Running head: CONDOM USE AS HIV PREVENTION IN THAILAND

Prevention of HIV Infection in Thailand through Condom Use

Amanda Rose, Ashlee Burnam, Chomphunuch Marino, Erica Powell, and JoAnne Saba
California State University, Stanislaus

CONDOM USE AS HIV PREVENTION IN THAILAND

Background
Thailand is a Southeast Asian country located along the Andaman Sea and the Gulf of
Thailand (The Global Road Warrior, 2015). Mountains lie to the west and north of the country,
while a central plain is in the east. The climate is tropical and is always hot and humid. The
largest ethnicity is native Thais comprising 75% of the population. Chinese make up 14% and
11% are immigrants, mostly from South Asia (The Global Road Warrior, 2015). About 95% of
Thais are Buddhists, and Buddhism greatly influences Thai culture (Tourism Authority of
Thailand, n.d.). Though Thailand has been known for sex tourism, sexual modesty is a key virtue
in Thai culture (Piayura, 2012). Public displays of affection are not customary, and discussions
about sexual subjects are considered inappropriate in Thailand (Piayura, 2012).
The Acquired Immunodeficiency Syndrome (AIDS) Education and Research Trust
(AVERT) (n.d.) indicated that human immunodeficiency virus (HIV) infections have been an
ongoing problem in Thailand. In 2012, the number of people living with HIV in Thailand was
440,000, most of which was from age 15 and older (AVERT, n.d.). High-risk populations
include sex workers, injection illicit drug users and men who have sex with men. The rate of
HIV infections is also increasing among young Thais due to earlier sexual activity and unsafe
sex (The United Nations Childrens Fund [UNICEF], 2010). Though the Thai government has
been promoting protected sex, only 20 to 30 percent of sexually active teenagers reported the use
of condoms (AVERT, n.d.). Several campaigns were launched to make condom use common but
were dismissed due to lack of funding, and the idea that the campaigns tainted Thai culture and
encouraged teenagers to be sexually active (Avert, n.d.). Sex education and condom use needs to
be more sponsored in Thailand in order to effectively solve HIV prevalence, and prevention is
the emphasis of community health.

CONDOM USE AS HIV PREVENTION IN THAILAND

Literature Review
Amanda Rose. Researchers in Thailand found that although there were many studies
involving condom use among Thai youth, there werent too many studies that focused on the
psychosocial factors associated with risk behaviors related to HIV transmission (Yuntadilok et
al., 2014). The authors conducted this study to find out what young Thai men knew about HIV
transmission and their perceived risk of contracting HIV, what their sexual behaviors and
intentions were, and whether or not they practiced consistent condom use. This cross-sectional
survey was conducted among 3,299 male recruits in the Thai Navy. Since Thailand has a
mandatory service requirement once men turn 21, this group can be regarded as a representative
sample of all 21 year-old men living in Thailand (Yuntadilok et al., 2014).
There were a number of findings that came from this study. First, it was found that this
population of young men from Thailand exhibited high-risk behaviors related to HIV
transmission (Yuntadilok et al., 2014). For example, the study revealed that fewer than one out
of five of these young men used condoms when participating in sexual activity, and more than 2
out of 5 stated that they had engaged in sex with a female sex worker. When it came time to
analyze the psychosocial factors that were related to risky sexual behavior, the researchers found
that men were less likely to use a condom during a first sexual encounter with a casual or stable
girlfriend than they were with a sex worker or stable male partner. This finding indicates that
men may associate HIV transmission risk with males and sex workers, but not with their stable
or casual female partners (Yuntadilok et al., 2014).
The findings that were associated with regular, consistent condom use were men who had
gone through voluntary HIV testing in the past, men who were heterosexual, men who lived in
the Northeast region of Thailand, men who were single, and men who had used a condom during

CONDOM USE AS HIV PREVENTION IN THAILAND

their first-ever sexual encounter. This last finding (men who used condoms during the first time
they had sex) indicates that programs provided for teenage boys and girls before the onset of
sexual activity that aim at encouraging condom use could be successful in helping them establish
what the researchers called a condom habit (using condoms routinely because its what youve
always done) (Yuntadilok et al., 2014).
Another study was conducted amongst 3,405 male and female migrant workers in
Thailand to discover whether factors such as social integration, relationship status, and
demographic influences were correlated with their capability of preventing HIV through condom
use and knowledge (Ford, Chamratrithirong, Apipornchaisakul, Panichapak, & Pinyosinwat,
2014). These researchers indicated (writers cant state) that the majority of migrants from
other countries who come to work in Thailand will stay in Thailand for long periods of time, so it
is of benefit for the Thai community to have migrant workers who are knowledgeable about HIV
and who practice safe-sex techniques, because they can influence the overall health of the
country (Ford, Chamratrithirong, Apipornchaisakul, Panichapak, & Pinyosinwat, 2014).
Data for this study was gathered through questionnaires and personal interviews with the
migrant laborers (Ford, Chamratrithirong, Apipornchaisakul, Panichapak, & Pinyosinwat, 2014).
The researchers found a number of findings when it came to the factors that influenced
HIV/AIDS knowledge and consistent condom use. The more socially integrated workers were in
their peer groups and society, the more knowledge they had regarding HIV prevention, and the
more likely they were to use condoms regularly. They also found that those with lower levels of
education had less knowledge regarding HIV and, consequently, less condom usage. The
opposite end of the spectrum was also true: those with higher education knew more about HIV
transmission and, therefore, used condoms much more frequently (Ford, Chamratrithirong,

