WHEN THE SCHOOL KIDS TALK ABOUT SEX: HIV KNOWLEDGE TRANSFER IN DAN SAI, THAILAND www.wecanbeatHIV.info
CONTENTS Introduction............................................................................................................................................. 1 Epidemic Trend ....................................................................................................................................... 3 HIV Knowledge Transfer in Student Population ...................................................................................... 4 Knowledge Transfer in Formal Class Setting ....................................................................................... 5 Knowledge Transfer in Extracurricular Setting .................................................................................... 7 HIV Knowledge Transfer in Non-Student Population .............................................................................. 9 SWOT Analysis of the Knowledge Transfer System .............................................................................. 12 SWOT Strategies of the Knowledge Transfer System ............................................................................ 13 Conclusion ............................................................................................................................................ 13 Bibliography ......................................................................................................................................... 15 APPENDIX: Pictures Taken during the Field Research.......................................................................... 16
List of Tables Table 1 Key Comprehension for Sex Education in M1 to M6 Students..................................................... 6 Table 2 Kor Paii Club's Activities ............................................................................................................ 8 Table 3 SWOT Analysis ........................................................................................................................ 13 Table 4 SWOT Strategies ...................................................................................................................... 13
Introduction Three decades after the HIV virus was found in 1980s, HIV has still been a global epidemic that tremendously curtails mankindâ€™s welfare and productivity. Though each country witness different trend of epidemic, Southeast Asia is still the second most affected region, after the Sub-Saharan Africa region, in regards to the number of new HIV infection, prevalence1 and the AIDS-related death cases (UNAIDS, 2011). Thailand has been showing progressive pace in combating the HIV epidemic and decreasing the HIV prevalence within its citizen yet the country still hosts the largest number of HIV-infected population in the region (UNAIDS, 2012). Female sex workers, men having sex with men (MSM) and injected drug users are the key-affected demography in Thailand. However, the country also experiences a concerning trend within its youth demography in the recent years. Youth citizens, ranging from 15 to 24 years old, account for half of all new cases of HIV in Thailand. Premarital sex has become more common among young Thais, but only 20-30% of sexually active young people are using condoms consistently (World Bank, 2008). All in all, the aforesaid statistics indicate the necessity of mitigating interruption in order to thwart the epidemic. Education in regards to sexuality knowledge that emphasize the HIV-related information has been dubbed as such mitigating interuption. Cohen, Sande, & Volberding (1999) stated that HIV knowledge provides a fundamental platform to enable the society: to prevent the infection, to medicate the health consequences and to eradicate the stigma. A recent report, Review of Policies and Strategies to Implement and Scale Up Sexuality Education in Asia and the Pacific, from UNESCO (2012) mentioned that evidence demonstrates that HIV-related education provides people with the information and skills to make healthy choices about the initiation of sex and sexual behaviours, may prevent negative sexual and reproductive health outcomes, and may present an important platform for addressing gender issues as well as advocating mutually respectful and non-violent relationships between the HIV positive and HIV negative people. Ensuring access to HIV education has become increasingly important. Progress is being made across Asia in emphasizing the policies, strategies and activities to support the implementation of some form of sexuality education, that is mainly driven by the essentiality of HIV knowledge, in secondary and, in some cases, primary education (Clarke, 2010). Regardless the centrality of Thaiâ€™s Minister of Health in running the National AIDS Strategy, there is substantial variety in approach and implementation, though there are significant harmony, which reflects different policy priorities, social contexts, levels of resources and forms of governance. This notion is vehemently applied to the level of provinces, cities, district and 1
HIV prevalence is a medical term used to describe the level of severity of HIV epidemic in certain demographic by comparing the ration between the infected people to the HIV-negative individuals. Prevalence of 60% means that 6 out of surveyed 10 people are infected with HIV.
