Soyun Jung UNESCO Bangkok /London School of Hygiene and Tropical Medicine

1. Enhancing HIV prevention education for youth in Thailand; identifying barriers to behaviour changes and suggesting improved educational approaches to UNESCO in Bangkok Soyun Jung UNESCO Bangkok /London School of Hygiene and Tropical Medicine Implement HISE

2. Lists of Abbreviations GFATM – Global Fund AIDs Tuberculosis and Malaria HISE – HIV Intervention Sexuality Education MOE-Ministry of Education MOPH – Ministry of Public Health MSM-Men who have Sex with Men NGO-Non-Governmental Organisation UNGASS-United Nations General Assembly Special Session Implement HISE

3. Aims This project aims to • Suggest better educational approaches to MOE, MOPH and UNESCO Bangkok to promote safe sex behaviour in order to reduce youth HIV incidence and prevalence through reviewing cultural obstacles on HIV Intervention and Sexuality Education Noteworthy ; 1) An internship has been offered to me to write on this project at UNESCO Bangkok. 2) An implemented approach can be adapted into other South-East Asian nations if it is effective enough with modification in their context 3) In the study, adolescent, young people and youth are interchangely used as the same meaning. Implement HISE

4. Methodology • Review of qualitative studies and literatures as well as grey ones primarily using official government websites including Ministries, INGOs like PATH and UN • Also, searching through University London of Hygiene and Tropical Medicine database such as Pub Med, Global Health/Global Health Archive (via Ovid), Medline, Embase, Web of Science, Science Directory, the Cochrane library etc • Internet using Google; Googling * In order to find articles on culture, youth attitudes/behaviours, policy , teacher education on sexuality with HIV intervention education and contraceptive use among adolescents. Implement HISE

5. Definitions of Key concepts • Sexuality; the Basic need of human life influenced by physical, psychological, spiritual, social economic, political and cultural dimensions (UNESCO, 2009) • Adolescent Sexuality; Sexual feelings and behaviors developed during puberty by adolescents. It is the period of starting to be interested in sexuality and sexual desire (Macmillan Dictionary, 1981) • Risk Behaviour; Human activities that make one more susceptible to sexually transmitted diseases and HIV infections (UNESCO, 2006) • Safe Sex; Sexual Behaviours that do not transmit HIV such as clean blood of partners, semen, vaginal mucus (UNESCO, 2006) • Sexuality Education with HIV Interventions; teaching sex and relationships at an appropriate age in their cultural context based on scientific evidence and realistic, non-judgemental information. It aims to explore individuals’ values and attitudes, strengthen the skills of decision-making, communication and reducing risks in sexuality (UNAIDS, 2009) Implement HISE

6. Outline 1 . Background 2. Sexuality and HIV pandemic 3. HIV Intervention and Sexuality Education for young people 4.Conclusions and Recommendations 5.Study limitations Implement HISE

7. 1.Background Causes • Significant changes in a society and culture • Economic disparities not only among people, but also among regions • Globalisation; sexual diversity • Development in Mass Media and Technology, especially in communication technology • No preparation for youth sexuality and HIV intervention education • Over half of young people engage with sexual intercourse under 15 year olds • No surveillance system for youth HIV Outcomes • Today, an estimated half of the new HIV prevalence are among youth according to UNGASS 2010 • UN declares the war on youth HIV, primarily from 15 to 24 year old Therefore, HISE is necessary based on evidence Implement HISE

8. 2. Sexuality and HIV pandemic • Sexuality and youth HIV epidemic • What is the Sexuality? It is a cultural construct, significantly governed by cultures; some behaviors/attitudes are tolerable and desirable within culture while others are no. • Sexuality and HIV epidemic among young people HIV epidemic is linked to cultural concepts of sexuality; rapid changes in a society and socio-economic growth make youths more vulnerable to HIV . In fact, 60% of HIV new incidences are occurred among youth in developing nations, making this a GLOBAL IMPERATIVE! Implement HISE

9. 2. Sexuality and HIV pandemic 2. General Sexuality and HIV in Thailand • Sexual Vulnerable Groups; liquids addicts, child, female and male commercial sex, army conscripts, foreign migrants and MSM • Gender difference in sexuality norms • HIV in Thailand * Past ; the highest HIV prevalence in South-East Asia due to huge sex markets * Present; successful decrease in HIV prevalence due to multiple interventions, such as the 100% condom use campaign However, new warning signal hits the nation; rising Youth HIV Implement HISE

10. 2. Sexuality and HIV pandemic 3. Cultural, Social norms and behaviors/attitudes on Sexuality among the youth • Better living standard and nutrition; earlier puberty and earlier sexual desire • New youth sexuality norms * Totally differ from traditional one; Generation gap on sexuality * Premarital sex is acceptable by 67.2 % and is considered a personal choice as well as a human right * More approve living together • Material value affects early initiation of sexual intercourse regardless of gender • Multiple Partners/Low contraceptive use, especially condom • Drug and peer pressure related to Sexual Relationships • New modern dating way; web • No need to capitalize virginity Implement HISE