CONDOM USE AS HIV PREVENTION IN THAILAND

Apipornchaisakul, Panichapak, & Pinyosinwat, 2014).

Through their study and findings, the researchers found that that when it comes to
promoting safe-sex practices in regard to preventing HIV, having people be strongly integrated
into their social groups, as well as educating them about HIV will positively influence their
safe-sex behaviors (Ford, Chamratrithirong, Apipornchaisakul, Panichapak, & Pinyosinwat,
2014).
Ashlee Burnam. Khumsaen & Gary (2009) studied attitude, personal characteristics, selfefficacy, and condom use in Thai teens. It is the hope that the results from the study could offer
information about Thai students and their condom use so that nursing interventions could be
provided to help them avoid unwanted STI/ HIV. The sample size for this study was a
convenience sample of 270 vocational students from three randomly chosen vocational schools
in Ubonratchathani province, Thailand. Out of the 270 students that participated, 176 were male
and 96 were female. A descriptive correlational design was used as well as two additional openended questions. The findings of the study are as follows: Many Thai students reported
engaging in alcohol or drug behavior before engaging in sexual intercourse, and students with
positive views of condoms were more likely to engage in safe sex. Both attitudes towards
condom use and self-efficacy of condom use were related to actual condom use. Out of the 180
participants who had been sexually active, 51 of them said that they never used condoms at the
beginning of a relationship, 57 said that they hadnt used a condom the last couple times they had
had sexual intercourse, and 46 reported never using a condom (Khumsaen & Gary, 2009).
Many strengths were found within the research article. First, the sample size of 270 was a
large enough sample because based on Cohens framework for sample size, a number of 162 was
enough. Another strength is that the article used a theoretical framework. The theoretical

CONDOM USE AS HIV PREVENTION IN THAILAND

framework used was Banduras self-efficacy model for safer sexual behavior. The research was
approved by the Case Western Reserve University institutional review board and as well from
each of the three vocational school boards. All students who participated in the study gave a
verbal and written consent before the data was collected. A few limitations exist within the study
as well. The article never mentions if the tools used to collect the date had been properly
calibrated, therefore reliability of the tools is uncertain. There is a possibility as well for selection
bias due to the fact that the three vocational schools randomly chosen were still found within the
same district. Overall, the article proves to show that research is being done in Thailand in
regards to condom use and HIV and will hopefully be beneficial to those solving the issue.
The purpose of this study was to examine the rate? of condom use among female sex
workers in Thailand (Moraros, Buckingham, Bird, Prapasiri, & Graboski-Bauer, 2012). The
sample for this research was a cross sectional nonrandomized sample of convenience of 130
female teenagers under the age of eighteen that were from brothels in four different areas of
Thailand. A cross sectional survey was used to obtain sociodemographics, occupation related
data, condom use information and attitudes towards HIV/STIs. The results showed the average
age of all the participants was 15 years and all had either no or very little education. The average
time students had been working as a female sex worker was 2.7 years and participants came from
areas where poverty was rampant. On average 7.4 of the customers girls would see in a day, only
3.8 of them used condoms. The low rate of condom use was contributed to the fact that the
adolescents did not have them readily available anywhere and if they did want condoms they
would have to personally purchase them. According to the survey, the female sex workers all had
a fear of acquiring HIV and AIDS and believed that the use of condoms would help in not
attaining them (Moraros, Buckingham, Bird, Prapasiri, & Graboski-Bauer, 2012).

