Commercial Sex Workers and HIV/AIDS in Thailand: Sex Tourism and the

Globalization of Relationships

Arunan Sivalingam
309422
Geography 575
December 7, 2009
 2

Abstract

This paper analyzes the underlying factors that have led to Southeast Asia,
particularly Thailand coming to be seen as a “sex paradise”. Political and economic
factors will be analyzed to understand what has allowed the industry to exist and become
entrenched in the economic, social and cultural life of Thailand. The emerging dynamic
of sex tourism will be analyzed from the demand side of ‘John’s’ who travel halfway
across the world to service their desires, looking at the complex social space their
interaction creates. Finally, such intersections will be examined in light of the HIV/AIDS
pandemic.

Introduction

Before the advent of HIV/AIDS the words drugs users, prostitutes, gay men -

among others, would have been difficult to find in the same sentence together. But

HIV/AIDS has changed alot of things, or more simply brought much more into the open.

AIDS has proven to be the great revealer of the vast inequality and marginalization our

social structures, institutions and ideas have created among our fellow citizens. Above

all, “it defines those who can purchase well-being and those who cannot” (Barnett &

Whiteside 2006, 6). It has also demonstrated the vast differences in the relations of

power, and the contradictions in our perceptions of the ‘other’. Although disheartening

that it has taken the existential threat of HIV to bring the global community to this point;

an opportunity presents itself to dive deeper into the complexities that entangle

themselves in the web that is the pandemic. Much research has now gone into looking

into the lives of individuals, who before had little attention paid to them, such as

commercial sex workers (CSWs). A benign term itself utilized by the vast array of

epidemiologists, social scientists, economists, among others working to understand the

 3

lives of CSWs as pointed out by Pisani (2008), leaving little to be politically incorrect

any longer.

Research into international tourism in Thailand has proven to be of benefit in

regards to looking at the long-term implications of the epidemic, seeing migration

patterns and the intersection of foreign tourism’s impact to the general public. But in

doing so, one finds research into foreign sex tourism has not been as holistic in respect to

analyzing the perspectives of the ‘Johns’ who travel halfway across the world to service

their desires. Ironically, such dynamics reveal that intersections between history,

modernization and mediums of exchange go beyond merely being monetary. Rapid

changes in economic, social and communal structures are bringing a vast array of new

linkages, where modern forces are colliding to create factors that are products connected

more deeply then at the level of HIV/AIDS alone.

History of Prostitution in Thailand

“With the Vietnam War as a backdrop, early sex tourism in the form of
rest and recreation services in Thailand was born from the seed of western
capital” (Rho-ng, 2002, 10).

HIV/AIDS is not a disease existing within a vacuum, but is intrinsically linked to

social and environmental spaces traced back to various intersecting histories. It is

important to trace back the contemporary history of Thailand, albeit briefly, to gain an

understanding of the place that sex tourism has taken in contemporary society.

Thailand is one of a handful of countries never to have formally been colonized,

as successions of King Ramas were able to avoid the control of Europeans (Hunter, 2005,

133). Beginning in 1932 the country was controlled by the military until 1992, when a
 4

transition to civilian government began, although the monarchy continues with rule in the

hands of the Prime Minister (Hunter, 2005, 133). The following map points out Thailand

geographically, and reveals spatially the connection it would receive as a “sex haven”

paradise after the Vietnam War. Although commercially it would seem that prostitution

is a modern phenomenon, this is incorrect. The Bowring Treaty of 1855, which opened

Thailand to foreign labourers, mainly to men from southern China has been noted as an

important event in this regard (Bamber, Hewison & Underwood, 1993).

Figure 1. Thailand Map

Source: http://www.lonelyplanet.com/maps/asia/thailand/map_of_thailand.jpg

This is due to the fact that a large number of Chinese prostitutes accompanied the men,

creating the largest centers for sex Thailand had experienced prior to that time; a 1909

law effectively legalizing prostitution also seemed to add to this. (Leheny, 1995, 373).

The new influx of labourers and ensuing changes gave a small hint of what was to come
 5

in the latter mid part of the century. It is again important to note that the sex trade in

Thailand is surely not a “modern” phenomenon, with the idea of prostitution being part

and parcel of Thai culture revealing a rooted racialized notion of the ‘ethnic other’, as

found in many ethnographic accounts with sex tourists (Seabrook, 2001). The

development of sex tourism has always been in the making to what it manifests as today.

Research into the early prevalence of STD’s in the late 1800’s among the affluent, and

sex workers is proof of a working sector, with references by officials citing STD’s among

sex workers as a concern (Bamber, Hewison & Underwood, 1993).

Ryan & Hall (2001) break the history of prostitution in Southeast Asia down into

various stages: Indigenous prostitution that was pre-existing, secondly that of economic

colonialism and militarization, thirdly, international tourism and rapid economic

development, with international controls being the final (p.141). Both Thailand and

Japan have had long traditions of concubinage and prostitution, which lasted well into the

20th century; ingrained as part of the culture like so many civilizations (Jeffrey, 2002, 33).

The second and third stages mentioned above are important in building on the link

between indigenous prostitution and modern dynamics, and will be examined in the

ensuing paragraphs throughout this paper as phenomena that helped put forth the idea of

Thailand being a place of sex tourism within the role of rapid economic development.

