Prospects for Increased Condom Use Within Marriage in Thailand

Abstract

In Thailand where commercial sex patronage is widespread among married men the transmission of human immunodeficiency virus (HIV) from infected husbands to their wives has become a significant component of the acquired immunodeficiency syndrome (AIDS) epidemic. Although 70% of Thai couples of reproductive age are current users of a contraceptive method condoms are selected by fewer than 2%. Qualitative data from 14 focus groups (involving 59 men and 55 women) and 47 in-depth interviews identified numerous obstacles to condom use within marriage. Condoms are perceived as a means of preventing venereal diseases not pregnancy. As a result of effective government AIDS prevention campaigns condoms are now used in the majority of sexual encounters with prostitutes and have become associated with extramarital sex. Thus requests for condom use within marriage are viewed as insulting to the partner and arouse suspicions of marital infidelity. When either partner suspects infection with a sexually transmitted disease short-term abstinence until treatment can be obtained is more likely than condom use. A further barrier to condom use within marriage is mens strong dislike of the associated reduction of sexual pleasure. Of concern was the failure of any respondent to mention condom use as a precaution against premaritally acquired HIV infection; none had been tested for HIV. Recommended to increase the perception of personal risk is voluntary HIV testing and counseling among men with a history of risky behavior and possibly optional premarital testing. Continuation of government promotion of condom use in commercial sex encounters remains essential given the formidable obstacles to condom use within marriage.