subdistricts2 in Thailand. In light of this, the study is designed to examine the emergence of HIV-related education in the smaller unit of governance form. Dan Sai was chosen to be the focus of the study. The objective of the study is to analyze the mechanism of HIV knowledge transfer in Dan Sai. In retospect, the study seeks to elaborate the strength, weakness, opportunity and threat of the HIV knowledge transfer system found in Dan Sai. In accomplashing the objective, the study focuses on the epidemic trend in Dan Sai and the knowledge transfer given to two different study samples: the student population and the non-student demography. The reason for a separation within the study samples relies on the distinct environmental setting between student and non-student population. Noting the function of a school, the students are enclaved in an atmosphere that bears the aforementioned role of HIV knowledge giver. Meanwhile, the non-student demography, that includes the school dropouts and the graduates who might be employed or jobless, are technically no longer sustained by an educating nature of school. Thus, this implicitly shows the call for the town’s governance to weigh in in providing and enhancing the HIV knowledge. In retrospect, the division suggests that the scope of the HIV knowledge examined in the study includes both formal and informal education. In regards to this division, the study is determined to answer the following research questions: 1. Are Dan Sai students presented with HIV knowledge? 2. How do the Dan Sai students acquire the HIV knowledge? 3. Are Dan Sai’s non-student population accommodated with HIV knowledge? 4. How do Dan Sai’s non-student population acquire the HIV knowledge? 5. What are the factors that may affect the process of HIV knowledge transfer in Dan Sai? The hypothesis of the study, that takes off from the recent statistics that suggest Dan Sai to be hosting the third largest HIV-positive individuals in Loei province, is that the HIV knowledge trasfer is only administered by the central government yet the program failed to reach both student and non-student population. The methodology of research is conducted by constructed interview with certain actors that hold prominent role in empowering the HIV knowledge trasfer in Dan Sai. To examine the knowledge transfer in student population, the research studied Srisongrak Wittaya School. Two school teachers that beared the responsibility of HIV education within the school’s curriculum and the students who were members of HIV-education student activity club were interviewed. On the other hand, to examine the knowledge transfer within non-student demography, the authors interviewed the public health officer, the representative of community and family relations clinic and the nurse of HIV-specialized clinic in 2
In Thai’s governmental geography, district is called amphoe while subdistrict is called tambon. One amphoe normally covers more than one tambons. Dan Sai district, which is the focus this study, represent ten tambons.
Yupparat Hospital; a Buddhist monk and a prominent Dan Sai resident who served in parent committee in Srisongrak Wittaya School and had been running a Phitakon souvenir shops for years. The paper will start with the finding on the epidemic trend found in Dan Sai. The ellaboration on HIV knowledge transfer in both student and non-student population will follow subsequently. By intersecting the finding on the epidemic trend and on the knowledge transfer in Dan Saiâ€™s society, the paper will then analysis the strenght, weakness, opportunity and threat (SWOT) of the emerging knowledge transfer system. As a final point, the strategies to improve the knowledge transfer system resulting from the SWOT analysis will be presented as well.
Epidemic Trend Dan Sai district is divided into 10 subdistricts (tambon) which cover 98 villages (muban). Populated by 49,270 inhabitants, Dan Sai witnessed 115 new HIV infections and 89 AIDS-related death cases in the past one year. Though the numbers are the sluggish increase from the previous years, the lifestyle of Dan Sai residents has been progressing to become more vulnerable to the epidemic. Furthermore, many of the newly infected cases are found on the residents above 24 years old with the requirement of second line ARV3 treatment. The requirement of second line treatment indicates that the infection has been undetected for quite a time. This, therefore, suggests the low awareness of HIV status check update despite the risk lifestyle that one may practice. With the increasing popularity of the annual Phi Ta Khon festival4 as a tourist attraction, the economy in Dan Sai is becoming more progressive towards the tourism industry year after year. Without the existence of Phi Ta Khon, the economy of Dan Sai might have been stagnant or experiencing a slower pace. The growth of the economy is accompanied by the improvement of the schools found in the district. The schools in Dan Sai, therefore, have been the prime educational destination for the secondary school and college students originating from the poorer neighboring districts. Srisongrak Wittaya Secondary School and Dansai Industrial and Community Education College are the examples of the attracting schools. Given that many of these students are sent from their home and live in the district without their parents, the budget dormitories have been typical living places for these students. Regrettably, without the full 3
ARV (Antiretroviral) drugs are the medicines that are consumed by HIV-infected people to maintain the function of the immune system. The ARV treatment comes in different brands and presciptions or so-called regimens, depending on the severity of the infection. Drugs with a high efficacy and low side-effect profile or so-called first line regimen is given to the HIV positive person who is newly infected and still have a good immune system. The second line regimen, however, is given to those whose immune system has been damaged severely by the virus. Such damaged immune system may happen because the HIV-infected does not consume the first line regime. 4
Phi Ta Khon, also known as Ghost festival, takes place over three days between March and July with the date being chosen annually by the townâ€™s medium. The festival is part of ritual ceremony inspired from the intersection between Buddhism and Animism. The festival holds a series of parades, games and processions wearing ghost-illustrated masks and patchwork clothing.