CONDOM USE AS HIV PREVENTION IN THAILAND

There are some limitations ad strengths to this study. The first limitation is that although
there was verbal consent given by all the participants, there was no form of a signed consent.
Another limitation that was selection bias due the sample being nonrandomized which makes it
less generalized. It is also unknown if the sample size used was appropriate due to the lack of a
power analysis. There were some strengths found within the research article. The precaution
Adoption process model was the theoretical framework used for this study. Another strength to
this study was that the research listed its limitations which adds to its validity.
Chomphunuch Marino. Pawa et al. (2013) aimed to examine the efficiency of HIV
prevention strategies, specifically condom use, water-based lubricant use, and HIV counseling
and testing among Thai transgender women through Sisters, a community based organization for
transgender women. The sample, obtained through time-location sampling (TLS), was 308
randomized Thai transgender women participating in the Sisters program, which provideed HIV
prevention education. The outcomes were recorded using a questionnaire administered by
interviewers and analyzed using coarsened exact matching (CEM) to match the participants to
the control group from observational data. Using logistic regression, the results showed that, in
matched sample, the adjusted odds ratio (AOR) of 3.22 with 95% confidence interval (CI) of
1.64 to 6.31 presented that program participants who received any Sisters services in the last 12
months were more likely to use a condom and water-based lubricant during sexual intercourse
with commercial partners. Moreover, AOR of 2.58 with 95% CI of 1.47 to 4.52 showed that they
received an HIV testing in the past 6 months. The study concluded that community-based HIV
prevention programs for transgender women could report HIV risk factors and promote HIV
prevention by providing condoms, water-based lubricant, and HIV testing and education.
According to Wongkietkachorn, Nissaipan and Hiransuthikul (2014), disguised condom

CONDOM USE AS HIV PREVENTION IN THAILAND

packaging, using? mobile charms, key rings, and bag accessories, could decrease embarrassment
from carrying condoms, and subsequently increase the use of condoms, promoting safe sex. The
study also assessed opinions regarding condom use and sexual behaviors among Thai youths.
The purposive sample of this cross-sectional study was 680 randomized male and female
participants aged 15 to 24 years old in Siam Square, Bangkok. The outcomes were recorded by
using self-reported questionnaires, developed by the input from 111 medical students in
freshmen to junior years and related literature searches. The results show that about 72% of
participants perceived that condom use was required no matter who the sex partner is; however,
only 55% of these participants actually used a condom for every sexual encounter. About 11
percent thought it was unnecessary to carry condoms as they could buy condoms anywhere
(45%), carrying condoms made them look bad (26%), and intending not to have sex before
marriage (20%). Approximately 49% of participants reported that embarrassment was the main
reason why they did not buy or use condoms. About 30% of participants were sexually active,
but only 33.5% of them used condom every time they had sex, and only 9% carried condoms.
About 85% of participants found new, disguised condom packaging interesting due to the
attractive designs, the condom concealment, and the ease of carrying; moreover, 66.4% of the
interested participants reported that they would actually use the products. Female participants
were rather more interested in the products (86%) than males (80%). The study concluded that
new, disguised condom packaging could be a practical method to promote condom use among
young Thais.
Erica Powell. Tangmunkongvorakul, Carmichael, Banwell, Utomo, & Sleigh (2011)
studied insight into the sexual practices of contemporary young Thai people and how that is
contributing to poor health outcomes. In the quantitative portion of the study 909 males and 840

CONDOM USE AS HIV PREVENTION IN THAILAND

females participated, ranging in age from 17 to 20 years, some of which were in school or
university and some who were not. In the qualitative portion, the sample consisted of 16 males
and 14 females, who participated in a gender specific study group for 60 to 90 minutes. The
study found that many young adult Thais engage in risky sexual behavior that may expose them
to STIs and unplanned pregnancies. It was found that the sexual behavior of the young Thai
population varied by gender and educational background. Due to cultural constraints, more
young Thai people are having sex but are unable to receive the necessary sexual education that
allows them to make informed decisions about safe sex. The cultural belief in Thai society that a
womans virginity is a gift while allowing males to see sex workers has been found to greatly
disempower women when it comes to safe sexual choices.
Researchers found that not much is known about the behaviors that increased the HIV
risk for female sex workers who do not work in the traditional setting (much better start)
(Nemoto, Iwamoto, Sakata, Perngparn, & Areesantichai, 2013). The study design used a mixed
methods approach. The qualitative sample contained a total of 50 female sex workers who were
older than 18 years of age and currently engaging in sex work in Bangkok, Thailand. For the
quantitative portion 205 female sex workers were asked to take part in the survey. The results
showed that female sex workers have inaccurate knowledge about the prevention of STIs. Work
location had a great influence on whether the female sex worker would take drugs and engage in
sex leading to risky sex behaviors. The study found that more than 86% of indirect female sex
workers are engaging in unprotected sex for extra money. Possibly exposing them or their clients
to STIs.
JoAnne Saba. In this cross-sectional study of the 2006 National Sexual Behavior Study,
Chamratrithirong and Kaiser (2012) examined factors associated with condom use with regular

