Since the primary axis of HIV transmission

It is rare that an STD prevention program is hailed as an unqualified success. In the early 1990s, however, Thailand managed to impress scientists, activists, and educators worldwide with the accomplishments of their 100% condom program.

The 100% condom was designed to enforce 100% condom use at every commercial sex encounter in the country. Since the primary axis of HIV transmission in Thailand was from commercial sex workers (CSW) to men, from men to their wives, and from wives to their children, it was thought that reducing the risk of HIV transmission in commercial sex would be an effective means of slowing the spread of the HIV epidemic.

Even though prostitution had been illegal in Thailand for almost 30 years, even prior to the HIV epidemic the government had found it easier to regulate it than to stamp it out. Part of that regulation was the use of contact tracing whenever anyone came in to be tested for an STD. Thai men would almost always mention patronizing a commercial sex establishment (such as a brothel) in these conversations, and the STD control unit would send outreach workers to each brothel to try and convince the workers there to be tested and treated. Because of the outreach program, at the start of the AIDS epidemic the government had a very good idea of how many CSW were working in the country and where they were employed.

When the 100% condom program was put in place, the existing infrastructure was used to support it. Every time a CSW came in for testing, she was given as many boxes of condoms as she might need. The commercial sex establishments were also provided with condoms. Millions upon millions of condoms were sent throughout the country, enough so that no one should ever need to buy one to engage in sex.

Enforcement was also active. Whenever a man would come in with an STD, the government would ask where he acquired it. Brothels that were found not to be requiring condom use were fined or otherwise pressured. Eventually the process became easier. Brothels stopped worrying about losing customers by requiring condoms once they realized that everywhere else was requiring them too.

It was an incredibly effective program. Within 5 years, the percentage of commercial sex acts where condoms were used increased from 15% to over 90%, and the number of men coming in with STDs decreased enormously. The quickly spreading HIV epidemic was largely brought under control. Although the 100% condom program couldn't eliminate all HIV transmission, in its early years it was one of the most effective government-instituted HIV control programs in history.

Unfortunately, in the 15 years since the program's inception, things in Thailand have changed. Since the program was primarily aimed at commercial sex establishments, condom use never became part of the public discussion. The result of that is that today, most new HIV cases are seen in married women.