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Background and Objective: In an investigation of condom breakage in commercial sex, we found a high proportion of multiple condoms use. This study sought to ascertain the characteristics of brothel-based commercial sex workers (CSWs) and their clients; to identify the decision makers (clients and/or CSWs) active in choosing multiple condom use; and to determine whether there is an implicit hierarchy of condom use negotiation. Goals: To identify factors associated with multiple condom use in commercial sex and to provide an understanding of how this innovation developed in this setting. Study Design: Sixty-seven brothel-based CSWs in Lamphun Province who participated in a study of condom breakage participated in a case-control study of multiple versus single condom use, which determined CSW and client characteristics for evidence of multiple condom use. Interviews and focus groups were used to determine decision making for condom use and the contexts for multiple use. Association between characteristics of CSWs/clients and multiple condom use was analyzed using [chi square] for trend. Results: No official program encouraged multiple condom use; this appeared to be a community-devised strategy to increase protection from human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). CSWs working in daytime brothels had significantly greater multiple condom use than those working in nighttime brothels; mean percentages + SD of multiple simultaneous use were 57.5% + 28.6 and 35.5% + 22.4, respectively (p [is less than] 0.001). Day CSWs were older, had more pregnancies, reported higher frequency of STD symptoms and history of pelvic inflammatory disease, and had more clients per day but had a lower number of sex acts per client than night CSWs. Among factors associated with multiple condoms, only age was significant. The decision to use single or multiple condoms for a sex act was primarily (78.2% in single and 793% in multiple) made by the CSW herself. The main reason given for multiple condom use was protection from HIV/STD. Conclusions: There is high compliance between CSWs in Lamphun province and the Ministry of Public Health--sponsored 100% condom use campaign, and CSWs are attempting to further reduce their risks of HIV/STD exposure by using multiple condoms for sex with their clients., Many prostitutes in Thailand appear to have independently initiated a policy of using multiple condoms simultaneously during sexual encounters in order to reduce their disease risk further. Sixty-seven Thai prostitutes identified as occasionally using multiple condoms were interviewed about condom use during their sexual encounters. The prostitute made most decisions about using single or multiple condoms. Most prostitutes indicated that using multiple condoms was a strategy to reduce risk for sexually transmitted diseases or HIV infection. Older clients were more likely to use multiple condoms than younger clients.