Thailand's 100% Condom Program - A Paradigm for Prevention

Beautiful temple in Thailand at twilight
Beautiful temple in Thailand at twilight. Prasit photo / Moment / Getty Images

The 100% Condom Program: A Paradigm for Prevention

It is rare that an STD prevention program is hailed as an unqualified success. In the early 1990s, however, Thailand managed to impress scientists, activists, and educators worldwide with the accomplishments of their 100% condom program.

The 100% condom was designed to enforce 100% condom use at every commercial sex encounter in the country. The primary axis of HIV transmission in Thailand was from commercial sex workers (CSW) to men, from men to their wives, and from wives to their children.

Therefore, it was thought that reducing the risk of HIV transmission in commercial sex would be an effective means of slowing the spread of the HIV epidemic.

Prostitution had been illegal in Thailand for almost 30 years. However, even prior to the HIV epidemic, the government had found it easier to regulate it than to stamp it out. Part of that regulation was the use of contact tracing whenever anyone came in to be tested for an STD. Thai men would almost always mention patronizing a commercial sex establishment (such as a brothel) in these conversations. Then the STD control unit would send outreach workers to each brothel to try and convince the workers there to be tested and treated. Because of the outreach program, at the start of the AIDS epidemic the government had a very good idea of how many CSW were working in the country. They also knew where they were employed.

When the 100% condom program was put in place, the existing infrastructure was used to support it.

Every time a CSW came in for testing, she was given as many boxes of condoms as she might need. The commercial sex establishments were also provided with condoms. Millions upon millions of condoms were sent throughout the country. Enough condoms were sent out  so that no one should ever need to buy one to engage in sex.

Enforcement was also active. Whenever a man would come in with an STD, the government would ask where he acquired it. Brothels that were found not to be requiring condom use were fined or otherwise pressured. Eventually the process became easier. Brothels stopped worrying about losing customers by requiring condoms. It was easy once they realized that everywhere else was requiring them too.

It was an incredibly effective program. Within 5 years, the percentage of commercial sex acts where condoms were used increased from 15% to over 90%. At the same time, the number of men coming in with STDs decreased enormously. The quickly spreading HIV epidemic was largely brought under control. The 100% condom program couldn't eliminate all HIV transmission. However, in its early years it was one of the most effective government-instituted HIV control programs in history.

Unfortunately, in the 15 years since the program's inception, things in Thailand have changed. Since the program was primarily aimed at commercial sex establishments, condom use never became part of the public discussion. The result of that is that today, most new HIV cases are seen in married women.

What lessons can the U.S. learn from the successes and the failures of the Thai program?

  1. Just because something is illegal, doesn't mean that people don't do it. Making illegal activities, such as commercial sex work and injection drug use, safer is easier than stamping them out.
  1. In areas with a high prevalence of HIV transmission, promoting condom use among casual partners isn't enough. People have to be convinced to use them with their regular partners and spouses as well.
  2. The government can have a positive effect on the rate of HIV transmission. The government can't do that by hoping to change people's morals. When even altering behaviors is difficult, eliminating them may be almost impossible.


Beyrer et al. (2007) "Patterns of HIV and syphilis infection in Northern Thailand 1998–2001" International Journal of STD & AIDS 18: 179–183.

Rojanpithayakorn W. (2006) "The 100% Condom Use Programme in Asia." Reproductive Health Matters 14(28):41-53.

Hanenberg and Rojanapithayakorn (1996) " Prevention as Policy: How Thailand Reduced STD and HIV Transmission" AIDScaptions 3(1) (accessed 11-4-07).

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