CONDOM USE AS HIV PREVENTION IN THAILAND

10

and casual partners. The sample consisted of 2,281 Thai men between the ages of 18 and 59
from Bangkok, non-Bangkok urban areas, and rural areas of Thailand. It was found that those
with regular partners used condoms more frequently if they had higher education, knowledge of
condom effectiveness, and used pro-condom strategy. Reduced use of condoms was related to
non-professional employment, marriage status, and short relationship duration. Thai men who
reported having casual partners were observed to have more condom compliance with increased
education, more condom knowledge, non-professional occupation, short relationship duration,
and a lack of history of paid sex.
Determinants for consistent condom use for Thai males were explored by Janepanish,
Dancy, & Park (2011) in a cross sectional descriptive study. The study used a convenience
sample of 400 Thai heterosexual males aged from twenty to thirty-nine years old living in
Bangkok. Participants filled out a questionnaire which included demographic information,
sexual behaviors index, intent to use condoms, social norms associated with condom use, attitude
to use of condoms, and perceived behavior of consistent condom use. Researchers found
that,married men were 4.5 times less likely to use condoms than males who were single,
divorced, or widowed. In addition, those who made more than the mean monthly income were
twice as likely to use condoms in comparison to those who made below the mean monthly
income. It was also found that the intent to use condoms was influenced by increased attitude
toward use, subjective norms related to use, and an increased perceived behavior related to
condom use. However, personal intention to use condoms did effect attitude and view of
subjective norms related to use. Finally, all of the aforementioned variables Im lost` also were
strong predictors for consistent condom use.
Executive Summary

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11

The Human Immunodeficiency Virus (HIV) rate in Thailand is a concerning problem,

with younger generations being especially vulnerable (Avert, n.d.; The United Nations
Childrens Fund [UNICEF], 2010). Thai culture has contributed to the rise in HIV rates by
making it unacceptable to discuss sex and shunning condom use (Tangmunkongvorakul,
Carmichael, Banwell, Umoto, & Sleigh, 2011; Wongkietkachorn, Nissaipan & Hiransuthikul,
2014). This program aims to make necessary changes to allow condom use to be accepted and
sex to be a more openly discussed topic in the Thai culture.
This project has a goal to lower the HIV infection rate by 10% within 5 years. This
objective will be accomplished by implementing a sex education course into the Thai school
system, providing the public with testimonials of those affected by HIV, and employing a free
condom program. The goal of providing the sex education course in schools is to abolish sex as
a taboo topic and increase the knowledge related to risky sexual practices. The program will
provide training for the teachers who will be teaching these sex education classes.
Another approach of this project is to have a free condom program allowing students to
anonymously receive condoms while at school. Students will be able to go to a designated
teacher and receive the condoms as desired. This will encourage safe sex practices and HIV
prevention by allowing the target population of high school age adolescents easy access to
condoms and condom education. The program will also include people affected by HIV give
testimonials in the classes and through radio to raise awareness of the risks and impacts of HIV.
Through these interventions, the Thai public will become more comfortable with
discussing sex and the risks associated with unsafe sex practices. As a result of these
interventions, the HIV rates will decline as the population grows more knowledgeable and
responsible for their sexual behaviors.

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12

Goals and Objectives

Based on the literature, the human immunodeficiency virus (HIV) infection rate in
Thailand is rising among the countrys young population due to earlier sexual activity, decreased
HIV knowledge, and inconsistent condom use (Acquired Immunodeficiency Syndrome
Education and Research Trust [AVERT], n.d.). Moreover, sexually active young Thais
frequently engage in unprotected sex with multiple partners (Tangmunkongvorakul, Carmichael,
Banwell, Utomo, & Sleigh, 2011; Yuntadilok et al., 2014). Studies have shown that increased
sex education that highlights the importance of condom use is effective in increasing safe sex
practices among the high-risk Thai population (Chamratrithirong & Kaiser, 2012; Ford et al.,
2014; Pawa et al., 2013; Tangmunkongvorakul et al., 2011). Therefore, emphasis on sex
education and condom use among teens is vital in decreasing the HIV infection rate in Thailand.
As indicated in the Logic Model, implementing sex education in the Thai school system
will increase HIV knowledge among Thai teenagers regarding correct condom usage and the
benefits of condom use. Thai educators will be utilized in this endeavor to teach the Thai
students about sex education in a sensitive, creative, and effective way. Knowledge regarding
the HIV infection rate in Thailand, along with how to effectively distribute condoms in the Thai
school system will also be increased among school officials.
As knowledge about HIV rises, Thai teens will increase their acceptance of condom use
and recognize HIV risk factors. The Thai government will recognize the significance of condom
use and accessibility for teenagers as well. This change of attitude by the Thai teens and
government about the importance of condom use will aid in increasing safe sex practices.
Furthermore, the Thai government will include in-depth sex education focusing on condom use
in secondary school curriculum and distribute free condoms within high schools. The stated

