4. Cost–Effective Strategies for the Excess Burden of Disease in Developing Countries

Thailand's HIV prevalence, fueled primarily by high rates of commercial sex work and low levels of condom use, began to rise rapidly in the late 1980s. Beginning in 1989, the Thai government initiated a nationwide condom distribution and education campaign focusing on commercial sex workers and their clients, to ensure 100 percent condom use in all commercial sex encounters. Elements thought to contribute to the program's success include the following:

• government-mandated 100 percent condom use in commercial sex establishments

• mass condom promotion advertising campaign

• education in commercial sex workplaces

• government-distributed condoms

• STI testing and treatment

• surveillance and tracking of infections to points of origin

• strong political and financial commitment

• active involvement of provincial and local governments.

Despite this unprecedented success, evidence indicates that enforcement of the 100 Percent Condom Program is not as strong today as when it was initially implemented. A recent study in Bangkok found that 89 percent of sex workers used condoms, a decline from 96 percent in 2000 (UNDP 2004).

Source: DCP2, chapter 18, box 18.4.