presence of parents, such conglomeration turns out to create a living setting that makes the teenager residents prone to pre-marital sex and promiscuity. In the same time, many of the local Dan Sai’s households also witness parents’ absences. A fair share of parents works outside the district and come home only during weekend or few times a month. This applies strongly to those who have an occupation as a lottery ticket seller, particularly in other Isan provinces. Consequently, many Dan Sai teenagers also pass by their days without being fairly monitored by their parents. These teenagers are as equally prone to pre-marital sex as the visiting teenagers from the neighboring districts. All things said, the precarious lifestyle that attaches to Dan Sai teenagers has been proven by the fact that the hospital sees increasing number of pre-marital sex pregnancy over the past 10 years. The students, however, are not the only group that is prone to risky lifestyle. Executed in covert, a number of Dan Sai male adults have been engaging in sexual transaction with female prostitutes. The prostitutes are claimed to be the Lao female who unofficially migrated to the district. Bordered with small river stream that can be easily bridged, Dan Sai is adjacent to Laotian province, Xaignabouli. With lack of control mechanism, the border has been an easy way in for the Laotian female sex workers. The influx of female sex workers will not emerge had there been no potential customers in Dan Sai. Recent observation made by the hospital reveals that, sadly, many of the customers are heads of district and heads of village. The clandestine transactions are claimed to be executed in restaurant and karaoke place found in the district. Furthermore, another surveillance suggested by the hospital also discloses the trend of vocational school female students engaging in prostitution. All in all, though the hospital is unable to provide the exact figure for the prevalence of prostitution in the district, the hospital believes that without any mitigating measures the trend of prostitution in the area will escalate to a higher degree. The trend of sex worker, nevertheless, should not be the only trend the hospital is being alert for. As mentioned before, alongside the female sex worker population, MSM and injected drug users are the most vulnerable demographic. The hospital, however, suggests that the existence of MSM and injected drug users in the district is little known. Nonetheless, little known detail about these groups does not automatically mean that they do not exist. Hitherto, the trend of drug abuse that has come under the hospital’s radar, on the other hand, is the consumption of amphetamine pills.
HIV Knowledge Transfer in Student Population The importance of sexuality education in the school has been demanded not only by the civil societies, but also by the students itself. In 2008’s 17th International AIDS Conference in Mexico City, Sukrit, a Thai student who participated in a satellite session suggested that students also talked about sex among themselves, but they could only talk to each other because they usually could not talk with adults, neither
those in the family or schools, because he thought that the teachers, just like the parents, would be afraid of prompting the students to have sex if they discussed about how to prevent the unwanted consequences (Clarke, 2010). Sukrit went further by saying that in Thailand sex education meant “showing the squirrel how to get in the hole” but he thought that “squirrels already knew the hole” because young people already knew about sex but they lack of the correct knowledge. The paragraph above accurately articulates the concern of PATH in regards to the sex knowledge acquired by Thai students. PATH is a Seattle-based international nonprofit organization that focuses on delivering the high-impact, low-cost solutions to the epidemic diseases like AIDS, tuberculosis and Malaria (PATH, 1995). One of the organization’s agenda is sustaining HIV-free adolescents and Thailand has been the primary focus since 1980s. Working closely with Thai’s Minister of Health, PATH creates and advocates a sexuality education curriculum for the secondary schools in Thailand. PATH's assistance turns out not to stick only with formal class setting but also to intersect with the students' extracurricular activity. The subsections below, therefore, will provide the explanation on both formal and extracurricular settings.
