Running head: PREVENTION OF HIV IN THAILAND

Prevention of HIV in Thailand Through Condom Use

Megan Dalrymple, Katie M. den Dulk, Caitlin A. Martinez, Andrea R. Moreno, Tuyet Nguyen,
Tiffannie N. Snyder, & Nora M. Vue
California State University, Stanislaus

PREVENTION OF HIV IN THAILAND

Prevention of HIV in Thailand through Condom Use

Executive Summary
The Human Immunodeficiency Virus (HIV) is an epidemic that is too familiar in
Thailand. Thailand has the second highest HIV prevalence in the continent of Asia and there
were over 500,000 existing cases of HIV in 2005 (Park et al., 2010). Due to the high prevalence
and transmission in the country, prospective reduction initiatives have been set out in our
proposed program, Condom Culture. This program provides an analysis of the prevalence of
HIV in Thailand and the prospective decline of transmission with the correct use of condoms.
Our proposed program is designed to decrease the HIV transmission rate in Thailand by
educating our participants on how to use condoms correctly and teaching the benefits of using
condoms to prevent the transmission of HIV. Our target population includes those who are at
high risk for developing HIV, which includes sex workers, intravenous drug users, youth, and
homosexual men in Thailand. We have focused on this population because we believe that once
the transmission rate decreases in the high-risk population, it will in turn decrease the
transmission in low-risk groups. Our proposed solutions include developing the sexual health
curriculum in schools and high risk groups, implementing a mass media project about the HIV
transmission risk, and increasing the availability and accessibility of condoms. Condom Culture
is projected to increase correct condom use in those who participate in our program by 35% in
Thailand, which in turn will decrease the transmission of HIV in the overall population. We
propose that 98% of participants in the program will know how to use the condoms correctly at
the end of our teaching. By the end of the second year of our program, 60% of participants will
report that they have used condoms correctly with each sexual encounter. The ultimate goal of
implementing Condom Culture in Thailand is a 30% decrease in HIV transmission in the

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Thailand population in 10 years. In order to achieve this goal, all divisions of the program will
be fully implemented within one year of the start of the program and we will quarterly assess that
we are meeting our intended goals by use of a Gantt chart (see Appendix A).
Background
Prevention of HIV with condom use is an undertaking that is fitting for the country of
Thailand. As previously mentioned statistics show that Thailand has the second highest HIV
prevalence in the continent of Asia (Park et al., 2010). What is causing this epidemic? To start,
Thai youth of today are exposed to two different views regarding sexuality and HIV and AIDS
(Thianthai, 2004). The first view is more of a traditional, old world view. As with any culture,
children are expected to fulfill specific gender roles. Thai girls are taught to be reserved and
nave in regards to sexuality, while Thai boys are encouraged to explore sexuality. In fact, it is
an accepted rite of passage that teenage boys in Thailand visit a prostitute for their first sexual
experience (Thianthai, 2004).
Western society has also been a major influence in Thailand, creating the second, new age
view on sexuality and HIV and AIDS (Thianthai, 2004). Some Thai individuals are moving
away from the traditional values that they have been conditioned to believe. These Western
influences encourage young Thai women to discuss sexuality and engage in premarital
intercourse. To combat both of these views, Thai youth receive sex education in schools. Yet,
young women state that the emotional impact of a sexual relationship is not addressed, creating
an imbalance between premarital intercourse and knowledge of emotional impacts of such
activities (Thianthai, 2004).
The problem arises when the old world beliefs and the new age views collide. Young
Thai boys looking for a girlfriend seek the good girl image that is exemplified in Thai culture