Development becomes leisure

In the 1960’s the era of ‘development’ came to manifest itself in a convoluted

way. Thailand indirectly became a part of the fight against Communism, which had its

links to the Indo-Chinese and Vietnam War. The results of which left behind a Western
 6

development culture – big dams, electricity for military bases all working for the larger

goal of destroying Communism (Seabrook, 2001, 105). Yet this goal of destroying

Communism also became manifested by the Thai political establishment toward its own

people, as Chantawipa, founder of the NGO EMPOWER points out, “there was fear that

rural people would become Communists and demand better food, housing and education”

(Seabrook, 2001, 105). Thus education was made to be minimal, and the idea of

modernization and development came to manifest itself with the Rest and Recreation

(R&R) facilities. Such centers, mainly in Bangkok were negotiated by government

officials on both sides to allow for troops stationed in Vietnam to come to Thailand as a

place of rest (Ryan & Hall, 2001). As Chatawipa points out, Thailand’s role in

‘development’ would manifest itself in a most bizarre way,

“The phenomenon of the Miachao, the ‘rented wife’, was common; women
hired... [by American troops] for cleaning, washing and sex, all of the most
degrading elements rolled into one...this was the beginning of the rent-a-woman
culture which has since become institutionalized in the sex industry: the farangs
[westerners] come, pick up a woman, [and] take her...”(Seabrook, 2001, 106).

These early interactions would act as a catalyst that would leave a cultural and

social mark that has begun to manifest itself now. Early interaction with American

troops served as the initial development of a sub-economy where women, mainly from

the north would migrate to the urban centers to provide sexual services in the bars, discos

and massage parlours built to cater to the military and later tourists (Jeffrey, 2002, xii).

The close alignment of the Thai political leadership to the United States made Thailand a

beneficiary of aid that became predictably tied to its military. The first development

plan, following along the World Bank and International Monetary Fund (IMF) mantra of
 7

economic liberalization was also in full effect now (Jeffrey, 2002, 33). As Hunter (2005)

points out, Asia with close to 60 percent of the world’s population has emerged as a

premier world economic zone; a result of a ‘modernization’ process that has been 30

years in the making (p.58).

The departure of American soldiers as the Vietnam War looked to be coming to

its end, left the Thai political leadership in a bind: as they no longer would be at the

receiving end of U.S support. Yet this came right in the middle of the modernization

process in which Thailand found itself. Many developing countries did not have much in

the way of attracting foreign investment other than their ‘cultural assets’ or essentially

what they could showcase to induce the bringing in of tourist dollars (Singh & Hart,

2007). The process of rapid modernization meant that Thai’s would have to unite in

working toward the goals of modernization, the pressure of American advisors telling the

Thai government to advise monks to not preach on the value of contentedness, as this was

seen as counteractive to the values underlying modern development serves to

demonstrate this point clearly (Rigg, 1997, 33). Although this did not seem to be

particularly necessary as the interaction and consequent (R&R) culture would help bring

in western Americanized ways of culture, being and longing (Seabrook, 2001, 74). The

proliferation of R&R spending is telling: by 1970, $20 million was spent by U.S army

personnel on leave, up four times the amount from only three years prior – and “as much

as one-forth of the total value of rice exports for that year” (Rho-ng, 2002, 10). Although

not something that would be popularly accepted, the economy of ‘sex’ had

unintentionally become a part of Thailand’s industrial development. It became

understood that the high cost of travel at the time to Thailand would not make it a family
 8

friendly area of tourism, and thus made the (R&R) infrastructure go toward a new type of

leisure tourism based on prostitution, an inevitably that could not help but occur in the

mind of the government and World Bank (Ryan & Hall, 2001, 12)

Growth gone astray

The 1960’s acted as the take-off point for Thailand with the massive influx of

money invested into the economy to build up its infrastructure and contain the security

threat of communism as mentioned previously. Yet as with many other cases in the

developing world, such investment seemed to work against the poor, as at one moment

rural development was touted to gain popular support, and rhetoric quickly changing as

the tide transformed against any inklings that could seen to be promoting the wrong

ideology (Jeffrey, 2002, 31). Such massive changes within the context of an unstable

Thai economy, and the decline in agriculture as a staple of economic life, signalled the

beginning of the path the country would take with the influx of the American military

(Rho-ng, 2002, 11). Like many countries at the time, the preferred mode of

‘development’ was to undertake the quickest path to modernize and grow the economy.

This meant creating the most favourable conditions for corporate investment, which took

away support and focus on the majority – the poor, rural women in the countryside who

were losing out with falling terms of trade (Jeffrey, 2002, 37). The divide that emerged

between those in rural and urban areas, also known as ‘dualistic development’, acted as

the catalyst for massive migration to cities and the supply for sex work (Singh & Hart,

2007, 161). The easy transition that was available with R&R infrastructure already in

place made the sex industry in Thailand a significant part of the Thai economy.
 9

The cultural industry focus of many developing countries, made it imperative to

place anything that could be seen of value onto the international market – in Thailand’s

case it became sex (Singh & Hart, 2007). Early on it was even implied and encouraged

by officials, for businesses’ to come to Thailand as a friendly place to bring employees,

especially males for holidays; the idea of cultural industry even spun into how Thai

culture itself was perceived with sexual services being their economic advantage (Cohen,

1988, 470). Thailand’s impressive growth in some ways has been linked with the sex

industry, although never formally acknowledged. The asset inflation and speculative

investment that spawned the Asian Financial crash of 1997, is related to the underground

economy that is very much linked with various facets of everyday life as studied by

various economists, such as Paul Krugman among others. Recent studies of the Thai

economy put the value of the underground economy at between $33 to $44 billion dollars

per year, with sex work accounting for two-thirds or around 15-18 percent of gross

domestic product (Hunter, 2005, 194).