CONDOM USE AS HIV PREVENTION IN THAILAND

13

effects of increased HIV knowledge, change of attitude towards condom use, and increased HIV
prevention practices among Thai teenagers, educators, and government officials will decrease
HIV infection in Thailand by 10% within 5 years.
Technical Approach
The first objective in the plan to decrease HIV/AIDs in Thailand by 10%, as outlined in
the Gantt chart, is to propose incorporating an in-depth sex education curriculum into the Thai
school system. Various activities will take place in the month of January, such as assigning the
project manager, identifying the partners and stakeholders, and meeting with the CDC, WHO,
USAID and Thai Ministry of Education. The financial representative will also be appointed in
the month of January and will conduct several financial tasks including submitting the grant
proposal to the partners, signing contracts with the program partners, and securing the funding
for the project.
The second objective within the program consists of establishing the teaching technique
and curriculum that will be implemented in the school system. The activities that must take
place in order for this objective to be met will begin in the month of February after funding has
been approved. Before the curriculum can be created, an education committee must be
established consisting of teachers, school board members, principals and project members. Once
the committee is formed, the group will develop age-appropriate teaching techniques that will be
aimed for the target population. After the curriculum has been established, it will be the
education committees responsibility to train the teachers who will be implementing the new
teaching techniques into their classrooms. These activities, though planned to take place in
February, can be extended into other months as needed, especially if putting together a
curriculum takes longer than anticipated.

CONDOM USE AS HIV PREVENTION IN THAILAND

14

The third objective to be implemented is to have HIV-positive individuals present their

testimonials in schools and on the radio, in order to encourage young people to use protection by
revealing real life examples of those affected by HIV. The first activity that must take place in
order to accomplish this objective is to form a committee that will find HIV-positive volunteers
who are willing to share his or her story. After these individuals are found, the committee will
request permission from radio stations and the Thai Ministry of Education to allow the
volunteers to share their stories. These activities will all take place in February but can be
extended as needed. Implementing the testimonials into the curriculum, as well as playing them
on the radio, will be an ongoing occurrence that happens on a monthly basis throughout the year.
The final objective of composing a free condom program for students will also begin in
February. The project manager must first propose the plan for the program to government
officials in order to secure funding from the government. Once funding plans are secure, an
effective distribution system in which condoms are distributed to the Thai high schools must be
created. The third activity that must take place to meet this objective is the designation of
specific classrooms and teachers that will be in charge of distributing the condoms to the
students. The purpose for designating specific classrooms and teachers as distribution locations
is to allow students to obtain the contraceptives confidentially. Condoms may also be distributed
during class. The delivery of condoms to schools and distribution to students will be continuous
throughout the year.
Monitoring and Evaluation
The project manager, with assistance from each committee, will be monitoring the
project. Reports from the individual committees will be given to the project manager monthly to
share with the financial representative.

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15

Indicators of the teaching technique and curriculum portion of the project will include
testing the target population prior to and at the conclusion of the sex education course. The tests
will be a compilation of questions testing knowledge of condom use, types, and benefits; human
immunodeficiency virus (HIV) rates; and proper safe sex practices. Grades received on these
tests will evaluate what was already known about HIV rates and proper condom use and the
amount of knowledge gained from the lessons. Attached to the tests, surveys made of openended response questions and Likert scales will be used to assess how attitudes toward condoms
were initially and how they have changed following the course. The surveys will also indicate
the effectiveness of the testimonials given in class and on the radio regarding change of attitudes
toward condom use and HIV.
The free condom distribution program will be evaluated using data taken by the teachers
and administrators handing out condoms. These participants will keep a record of the number of
students using the program and the number of condoms dispensed. In addition, though the
condoms are free, users must complete an anonymous questionnaire stating how often they
engaged in sexual encounters in the last week and, of these encounters, how many times a
condom was utilized. Data will be assessed every three months to note alterations in the rate of
National statistics will be used to evaluate the overall impact of the program. The
incidence and prevalence of HIV will be noted prior to the start of the program and reevaluated
each year with the goal of a 10% decrease by the fifth year of program implementation. These
statistics will verify that the rate of new cases has decreased as well as the number of existing
cases. This decrease in HIV cases will verify that our program is having an impact on the HIV
rate in Thailand.

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16

References
The Acquired Immunodeficiency Syndrome Education and Research Trust (AVERT). (n.d.).
HIV & AIDS in Thailand. Retrieved from http://www.avert.org/hiv-aids-thailand.htm
Chamratrithirong, A., & Kaiser, P. (2012). The dynamics of condom use with regular and casual
partners: Analysis of the 2006 national sexual behavior survey of thailand. Plos ONE,
7(7). 1-11. doi: 10.1371/journal.pone.0042009
Ford, K., Chamratrithirong, A., Apipornchaisakul, K., Panichapak, P., & Pinyosinwat, T. (2014).
Social integration, AIDS knowledge and factors related to HIV prevention among
migrant workers in thailand. AIDS and Behavior, 18(2), 390-397. doi:10.1007/s10461013-0410-7
Janepanish, P., Dancy, B.L., & Park, C. (2011). Consistent condom use among thai heterosexual
adult males in Bangkok, Thailand. AIDS Care, 23(4), 460-466.
doi:10.1080/09540121.2010.516336
Khumsaen, N., & Gary, F. (2009). Determinants of actual condom use among adolescents in
Thailand. Journal of the Association of Nurses in AIDS Care, 20(3), 218-229.
Moraros, J., Buckingham, R., Bird, Y., Prapasiri, S., & Graboski-Bauer, A. (2012). Low condom
use among adolescent female sex workers in Thailand. Journal of HIV/AIDS & Social
Services, 11(2), 125-139.
Nemoto, T., Iwamoto, M., Sakata, M., Perngparn, U., & Areesantichai, C. (2013). Social and
cultural contexts of HIV risk behaviors among Thai female sex workers in Bangkok,
Thailand. AIDS Care, 25(5), 613-618. doi:10.1080/09540121.2012.726336
Pawa, D., Firestone, R., Ratchasi, S., Dowling, O., Jittakoat, Y., Duke, A., & Mundy, G. (2013).
Reducing HIV risk among transgender women in Thailand: A quasi-experimental