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(Thianthai, 2004). Many young Thai boys do not feel the need to use protection with good girls
because these girls do not pose a risk. These young men do not realize the risks associated with
unprotected sex. Furthermore, they do not recognize the changing culture that encourages
expression of sexuality and premarital intercourse among young Thai women, thus increasing the
risk of HIV transmission (Thianthai, 2004).
The risks of HIV transmission embedded in Thai cultural beliefs increase even further in
vulnerable populations, such as with homosexual men, intravenous drug users, and sex workers
(Tan, Huedo-Medina, Warren, Carey, & Johnson, 2012). These individuals increase the general
populations risk of contracting HIV through a process called sexual bridging (Tan et al., 2012,
p. 676). For example, in the case of a low-risk individual who has a sexual encounter with a
high-risk sex worker, the low-risk of the individual dramatically increases because of the high
number of sexual partners that the sex worker has had. The low-risk individual is essentially
being exposed to all of the previous partners that the sex worker has been with (Tan et al., 2012).
Sex work in Thailand is illegal, but not regulated (Wirtz et al., 2014). Sex workers in
general are not a population that is well-respected. Because of the illegality and lack of
regulation in their work, they have very few rights. Some sex workers feel that if they seek out
HIV prevention programs, they will be arrested. This fear prevents them from obtaining the
preventative care that they need (Wirtz et al., 2014).
Initiative has been taken to reduce transmission of HIV and to prevent the infection
altogether, but there is still need for more improvement (Park et al., 2010). The Thai government
has teamed up with nongovernmental organizations to establish policies and funding that have
brought them much success. An example of a recently established prevention program is the
Thai Women and AIDS Task Force. The combination of prevention programs and a disease

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surveillance system has allowed Thailand to reach Millennium Development Goal 6, which aims
to decrease the spread of HIV by 2015. Some interventions have been aimed at the increase in
correct use of condoms and increase in education regarding HIV transmission and prevention.
This has been accomplished through government policies and public health efforts. These
efforts, which have been implemented for over twenty years, have proven to be effective because
although there were over 500,000 existing cases of HIV in 2005, only 3% were new cases (Park
et al., 2010).
There is new concern that successful prevention strategies may become less effective
with the changing sexual behaviors and attitudes from past to present decades, (Park et al.,
2010, p. 430) which makes continued assessment and interventions increasingly important.
Because of the proven effectiveness of the previously mentioned interventions, our program
focuses on similar strategies of promoting the correct use of condoms and educating program
participants about HIV transmission. The literature review to follow will further shed light on
recent research, programs, and efforts regarding reduction in HIV transmission.
Literature Review
Thailand has become a target for HIV prevention and education (Park et al., 2010).
According to a recent article, the Thai government and its nongovernmental organization
collaborators launched programs to increase condom use, implement education, public
awareness, and decrease prostitution services. The national transmission rate in 1991 was 32%;
however, by the late 1990s, the transmission rate decreased to 4%, which correlates with
prevention strategies that were implemented. Despite the success of lowering its transmission
rates, the subgroup that continues to be the biggest concern with the highest transmission rate is
the male sex workers. In response, the Thai government generated a 2008 plan to target these

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specific subgroups and provide them with education and easy-access to condoms and lubricants
(Park et al., 2010).
Thailand is considered as mixture of concentrated and generalized epidemics of HIV
infection (Pattanaphesaj & Teerawattananon, 2010, p. 1). This review measured the changes in
risk behaviors, incidence, and cost-effective interventions per HIV infection averted or cost per
quality-adjusted life year gained and identified a comprehensive list of HIV/AIDS preventive
interventions that are likely to be effective in Thailand. The findings demonstrated that school
based sex education, HIV counseling, HIV testing, male condoms, street outreach programs,
needle and syringe programs, programs for the prevention of mother-to-child HIV transmission,
male circumcision, screening blood products and donated organs for HIV, and increased alcohol
tax showed strong evidence of reducing HIV infection among targeted populations in Thailand.
Condom use was proven to be effective for the majority of targeted populations in Thailand,
including sex workers, injecting drug users, men who have sex with men, serodiscordant
couples, and general people as well (Pattanaphesaj & Teerawattananon, 2010).
In the article, A Meta-Analysis of the Efficacy of HIV/AIDS Prevention Interventions in
Asia, 1995-2009, Tan, Huedo-Medina, Warren, Carey, and Johnson (2012) evaluated and
compared studies which contained various interventions in Asia aiming to increase condom use
and decrease HIV/AIDS transmission. In Asian countries, HIV is prevalent among injection
drug users and female sex workers, these high-risk populations increase HIV risk to lower-risk
populations since they often times have multiple sexual partners. In addition, the authors of the
study found that it is important to evaluate socio-ecological structures, and gender composition.
The study found that behavioral risk-reduction interventions that were the most successful in
reducing the incidence and risk of HIV, were even more successful when the population included

