Other success stories indicate positive

Other success stories indicate positive interactions between different approaches, with
some interventions leading to outcomes beyond those intended. Programmes in several
countries have shown that positive interactions among prevention interventions can
stabilize or reduce HIV prevalence. A condom promotion campaign directed at male port
workers in Brazil had the unexpected result of not only increasing condom use among
these men but also decreasing the proportion of men who reported having sex with casual
partners4. Senegal’s prevention efforts, which began in the mid-1980s, led to high levels
of knowledge about HIV prevention in the general population and to unexpectedly high
rates of condom use with non-regular partners, particularly by sex workers and their
clients. Prevention programmes in Thailand and Uganda are outstanding examples of
the effectiveness of comprehensive programmes including condom promotion leading
to reductions in HIV transmission. Condom promotion played a different role in each of
these two countries’ successes.
Learning from successes
The Thai lesson: targeting condom promotion
Condoms clearly played a key role in HIV prevention efforts in Thailand. Promoting the
use of condoms in sex work venues such as brothels was the core strategy of the Thai
100% Condom Use Programme, but other interventions—such as substantial health
education, sexually transmitted infection (STI) control, HIV testing, and clinical care
for persons with HIV-related disease—played supporting roles. The success of the 100%
Condom Use Programme’s implementation was rooted in strong political commitment
and support at all levels, including that of government officials, local health workers,
nongovernmental organizations (NGOs), the media, brothel owners, and the public in
general. The pattern of the epidemic in Thailand in the late 1980s mandated the need
for a prevention strategy targeting sex work venues, at a time when unprotected sexual
activity was the driving force of the Thai epidemic.