Chai Podhisita

Origins and working conditions of female sex workers in urban Thailand: Consequences of social context for HIV transmission

This paper examines the social origins and working conditions of selected female commercial sex workers in Thailand. Quantitative data gathered from 678 commercial sex workers (CSWs) in low-price brothels, tea houses and other work sites in three urban centers were supplemented by focus group discussions and in-depth interviews. The commercial sex establishments were selected from lists provided by local health officials. Social factors associated with entry into commercial sex work and condom use for sexual intercourse were investigated as they operate on contextual, intermediate and proximate levels. Women from the North region of Thailand predominated (68%) and they tended to be younger than the 27% from the Northeast. The majority of all women maintained financial ties to the home by sending income to parents, siblings and other relatives but this pattern is stronger among Northern women. Qualitative data suggest that women were systematically recruited into prostitution from villages in the North and their work enabled them to comply with traditional family support roles. Women from the Northeast revealed a more complex pattern of entry with intrafamily strife, divorce, efforts to find other employment, and entry into sex work at a later age than the women from the North. Northeastern women were more than twice as likely as Northern women to have had a husband as their first sex partner (55% vs 22%). The lives of CSWs were found to be tightly controlled by brothel owners and managers, although 8% were living with a husband or partner, and non-commercial sexual relationships in the month prior to interview were reported by up to 23%. Data indicate need for even more intensive education on HIV transmission, especially with respect to risk of transmission in the absence of AIDS symptoms. Appearance and a trusting relationship were the common reasons given for not using condoms. With the most recent client, 92% reported use if the client was not known and 70% reported use if the client had visited the same CSW three or more times. Education on HIV must take these attitudes and motivations into account as well as sanctions for brothel owners who do not enforce condom use. The proportion of Thai men who visit brothels in addition to other sexual partners, high rates of HIV among CSWs, and inconsistent use of condoms create a complex web that accelerates the spread of the HIV epidemic in Thailand.

The relational determinants of condom use with commercial sex partners in Thailand

Objective: To analyze the extent and determinants of condom use with commercial sex partners among lower socioeconomic status groups in the Thai population. Design: Respondents were sampled in Udon Thani, Saraburi and Bangkok in 1992. Completed sample size was 678 women in brothels, 330 male truck drivers and 1075 men aged 17‐45 years. Behavioral data and local sexual network information were collected using structured questionnaires (face‐to‐face interviews), focus groups and in‐depth unstructured interviews. Methods: Data were analyzed using univariate and multivariate logistic regression. Results: Condom use with commercial partners remains inconsistent. Consistent use was reported by 61% of women in brothels, 25% of truck drivers, and 29% of men in the low‐income population. The single strongest predictor of consistent condom use for all groups is type of partnership. Consistent use drops significantly with regular (multivisit) commercial sex partners compared with casual (single visit) commercial partners; adjusted odds of consistent use are 0.22 for women and 0.25 for men. Brothel women report that one in five of their commercial partners is a ‘regular’, and 20% of the young men who report a commercial partner report a ‘regular’. Discussion: The strongest determinant of consistent condom use is the nature of the relational bond between the partners, rather than their individual characteristics, knowledge or attitudes. To raise condom use further, programs will have to move beyond the standard knowledge‐attitudes‐practices paradigm focus on individual attributes to address the contextual determinants of behavior. AIDS 1995, 9:507‐515

The Impact of Child Care on Fertility in Urban Thailand

Women’s labor force participation in Thailand, particularly in the modem sector, recently has increased in conjunction with rapid declines in fertility. This paper examines whether a relationship exists between child care considerations and fertility decision making among Bangkok women. Although the two-child family has become the norm in recent years, and although most respondents said that ideally they would like to have two children, a high proportion of women surveyed said they planned to only have one child. Women’s work status and type of employment is found to strongly affect the likelihood of having a second birth: those who work at jobs that not only are low-paying but are located in a formal setting are least likely to have a second child. The type of child care for the first child also has an impact: those whose first child is in a less preferred situation are less likely to have a second. Variables measuring the need for and type of child care are found to have greater consequences for fertility than do usual measures of socioeconomic status.

Household headship and child death: Evidence from Nepal

BackgroundNepal has seen substantial improvements in its reproductive health outcomes, but infant and child mortality are still high. This study attempts to examine the prevalence and factors influencing the experience of child death of mothers who have given birth during a five-year period. More specifically, this paper aims to investigate whether household headship has an impact on child death in Nepal.MethodsThis paper reports on data drawn from the Nepal Demographic and Health Survey (NDHS 2006), a nationally representative sample survey. The analysis is confined to women who had given birth during the five years preceding the survey (n = 4066). The association between experience of child death of mother and the explanatory variables was assessed via bivariate analysis using a chi-square test. The variables were also examined using multivariate analysis (binary logistic regression) to assess the net effect of household headship on child death after controlling for the other variables.ResultsOut of all the mothers who had given birth during a five-years period, 3,229 (79.4%) were from male-headed households; the remaining 837 (20.6%) were from female-headed households. A significantly higher proportion of mothers from male-headed households (6.5%) than female-headed households (4.5%) had experienced the death of a child over the five years preceding the survey. Several socio-demographic, economic, and cultural variables were significant predicators for death of a child. For instance, women who had given birth to three or more children and who were Hindu were more likely to experience a childs death than were their counterparts. On the other hand, women who were literate, who had ever used family planning methods, who had visited a health facility, who utilized antenatal care for the last pregnancy, and who were from female-headed households were less likely to see a child die than were women in their comparison group. Notably, keeping all other control variables constant in the logistic model, women from female-headed households were 31 percent less likely to experience the death of a child (odds ratio = 0.69) than were women from male-headed households.ConclusionThe death of children is not uncommon in Nepal. No single factor can account for the high child mortality in the country; many factors contribute to the problem. After controlling for other variables, this study found that, among many other factors, household headship was a strong predictor. Programs seeking to help remedy this problem should focus on the issues identified here regarding womens autonomy, such as reducing the number of children born, increasing womens literacy status, increasing the use of family planning, increasing the use of antenatal care, and increasing female household headship so that child mortality will decrease and the overall well-being of the family can be maintained and enhance.