Knowledge Transfer in Formal Class Setting In commencing the sexuality education-contained curriculum program, PATH creates a school network for 36 Thai provinces through a project called Phet Suksa Rob Dan (Sex Education in All Aspects) conducts an annual training that is designed to introduce as well as train the teachers of Thai secondary schools the implementation of the program. However, due to the budget constraint and the different adaptability quality between one school to another, the training is designed to be conducted to limited amount of schools yet the number of the covered schools is expected to increase every year. In 2010, PATH finally invited teachers from Srisongrak Wittaya School, a secondary school in Dan Sai district that hosts 950 students ranging from grade 7 to grade 12 students5, to join the annual training. Under the assessment of Bureau of Local Government of Education, Srisongrak Wittaya School was chosen by PATH to be the first school in Dan Sai district that was mandated with the implementation of the sexuality education-contained curriculum, and thus, began to hold the role model for the other schools in the district in terms of the amplification of HIV knowledge. In retrospect, PATH and the Bureau of Local Government of Education establish a school network in which Srisongrak Wittaya school become the network leader. The network covers 53 schools within the administrative zone set up by the Bureau called
Unlike American education system, Thai education system defines the secondary school to be ranging from grade 7 to grade 12. The Thai terminology for the secondary grades are Matthayom and shorten as M1 to M6. The numbering begins from 1 again since the primary school grades use different terminology called Pratom and shorten as P1 to P6.
The Secondary Educational Service Area Office 19. This administrative area covers all schools in the districts and some schools in other Loei’s districts as well as other district in Nongbua Lamphu province. The training was attended by the school’s head master and six other teachers. The first training, eventually, became the defining point for Srisongrak Wittaya School to commence a comprehensive HIVknowledge towards its students. While previously the sexuality education is partially covered in Physical Education class with no assurance that the content would broadly cover the HIV-knowledge, starting in 2010 the sexuality education class has been included in the students’ class schedule. The sexuality education class takes 8 hours a semester with one-hour class per week for eight consecutive weeks. Particular sets of textbook that separately caters the teacher and the students have been provided by PATH under the collaboration with Thai’ Minister of Health to accompany the class teaching. Other than the textbooks, PATH also provides the equipments for teaching demonstration, such as poster, male and female condoms that are wrapped in a shape of lollipop, birth control kit, pamphlet and the instrument that helps to illustrate the infection of HIV. Under the designed curriculum, the class does not entail a grading system yet each grade has its own key comprehension that matches the compatibility of the students’ physiology and psychology in adapting to the sexuality-related information. It is important to note that one key comprehension might be delivered in two consecutive years, and in practice, might be presented in all years regardless the given guideline. The main topics covered by the class are: human’s physiology and psychology development, love relationships, sexual behaviors, sexual health and role of society and culture. Table 1 below represents the range of knowledge emphasizes given to grade 7 to grade 12 (or M1 to M6) students. GRADE
Basic Knowledge of HIV
The Awareness of HIV Transmission and Prevention
M3 M4 M5 M6
The Attentiveness of STDs, HIV, AIDS and HIV-related Opportunistic Diseases The Importance of Safe Sex Eliminating Discrimination against HIV-Infected People
Table 1 Key Comprehension for Sex Education in M1 to M6 Students
Though the contents of the class differ from one grade to another, all grades have the commonality in terms of the class teaching’s method. Unlike the typical class where the teacher becomes the center of the learning, the significance of learning in sex education class is the two-way communication from the students to the teacher and vice versa. The class normally begins with case study that requires the students to brainstorm the issues. The students will be divided into groups consisting of eight to ten people and 6
each group will later present the discussion result to the class. In order to distinguish the point of views between male and female students, each group only represents one sex. The teacher later will review the class' discussion result by replacing the misunderstanding that may come from the students' perspective with the right knowledge as well as mediating the discrepancy, if any, between the assertion from the male and female groups' discussion. For brief example, grade 9 students will be required to discuss how to cope with sexual desire. The case study will lead the students to express their opinion whether sexual desire should be expressed or not. The teacher will then explain that sexual desire is a normal mankind's nature, and subsequently, the teacher will entail the unwanted consequences of irresponsible expression of sexual desire. Within three years running the sexuality education-contained curriculum, the school has sent twenty four out of fifty resident teachers to the annual training provided by PATH. The school is committed to send the rest of the teachers to the annual training but that is entirely up to the spot, which is mainly based on the PATHâ€™s budget, given to the school. The number of the teachers sent to the training differs from year to year. In 2011, the school got the spot for seven teachers, while in 2012, the school was given out a quota of ten teachers. Despite the inconsistency of the number of teachers being sent, the figure indicates a constant willingness in massificating the HIV knowledge in the level of educators, which may be followed by the knowledge amplification within the students.
