding STI services– Monitoring/evaluationMonitoring/evaluation– Closure of sex establishmentClosure of sex establishment

• GOALGOAL

PPrevent heterosexual transmission of HIVrevent heterosexual transmission of HIV• sex workers and their clientssex workers and their clients• spouses and friendsspouses and friends of clients of sex workers of clients of sex workers• general population general population

Goal & objective ofGoal & objective of100% condom use programme100% condom use programme

• OBJECTIVEOBJECTIVE

• To increase condom use in high-risk situations To increase condom use in high-risk situations to 100% to 100%

Why targetingWhy targeting

Sex workers?Sex workers?

Prevalence of STI/HIVPrevalence of STI/HIV by risk groups by risk groups(Cambodia, 1996)(Cambodia, 1996)

0

5

10

15

20

25

30

35

40

45

C hl amydi ae G onoc . Syphi l i s H I V - 1

FemaleReproductiveHealth

Men (Militaryand Police)

Female SexWorkers

Estimated number of new HIV cases per year if no Estimated number of new HIV cases per year if no control (year 199X):control (year 199X):

- - contracted from sex workers:contracted from sex workers: 400,000400,000- contracted from casual sex:- contracted from casual sex: 15,000 15,000- contracted from spouse:- contracted from spouse: 20,000 20,000- contracted from drug use:- contracted from drug use: 8,000 8,000- contracted from MTCT:- contracted from MTCT: 6,000 6,000- contracted from blood transfusion:- contracted from blood transfusion: 4,000 4,000

TOTALTOTAL 453,000453,000

Main source of HIV InfectionMain source of HIV InfectionThailandThailand

LOW COST-EFFECTIVELOW COST-EFFECTIVE

Strategy 1: Strategy 1: Supply condom to Supply condom to general populationgeneral population

• Massive amount Massive amount of condoms requiredof condoms required

• Low coverageLow coverage• Limited impactLimited impact

Strategy 2: Strategy 2: Supply condom to Supply condom to sex worker & clientsex worker & client

• Concentration Concentration on a selectedon a selected group group

• High coverageHigh coverage• Marked impactMarked impact

HIGH COST-EFFECTIVEHIGH COST-EFFECTIVE

High cost-effectivenessHigh cost-effectivenessof the strategyof the strategy

Why is 100% CUPWhy is 100% CUP

based based

on establishments?on establishments?

Indirect sex workers

Direct sex workers

Freelance sex workersFreelance sex workers

Establishment-based Establishment-based sex workerssex workers

Target onTarget onEstablishment-baseEstablishment-basedd Sex Workers Sex Workers

Brothel

• Beer bar• Nightclub• Massage parlour• Karaoke lounge … ...

FIRST PRIORITYFIRST PRIORITY

Establishment-basedEstablishment-basedsex workerssex workers

AccessibleAccessibleEasierEasier to to enrol enrol

in the programmein the programmeand monitorand monitor

FreelanceFreelancesex workerssex workers

Difficult to accessDifficult to access Difficult toDifficult to

enrol and monitorenrol and monitor

SECOND PRIORITYSECOND PRIORITY

Target onTarget onEstablishment-based Sex WorkersEstablishment-based Sex Workers

Benefits ofBenefits of100% condom use programme100% condom use programme

• To COUNTRYTo COUNTRY:: Decreasing burden on health care systems and social/economic impact of STI/HIV epidemic

• To SEX WORKER: To SEX WORKER: Protection from HIV and other STIs

• To CLIENT:To CLIENT: Protection from infections with HIV and other STIs

• To HIV/AIDS programmes:To HIV/AIDS programmes: Rapid impact of intervention Credibility - political support.

Key players ofKey players of100% condom use programme100% condom use programme

A. Health SectorA. Health Sector STSTII services services Condom supplyCondom supply Health education and information to target groupsHealth education and information to target groups Collecting data on condom use from STCollecting data on condom use from STII clients and sex workers clients and sex workers Reporting of non-cooperative sex establishment to the policeReporting of non-cooperative sex establishment to the police

B. Police SectorB. Police Sector Management of non-cooperative sex establishmentManagement of non-cooperative sex establishment

C. Local Administrative SectorC. Local Administrative Sector Coordination between the government sectors and the owners Coordination between the government sectors and the owners of sex establishmentsof sex establishments

Three Responsible SectorsThree Responsible Sectors

Evaluation ofEvaluation of100% condom use programme100% condom use programme

ProcessProcess

OutcomeOutcome

ImpactImpact

EVALUATIONEVALUATION

e.g. condom salese.g. condom sales

e.g. condom use ratee.g. condom use rate

e.g. STI/HIV prevalencee.g. STI/HIV prevalence

INDICATORSINDICATORS

- - Launch of the pilot programme for Launch of the pilot programme for 100% condom use in Ratchaburi 100% condom use in Ratchaburi Province in 1989.Province in 1989.

Example ofExample of100% CUP in Thailand100% CUP in Thailand

- - National AIDS Committee called National AIDS Committee called for the nationwide expansion of the for the nationwide expansion of the programme in August 1991.programme in August 1991.

HIV Prevalence rate (%)HIV Prevalence rate (%)

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

0

Year

Nationwide Expansion Nationwide Expansion of 100% Condom Useof 100% Condom Use

Impact of 100% CUPImpact of 100% CUPThailandThailand

Condom use in clients

Conscripts

Pregnant women

HIV prevention (1989-1995)HIV prevention (1989-1995)• Two million infectionsTwo million infections

Impact of 100% CUP Impact of 100% CUP ThailandThailand

STI prevention (1990-1997)STI prevention (1990-1997)• 260,000 STI cases per year among people 260,000 STI cases per year among people

receiving government clinic servicesreceiving government clinic services• 3-4 times higher among people receiving 3-4 times higher among people receiving

private clinic servicesprivate clinic services

Without 100% condom programme

100% condom programme

Effectiveness of condom programmeEffectiveness of condom programme in HIV preventionin HIV prevention

HIV infection

- - Launch of pilot project for 100% Launch of pilot project for 100% condom use in Sihanoukville province in condom use in Sihanoukville province in 19981998

Example ofExample of100% CUP in Cambodia100% CUP in Cambodia

- - The Prime Minister signed an order The Prime Minister signed an order requiring nationwide implementation of the requiring nationwide implementation of the programme in October 1999programme in October 1999

- - Expansion activities are underwayExpansion activities are underway

HIV prevalence rate (%)HIV prevalence rate (%)

100

80

60

40

20

0

Year

Impact of 100% CUPImpact of 100% CUPCambodiaCambodia

Initiation of 100% Initiation of 100% Condom UseCondom Use

ChinaChina IndiaIndia IndonesiaIndonesia MyanmarMyanmar PhilippinesPhilippines Viet NamViet Nam

100% CUP in 100% CUP in other Asian countriesother Asian countries

CONDOMSCONDOMSare are

NOTNOT a 100% solution to STI/HIV problema 100% solution to STI/HIV problem

BUT...BUT...

the MOST the MOST effective method of effective method of preventing sexual transmission of STI/HIVpreventing sexual transmission of STI/HIV