The majority of sex workers are indirect, in the sense that they work in bars and

disco’s, with many hotel managers, English speaking tour guides and others all linked to

the industry (Singh & Hart, 2007, 162). It is for this reason that the sex industry has

become such a significant link within the Thai economy. Remittances sent back to

families by daughters who are CSWs in urban areas act as a significant economic safety

net for those in rural areas (Singh & Hart, 2007). Millions within the service sector rely

on the external economy of the sex industry, and for this reason if ruptured would have

little effect on the rich and middle-class, but devastate the poor (Steinfatt, 2002, 36). The

complexities of the trade are found when looking into how the industry functions: from
 10

men who go to rural areas in the north, often deceiving mothers to allow their daughters

to go with them into the cities, to the bar owners, who operate maliciously, pitting women

against one another to generate the most revenue (Engstrom, Minas, Epinoza & Jones,

2004, 197). Dr. Charoenlot, an economist at Chulalongkorn University remarks,

“corruption severely distorts wealth into the hands of the rich...this degree of inequality

and promise of wealth appears as a quick way for the poorest to gain a share” (Seabrook,

2001, 70).

In the cynical view of Ryan & Hall (2001), “many countries in East Asia utilized

the sex industry as the initial mode of development to attract tourist revenue, but only

started to crackdown, once other modes of economic development became more

established” (p.142). In Thailand’s case, the cost that was becoming apparent with the

looming potential of the impact of HIV/AIDS, once acknowledged, revealed how much

the country’s ‘race to the bottom’ socially, economically and morally could have. Dr.

Kua a demographer also at Chulalongkorn University puts this in perspective, remarking,

“We should be finding more imaginative and sustainable ways of becoming

prosperous...the cost of AIDS may eventually outweigh the income from sex
tourism...there is a [problem if] social costs are not taken [into account]...by only
choosing to see what is expressed in monetary terms. We can see the costs of our
economic ‘success’...they are upon the faces and the bodies of our people.” (Seabrook,
2001, 78).

Yet with an industry that has had such a link to the country’s growth and development,

the value of the ‘work’ undertaken by women is still unaccounted, unvalued, unmeasured

and disgraceful when looking at such a phenomena as having become the pseudo mode

for human development.

 11

Thailand and the Commercial Sex Industry

The interface between the commercial sex industry (CSI) and Thailand as a whole

is indeed a relationship that goes well beyond cosmetic; with the industry being an

unfortunate reality of social and political life. In reality, the CSI in Thailand, like so

many other countries in the region is linked to economic development, and rapid change

brought on by modernization (Eades, 2009). The ironic twist being that the industry acts

as a lifeline for politicians, bureaucrats and other officials entrenched in the trade, with

resistance and action to combat this issue only a show for a concerned international

community.

Sex work and society

To many the linkage of sex work to social and economic disempowerment is

clear. Louise Brown (2001) for instance, links sexual exploitation to labour exploitation

in the global economy, as women’s work, which is largely unpaid and unaccounted in

official measures, devalues them of official ‘economic value’ (p.33). Marilyn Warring a

feminist economist has also been at the forefront in examining this issue. It is sad that

when women are brought in from various countries to be ‘nannies’ or care providers in

Canada and other western countries, they are counted economically for carrying out roles

they take up, but only when done through monetary exchange for others.

The idea of value here becomes quite perverse, with many young women

returning from working in the bars, discos and streets in Bangkok to rural villages in the

north. Many on their return respond how they feel good that they were able to use the

incomes from farang’s (western men) to help build and contribute tangibly to supporting
 12

their families (Seabrook, 2001, 101). It is a sad reality that the only form of being able to

provide is through the income earned from ‘exchanging’ one’s body – the only thing that

seems to hold transactional value. Shocking still, some parents now celebrate the birth of

a daughter because she can possibly help to alleviate poverty by entering prostitution

(Belk, Ostergaard & Groves, 1998, 199). In some instances, women who work in the sex

industry and use the money to provide for their families are not seen as being as

dishonourable to some who advocate such ideas under Theravada Buddhism, which is

dominant in Thailand (Belk, Ostergaard & Groves, 1998, 199). This is in no way to say

that prostitution has become more accepted, as it is the ‘sexual value’ placed upon these

women by local and foreign men that perpetuates their existence. But the provision their

work provides families, and in some cases the luxuries they are able to afford, has in

some way made the acceptance of the new development model inevitable to individuals

who see no other way to survive within the confines of the modern economy.

Stigma

The stigma that surrounds HIV/AIDS makes living with the disease unbearable

for many who become infected, with little sympathy shown by many within an

individual’s family and those in the community. Yet on top of this, things get a lot worse

when you are a woman and worse still a female sex worker. Women are perceived as the

carriers of HIV, “with prevailing social and cultural attitudes toward women only helping

to make their treatment worse – the worst scenarios being abandonment and death”

(Hunter 2005, 191). The double standard that exists between men and women reinforces

the ideal expected of women to be pure, whereas alcohol, drug use and the promiscuous

sexual behaviour that goes along with it is accepted as ‘normal’ for men (Hunter, 2005,
 13

191). Yet the real story as Hunter (2005) puts it is that at least 4 million women are

forced into sexual slavery each year, and the majority of initial sexual intercourse for

women is forced (p.201). Thus the expectation of women’s role and place is contradicted

by the status that women are actually given within society. The 2003 Economic and

Social Commission for Asia and the Pacific looked at discrimination of sex workers, and

stated, “sex work is regarded with contempt and sex workers tend to be despised” (p.53).