Knowledge Transfer in Extracurricular Setting The accomplishment of the school in sexuality education and HIV awareness magnification does not limit to the formal class setting. Still under PATHâ€™s initiative measure, the school initiated the extracurricular activity that revolves around HIV/AIDS issues. Named as Kor Paii club, the club is found in 2010 to endorse the students to be more aware of HIV issues and spread the knowledge to the fellow students inside and outside their school. Two teachers were selected to be trained by PATH to initiate the club. Subsequently, PATH also trained five students chosen by the two teachers to be the team leaders in the process of the club's commencing. The training for the students is consistently carried out annually yet the representative students are different from one year to another in order to rotate the team leader's position. The two teachers, along with PATH activist who will visit the club occasionally, will then be the facilitators of the club but still emphasize the club's campaign on the students' involvement. This year alone, the second year of club's existence, the club consists of 70 student members. These students are basically trained by the facilitators and the team leaders. With more students joining in, the club began to substantially perform a knowledge spillover role outside the formal class. Utilizing the regular and occasional events, the club performs its duty as HIV awareness promoter by setting up a booth where the fellow students can come and discuss HIV-related issues with the club members. Just like in the class, the 7
booth also normally provides instruments that demonstrate HIV knowledge in a form of leaflet, poster and free condom. In the bigger setting, the club may build more than one booth and each booth will carry specific sexuality education learning points. For example, in the setting of three booths capacity, first booth discusses how HIV is spread, the second emphasizes how HIV can be prevented, while the third focuses on the elimination of the discrimination towards HIV-infected people. In order to secure the accuracy of the knowledge transferred in the event, PATH staffs occasionally comes to assess the Kor Paii members’ performance. That way, there is a control mechanism in sustaining the capability of the club members in spreading the knowledge. The table below enlists the events in which Kor Paii club has performed their duty. EVENTS Pre-Valentine Day Children Day
World’s AIDS Day
Parents Day New Student Orientation Week
ACTIVITIES Setting up educational booths in their own school targeted to the fellow students. Cooperating with Yupparat Hospital, setting up educational booths in other schools targeted to the fellow students. Cooperating with Dan Sai Administration Office and Yupparat Hospital, setting up educational booths, targeted to all Dan Sai residents, in the public space such as Dan Sai town’s field or market. Free condom is substantially spread out. Setting up educational booths in their own school as well as other schools targeted to the students’ parents. Setting up educational booths in their own school targeted to the new students of M1 and M4
Table 2 Kor Paii Club's Activities
As the table above suggests, the club maintains cooperation with Yupparat hospital. This indicates that assuming that the hospital will only deal with the non-student population is an understatement. As the hospital is divided into different clinical management, the Community and Family Relations Clinic becomes the hospital’s front leader in engaging with the school and cooperation between Kor Paii club and the hospital is the epitome of it. Before 2010, or precisely before the emergence of PATH involvement, the clinic had tried to cooperate with schools to penetrate a bolder sexuality education by utilizing the importance of birth control and condom. Unfortunately, such effort did not gain warm response from the schools. With no exact guideline to follow, oftentimes the clinic has no clarity in mapping out their educational agenda towards the school. Today, with the existence of PATH’s guideline, the hospital works with Kor Paii club to expand the knowledge towards other schools. As mentioned in Table 2, the hospital has been engaging the role of Kor Paii club to use peer-to-peer knowledge transfer. The hospital agrees with PATH’s idea that transferring the awareness among the students is more effective than the typical practitioner-to-adolescent communication. In doing so, the hospital, along with occasional PATH staff’s assessment, closely monitor the delivery method conducted by the Kor Paii members. On top of that, the hospital will also 8
