Thailand is currently experiencing a major HIV epidemic, spread primarily through heterosexual contact. Patronage of prostitutes is relatively common. In-depth, open-ended interviews were conducted in a Central Thai province with a purposive sample of 181 urban men who had had sexual relations with at least two different women during the prior year. Additional qualitative information is provided by interviews with 50 women. The most common network pattern for men was a combination of commercial and noncommercial sexual relationships. Men reported that they commonly used condoms when they engaged in sex with prostitutes, but condom use was lowest for men who were the most frequent patrons. In noncommercial, nonmarital relationships, men screen partners for risk rather than practice safe sex, and condom use is generally low. Persons involved in noncommercial sexual networks are largely unaware that their partner may link them to a larger network of sexual contacts and associated risks of HIV infection. Men who have both commercial and noncommercial sexual partners can be found throughout the social strata. A program that focuses only on the closed commercial sex network will address only partially the real risk situations.
PIP: In Thailand a major HIV epidemic is spreading primarily through heterosexual contact and prostitutes. In the central region, 3 districts were chosen for interviews with 181 urban men (single and married blue-collar workers, single and married white-collar workers, and single college-level students) who had had sexual relations with at least 2 different women during the prior year. For further information, 50 women were interviewed: 24 service and entertainment workers, 18 students and unemployed teenagers, 6 wives of STD clients, and 2 village women who sometimes engaged in commercial sex. Only 1 out of the 181 male respondents had never patronized a commercial sex worker. 82% of the respondents indicated that they had drunk at their most recent episode and 74% said they had been drunk. 47% of the single men (excluding students) had noncommercial sexual relationships with more than 1 woman. Only 38% of the married men had no extramarital sex in the past year. Among married men, 38% engaged only in commercial extramarital sex, 22% had sex only with their wives and noncommercial partners, the remainder had sex with both commercial and noncommercial partners and also with their wives. 35% of the men reporting more than 20 commercial sex episodes in the past year usually used condoms. 58% of the men who had fewer than 5 episodes in the past year usually used condoms; 60% of the men who had 5-9 episodes did; and 65% of the men who had 10-19 episodes used them. 83% of the respondents mentioned fear of disease, while 35% cited HIV/AIDS as the reason for condom use in the last commercial sex event. More than 60% of the men showed very high- risk or high-risk behavior. The dominant pattern (64%) was a combination of commercial and noncommercial sex. The networking data revealed pathways for HIV/STD transmission and for intervention programs: 1) single men who have both commercial and noncommercial sex; 2) married men who have commercial, noncommercial, and marital sex; 3) married men who have noncommercial and marital sex.