Yet many times they are young, uneducated rural women who depend on sex work to

support their parents and families (p.54). This all seems to fit together when one

considers the lack of opportunity given to women, coupled with the fact that less than 15

percent of seats in Asian parliaments are held by women (Hunter, 2005, 192). Thus, with

the lack of social support by governments, and the feelings of debt girl children have

toward their parents, such activities can be seen to be reasonable (Steinfatt, 2002, 53).

Not to mention the hypocrisy of governments realizing the business potential of the

industry – thus stigmatizing the morality of women on the one hand, and instilling their

role as a duty for national development on the other (Ryan & Hall, 2001, 142). The

UNAIDS Guidance note on HIV and Sex Work, also addresses this issue in looking at

approaching and respecting rights of sex workers. But in trying to do so, the difficulty of

first reducing the impetus to “punish suppliers, while ignoring the consistent demand for

sex” must be addressed (p.5). The criminalization of women in the industry is also

demonstrated at the highest level, with prostitution illegal under the Thai penal code as

the “crime of promiscuity” (Rho-ng, 2002, 11). The irony of the language used seems to

not be lost when considering the dynamic of how sex work actually happens.
 14

The Man Factor

The various complex inter-linkages underpinning prostitution in Thailand have

been examined earlier in this paper. The economic, political and social reasons for the

development and continuation of prostitution in Thailand are apparent, but it can only

operate and be so entrenched due to a constant and evolving demand. Examining the

underlying reasons for sex tourism is hard to understand or capture, as such a relationship

is human and is situated at a level that is both rooted psychologically and culturally, but

inhibited contextually in the realm of regulating exploitative relationships. Ethnographic

accounts in this area are few and far between, but such revelations given by the ‘John’s’

that come to undertake the role of sex tourists give insight to the conceptualizations for

the relationships they have. The accounts reveal that those who do look to go halfway

across the world to service their desires also exist in a web that is quite complex. This is

evident in looking at the type of men that have become embodied to be the sex tourist:

the loner, the macho lad and the white night (Garrick, 2005).

Travel is not simply an activity that is undertaken to provide leisure for one’s

labour that has been given to society in return for such a privilege. For many, going to

see exotic and new places halfway across the world is an embodiment of so many things;

the freedom to explore new places, environments and people, all with the anonymity of

being a stranger. Looking at travel more recently, the advances in technology have

allowed for more leisure time. This coupled with the fall of air transport, and the race to

the bottom of many developing countries in promoting their heritage as a commodity to

be consumed by wealthy outsiders has made travel quite accessible (Eades, 2009, 236).

College breaks, which used to be a time to visit parents or relatives close by, have been
 15

replaced by ‘spring breaks in Mexico’ or ‘summer holidays in Thailand’. Even for a

demographic where travel would seem to be inaccessible, competitive tourism as

mentioned above has made travel viable for those who want to go. The impetus of

traveling for pleasure makes it logical that sex and travel would go together, with Ryan &

Hall (2001) pointing out astutely the connotations for such activity so obviously pointed

out in advertising and marketing for travel itself (p.32). Yet the innocence imagined here

is now being replaced with the “sex tourism” phenomenon, which has received heavy

attention since the early 1990’s (Fordham, 2004).

The WTO (World Tourism Organization) defines sex tourism as, “trips organized

from within the tourism sector, or from outside this sector, but using its structures and

networks with the primary purpose of effecting a commercial sexual relationship by the

tourist with residents at the destination.”1

The United Nations in the same statement discusses the opposition to sex tourism citing,

health, social and cultural effects. In effect, sex tourism results in the spread of disease,

social problems, destruction of local cultures, and exploitation of women, the young and

the poor (Eades, 2009, 239). These ironically are the same effects cited by many as the

results of the current modes of globalization and development. Although both processes

do go together - globalization and sex tourism, the panic seen by such a phenomenon

seems to have reached a peak in the early 1990’s with greater attention paid to it by

media sources globally. This is evident in the compilation undertaken by Eades (2009),

1
For further information see, World Tourism Organization. (1995). WTO statement on the prevention of
organized sex tourism, adopted by the general assembly of the World Tourism Organization at its eleventh
session. (Resolution A/RES/338 (XI)). Cairo, Egypt: World Tourism Organization.
 16

revealing the massive increase in citations of sex tourism in major print sources

beginning in the mid-nineties, and again continuing onward from 2003 (p.230).

Table 1. References to Sex Tourism in Major World Publications,

1990-2007.
________________________________________________________________________
Year References
________________________________________________________________________

1990 8
1991 22
1992 22
1993 44
1994 51
1995 171
1996 282
1997 103
1998 102
1999 105
2000 102
2001 92
2002 105
2003 138
2004 213
2005 181
2006 258
2007 180
________________________________________________________________________
Source: LexisNexis Total Research (www.lexis.com), searching “Major Newspapers,” retrieved November
30, 2008, taken from (Eades, 2009, 230).

The advent in the consciousness of “sex tourism” has brought forth more questions

around the motivations for those who travel to such destinations for such purposes, but

also the revulsion many have come to show at the exploitation of underage children

especially. Examining the motivations of such tourists can give insight into the way that

such personal activities have linkages to wider communities, economies and even

relationships that one may not come to expect initially.

Who are the ‘Johns’?

