2007 Survey of Sexual and Reproductive Health of Sex Workers in Thailand

The Institute for Population and Social Research (IPSR), Mahidol University together with the Service Workers in Group (SWING) conducted a survey on Sexual and Reproductive Health of Sex Workers in four major cities in Thailand in 2007. The survey was structured to provide up-to-date information about sex workers regarding their socio-economic background, their access to health care, health care seeking behaviour, and their sexual and reproductive health well-being.
 
The study found few sex workers under the age of 18. The average age of respondents in the sample was 28.3 years. 9.4 percent of respondents were under 18 when they first sold sex for money. Almost half of respondents lived alone, 65 percent had at least one child, but only twelve percent currently lived with a child. One-third of respondents had one or more secondary partners - a category in between client and partner - who generally provide financial support to the sex workers. Median monthly earnings were around four times higher than the median for women of their age and education (who did not work in the sex industry). Approximately 40 percent of women had debts of their own, and 38 percent took responsibility for debts of family members. Eighty percent of women had managed to reduce debts or save money during the previous month.
 
Many women reported looking for long-term relationships with men (including foreigners). This is seen as a route out of the sex industry. Non-use of condoms can be a strategy to demonstrate commitment in a relationship. Twenty-two percent of respondents had worked in at least one other sex industry establishment, and four percent had worked in at least one other province.
 
Demand is seasonal - highest at New Year, and lowest during the rainy season. Some women enter and leave the industry according to the seasons. Most women have sex with clients away from the establishment, though sometimes the hotels are owned by the establishment. Having sex outside is seen as dangerous.
 
Solidarity among workers is highest among brothel-based sex workers, and lowest among freelance workers.
 
Quantitative data suggests low drug use, other than alcohol. Twenty percent of workers got intoxicated most days or every day. The main reason is that selling drinks is part of their work. Few report that they get drunk in order to be able to do sex work. Qualitative data indicate that drunkenness can lead to high-risk behaviours
such as non-use of condoms.
 
The median number of times having vaginal sex with clients in the previous month was 14, though 16 percent had vaginal sex more than 50 times. Sixty percent had had oral sex at least once during the previous month, but only three percent had had anal sex. Condom use was 97 percent for vaginal sex. Although reported levels of anal sex were low, condom use was lowest for anal sex compared to vaginal or oral sex. Use rates were higher among brothel-based sex workers and sex workers in massage parlors than among sex workers in other establishments or freelance sex workers.
 
Having clients refuse to use condoms appeared to be just as common among brothel and massage parlor workers; but massage parlor workers were more successful in persuading clients to use condoms. It is important to note that condom use with clients was high among all groups. However the majority of women never used a condom with their regular partners.
 
Although over two-thirds of the women surveyed were covered by the universal health care scheme, almost 60 percent were not registered for the scheme in the place where they were working. A further 23 percent reported that they had no health insurance at all. Almost seventy percent of women reported using antibiotics in the four months before the survey.
 
Although less than ten percent of women reported having experienced a pregnancy while working as a sex worker, it appears that most of these pregnancies are aborted. Most contraceptive protection is through condom use. Forty-one percent of women obtained their most recent supply of contraceptives from a pharmacy. Only five percent reported obtaining their supplies from where they worked.
 
Approximately 40 percent of the women surveyed reported experiencing a vaginal discharge during the previous twelve months, and of these women almost 90 percent sought treatment for the discharge. The main source of treatment was a pharmacy. Those in the
lowest paid sectors were the most likely to seek treatment at a pharmacy.
 
Only 57 percent of surveyed women reported having heard of STIs. The level of recognition of STIs was much higher for women working in brothels and massage parlors. These latter two types of establishments are often the focus of public health interventions because they are easier to access as they are generally acknowledged as providing sex services.
 
Knowledge of HIV was almost universal. Approximately one-half of women reported having had an STI test in the previous six months. This contrasts with 57 percent
who had an HIV test in the previous six months. Awareness of, and behaviour regarding, HIV testing is also much higher than for STI testing. Only 16.8 percent reported that they had never had a HIV test.
 
The main reasons for not having had an HIV test were too far away (38 percent), do not know where to go (15.3 percent), staff not friendly (15.3 percent), no symptoms (10.9 percent) and too embarrassed or too shy (10.9 percent). It is evident from these responses that in order to achieve even higher coverage of HIV testing, more emphasis needs to be placed in improving access to testing and improving quality of care.
 
Only eight percent of the women reported that they experienced first sex before the age of 15. Over 80 percent of women had their first sex with a regular partner; less than six percent experienced their first sex with a customer. Although 20 percent who reported
that their first sex was with a customer stated that the sex was against their will, this proportion was not substantially different to the overall figure of 19 percent that said that their first sex was against their will.
 
In the seven days before the survey, 22 percent of respondents reported being yelled at, 15 percent being paid less than they agreed, twelve percent reported not being paid at all and 11.5 percent were forced to perform a sex act that they did not want. Levels of abuse appear to be much greater among women who may have less support from their place of employment, or in the case of freelance sex workers, have no place of employment. Levels of discrimination by officials appear to be low.

(summary abridged version of authors' conclusion)

Year of publication: 
2007
Theme: 
Health and HIV
Author: 
Philip Guest, Aree Prohmmo, John Bryant, Surang Janyam and Dusita Phuengsamran