CONDOM USE AS HIV PREVENTION IN THAILAND

17

evaluation of the Sisters program. Public Library of Science, 8(10), 1-8.

doi:10.1371/journal.pone.0077113
Piayura, O. (2012). Thai women, cross-cultural marriage and sexuality. International Journal of
Social Science and Humanity, 2(2), 156-158. Retrieved from
http://www.ijssh.org/papers/87-CH014.pdf
Tangmunkongvorakul, A., Carmichael, G., Banwell, C., Utomo, I. D., & Sleigh, A. (2011).
Sexual perceptions and practices of young people in Northern Thailand. Journal Of
Youth Studies, 14(3), 315-339. doi:10.1080/13676261.2010.522562
The Global Road Warrior. (2015). Thailand: Country Snapshot. Retrieved from
http://www.globalroadwarrior.com.ezproxy.lib.csustan.edu:2048/contentinfo.asp?cid=14
7&nid=65&next_nid=66
The United Nations Childrens Fund (UNICEF). (2010). HIV/AIDS overview. Retrieved from
http://www.unicef.org/thailand/hiv_aids.html
Tourism Authority of Thailand. (n.d.). About Thailand. Retrieved from
http://www.tourismthailand.org/Thailand/religion
Wongkietkachorn, A., Nissaipan, K., & Hiransuthikul, N. (2014). Attitude towards new
packaging to reduce condomcarrying embarrassment among Thai youth, a crosssectional
study. International Journal of Medical Student, 2(2), 44-48. Retrieved from
http://www.ijms.info/ojs/index.php/IJMS/article/view/71/html_53#.VNp6L8Yhxhr
Yuntadilok, N., Timmuang, R., Timsard, S., Guadamuz, T. E., Heylen, E., Mandel, J., &
Ekstrand, M. L. (2014). Eroding gains in safe sex behavior, HIV/AIDS knowledge, and
risk perceptions among royal Thai Navy conscripts after 28 years of the AIDS epidemic
in Thailand. AIDS and Behavior, 18(S1), 42-49. doi: 10.1007/s10461-013-0522-0

Running head: CONDOM USE AS HIV PREVENTION IN THAILAND

18

Appendix A
Inputs
1. Educators,
Government
funding and
campaigns
2. Experts on
curriculum
teaching
strategies,
Experts on
dealing with
sensitive
topics,
Developmenta
l experts on
teenagers
3. Government
officials, radio
stations,
school
administrators
, volunteers
with HIV
4. Government
officials, condom
manufacturers,
condom
distributors,
funding to

Logic Model
Program activities/Outputs
Effects
Activities
Outputs
Knowledge Attitudes
Practices
1. Communicate with
1. Incorporate a
1. Know
1. Increase
1. Increase
school teachers,
minimum of 8
benefits of
acceptance
condom use
community leaders
hours of sex
using
of condom
(during every
and government
education
condoms,
use for
sexual
about incorporating
focusing on
different
sexual
encounter)
the more in-depth
condom use
types of
encounters
among
sex education to
using different,
condoms
2. Target
targeted
school curriculum
interesting
available,
population
population
2. Establish a
teaching
where to
will
2. Include more
committee to decide
techniques, such
buy or get
respect
in-depth sex
what information and
as games,
free
informatio
education
teaching techniques
videos, scenarios
condoms,
n given to
focusing on
to use in the
and
and how to
them by
condom use in
curriculum.
demonstrations,
correctly put
the teacher
secondary
Talk to the people
in school
on a
3. Target
school
in charge to be able
curriculum
condom
population
curriculum
to create a program in
2. Train teachers
2. Know how
will
(Thai
which the experts
on what to teach
to
recognize
secondary
provide additional
and how to
sensitively,
the risks of
school = 12training for the teachers.
effectively teach
creatively,
HIV/AIDS
18 years old)
3.Committee to find
sex education
and
such as
3. Increase use
volunteers willing to
3. Begin program
effectively
having sex
of safe sex
share experience with
where guest
teach
without a
practices and
HIV, get a contract with
speakers come
information
condom.
behaviors.
radio stations to allow
and give
to students
4.
4. Government
ads to run with
testimonials
3. Increase
government
will buy and
testimonials of HIV
about
knowledge
officials will
distribute
positive people, get
HIV/AIDS in
of HIV Risk recognize the condoms within

Impacts
Decrease
HIV
infection
by 10%
within 5
years

CONDOM USE AS HIV PREVENTION IN THAILAND

purchase
condoms

contract with schools to

allow people with HIV
to share experience.
4.Create a committee to
talk to government
officials about
providing free condoms
in the high school. Have
a committee to talk to
condom manufacturers
and distributors to
effectively distribute
condoms to high
schools effectively.
Designate certain
teachers and classrooms
to be the ones to
distribute the condoms
to the students.