 17

Studies looking at tourism into Thailand have estimated that 70-80% of men

coming to Thailand from other parts of Asia, Australia, Japan, Western Europe and the

U.S, come for the sole purpose of sexual entertainment (Belk, Østergaard, & Groves,

1998, 201). The motivations and reasons for such travels are not uniform, with men

neither embodying the stereotypical ‘loner’, or racist smock who believes his money

entitles him to whatever power he wishes to enjoy. In his ethnography of foreign sex

tourists, Seabrook (2001) reveals a world that is made of extremes and all that is in-

between, through the words of the men themselves. Some are lonely men whose

relationships at home have left them in despair at the impasse they feel in their own lives;

to them this is a second chance at love. To other men, Thailand is another commodity to

be consumed, with sex being the primary:

“I use them like I might use any other amenity, a restaurant or a public
convenience. It answers my needs. No questions, no answers, no future. It’s
clean, it’s efficient, it’s over.” (Seabrook, 2001, 33).

The sentiment expressed above is only the beginning of the projections of understanding

western men, or farang’s as they are called, conceptualize in their relationships with the

women they meet. Many of the men carry along old imperialist attitudes, and see

interactions only as economic, with the comparative advantage of the women being the

offering of sex, “that’s their fate; this is mine” as expressed by one man interviewed

(Seabrook, 2001, 32). In a strange way, as Seabrook (2001) points out, the contradiction

of taking credit for their own free choices, but blaming others for the lack of theirs is

quite interesting. This is seen in the justifications presented in Thai’s messing up their

country, with corruption and underdevelopment as a case for the benefits that

colonization would have brought (p.31). The idea that money is the privilege that allows
 18

these men the right to travel the country, with the opposite seen as “scum flooding into

western countries taking jobs”, is a contradiction that comes up frequently in the idea of

men feeling cheated when used solely for their money (Seabrook, 2001, 34). The power

that money brings is very important to examine in these relationships, as it is after all,

money that allows them to happen. Money brings with it the power to gain status that is

otherwise inaccessible to most men, as even their relatively modest incomes are not such

in the context of Thailand, a developing country. The perceived lack of autonomy of

prostitutes, and the freedom that money brings to men to engage with prostitutes on their

terms, has been revealed as one of the most appealing aspects by male sex-tourists

(Garrick, 2005). Ironically, cost never becomes the issue, with women lowered to the

status of commodities,

“If one woman is not pleasing to the farang, her low cost makes her expendable
and another woman may be easily bought...the matching costumes of girls in the
bars and the dozens of girls sitting behind glass windows in brothels with
numbers pinned on their chests waiting to be selected by clients, indicates the
consumeristic nature of the sex industry. Men...‘order up’ girls as they please”.
(Garrick, 2005, 501).

The power of money and male patriarchy is only reinforced with the misguided belief

that women enjoy the experience as well, believing women to be looking also for fun,

with the men not looking or caring about their underlying circumstances (Seabrook,

2001, 38). This is evident with men who take up long-term relations with the women

they meet, or come back ‘regularly’; many make no attempt to learn Thai language or

culture (Seabrook, 2001). To other men, sexual relations with women is seen as their

contribution to helping them in their desperate situations, with sleeping with fewer

women, and the fact they pay to support them being their self-justifications (Garrick,

2005, 506). Yet what is important to see is the excitement of risk involved in the
 19

adventures these men have come to undertake, with one defining it as “a high-risk sport”,

especially in the age of AIDS (Belk, Østergaard, & Groves, 1998, 207). This is both

alarming and expected at the same time: an activity that is premised off the value of self-

gratification, assisted by the consumerist nature that sex tourism embodies, makes it

something where some benefit must accrue – in this case the excitement of the risk. Yet

the outcomes of such activities are dangerous in respect to HIV transmission. But even

more troubling the idea that men perceive of woman “looking too innocent to be

infected” (Belk, Østergaard, & Groves, 1998, 206). This together with the fact that

‘rational choice’ does not come into play in unfamiliar environments; as one of the main

motivations for men is being able to carry out acts and activities limited in home places

of residence, be that psychologically or due to the differing levels of perceived autonomy

of women in the respective places (Garrick, 2005).

Landscapes of desire

The perception of Thailand is also important in coming to understand the role it

plays in the minds of those who go there seeking the multitude of things they do. The

survey of the literature on sex tourists, as limited as it may be is telling in what men seek.

The vast majority look to Thailand as a second chance to make up for their broken

relationships and lives, with Thailand being a place to be accepted by women (Seabrook,

2001). Although it seems men recognize it is their money that women seek, and not their

reciprocity or love, “it hit me hard to see it in their eyes you are nothing in their

lives...their family that is what exists...you are only a means to that end.” (Seabrook,

2001, 42).
 20

Many have pointed out that the majority of visitors are single males, many who

came initially with others, but return to explore the fascination of such a ‘sex paradise’

deeper (Seabrook, 2001). Some men come at old age and make Thailand a place of

permanent residence, looking for love, going from women to women, but often times

bitter after realizing they have been taken clean of their money, with nothing to show for

it (Garrick, 2005). It is these dynamics that must be examined further, men who come

and seek the side of multiple women, whose self-awareness is disturbed by their own

self-doubts leading to risky behaviour, with the lack of anticipated reciprocity from

women leading to violence in some cases (Seabrook, 2001, 71). These behaviours raise

larger questions around risks of infection due to the lack of perceived risk by men,

multiple partner change, and inevitably, the passing on of infection when women

eventually do return back to their villages – in many cases using the income from the men

they take on long-term relations with (Seabrook, 2001, 56).

