December 2003

Programming for HIV Prevention Among College Students in Thailand

Key Findings

The program did not increase initiation of sexual activity. Although the proportion of students having sex increased in both groups, this increase was not statistically significant when comparing the intervention and control groups. This increase likely reflects the fact that as students become older, a growing proportion have their first sexual encounter. At baseline, 61 and 55 percent of males in the intervention and control groups, respectively, reported ever having sex. At T2, these proportions increased slightly to 65 and 61 percent, respectively. At T3, the proportion that had had sex in the intervention group increased slightly to 67 percent, but remained stable at 60 percent in the control group. A similar trend was observed among females, albeit a smaller proportion reported ever having sex at each point in time. These increases in initiation of sexual activity were not statistically significant for male or female students in the intervention vs. the control groups.

Students already had high levels of knowledge, and the program improved these levels. Among males in the intervention group, mean HIV knowledge scores (out of 100) increased from 82.9 at baseline to 85.5 at T2 and then decreased slightly to 84.4 at T3 (p < .001). The mean HIV knowledge scores of females in the intervention group also increased from 81 at baseline to 83.7 at T2 and then decreased slightly to 82.8 (p < .001). In contrast, mean knowledge scores among males and females in the control group declined at T2 and T3 from baseline figures.

The program improved students’ attitudes about condom use, particularly among females. Mean condom attitude scores among males in the intervention group increased from 71.4 (out of 100) at T1 to 73.8 at T2 and then remained relatively stable at 73.1 at T3 (p < .001). This indicates a small sustained increase in favorable attitudes about condoms, such as feeling confident about using a condom correctly. No similar change was found in the control group. Among females in the intervention group improvements in attitudes about condom use were more substantial: 70.3 at T1 to 74.8 at T2, remaining stable at 74.5 at T3 (p < .001). Although scores for females in the control group increased slightly between T1 and T3, the researchers did not find these increases to be statistically significant. There were no statistically significant changes in the number of partners for males or females.

Immediately after the program, condom use among females in the intervention group increased. At baseline, about one fourth of sexually experienced females in the intervention and control groups had used a condom the last time they had sex during the recall period (Figure 1). For females in the intervention group at T2, the figure increased to 38 percent, while the figure for the control group decreased to 16 percent (p < .001). At T3, however, there was a slight decline in the proportion of condom use at last sex among the intervention group and an increase in the control group. There was no similar increase in condom use among male students, although a greater proportion of males compared to females reported using condoms at baseline.

Male students feel more pressure from friends to engage in sexual activity than female students; the program did not affect these perceptions. At baseline, 41 and 47 percent of males in the control and intervention groups, respectively, agreed with the statement, “My friends encourage me to have sex,” while only 5 and 7 percent of females in these groups felt the same way. Among both male and female students, participation in the program did not have a statistically significant effect on perceptions of peer pressure to have sex.

The program helped increase communication among specific intervention subgroups, but gaps remain. At T1, 9 and 6 percent of females with no sexual experience within the intervention and control groups, respectively, had discussed HIV/AIDS with a boyfriend. At T2, the proportion of sexually inexperienced females who talked to a boyfriend more than doubled, even though there was only a modest increase in the control group (19 vs. 9 percent; p < .001). These figures were similar at T3. There were no statistically significant increases in communication with boyfriends among sexually active female students, or with girlfriends among male students, regardless of sexual experience.

At baseline, about a fourth of sexually experienced males in both groups reported discussing HIV/AIDS with a teacher or counselor. At T2, 37 and 29 percent in the intervention and control groups, respectively, reported this type of communication. However, this difference was not statistically significant until T3, when 40 percent of intervention males and 28 percent of control males reported discussing HIV/AIDS with a counselor or teacher (p < .05). Similar changes were not found among intervention females.

Participation in the program had no effect on the proportion of students talking about HIV/AIDS with a parent, other family members, or health professionals.

The program improved students’ acceptance of people living with HIV and AIDS (PLHA). Among males in the intervention group, the mean attitude score (out of 100) increased from 69.7 at T1 to 78.1 at T2, and then decreased slightly to 77 at T3 (p < .001). This indicates more favorable attitudes about PLHA, such as HIV-positive students should remain in school. No such increase occurred among males in the control group.

Similarly, the mean attitudes score for females in the intervention group increased from 71.6 at T1 to 78.1 at T2 and then decreased slightly to 76.9 at T3 (p < .001). There was also an improvement in the mean attitude score among females in the control group, although it was not as strong as the change observed in the intervention group (68.5 at T1 to 71 at T2 to 71.7 at T3; p < .05). This indicates that outside influences also played a role in improving students’ attitudes about PLHA.

Teacher training and experience contributed to improvements in knowledge and attitudes. After the three-day teacher training course, teachers' mean scores on HIV knowledge, attitudes about sexuality and gender, and attitudes toward PLHA each increased significantly (p < .001) from baseline among the 35 teachers and four administrators participating. For example, the mean score for correct answers on HIV knowledge rose from 79 to 89 (out of a maximum score of 100). Nevertheless, some teachers did express concerns about their ability to effectively teach the curriculum, and some felt uncomfortable discussing and demonstrating condom use. They suggested enlisting the help of health professionals to teach sensitive aspects of the course.

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This page updated
03 Jan 2009