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more women, incorporated life goals and social values, and excluded sexually transmitted
infection testing without using risk-reduction strategies (Tan et al., 2012).
In the article, State of Condom Use in HIV Prevention Science and Practice, Crosby
(2013) discusses how condoms still remain the frontline defense against the HIV/AIDS
pandemic. It was found in recent studies that condoms are 80% effective against HIV with
consistent use. Recent advances in condom use include improved measurement of condom use
behaviors, innovations in the design of condoms, and greater intervention efficiency for high-risk
populations. The science of condom use for HIV prevention is rapidly evolving and this article
mentions female condoms as an example of an innovation that is intended for giving women
options that they can control. Combination prevention will also be an important strategy in the
future, which includes the combination of condoms with any given biomedical innovation,
including vaginal microbicides. Crosby discusses how viewing condoms as a prophylactic
causes people to think of disease prevention, which is not compatible with satisfying, pleasurable
sex. The author concludes that future of condom use in preventing HIV is dependent on redefining condom use as a method of making sex healthy and satisfying (Crosby, 2013).
A high incidence of HIV is prevalent among female sex workers in the countries of
Kenya, Thailand, Brazil, and Ukraine (Wirtz et al., 2014). The authors came up with a model to
theoretically predict the effectiveness of increased community-led peer education programs.
They also studied the effects of increased antiretroviral therapy available to female sex workers
who have CD4 levels that qualify for treatment. The authors concluded that community
empowerment programs and actions to address the rights of sex workers, as oftentimes they are
discriminated could reduce or maintain infections. Furthermore, antiretroviral therapy could
significantly decrease the rate of new infections (Wirtz et al., 2014).

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The qualitative study of, Gender and Class Differences in Young People's Sexuality and
HIV/AIDS Risk-Taking Behaviours in Thailand, Thianthai (2004) evaluated Thai youth
between the ages of 15 and 19 years old regarding their perception of HIV/AIDS. Results
showed that Thai youth were knowledgeable about how HIV is transmitted, treated, and how to
protect themselves. Yet young Thai men have still admitted to visiting female sex workers.
Results also showed that young Thai women are conflicted between cultural beliefs that a Thai
woman is expected to be refrained regarding sexuality and Western influences making it difficult
for young Thai women to request the use of a condom and protect themselves against HIV. The
biggest HIV risk factor found in all participants of this study was that many participants agreed
that there was no need to use protection with a good Thai boy or girl because they felt there was
no HIV risk (Thianthai, 2004).
In the article, Common Principles Embedded in Effective Adolescent HIV Prevention
Programs, evidence-based programs are compared to see the common successful trends that
help adolescents shift their HIV risk behavior (Rotheram-Borus, Ingram, Swendeman &
Flannery, 2009). Theses evidence-based programs had ten common elements or core principles
that helped the adolescents with HIV prevention. The core principles revolved around protecting
yourself, self-worth, self-control, risk verses reward, sharing the knowledge of sexual diseases
and how they spread, protecting others and showing others respect, how to be prepared for
sexual interaction, how to diffuse sexual interaction, and change yourself for you because you
are worth it. This article lays out how these ten common principles were used in the evidencebased prevention programs and compares the different activities each program used to reach the
same goals (Rotheram-Borus et al., 2009).

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Studies researched for Condom Culture in Thailand document prevalent Thai cultural
beliefs, behaviors, evidence-based programs, and high risk groups. The literature reviewed also
provides evidence-based interventions that have resulted in decreased HIV transmission rates in
Thailand. The programs most successful in decreasing the HIV rate in Thailand and that will be
implemented in Condom Culture encouraged behavioral risk reduction interventions such as
condom use, education, and the targeting of women in the awareness of HIV/AIDS. Other
interventions that will utilized from the literature review for high risk populations are lubricant
use and availability amongst male sex workers, HIV testing and counseling, use of female
condoms, making condoms more pleasurable, street outreach programs, improved screening of
blood products and organs for donation, needle and syringe programs, and antiretroviral therapy.
Though it is a still a constant challenge to lower the incidences of HIV transmission, with the
increase of HIV prevention and education, the transmission rate has shown a steady decline,
validating the success of these interventions.
Goals and Objectives
The overall goal of Condom Culture is that it will contribute to the decreasing HIV
transmission rates by 30% within 10 years in Thailand by promoting correct condom use. The
goal will be obtained by setting three specific objectives. The first objective is to increase the
correct use of condoms by 35% in targeted high-risk groups, including sex workers, intravenous
drug users, youth, and homosexual men, in Thailand within 10 years. This objective will
contribute to the overall goal by decreasing the risk of HIV transmission. The second objective
is that 98% of participants in the program will know how to use condoms correctly; therefore, it
will help decrease the transmission rate, especially from high-risk groups to low-risk groups.