Domestic demand

The popularity of looking at the phenomena of sex tourism in the media is well

known as evidenced above, and for this reason has given Thailand the label of being an

outsider’s sex haven. Yet such media attention often fails to reveal the fact that the

majority of sexual relations with prostitutes are domestic as mentioned by Fordham

(2005) among others. Simple reflection reveals the logic of this: how could such an

industry thrive and be connected within Thai society, if only set up to cater to foreign

demand. Research into early prevalence rates of STD’s as mentioned earlier also helps to

validate this argument. Looking into the dynamics of the domestic demand for
 21

prostitutes is important for a few reasons: first, to allow one to understand social and

cultural frameworks that allow for such high levels of visitation of female sex workers,

secondly, to help illustrate the justifications and linkages of foreign sex tourism

embedded in underlying assumptions of what is perceived to be domestic; and finally to

look at the effect on HIV transmission within the Thai population.

It is important to start by looking at the notion Belk, Ostergaard and Groves

(1998) point out of sexuality in the context of Thailand, counter to the western notion it

is, “not characterized by reason, assumed to be a private activity” but actually a form of

social understanding (p.198). The high rates reported of young men going to prostitutes

reinforces this idea, with most studies citing over 80 percent of men admitting they have

had sex with a prostitute (Fordham, 2005) and (Belk, Ostergaard & Groves, 1998).

Fordham (2005) in his extensive anthropological studies in Thailand is of the opinion that

the culture of risk embedded socially, and reinforced with the Buddhist worldview

contributes to the way that men act out their male roles (Fordham, 2005). It is for this

reason that many men who visit prostitutes do so after the group ritual of excessive

drinking, which is done to ironically show who is able to demonstrate the most self-

control, with the only individual act being that of consummation with the prostitute

(Fordham, 2005, 63).

It makes sense that many women who were interviewed about such behaviour do

not see it as concerning, but as the social activity of men, with one women pointedly

stating, “I don’t know why they call it promiscuity (samsorn), it’s [just] what men do.”

(Fordham, 2005, 63). The activities of men in this case were not seen as deviant, but

appropriate for men to have an outlet for their stress and so on. Interestingly now, with
 22

the advent of HIV/AIDS, but modernization more importantly, men feel as though such

changes have “intruded into the village lifestyle” (Fordham, 2005, 63). Men also pointed

out the clear male dominance, sexually that existed, and the idealization of women’s

purity, but the intrusion of foreign influence, be it American, Japanese or whoever

becoming a convenient excuse – for the defiling of women by ‘outsiders’, in reference to

the sex industry in looking at lost morality (Fordham, 2005, 140). Such notions can help

explain the proliferation of younger women and children who are trafficked, with the

ideal for men to be with younger women who are ‘pure’ and undefiled (Engstrom, Minas,

Espinoza, & Jones, 2004). The same reasoning is used by sex tourists who come to

Thailand for such a purpose, but now is also being reinforced by the idea that younger

girls, will not be at risk of having STD’s but more importantly AIDS (Belk, Ostergaard &

Groves, 1998). The massive scale of prostitution in Thailand has helped engender the

idea in sex tourists that they are often supporting prostitutes, as the local men will not

treat them with the same respect they can. In addition, the idea also that if it is so

pronounced then it must be a social expectation and norm for what women do; at times

even using cultural discourse to imply, “who are we (the sex tourists and westerners) to

judge what happens” (Seabrook, 2001).

The preceding analysis was important to shed light on the discourse of various sex

tourists, but also to put CSW in perspective. Yet as demonstrated earlier, the sex industry

is not homogenous, and sadly as pointed out by many, “prostitution has been modernized,

and systematized” (Seabrook, 2001, 71). Infrastructure has been created to service men

both domestically and from abroad, with variations in service falling in between. For this

reason, the routes for HIV transmission to the general population has now become more
 23

closely examined, focusing in on the ‘wave effect’ of men infecting prostitutes, to

prostitute infecting men - to men infecting wives, with the risk preference of foreigners

being the factor in transmission outside the immediate geography of Thailand (Economic

and Social Commission for Asia and the Pacific, 2004).

Fighting the Pandemic

The first case of AIDS was reported in Thailand in September of 1984, with early

cases of AIDS first being linked to homosexual males, then injecting drug users (IDUs)

in 1987, and detection in female sex workers in Northern Thailand later in 1989

(Chitwarakorn, 2004). Similar to many governments, the response of the Thai

government was that of denial in the early stages, as to avoid the acknowledgment that

the potential for an epidemic could exist. Yet as the fear heightened that sex workers

could pass on the virus through clients through the second wave of infection,

policymakers became much more inclined to respond (Fordham, 2004, 60). The

intricacies and the motivations around the responses that were to come are very much

linked to the genderized notions mentioned above, and also government perceptions of

how to maintain political and social control. In Fordham’s (2004) analysis the linkage of

the changes brought on by rapid economic growth, the convenience to attack

unconstrained female sexuality and the reliance of biomedical approaches early on, which

emphasized concepts such as “risk groups” underpinned government responses (p.128).

The combination of all of the above helped guide government responses, and the

effectiveness of its policy has been touted as one of the most effective strategies in HIV

prevention. Yet all this must be examined in context, to see what exactly made such
 24

responses effective, and on what perceptions they were modelled. Control in this context

may have been more than just about achieving a particular health outcome (Fordham,

2004).

