Used condoms in 30 female brothels in Chiang Mai, Thailand, during the period from August 1992 to October 1992 were examined for breakage. Data were also collected by interviewing 326 prostitutes who accounted for 65 percent of the total prostitutes providing condoms. The prostitutes had a mean age of 20.6 +/- 3.2 years. Sixty-one percent had no formal education. The median duration of prostitution was 13 months. The average number of clients per day in the past 24 hours and in the past 3 months was 4.4 +/- 2.5 and 5.5 +/- 2.2, respectively. Eighty-eight percent charged between $2 and less than $8 for their sexual service. All refused to practice oral or anal sex during the past 24 hours. Of 5,559 condoms, 298 were used two at a time and 15 were used three at a time. The breakage rate per act of intercourse was 5.9 percent (95% CI = 5.3, 6.5). The breakage per total condoms examined was 5.7 percent (95% CI = 5.1, 6.3). Breakage relating to manufacturing defect, i.e., pinholes, and that relating to use was 0.8 percent (95% CI = 0.6, 1.0) and 5.0 percent (95% CI = 4.4, 5.6), respectively. The probability of breakage when using two condoms at the same time was 3.4 percent (95% CI = 0.5, 6.3). Most of the breakage occurred at the distal part of the condom. There was no difference between the breakage rates of condoms provided by the brothels and those brought by the client; nor was there any difference between manufacturing defect or use. The breakage rate per client as estimated by prostitutes in the past 24 hours corroborated with that assessed by examination.
PIP: Brothel-based female prostitution has been the most important source of HIV spread in Thailand, especially in Chiang Mai. Proper and consistent use of condoms during sexual intercourse greatly minimizes the risk of HIV transmission between sex partners. Condoms do, however, occasionally rupture during use. The authors examined used condoms for breakage in thirty female brothels in Chiang Mai, Thailand, over the period August-October 1992, to assess the true level of breakage among users in such a context. 326 prostitutes, or 65% of prostitutes providing condoms, were also interviewed. The women were of mean age 20.6 years and had been working as prostitutes for a median duration of thirteen months. They reported having an average 4.4 clients during the preceding 24 hours, but an average 5.5 clients per day during the preceding three months. All refused to practice oral or anal sex during the preceding 24 hours. Of 5559 condoms, 298 were used two at a time and fifteen were used three at a time. Examination found a 5.9% rate of condom breakage per act of intercourse and a 5.7% rate of breakage per total condoms examined. Most breakage occurred in the distal region of the condom. The breakage rate per client as estimated by prostitutes during the preceding 24 hours corroborated with that assessed by examination. Breakage related to manufacturing defect and use was 0.8% and 5.0%, respectively, with a 3.4% probability of condom breakage when two were used at the same time. No difference was found between the breakage rates of condoms provided by the brothels and those brought by the client, nor was there any difference between manufacturing defect or use.