Target Population Defined

Boys and girls ages 12 to 15 years old

schools and on
the radio.
4. Begin a program
in which students
can access free
condoms from
designated
classrooms or
teachers. Students
will be able to
acquire them
confidentially with
no scrutiny.

19
and
behaviors
that put one
at risk.
4.Know the
rate of HIV in
Thailand.
Know how to
distribute
condoms
within the
school system.

Stakeholders/Partners Identified
Thai government
CDC
WHO
USAID
Thai school system

importance of
condom
usage and
availability
for teenagers.

the high schools

in order for
student to have
free access to
contraception.

CONDOM USE AS HIV PREVENTION IN THAILAND

20

Appendix B

Appendix C
Author(s) &
Date
Buckingham, R.
W., Moraros, J.,
Bird, Y., Meister,
E., & Webb, N. C.

Questions, Variables, Objectives,

Hypotheses
Condom use among the female sex worker
population in Thailand
It examined the influence that the country of
origin of the FSW patrons exerted on usage
of a condom

Chamratrithirong,
A. & Kaiser, P.

To decipher factors associated with condom

use during sex with regular and casual

Design, Sample, Setting

Qualitative
Non-Randomized Survey
150 Female Sex Workers
(FSW)
Brothels in Bangkok, Chang
Mai, Mae Hong Son, Thailand

Findings

Thai FSW requested condom use

in 63% of the cases
Mean Condom use was 51%
Condom use by patrons' country
of origin was as follows:
Westerners 76%, foreign Asians
52% and native Thai men 27%.
Cross-Sectional Study of the
With regular partners, condom
2006 National Sexual Behavior use was more prevalent with

CONDOM USE AS HIV PREVENTION IN THAILAND

21

(2012)

partners.
Variables: condom use, access to condoms,
condom knowledge and attitudes, partner
type, partner characteristics, demographics
and socioeconomic status

Study including 2,281 Thai

men ranging in ages 18-59
from rural areas of Thailand,
non-Bangkok urban areas, and
Bangkok.

Ford,
Chamratrithirong,
Apipornchaisakul,
Panichapak,
Pinyosinwat
(2014).

To determine whether social integration,

demographic, relationship and other factors
were related to migrants ability to prevent
HIV infection through AIDS knowledge
and condom use

Qualitative. Survey of 3,405

male and female migrant
laborers. Thailand. Regression
Analysis.

Hasque, M. &
Soonthorndhada,
A.

Explore the characteristics

of youths and other conducive, facilitating
and reinforcing factors associated with risk
perception
of sexually transmitted infections (STIs)

Qualitative
195 Condom users aged 15-24
Structured Interview &
Questionnaire
Thailand

education, knowledge of condom

effectiveness, and pro-condom
strategy. However, there was
less use with non-professional
employment, status of registered
marriage, and short relationship
duration.
With casual partners, condom
use was increased with
education, condom knowledge,
non-professional occupation,
short relationship duration, and
lack of history of paid sex.
Social integration of migrants
was positively related to HIV
prevention through knowledge
and condom use. Migrants with
lower levels of education had
less knowledge of AIDS and less
condom use. Exposure to AIDS
education had a positive effect
on AIDS knowledge and
condom use.
Youths who were unmarried and
had a temporary partner were
more likely to perceive the risks
associated with STI related to
condom use.
A greater proportion of
unmarried youths had sex before
the age of 20 and did not use
condoms consistently
Education played a significant
role in STI risk perception

CONDOM USE AS HIV PREVENTION IN THAILAND

Janepanish, P.,
Dancy, B., &
Park C. (2011).

To explore determinants for consistent

condom use for Thai males ranging in age
from 20-39 years old.
Hypothesis: (1) demographics would affect
consistent condom use. (2) attitude,
subjective norms, and perceived behavioral
control or consistent condom use would
positively influence intention of using
condoms consistently. (3) there would be a
positive correlation between consistent
condom use and attitudes and subjective
norms about condom use. (4) intention to
use condoms consistently would mediate
attitude ,subjective norms, and perceived
behavioral control toward condom use
Variables: Consistent condom use, attitude
toward condom use, subjective norm about
condom use, perceived behavioral control of
consistent condom use, intention to use
condoms consistently, sexual behaviors,
demographics (age ,education level, martial
status, income, occupation)

22

Cross Sectional descriptive

design of 400 Thai
heterosexual adult males
ranging in age from 20-39
years old living in Bangkok.
Each participant filled out a
15-30 minute questionnaire.