Scaring away the “tourists”

By the late 1980’s, the epidemic’s spread in Thailand was growing faster than any

other part of the world (Fordham, 2005). Yet this could not come at a worse time with

international tourism becoming the biggest earner of foreign exchange for the country

(Cohen, 1988). By 1987, the increase in tourism over the last four years prior was on the

order of 24 percent annualized, due in large part to the marketing strategy of the ministry

of tourism to attract foreigners (Lehany, 1995, 372). It clearly was not a priority of

government officials to react immediately to the evidence being presented to them;

instead it seemed they would do what they could to forestall having to take proactive

measures. The underlying concern with lost tourist revenue, and not public health

impacts was made clear with the reiteration of the talk about AIDS not being trumped up

as to effect the country’s image, with the director-general of health even stating, “

inappropriate AIDS coverage will effect the tourist industry, Thailand’s major source of

income” (Cohen, 1988, 469).

Early detection found the prevalence of HIV/AIDS in tourist spots linked to the

sex industry with infections among foreign nationals, this helped to spawn the stigma

against women in the industry, with the real concern for the tourists who came to visit

them (Law, 2000, 26). Yet the prevalence among injecting drug users (IDUs) was well

known before the detection of HIV among female sex workers. (Chitwarakorn, 2004).
 25

Strong demands from journalists to push officials for better information about the number

of AIDS cases, can be credited with pushing the government to slowly take responsibility

for what was going on – as even sex workers themselves had no idea about what AIDS

was, due to the tight-lipped policy of the government (Cohen, 1988, 470). By the latter

part of the 1980’s the government looked to trace the spread of the virus by way of

tracking sexually transmitted infection (STI) control strategies. Officials soon began to

realize these may not be enough to curb the spread of infections, and realized something

had to be done to promote safe sex more broadly (Rojanapithayakorn, 2004, 78). If

tourist fears could be put to ease, it seemed the fear of the disease could be stopped in its

tracks, and potential damage already done mitigated.

Government responses

The 100 percent condom use program has been highlighted as the most significant

government response to halt the spread of HIV, and particularly its impact on sex

workers. Early collaboration between health officials, bar owners and local police can be

credited with allowing for the program to be so successful (Rojanapithaykorn, 2004, 78).

It was well known that condom use could be side-stepped for extra money, thus in this

case the automatic compliance of bar owners to dictates of local authorities ensured the

enforcement of the use of condoms (Rojanapithaykorn, 2004, 80). Figure 2 below

demonstrates the effect of the program, increasing condom use to above 90 percent in a

matter of only a few years. Although condom use outside this context did and still does

not appear to be as high, and is the main reason why potential jumps in prevalence to the

general population are feared - one can be sure of compliance in settings of direct
 26

interaction (Economic and Social Commission for Asia and the Pacific, 2003). Many

indirect studies have shown that condom use rates above 90 percent are accurate, as done

with surveys with sex workers themselves, and even Thai journalists going undercover to

test compliance (Steinfatt, 2002, 238).

Figure 2. Percentage of Condom Use a mong Direct Sex Workers in Thailand: 1989-2001

Source: Department of Communicable Disease Control (CDC), Ministry of Public Health, Thailand. Taken
from AIDS in Asia: The Challenge Ahead, p.82. New Delhi: Sage Publications.

The results of government intervention in this regard is astounding, in just over 10 years

the incidence of STI’s has fallen by over 95 percent, as revealed in figure. 3, with HIV

incidence rates showing a high drop as well, going from close to 143,000 new infections

in 1991, to about 25,800 by 2001 ten years later (Rojanapithayakorn, 2004, 82).
 27

Figure 3. Number of STD Cases Thailand: 1970-2001

Source: Department of Communicable Disease Control (CDC), Ministry of Public Health, Thailand. Taken
from AIDS in Asia: The Challenge Ahead, p.83. New Delhi: Sage Publications.

Much of the progress of the 90’s is promising, and is responsible for the saving of

countless lives, with some estimates pointing out that prevalence rates could have

reached a high of 20 percent without such interventions (Economic and Social

Commission for Asian and the Pacific, 2003, 38). Yet a false sense of confidence may be

appearing with condom use outside the contexts of sex work being quite low, and the

highest prevalence rates now among men (UNGASS, 2008). Such changes are

frightening when looking at transmission patterns officials were originally trying to

prevent: that between sex workers, clients and subsequently their partners. Furthermore,

the reduced fear of AIDS as mentioned by some foreign sex tourists may increase

transmission risks that have the potential to contribute to rates outside of Thailand

(Seabrook, 2001).
 28

Figure 4. National AIDS Budget, Government of Thailand: 1988-2000

Source: Ministry of Public Health, Thailand (2002). Taken from AIDS in Asia: The Challenge Ahead, p.83.
New Delhi: Sage Publications.

The commitment by the Thai government throughout the 1990’s has been nothing

short of extraordinary, as yearly budget allocations toward fighting HIV/AIDS have

increased dramatically, as evidenced above in figure 4. The decreases seen in the late

1990’s can be attributed to the Asian financial crisis, but again concerns loom at the

priority AIDS will take with it no longer standing out as a pressing issue.