provide the budget and materials needed for the progress of the event. In retrospect, the cooperation between PATH, Kor Paii club and hospital represents the aspired school network designed by PATH and the Bureau of Local Government of Education. The cooperation between Srisongwat School, Kor Paii club, PATH and the hospital is proven to come to fruition with the knowledge expansion to other schools such as Phurua Wittaya School, Wang Ponggam Wittaya School, Dan Sai Wittaya School and Huay Mun Wittaya School and Prakaewarsa School through occasional events, regular discussion and the set up for the HIV-education student club. Within their own school itself, Kor Paii club has been actively transferring the HIV knowledge towards the fellow student friends. The club manages to perform their duty by utilizing both physical and virtual spaces. Kor Paii club runs a board magazine in which the HIV knowledge is conveyed through the attached leaflet and posters that are either self-made or given by PATH and the hospital. In addition, the club also runs a Facebook page. Kor Paii club created a page named "Sex Story" to help the students openly discuss sexuality-related information with the page administrators who are the senior students and hospital staff from Yupparat Hospital. Such open discussion has been a convenient platform to penetrate sexual health and HIV awareness information given that Facebook setting exudes a less serious realm than what students feels inside the classroom setting. The innovativeness of the club in diminishing the sexual health knowledge gap between the teachers and the students also becomes more evident with the anonymous mailbox system called "The Box". Kor Paii club provides the school with a mailbox where the students can anonymously send a letter containing questions related to sexual matters. At the end of school day Kor Paii members will collect the submitted letters and hand them to the facilitator teachers to be answered. The questions and the answers will then be announced in the following morning through the school's speaker every after the morning ceremony. All in all, the aforementioned breakthroughs confirm that the knowledge transfer of HIV awareness in the school may be carried out in day to day basis despite the singular schedule of the formal class.
HIV Knowledge Transfer in Non-Student Population UNESCO (2012) reveals that the key issues of HIV knowledge are the empowerment of both duty bearers and the target. Ideally, the duty bearer is the national government while the target is its citizen, particularly the key affected population groups. The role of national government as duty bearer, however, will be much more effective if it is mediated by and scoped down to certain actor that is, in hierarchic way, closer to the target population. While the position of duty bearers for student population can easily be scoped down to the school and its teachers, the non-student population may have a difficulty in accessing the knowledge due to the lack of clarity in defining the aforementioned duty bearers. Such assertion is commonly afflicted by the cases happening in developing countries in which the role of NGO 9
and other civil societies becomes more prominent, with little or no contribution from the government. Thai government, on the other hand, has been dubbed as a role model nation in which the government's involvement has been increasingly significant in combating the epidemic (UNAIDS, 2012) yet many civil societies also claim that the funding given to national AIDS strategy conducted by developing countries such as Thailand do not effectively aim the key affected groups (UNAIDS, 2011). The finding of how Dan Sai copes with the non-student population's lack of knowledge might be the right example to examine those assertions. With a substantial support from collaboration of Thai's Minister of Health, Minister of Interior and Bureau of Local Government for Education, Yupparat Hospital – Dan Sai's local hospital – has been carrying out the role of duty bearers to non-student population. Throughout the series of hospital's clinical and educational agenda, Yupparat hospital is the front leader of HIV-knowledge giver towards Dan Sai population who are no longer in school. Those knowledge-transfer agenda can be detailed into seven activities explained below. Internal Group Meeting It is important to note that, in regards to the multidisciplinary medical setting performed in the hospital, discrepancy of HIV-knowledge from one staff to another may vehemently exist. The doctors may know better than the nurses. The nurses in the laboratory for pathogenic diseases may understand the epidemic better than the nurses in pediatric clinic do. The internal group meeting, therefore, is designed to decrease the HIV-knowledge gap, along with other medical knowledge, among the staffs. This knowledge transfer is crucial given that, with the variety of opportunistic