HIV/AIDS AND YOUTH IN THAILAND: FROM AWARENESS TO BEHAVIORAL CHANGE
By Brian Fabian, MPA, Past Thailand In-Country Coordinator
Since the early 1990s, the HIV/AIDS epidemic in Thailand has been classified as a generalized epidemic with a prevalence rate in the general population of greater than 1%. Initial cases of HIV/AIDS in Thailand were found in high-risk groups including commercial sex workers and men who have sex with men. However, as the epidemic exploded in the Kingdom during the late 1980s and early 1990s, the demographics of those infected began to change. No longer was it a disease found exclusively in men who have sex with men or commercial sex workers. Intravenous drug users became one of the highest risk groups in the kingdom with 50% of its population testing positive for HIV (Suwannawong, 2004). The wives and girlfriends of men who would visit commercial sex workers were also testing positive at a higher rate, and the children of infected mothers were acquiring the deadly virus (UNGASS, 2004).
“100% Condom Use Campaign”
Though prostitution has been illegal in Thailand since the 1960’s it is an industry that is tolerated by both the political powers and law enforcement. The social acceptance of this otherwise illegal activity made targeting commercial sex workers much easier for HIV prevention programs. In 1991 the Thai government made the “100% Condom Use Campaign” a national policy (Porapakkham et. al., 1995). The purpose of this program was to mandate the use of condoms for commercial sex workers. Compliance of this program was ensured by making sex without a common in the commercial sex industry illegal. If commercial sex establishments were found not complying with this policy they ran the risk of temporary or permanent closure (United Nations Development Programme, 2004).
A combination of a strong political commitment, high public spending, and quick mobilization by the Ministry of Health, non-governmental organizations, and dedicated individuals has enabled Thailand to become one of a handful of developing countries to achieve Millennium Development Goal number 6 – to halt and reverse the spread of HIV/AIDS by 2015. With a peak of 143,000 new cases of HIV in 1991, Thailand was able to decrease this number to 19,000 in 2003.
After years of success, the Thai HIV prevention campaign is being challenged. The face of HIV is changing in Thailand, more and more women are testing positive, clusters are moving from the Northern provinces to the Southern, and despite intervention AIDS is still the number one killer of young adults in the Kingdom.
The Resurgence of HIV
The new threat of HIV became relevant in 2005 when Thailand began to see a resurgence of HIV cases. The number of new cases of HIV increased from 19,000 in 2003 to 21,000 in 2005 (Kanabus and Fredriksson, 2006). This increase is primarily affecting teenagers, women, migrant workers, sex workers, fishermen, and intravenous drug users.
Teenagers now in high school in Thailand are among the first generation to be affected by Thai budget cuts in HIV prevention. School education about HIV is neither required nor extensive when it is present (The Nation 2006). New surveys are finding that Thai teenagers, though not purchasing sex, are sexually active and have confused views on how to protect themselves from HIV (UN Development Programme, 2004).
The Global Service Corps Response
Acknowledging recent trends in Thailand of the rising HIV prevalence among Thai young people, GSC partnered with the Bangkok office of Programs for Appropriate Technology in Health (PATH) to design and implement the ‘English for Life’ (EFL) weekend camp program in the Summer of 2007. This youth education program was designed to provide HIV/AIDS prevention and English training for Thai secondary school teachers and students. The program utilized English as the mode of information transmission to also meet the great demand in secondary schools for training in English. The EFL camps took place over a series of six weekends in June and July of 2007 under the direction of GSC and PATH technical staff based in Singburi and Bangkok. The GSC and PATH staff were assisted by 19 visiting GSC volunteers, 42 Rajabaht University students, and 45 Thai secondary school teachers. 259 Thai secondary school students from 27 schools attended the camps
The EFL program consisted of two distinct components; 1) an initial teachers training workshop and 2) a weekend student camp. Each month consisted of one training workshop and four student camps. The training workshops were conducted over a three-day period, while the student camps were conducted over a three-day period as well as an additional day prior to the camp set aside for preparation.
The teacher training workshops were held to meet the following objectives:
1. To introduce teachers to a more comprehensive approach to sexual education for young people including human development, personal health, relationships, society and culture, sexuality and sexual behavior,
2. To increase the comfort level in which teachers are able to discuss sensitive issues related to youth sexuality and HIV/AIDS,
3. To familiarize teachers with different approaches to utilize engaging youth activities related to sexuality and HIV/AIDS,
4. To effectively use English language training using practical situations in regards to youth sexuality issues that will develop the language skills of teachers,
5. To provide training and support for teachers in order to effectively and sustainably promote HIV/AIDS education and prevention, sexual health and English language skills within schools, and
6. To clarify common misconceptions about HIV/AIDS and youth sexuality.
The student camps were held to meet the following objectives:
1. To provide clear and accurate information regarding HIV/AIDS, STIs, transmission and prevention in a way that is relevant and meaningful to students,
2. To effectively use English language training using practical situations in regards to youth sexuality issues that will develop the language skills of students,
3. To provide a safe and comfortable environment for young people to communicate with their peers and adults about sexuality and HIV/AIDS, and
4. To empower students to become peer educators within their own schools and establish sustainable student-led peer education health clubs.
Surveys were given to student before the camps began to measure their basic knowledge about HIV/AIDS and STIs, as well as to gauge their willingness to discuss sensitive subject regarding the virus and their own sexuality. Identical surveys were also given to the students after the completion of the camps to measure knowledge gained and willingness to discuss sensitive subjects related to HIV/AIDS and other sexually transmitted diseases.
Cumulative responses from the surveys were very promising:
• Survey results showed a dramatic increase in the number of students who knew that condoms can help prevent the transmission of HIV.
• A similar increase was seen in the number of students who answered correctly at the end of the camps that HIV and AIDS cannot be spread by casual contact such as hugging or touching.
• A sharp increase was also seen in the number of students who answered correctly on the survey that HIV can be transmitted on the first time you have sex if you do not use a condom.
Analysis of the pre- and post-camp data also shows confusion regarding HIV perception and commonly held myths. Post-camp survey results were encouraging with large shifts in perception and information:
• There was nearly a 30% increase in the number of students who were able to correctly answer that choosing only healthy looking partners will not protect you from transmission of HIV.
• Post-camp surveys show that 95% of students knew that that the birth control pill only protects against pregnancy and not HIV and STIs.
• Although not 100% of students left the camp knowing that mosquitoes cannot spread HIV and AIDS, it is a step in the right direction when the percentage of students who knew that this myth was false rose from 48% to 90%.
These results clearly demonstrate that the GSC camps achieved the desired effect of presenting accurate and clear information about HIV/AIDS to students and that the students were able to retain this knowledge.
Questions were also posed in the pre- and post-camp survey to gauge the willingness of students to talk about these sensitive issues. Survey results showed:
• That students would feel more comfortable talking about HIV and AIDS with their families, peers, and teachers after completion of the camps.
• Post-camp surveys also demonstrate that students would feel comfortable setting up extracurricular activities, but they would also feel comfortable approaching their principal about establishing such activities.
• Additionally, the majority of students also indicated that a peer education health club would have a positive impact on their school. More encouraging was that all levels of agreement rose from the pre-camp survey to the post-camp survey.
GSC is now building on the success of the EFL camps by working with teachers and students at a number of the participating schools. Volunteers in the GSC Thailand HIV/AIDS Education and Prevention Program will help to implement continuing prevention education activities.