It’s early evening, and Smornthum Suknirundr waits outside in a van with the rest of her team as a male volunteer enters the Bangkok gay bar. Inside it is mostly young men — just the demographic Ms Smornthum is looking for.
The volunteer approaches men inside the venue, asking them whether they would like to be tested for HIV. The method is simple: a quick swab of the mouth with a cotton tip is all that is needed to detect antibodies for the virus.
The men are each given a number and asked to wait while the samples are taken back to the van for analysis. When the testing is finished, they can come out to ask for their results.
“We give them the results without asking any questions,” Ms Smornthum said.
At one venue, 27 out of the 50 men who were tested are found to be HIV-positive. But only some of them bothered to come out to ask for their results.
“I am not sure whether they are ignorant, whether they already know the result or if perhaps they just don’t care,” Ms Smornthum said.
One young man who returned a positive test is encouraged to go back and tell the others. “He has just had unprotected sex with four people,” Ms Smornthum said. She then advised him on his options for medical treatment.
“He is lucky to have access to early detection because the infection can be treated,” she said.
Ms Smornthum has been working to promote sex education for decades. An educator at the Population and Community Development Association, she has lectured at schools, met with sex workers and provided phone hotline advice on sex education and family planning.
Still, she was surprised by her recent findings when she conducted a survey for HIV infection rates among young men who have sex with men (MSM).
Chutima Saisaengjan, coordinator of the Children and Youth Programme at the Thai Red Cross Aids Research Centre, said, “The level of ignorance and misunderstanding of people when it comes to HIV/Aids is still high. We have found many adolescents are HIV-positive.”
She admitted part of this might be because campaigns to raise awareness of the virus may be encouraging more people to come forward for voluntary testing. A change to health regulations also means adolescents can now test for HIV without parental consent.
But Ms Chutima said teenagers remain the most vulnerable group in Thailand.
“Some don’t have proper knowledge about how to protect themselves,” she said. “The death rate among adolescents with HIV/Aids is higher than other groups because they don’t know how to take care of themselves.”
‘IT CAN BE TREATED’
“I contracted HIV when I was 15 years old,” said Mr A, now 18, who preferred not to use his real name. “I had unprotected sex with my partner. I was very young then. I was not fully aware of the importance of safe sex.”
Before the virus was detected, Mr A began suffering from various symptoms such diarrhoea alternating with constipation. He went to a clinic in Bangkok operated by the Thai Red Cross, and was soon given the news that he had HIV.
Breaking taboos: Teacher Sumon Kananit is encouraging open discussion.
He told his mother, whose initial shock quickly gave way to support as he began his treatment. “I am lucky that I have support from my family to go through this,” he said.
Today, Mr A studies at university. He looks healthy.
“I take a tablet every day to control the HIV. I want to make people understand the nature of HIV infection, that it can be treated and prevented,” he said.
“People who are found to be infected can receive medical treatment and live their lives as normal.”
Mr A said society still had many misconceptions about HIV. “There is a stigma attached,” he said. He recalled telling a work colleague that he had HIV. The next day, he was fired by his employer.
“Even these adults do not understand that HIV is not easily transmitted,” he said.
The stigma surrounding a positive diagnosis prevents many from getting tested in the first place. “HIV/Aids patients are often portrayed as hopeless and dying characters, which is not always the case,” said Mr A.
He said it was critical that schools provide more practical information to adolescents.
“Sex education should not only be about anatomy, but who we can go to for advice and what kind of services are available to us,” Mr A said.
But Mr A is a rare case among adolescents, in that he decided to test for HIV and sought medical treatment.
“Many refuse to receive any treatment. They are still under the misunderstanding that a HIV diagnosis is the end of the road,” Ms Chutima said.
She said the stereotypical image of HIV/Aids patients in the media made some adolescents feel too scared to approach the Red Cross or other health centres for testing.
UNSAFE SEX
While the number of new HIV infections among adolescents (aged 15-19) fell from 4,300 in 2004 to 1,600 last year, the group remains disproportionately represented in HIV/Aids statistics. Unicef is aiming to stop new infections among this group as part of efforts to help Thailand achieve its zero infection goal as soon as possible.
The key demographic Unicef is focused on is young MSM, which includes gay men, male sex workers and transgenders.
In Thailand, according to recent UN figures, 11% of MSM aged under 25 are HIV-positive. This compares with 8.3% of MSM aged over 25.
Among female sex workers, another high-risk group, HIV prevalence was much lower at 1.8% in 2011.
“Everyone is at risk, but MSM are more at risk due to their sexual behaviour, number of partners and how causal it is for them to change their sexual partner,” said Beena Kuttiparambil, chief of HIV/Aids (Adolescent Development) at Unicef Thailand.