diseases that may easily appear towards HIV positive people, it is not uncommon for the HIV-infected patients to be transferred from one clinic to another. That said, the knowledge transfer also invests heavily on the elimination of stigma and discrimination towards the HIV-infected patients within the medical setting. World’s AIDS Day Annual Event As mentioned in Table 2, to commemorate the World’s AIDS Day, the hospital, cooperated with Dansai Government Council and Kor Paii club from Sringsongrak Wittaya School, creates an event that aims to teach the Dan Sai residents the HIV knowledge, particularly the endorsement of condom use. Designed with setting up several booths containing different information in regards to HIV awareness, the event normally takes place in the field in front of Dansai Governmental Office. Community Leader Meeting The hospital is aware of the prominent role of community leader in spreading health information towards each community in Dan Sai. Thus, the hospital has been sending representative to attend 10
the monthly community leader meeting arranged by Dan Sai’s central government. The meeting is attended by crucial community leaders such as kamnan (the head of subdistrict), pooyaiiban (the head of village), police, government officials and school teachers. The main objective of the hospital’s participation in the meeting is to penetrate the awareness of HIV as well as empower these community leaders to be more assertive and engaging towards the community they lead in terms of healthy and HIV-free lifestyle. Daily Radio Program As the main healthcare provider of Dan Sai residents, the hospital bears a responsibility to maintain the Dan Sai society’s healthiness. In conducting such responsibility, the hospital’s healthcare delivery does not only limit to on-site practice. A radio broadcast is utilized by the hospital to sustain the awareness of healthy lifestyle. Cooperating with the district’s only community radio station, the hospital runs a daily program from Monday to Friday on 11:00 to 11:59 and 14:00 to 15:00. Hosted by the hospital’s public health officer, Mr. Decha Saiboontang, the program becomes the hospital’s main tool for updating the current public health-related situation in Dan Sai. In doing so, the general health-related knowledge is inclusively delivered and HIV knowledge substantially becomes the content of such knowledge transfer. Given that 40% of the radio listeners are farmers, the radio program has been an effective instrument to transfer the HIV knowledge to this less-educated demography. In-House Newsletter Issued once a month, the hospital newsletter comes in limited number of exemplars. Targeted for the hospital visitors, the newsletter do not circulate outside the hospital. HIV knowledge is presented along with other general health information. Alongside the fresh information, the newsletter may also contain the summary of the news’ compilation that has been delivered in the daily radio program. Dissimilar to radio program, the hospital aims to target more sophisticated demographic. Announcement Board Just like in school, the hospital also employs announcement boards in which the hospital attach posters and leaflet containing basic HIV knowledge, such as the importance of safe sex, along with other general health knowledge. Ideally, each clinic has its own announcement boards and the attached HIV-themed poster might differ from one clinic’s board to another. For example, the maternity clinic may attach a poster showcasing the importance of HIV status test in order to secure baby to be HIV negative, while the general clinic may put up a poster that endorses the use of condom. 11
Speaker Announcement The hospital understands that in-house newsletter and announcement board may not always be effectively conveyed to all visitors. The speaker announcement is designed to present brief health-related information, including HIV knowledge, that can be easily digested by all visitors. While hospital newsletter and announcement board may not always be found in every corner of the hospital, the speakers that are installed to cover the whole space of hospital. Thus, though it is presented in very brief manner, the information is ensured to cover all visitors in every part of hospital. All in all, judging from the seven agendas explained above, the HIV knowledge transferred by the hospital does not seem to gain a higher priority scale given how most of the agenda combine the HIVrelated information with other health information. Another intriguing point from the hospital’s effort is that a mitigating program that targets key affected groups does not prevail significantly. This may, therefore, point out a palpable weakness of the knowledge transfer system for the non-student population in Dan Sai district.
