Narrative explorations and self-esteem: research, intervention and policy for HIV prevention in the sex industry in Thailand

Findings are presented from an integrated programme of research involving psychosocial analysis and programme design, implementation and evaluation, to promote consistent condom use by female sex workers in Thailand. The context is outlined with respect to Thai sexual culture, the HIV/AIDS epidemic and the changing structure of the sex industry. Essentially the programme seeks to contribute to the effective functioning of the Thai Government's policy of ‘100% condom use in the sex industry’. Following Phase I, which involved detailed psychosocial investigation, the programme sought to address the knowledge, attitudinal, motivational and self-esteem factors found to influence condom use. The design of this multifaceted intervention is discussed. The key element in the programme entailed the design and use of dramatic narrative scenarios on video to depict the dilemmas and concerns faced by sex workers, as a basis for open discussion and personal exploration. The programme was implemented in high-income and low-income sex establishments in Central Thailand. It was evaluated using a pre-test/post-test, intervention and control, quasi-experimental design. Findings are presented for the more crucial low-income settings to indicate the effects on cognition and behaviour. Most critically, the consistency of condom use over a one-month period increased from 66% pre-test to 86% in the post-test period in the intervention settings, but showed no change among the control sex workers. We consider the implications of the findings for HIV prevention in the Thai sex industry.