The reason that adolescents are the focus group in Thailand, she said, is because of the stigma that prevails. Despite Thailand’s seeming openness about sexual orientations, stigma still plays an important role when it comes to adolescents accessing information or support, Ms Beena said.
The same UN data, for example, found that only 27% of Thai MSM aged under 25 had received an HIV test and knew their result. That figure was far below Indonesia (92.3%), Myanmar (44.6%) and Cambodia (33%).
“Thai sex education is very good, but parents still feel uncomfortable talking about sexuality issues with their children,” Ms Kuttiparambil explained.
STARTING YOUNG
Ms Smornthum attributed the high HIV/Aids infection rate among young people to a refusal by parents to discuss such issues, and adults’ unwillingness to accept that teenagers are having sex earlier than they might have in previous generations.
“Many teenagers these days tell me they started having sex when they were 12. Their attitude has changed from the past. They think it is OK to have sex from early age,” said Ms Smornthum, who speaks regularly to young people about sex through her counselling services. “Some teenagers show off by collecting points based on the number of people they have slept with. I just spoke to a group of teenage students who didn’t have a proper education about sex, but are competing in this game. They thought it was safe to have anal sex, so they did not use a condom, even though in fact it is also risky to do that.”
Efforts to increase condom use have met opposition. An initiative to put condom vending machines in schools across the country, for example, has not always been welcomed by teachers and parents.
“Some principals said the machines would encourage students to have sex early,” Ms Smornthum said. “Some schools which cater to a broad age group were against the idea because they would not be able to prevent young students from seeing or using the vending machines since they share bathrooms with the adolescent students.”
She said the gap between young people’s perception towards sex and the conservative attitudes of older generations has discouraged some from protecting themselves because they feel embarrassed to ask for advice or buy condoms.
“Teenagers know about sex. They can learn from Google and new media these days. But when young people want to buy condoms, they often face judgemental stares,” Ms Smornthum said.
She said the Public Health Ministry had planned to produce special condom packaging to allow young people who are shy to ask for the right size. The condoms would be colour coded based on size. The plan has not been implemented yet.
Sex education in schools meanwhile remains light on practical detail. Ms Smornthum said she has to be creative in devising ways to discuss sex in an open setting.
Recently, she used cucumbers to teach around 1,200 male technical students how to measure their penis size so that they would be able to purchase condoms that would fit them properly. “So they won’t be awkward about asking for the right ones.”
LEARNING CURVE
Some schools have taken the initiative and are promoting better quality sex education in an effort to prevent teen pregnancy and sexually transmitted disease among students.
Satri Witthaya 2 Secondary School is one of them. Last week, it organised a sex education camp for 150 students.
“We want to give students a better understanding [of safe sex] as they are growing up. And it is safe for them to learn about this from school,” said Sumon Kananit, a teacher who organised the half-day event.
The students had an open discussion with outside volunteers about the differences between HIV and Aids, and how to have safe sex. A group of parents observed the event in the school’s auditorium.
Although young students giggled at times, they were attentive. Some blew condoms up like balloons to test their elasticity.
Nannapat Manokulanon, a 13-year-old student, said she had learned new things such as how to use a condom and the different stages of pregnancy termination. Chanana Rattanakanungthum, a 14-year-old Mathayom 3 student, said, “I know now that an HIV infection is not as scary as I thought.”
Ms Sumon said when she first tried to incorporate sex education into classroom teaching, she faced resistance from conservative parents. She recalled one time when she taught students about basic anatomy by showing them illustrated depictions of the human reproductive system. “One of the students’ parents came to school to complain that I had showed their child pornography,” she said.
Ms Sumon said having the cooperation of parents is essential to educating young people about sex, which is why Satri Witthaya 2 School invited parents to observe the sex education camp.
Visanu Wattanarujiwong, one of the parents, said, “I want my 13-year-old to learn about sex education. One of our relatives had to quit school because she had unprotected sex with her boyfriend and she became a mother before she finished school.”
Asked what would be appropriate an age for adolescents to have sex, Mr Visanu said, “I told my daughter that she should wait until she finishes high school, or even better, wait until you graduate university and are working.”
Hope lives: Kai, 19, was born with HIV. New infections among teens fell from 4,300 in 2004 to 1,600 last year, but the age group remains over represented.
Out in the open: Satri Witthaya 2 Secondary School last week held a sex education camp for 150 students. Teacher Sumon Kananit said she would have struggled to organise the event in the past.
Parental guidance: Parents of Satri Witthaya 2 Secondary School pupils support sex education.
Take cover: Staff from the Phaya Thai district office give away condoms to passers-by in the Saphan Khwai area, as part of a safer sex campaign to mark World Aids Day.