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The third objective is that by the end of the second year, 60% of participants will report that they
have used condoms correctly with each sexual encounter.
For the first objective, the program will develop the sexual health curriculum in high
schools with free condom incentives using different teaching styles to engage the students. A
program coordinator, along with other staff members, will be selected and trained for the high
school sexual health education. Interventions like education on the benefits of condom use and
offering emotional and financial support available if necessary are just two ways to guarantee
success with this objective. Implementation of a high-risk outreach program is also essential in
creating progress in other high-risk populations. The program will provide free condoms to
high-risk groups for the duration of Condom Culture.
For the second objective, the program, with the support of the government, will
implement a mass media project regarding the HIV transmission risk with every unprotected
sexual encounter. A coordinator will be selected to manage implementation of the mass media
campaign.
For the third objective, the program will focus on the availability and accessibility of
different types of condoms with reduced prices at various vendors, including grocery stores,
cosmetic stores, and shopping malls. Also, the program will provide free condoms during
Condom Month for completing a Condom Awareness survey. A coordinator will be selected to
organize partnerships between condom companies and potential businesses.
To obtain all three objectives, the program will first establish headquarters in major cities
and select program coordinators. The main headquarters will designate main contacts so that all
sub-program activities can utilize additional assistance if necessary. Early implementation of
coordinators will help determine the high-risk populations in individual provinces of Thailand.

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Early identification of high-risk populations will help the program coordinator determine the
needs of those specific populations. All divisions of the program will be fully implemented
within one year of the start of the program. The technical approach section will discuss how to
carry out these three objectives in detail in order to obtain the main goal.
Technical Approach
The main goal of Condom Cultures technical approach is to fulfill the goal and
objectives described in the previous section. As revealed in the Condom Cultures Logic Model
(see Appendix B) there are many steps, resources, and activities needed to help achieve the main
goal. Once the seeds of knowledge have been planted, changes in attitudes and practices can be
made.
Condom Cultures activities will change attitudes and practices. As stated before,
Condom Culture will develop teams with a coordinator to help maintain organization and
communication. The financial stakeholders or partners are: local hospitals, health clinics, social
services, grocery stores, mom and pop businesses, community leaders, government officials,
World Health Organization (WHO), United Nations, condom companies, retail outlets, private
businesses, colleges, and universities. All these organizations can help through contribution such
as input, grants, volunteers, and generous donations.
Through the resources provided by Condom Culture, high schools will offer updated
sexual health curriculum to all students with free condom incentives. As one study states,
adolescents account for 50% of new HIV infections worldwide (Rotheram-Borus et al., 2009,
p.387). Another study shows that school based sex education is both efficient in changing HIV
risk behaviors and is cost-effective (Pattanaphesaj & Teerawattananon, 2010). School staff and
health aides at each high school site will be trained by Condom Culture to deliver up-to-date

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evidence-based data on how to prevent, identify, and live with sexually transmitted diseases. The
staff and health aids will be assessed through testing to ensure they know the material that they
will teach to the students. Condom Culture will also have video presentations, guest speakers,
and an activity packet for the students to complete. This packet is based on the ten core
principles that the article Common Principles Embedded in Effective Adolescent HIV
Prevention Programs identified as being highly successful in helping adolescents practice safer
sex methods (Rotheram-Borus et al., 2009). At the end of the semester, at each participating
school, the students will fill out a survey to show what they have learned, if they will use a
condom in the future, and how they think this program can be improved for future students. The
communitys input helps Condom Culture to evolve over time to ensure it stays current and helps
promote the message of HIV prevention through condom use. At the end of the first year, at least
20% of the high schools in Thailand will be using the Condom Culture program. The
coordinator in charge of the School Education Program will collect the needed data obtained by
the schools teachers and students.
For the rest of the high-risk target group (sex workers, intravenous drug users, and
homosexual men in Thailand) free male and female condoms with lubricants will be given.
Since these high- risk individuals may not want themselves identified, Condom Culture will go
to known areas in Thailand, determined through surveys and local demographic information,
where these high-risk groups congregate and set up a coordinator with an outreach program. As
recent studies have shown, the use of condoms has decreased the spread of HIV by 80% (Crosby,
2013). By providing condoms to stay safe and the education on how to use them correctly, this
outreach program helps neutralize the most at risk. In 2008, the Thai government targeted these
high-risk groups by providing them with education and easy-access to condoms and lubricants.

