1. What is 100% condom use programme?

2. Components of 100% condom use programme Based on Government POLICIES:Based on Government POLICIES: ( Law, regulation, decrees, etc.) –Requiring use of condoms in sex relations negotiated through entertainment establishments –Imposing collaboration of establishment owners –Enforcing the policy : sanctionssanctions identifying and “screening” establishment workersidentifying and “screening” establishment workers –Monitoring condom use

3. Activities of 100% condom use programme Supported by PROGRAMME ACTIVITIES:Supported by PROGRAMME ACTIVITIES: –Advocacy (high level declaration) –Establishment of monitoring committees and working groups working groups –Mapping of establishments –IEC –Condom supply –Providing STI services –Monitoring/evaluation –Closure of sex establishment

4. GOAL GOAL Prevent heterosexual transmission of HIV Prevent heterosexual transmission of HIV sex workers and their clients sex workers and their clients spouses and friends of clients of sex workers spouses and friends of clients of sex workers general population general population Goal & objective of 100% condom use programme OBJECTIVE OBJECTIVE To increase condom use in high-risk situations to 100% To increase condom use in high-risk situations to 100%

5. Why targeting Sex workers?

6. Prevalence of STI/HIV by risk groups (Cambodia, 1996)

7. Estimated number of new HIV cases per year if no control (year 199X): - contracted from sex workers:400,000 - contracted from casual sex: 15,000 - contracted from spouse: 20,000 - contracted from drug use: 8,000 - contracted from MTCT: 6,000 - contracted from blood transfusion: 4,000 TOTAL 453,000 TOTAL 453,000 Main source of HIV Infection Thailand

8. LOW COST-EFFECTIVE Strategy 1: Supply condom to general population Massive amount of condoms required Massive amount of condoms required Low coverage Low coverage Limited impact Limited impact Strategy 2: Supply condom to sex worker & client Concentration Concentration on a selected group High coverage High coverage Marked impact Marked impact HIGH COST-EFFECTIVE High cost-effectiveness of the strategy

9. Why is 100% CUP based on establishments?

10. Indirect sex workers Direct sex workers Freelance sex workers Establishment-based sex workers Target on Establishment-based Sex Workers Brothel Beer bar Nightclub Massage parlour Karaoke lounge …...

11. FIRST PRIORITY Establishment-based sex workers Accessible Easier to enrol in the programme and monitor Freelance sex workers Difficult to access Difficult to Difficult to enrol and monitor enrol and monitor SECOND PRIORITY Target on Establishment-based Sex Workers

12. Benefits of 100% condom use programme To COUNTRY:To COUNTRY: Decreasing burden on health care systems and social/economic impact of STI/HIV epidemic To SEX WORKER:To SEX WORKER: Protection from HIV and other STIs To CLIENT:To CLIENT: Protection from infections with HIV and other STIs To HIV/AIDS programmes:To HIV/AIDS programmes: Rapid impact of intervention Credibility - political support.

13. Key players of 100% condom use programme A. Health Sector  STI services  Condom supply  Health education and information to target groups  Collecting data on condom use from STI clients and sex workers  Reporting of non-cooperative sex establishment to the police B. Police Sector  Management of non-cooperative sex establishment C. Local Administrative Sector  Coordination between the government sectors and the owners of sex establishments of sex establishments Three Responsible Sectors Three Responsible Sectors

14. Evaluation of 100% condom use programme Process Outcome Impact EVALUATION e.g. condom sales e.g. condom use rate e.g. STI/HIV prevalence INDICATORS

15. - Launch of the pilot programme for 100% condom use in Ratchaburi Province in 1989. Example of 100% CUP in Thailand - National AIDS Committee called for the nationwide expansion of the programme in August 1991.

16. HIV Prevalence rate (%) 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0 Year Nationwide Expansion of 100% Condom Use Impact of 100% CUP Thailand Condom use in clients Conscripts Pregnant women

17.  HIV prevention (1989-1995) Two million infections Two million infections Impact of 100% CUP Thailand  STI prevention (1990-1997) 260,000 STI cases per year among people receiving government clinic services 260,000 STI cases per year among people receiving government clinic services 3-4 times higher among people receiving private clinic services 3-4 times higher among people receiving private clinic services

18. Without 100% condom programme 100% condom programme Effectiveness of condom programme in HIV prevention HIV infection

19. - Launch of pilot project for 100% condom use in Sihanoukville province in 1998 Example of 100% CUP in Cambodia - The Prime Minister signed an order requiring nationwide implementation of the programme in October 1999 - Expansion activities are underway

20. HIV prevalence rate (%) 100 80 60 40 20 0 Year Impact of 100% CUP Cambodia Initiation of 100% Condom Use

21.  China  India  Indonesia  Myanmar  Philippines  Viet Nam 100% CUP in other Asian countries

22. CONDOMSare NOT a 100% solution to STI/HIV problem BUT... the MOST effective method of preventing sexual transmission of STI/HIV