Household wealth, living in

urban or semi-urban areas, and
access to mass media such as
television, also had a positive
influence on
risk perception.
Condom-users who had
indulgence in liquor were less
likely to perceive the risk of
STIs. Socioeconomic status had
a great influence on risk
perception of STIs
(1) Married males were 4.5 times
less likely to use condoms than
single, separated, divorced, and
widowed males. Males with
income above the mean monthly
income were 2 times more likely
to use condoms than those below
the mean monthly income.
(2) There was a significant
positive association between
attitude, subjective norms, and
PBC influencing an increase of
consistent condom use.
(3) attitude ,subjective norms,
perceived behavioral control
were predictors for consistent
condom use and had a positive
correlation.
(4) The intention to use
condoms did mediate attitude
and subjective norm.

CONDOM USE AS HIV PREVENTION IN THAILAND

Khumsaen, N. &
Gary, F.A.
(2009).

Moraros, J.,
Buckingham, R. ,
Bird, Y.,
Prapasiri, S., &
GraboskiBauer, A. (2012).

To examine the relationship among attitudes

toward condom use, personal
characteristics, condom use self efficacy
and actual condom use among Thai
adolescents. Independent Variables:
gender, age, self reported history of
drugs/alcohol, duration of the current
intimate relationship, perceived preventative
behavioral peer norms, knowledge of STDs,
HIV and pregnancy, attitudes toward
condom use and condom use self-efficacy.
dependent variable: Actual condom use.
Hypothesis: Results from this study could
provide relevant information to develop
nursing interventions that are culturally
specific to Thai adolescents. Questions:
What are the relationships between Thai
adolescents attitudes toward condom use,
the predictors of condom us, condom use
self efficacy and safer sexual behaviors
through condom use among Thai
adolescents? What are the statistical
predictors of actual condom use among Thai
adolescents?
- Condom use among adolescent FSWs
in Thailand.
- Variables: Bangkok, Chang Mai, Mai Ong
Son, other, customers, condom use, condom
purchase, ethnic origin of the patrons of
FSW, Westerners, Foreign Asians, Native
Thai, FSW HIV/AIDS worry, willingness to
use condom, condom use per day, stages of
precaution, unaware, unengaged, deciding
about acting, decided not to act, decided to

23
Bandura's self efficacy model
for safer sexual behavior
(theoretical framework).
Descriptive correlational
design. Sample: 270 vocational
students 18-21.
Thailand

Thai students reported using

alcohol or drugs before engaging
in sexual activity. Overall
attitudes toward condom use
were positively correlated with
actual condom use. Positive
linear relationship between
condom use self efficacy and
actual condom use was seen.

The Precaution Adoption

Process Model
Cross-sectional survey
Nonrandomized sample of
convenience 130 adolescents.
Brothel-based FSWs in four
geographic areas of Thailand.

On average adolescent FSWs

used 3.8 condoms per day, while
seeing 7.4 patrons per day.

CONDOM USE AS HIV PREVENTION IN THAILAND

24

act, maintenance
Pawa et al.,
Prevention of HIV infection in Thai
Quasi-experimental
(2013).
transgender women
Cross-sectional survey;
Promotion of condom use and HIV
questionnaire
testing by HIV prevention programs
308 Thai transgender
targeting Thai transgender women and
women participating in
HIV infection
Sisters program; mean age
To evaluated whether Sisters, a peer-led
= 24.56
program for transgender women, could
Pattaya, Thailand
reduce HIV risks in Pattaya, Thailand
HIV prevention programs for Thai
transgender women reduces HIV risks
among this population
Wongkietkachorn,
Condom-carrying embarrassment among
Cross-sectional Study
N. &
Thai Youth
Questionnaire
Hiransuthikul,
New condom packaging and condom
680 male and female
(2014).
use
participants in Siam Square;
To evaluate attitude toward condom use,
mean age = 19.72.7
sexual behavior and disguising condom
Siam Square, Thailand
packaging
Disguising condom packaging increases
chance of condom use
Yuntadilok,
To examine the rates and correlates of
Cross-sectional survey. 3,299
Timmuang,
consistent condom usage among Thai Navy recruits in the Thai Navy in
Timsard,
recruits
2010. Thailand
Guadamuz,
Heylen, Mandel,
Ekstrand (2014).

HIV prevention programs for

transgender women are effective
at reducing HIV risks

Disguising condom
packaging may reduce
embarrassment of carrying
condom and may increase
condom use

Prevention efforts are needed for

this population because it was
found that fewer than 1 in 5 of
these young, sexually active men
used condoms and 2 in 5
reporting having had sex with a
female sex worker.