SWOT Analysis of the Knowledge Transfer System As the previous chapters have brought out the epidemic trend and the methods of the knowledge transfer found in Dan Sai, the table below interpolates the aforementioned findings into an examination of strengths, weaknesses, opportunities and threats that are attached to the knowledge transfer scheme. STRENGTHS 1. Sexuality Education-contained curriculum conducted by Srisongrak School; 2. Commitment of Kor Paii club in knowledge spillover outside the formal class setting; 3. School network, executed by PATH, Srisongrak School and Yupparat Hospital, to penetrate the HIV knowledge to a wider student population; 4. Involvement of the hospital in the community; OPPORTUNITIES 1. 2. 3. 4.
Opening “Sex Story” Facebook Page to students from other schools; Support and guidance from PATH Organization Commitment of Thai Minister of Health’s National AIDS Strategy Support from the Bureau of Local Government of Education
Limits to HIV knowledge emphasize as the majority of hospital agenda slots in the HIV knowledge within the general knowledge Absence of hospital’s direct agenda targeted to the key affected groups: female sex workers, MSM and injected drug users; School that faces high vulnerability has not been covered by the school network
THREATS 1. The trend of pre-marital sex and promiscuity among student population; 2. Influx of Laotian female sex workers; 3. The trend of vocational college female students engaging in prostitution; 4. The trend of community leader engaging in sexual transaction; 5. The clandestine function of restaurant and karaoke in hosting the prostitution 6. Low awareness of HIV status check update
Table 3 SWOT Analysis
SWOT Strategies of the Knowledge Transfer System The project plan that may improve the system can be translated from the analysis of SWOT given in the previous section. Divided into four categories, the table below will provide action plans that take the strengths, weaknesses, opportunities and threats of Dan Sai’s HIV knowledge transfer system into a more solid mitigating measure in combating the HIV epidemic in the area. How the Strengths Take Advantage of the Opportunities 1. 2.
Promote Facebook Page “Sex Stories” for other schools’ students; Add network leader school in Service Area 19; 3. Add the frequency of PATH training for both teachers and students
How the Weaknesses is Overcame by Taking Advantage of the Opportunities 1.
Engage the hospital in a direct knowledge transfer to the key affected groups;
2. Push a stronger role of Bureau of Local Education in encouraging the implementation of curriculum How the Strengths Reduce the Likelihood and Impact of the Threats 1. 2.
Fasten the initiation of the sexuality education-contained curriculum in other schools; Set up more HIV-themed student clubs; 3. Emphasize “check your HIV status if you have engaged in risky situation” message and free test campaign
How to Overcome the Weaknesses that may Realize the Threats 1. 2. 3.
Design hospital’s specific HIV-awareness campaign outside the World’s AIDS Day event, e.g., one day of daily radio program is committed for sexuality-related discussion; Create hospital’s mitigating measures directly addressed to FSW, MSM and IDUs: HIV test routine, leaflet mentioning MSM and IDUs; Address the issues of prostitution in community leader meeting and work with in Dan Sai government in scaling up the campaign to uncovered schools, restaurants and villages
Table 4 SWOT Strategies
Conclusion The mechanism of HIV-knowledge transfer in Dan Sai is not only administered by the central government. In fact, the system is acknowledged by the collaboration of civil societes (such as PATH) and minister of education, the township government and the local hospital. The program reaches both student population and non-student populations in consistent basis, but in different scale. For the past few years, the programs has apperead in a constant schedule (for example: every world aids day or daily like a radio program). The knowledge transfer in the school deems to be strong given the effort on both formal class and extracurricular setting. Meanwhile, the knowledge trasfer for non-student population seems to
have a significant weakness in terms of lack of priority and the absence of direct program given to the key affection groups such as female sex workers and men having sex with men population.
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APPENDIX: Pictures Taken During The Field Research