Conclusions

The economic realities of the sex industry are clear throughout this paper, but the

intersection of social perception, risk and economic freedom are not as apparent when
 29

seeing sex tourism from the snippets of the media. Sex tourism’s link historically,

culturally and politically is important in examining its connection with the AIDS

epidemic. The reluctance many have come to feel with Thailand having not achieved the

explosive rate of HIV infections as projected by many within the international health

community, such as UNAIDS, and the Economic and Social Commission for Asia and

the Pacific, for example is a possible area for concern. But sex work is increasing, “with

a 50% increase in the total number of establishments offering sex services recorded

between 1998 and 2003” (AVERT, 2009). Sex work is often many times indirect, and

thus condom use is much less pronounced then in so called “established” venues, in

addition recent increases in prevalence rates amongst men who have sex with men

(MSM) is now a new focus for government officials (Avert, 2009). The lack of

opportunity, stigma and the perception of women socially has been well documented, and

as in many cases is the crucial point in reversing the trend of half of all new infections of

HIV worldwide being women (Barnett & Whiteside, 2006). The hidden nature of sex

work in Thailand makes it important for officials to be serious in continuing efforts

started in the 90’s around prevention and access of sex workers to information and

treatment (Chitwarakorn, 2004, 152). Focusing on prevention and treatment, as is

currently being done in Thailand, in the minds of many is the crucial link in determining

if the countries past achievements will be meaningful in future efforts (Avert, 2009).
 30

References

----. (2003). Economic and Social Progress in Jeopardy: HIV/AIDS in the Asian and
Pacific Region. United Nations Economic and Social Commission for Asia and the
Pacific. New York: United Nations.

----. (2009). UNAIDS Guidance Note on HIV and Sex Work. Joint United Nations
Programme on HIV/AIDS (UNAIDS). Geneva: UNAIDS Publications.

AVERT. (2009, November 12). HIV and AIDS in Thailand. Retrieved November 28,
2009, from http://www.avert.org/aidsthai.htm

Bamber, S.D., Hewison, K.J., & Underwood, P.J. (1993). A History of Sexually
Transmitted Diseases in Thailand: Policy and Politics. Genitourin Med, 69, 148-157.

Barnett, T., & Whiteside, A. (2006). AIDS in the Twenty-First Century Disease and
Globalization. New York: Palgrave Macmillan.

Belk, R.W., Østergaard, P., & Groves, R. (1998). Sexual Consumption in the Time of
AIDS: A Study of Prostitute Patronage in Thailand. Journal of Public Policy &
Marketing, 17(2), 197-214.

Brown, L. (2001). Sex Slaves: The Trafficking of Women in Asia. London: Virago Press

Chitwarakorn, A. (2004). HIV/AIDS and Sexually-transmitted Infections in Thailand:

Lessons Learned and Challenges Ahead. In Narain, P.J. (eds). AIDS in Asia: The
Challenge Ahead (pp. 141- 158). New Delhi: Sage Publications.

Cohen, E. (1988). Tourism and AIDS in Thailand. Annals of Tourism Research, 15, 467-
486.

Eades, J.S. (2009). Moving Bodies: The Intersections of Sex, Work, and Tourism.
Research in Economic Anthropology, 29, 225- 255.

Engstrom, D.W., Minas, S.A., Espinoza, M., & Jones, L. (2004). Halting the Trafficking
of Women and Children in Thailand for the Sex Trade: Progress and Challenges. Journal
of Social Work Research and Evaluation, 5(2), 193-206).

Fordham, G. (2005). A New Look at Thai Aids: Perspectives from the Margin. Oxford:
Berghahn Books.

Garrick, D. (2005). Excuses, excuses: Rationalisations of Western sex tourists in

Thailand. Current Issues in Tourism, 8(4), 497-509.

Hunter, S. (2005). Aids in Asia: A Continent in Peril. New York: Palgrave Macmillan.
 31

Jeffery, L.A. (2002). Sex and Borders: Gender, National Identity, and Prostitution Policy
in Thailand. Vancouver: UBC Press.

Law, L. (2000). Sex Work in Southeast Asia: The place of Desire in a Time of HIV/AIDS.
New York: Routledge Curzon.

Leheny, D. (1995). A political economy of Asian sex tourism. Annals of Tourism

Research, 22(2), 367-384.

Pisani, E. (2008). The Wisdom of Whores: Bureaucrats, Brothels and the Business of
AIDS. Toronto: Viking Canada.

Rho-ng, Patricia. (2002). Conscription: Asian Sex Slaves: The Development of

Thailand’s Modern-Day Sex Tourism Industry. Monolid Magazine, 2, 10-13.

Rigg, J. (1997). Southeast Asia: The Human Landscape of Modernization and

Development. New York: Routledge.

Rojanapithayakorn, W. (2004). The 100 Per Cent Condom Use Programme: A Success
Story. In Narain, P. J. (eds). AIDS in Asia: The Challenge Ahead (pp. 77- 91). New
Delhi: Sage Publications.

Ryan, C., & Hall, C.M. (2001). Sex tourism: Marginal people and liminalities. London:
Routledge.

Seabrook, J. (2001). Travels in the Skin Trade: Tourism and the Sex Industry. London:
Pluto Press.

Singh, J.P., & Hart, S.A. (2007). Sex Workers and Cultural Policy: Mapping the Issues
and Actors in Thailand. Review of Policy Research, 24(2), 155- 173.

Sirinirund, P., Danthamrongkul, V., Sangkote, S., Khemngern, P., Tangsaowapak, W.,
Kuaikiatkul, P (Eds). (2008). UNGASS Country Progress Report, Thailand Reporting
Period: January 2006- December 2007. National AIDS Prevention and Alleviation
Committee. Nonthaburi, Thailand: Ministry of Public Health.

Steinfatt, T.M. (2002). Working at the Bar: Sex Work & Health Communication in
Thailand. Westport, CT: Greenwood Publishing Group.