11. 2. Sexuality and HIV pandemic 4. Teachers attitude and school capacity on HIV Intervention and Sexuality education • Teachers’ belief, values and attitudes on teaching HISE • Comparatively conservative on sexuality in classes and for themselves • Ashamed of discussing sex-relevant topics in spite of an educational purpose • Reliance on external sexuality experts due to their self-judgement • Lack of self-confidence and passion/commitment to the topic B. School Capacities • The increase of the importance of HISE among educators • Lack of resources, funding, time, facilities, teachers and spaces • Lack of supports from community and family; parents object to HISE class for their kids • Lack of follow-up systems for parents sexuality seminars • Rural areas? Implement HISE

12. 2. Sexuality and HIV pandemic 5. Youth HIV and its vulnerability • Lack of School-based sexuality education • Lack of information of a youth sexuality as a human right • Lack of school capacities; limited of time in the school schedules; • Lack of opportunities to gain accurate information of sexuality; exposed to unsafe sex bahaviours • Misconception about contraceptive, especially condoms • Youth themselves can not be fully responsible for their behaviours Implement HISE

13. 3. HIV Intervention and Sexuality Education for Youth • Health policy in Thailand • Good infrastructures such as MOPH, International NGOs, Hospitals, Universities and Workforce • Quick response to Global Health Issues • Successful insurance scheme under the principle ‘triangle that moves the mountain’ – 30 baht for all; Health care needs, Human rights and business Nevertheless, there are still disparities between provinces and urban. Also, it does not cover HIV/AIDS on account of its huge cost and youth public health Implement HISE

14. 3. HIV Intervention and Sexuality Education for Youth 2. Existing HISE • Since 1978, HISE was one of basic curriculum, however, focusing more on biological or physical development of the human body and attempting to link to a part of life skills • In 2002, it incorporated into physical health and physical education • From 2003 to the present, MOE began to cooperate with international organisations like PATH and UN, emphasizing more on effectiveness of projects • Trying to disseminate Youth centred padagogy, using in mass media like television, radio, cartoon books and etc. • Comprehensive Sexuality Education needed • Prepare sexuality seminars for parents and provide teacher pre-package service Implement HISE

15. MOE STRATEGY • Incorporating Comprehensive Sexuality Education as the basic and a core strategy in the National AIDS Plan 2007-2011 by the MOE a. Policy Support b. Curriculum and Manual Development c. Training of teachers d. Coaching/Mentoring e. Experience sharing f. Extra-curriculum youth-led activities g. Pre-service teacher training h. Empowering schools i. Program evaluation Implement HISE

16. 3. HIV Intervention and Sexuality Education for Youth 3. Existing School Capacities and teacher training A. Existing School Capacities by MOE Implement HISE

17. 3. HIV Intervention and Sexuality Education for Youth B. Teacher Training How the OBEC program operates. Source; Rebecca Firestone. Assessment of the Office of the Basic Education Commission’s Sexuality Education Program. Thailand: UNESCO,2008 Implement HISE

18. 3. HIV Intervention and Sexuality Education for Youth 4. Barriers for HISE • Generation gaps on Sexuality and its influences on Education • Out-dated contents of Sexuality Curriculum • The way of the curriculum implementation • National religion and Gender issues about coercive sex • Lack of M&E system • Lack of HIV Intervention and Sexuality counselling services Implement HISE

19. 4. Conclusions and Limitations • Conclusions • Globalisation has changed youth life styles, behaviors/attitude patterns and norms on sexuality, therefore youth want to experience what sexual relationship is and acquires more knowledge of HIV and sexuality. Nevertheless, adults argue sex is an issue that should not be brought out in the public and should be forbidden. As a ramification of this, the HISE is not fully pragmatic and youth HIV prevalence has been increased. In response to this, MOE, MOPH and in coordinated with international organisations are to achieve four things; 1) providing curriculums to reflect new youth sexuality norms and behaviours/attitudes 2) changing teachers’ ideas and generation gaps on sexuality 3) Inventing contraceptive young people prefer 4) Empower school Implement HISE

20. 4. Conclusions and Limitations 2. Study Limitations • Key document was conducted by qualitative studies • Limited accessibility to sexuality education due to the difficulties to contact to government institutions • Language restriction • Lack of communication and cooperation among international organisations • Adult point of views permeate papers used Implement HISE

21. 5. Recommendations • Strengthen M&E to carry out regular assessment to implement and sustain HISE • Using mass media supported by the government • Invent youth preference contraceptive • Provide an essential sexuality including HIV curriculums containing more practical information • Provide family-planning guidelines for parents • Provide comprehensive sexuality counselling services • Provide a sound national HISE policy • Train curriculum designers to adapt innovative contents • Government ensures or enforces schools to teach HISE as a prerequisite subject Implement HISE

22. 5. Recommendations Innovative deliver system Condom tips from National Science Museum Implement HISE

23. 5. Recommendations • What is love? ;Innovative delivery System from the National Science Museum Implement HISE

24. Q & A Thank you 감사합니다/ขอบคุณค่ะ Implement HISE