Download Enhancing HIV prevention education for adolescents in

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
1
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
2
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
3
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
4
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
5
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
6
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 basedImplement
on evidence
HISE
7
2. Sexuality and HIV pandemic
1.
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
8
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
9
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
10
2. Sexuality and HIV pandemic
4. Teachers attitude and school capacity on HIV Intervention and Sexuality
education
A.
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
11
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
12
3. HIV Intervention and
Sexuality Education for Youth
1. 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
13
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
14
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
15
3. HIV Intervention and
Sexuality Education for Youth
3. Existing School Capacities and teacher training
A. Existing School Capacities by MOE
Implement HISE
16
3. HIV Intervention and
Sexuality Education for Youth
B. Teacher Training
Schools
teach
sexuality
education
School
teams
trained
Schools
recruited
Students
reduce risk
factors,
increase
protective
factors
Students practice
behavioral outcomes:
- Delay initiation of
intercourse
– Reduce # of sexual
partners
– Increase use of
condoms/contraception
Schools
plan
integration
of
sexuality
education
into
school
curriculum
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
17
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
18
4. Conclusions and Limitations
1.
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
19
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
20
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
21
5. Recommendations
•
Innovative deliver system Condom tips from National Science Museum
Implement HISE
22
5. Recommendations
•
What is love? ;Innovative delivery System from the National Science Museum
Implement HISE
23
Q&A
Thank you
감사합니다/ขอบคุณค่ะ
Implement HISE
24