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Condom Culture plans to support and help this program continue because it has shown a steady
decline in HIV transmissions, thus, proving its effectiveness with its interventions (Park et al.,
2010). The coordinator of this section will be a sub-coordinator who works with the established
government operated program, collects needed data, helps administer needed condoms,
educational materials, and helps organize educational classes for high-risk groups.
The government will also work with Condom Culture by the implementation of a mass
media campaign including: public service posters, commercials, and radio advertisements about
HIV risks with every unprotected sexual encounter. Surveys to the public will determine which
method of advertising is best to reach the general public. After the best method is determined
and media campaign perfected, 25% of the public when asked by survey should be aware
Condom Cultures message by the end of the year. The coordinator of this section will have the
largest team to help manage the different aspects of organizing a media campaign and calculating
the data provided. The input of local businesses and health department volunteers will spread the
word about this program. In addition, paid positions for graphic designers, website designers,
information technologists, educators, and trainers for sexual education will be needed. The
development of a government-based website for easy access to standardized information about
HIV prevention can be obtained by the Thailand public, along with addresses of local shops that
sell inexpensive condoms. The development of a media campaign, contracted celebrities, radio
personalities, endorsements, posters, brochures, cards, and other media will fill the streets and
airways with Condom Cultures message. In this way the message of how dangerous it is to have
unprotected sex and the realities of sexually transmitted diseases, especially HIV, will reach the
Thailand community.

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The availability and accessibility of different types of condoms with reasonable prices
will be present throughout Thailand. Local vendors in grocery stores, cosmetic stores, shopping
malls and private vendors will work with Condom Culture to offer discounts for lubricants and
condoms, male and female. Due to the programs bulk buying of condoms their prices can be
reduced. Also, Condom Culture will be able to offer free advertising to businesses on the
condom packaging. Spot inspections by this sections coordinator on different vendors who are
selling these items will be preformed to ensure availability and price. Vendors of condoms and
lubricants will be asked to keep records on products they are stocking and selling to help
Condom Culture evaluate the effectiveness of their condom promoting tactics. This data will be
reported to and recorded by this sections coordinator.
Condom Culture will offer other incentives during Condom Month. For the duration of
Condom Month free condoms will be offered to the public for completing a government
survey entitled Condom Awareness. This government survey will help Condom Culture evaluate
quantitative and qualitative data gathered from the community who complete the survey. At the
beginning of the Condom Month, the survey will establish a baseline of the Thailand
community understanding of sexually transmitted diseases, HIV, condom use, how to use a
condom correctly, why condoms are used, and if they personally use a condom. From the
answers and data gathered from this survey the Condom Culture program will model a plan to fit
the communitys needs. Throughout this month, classes and programs will enable the public
access to activities that will utilize the same core concepts found in article Common Principles
Embedded in Effective Adolescent HIV Prevention Programs (Rotheram-Borus et al., 2009). At
the end of Condom Month, a questionnaire will be given to Thais that participated to evaluate
what they have learned. The next year, during Condom Month, the government survey will be

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given again and the answers of the first survey will be compared. This sub-coordinator will
collect and maintain all surveys from Condom Month and monitor Condom Month activities
for quality assurance. The sub-coordinator will work under the coordinators who are in charge of
condom supplies and school education. After ten years of condom awareness, the attitudes of the
Thailand community should be evaluated and a change in practice noted. As seen in the surveys
over time, the Thailand community who participated in Condom Cultures activities should have
changed their practices and incorporated safe sexual activities into their daily life.
The Condom Culture program needs input from many different organizations to help
achieve its goal. Schools, government, vendors, and the Thailand community need to be willing
to make a change and become a Condom Culture. An outline and timeline of what this
program plans to do in its first year of operation can be seen on Gantt chart (see Appendix A).
Overcoming Barriers
As with most cultures, talking about sex can be taboo or uncomfortable. One of the
biggest barriers is overcoming the stigma of talking about sex. By flooding the airways, streets,
and schools with information about condom use, a discussion within the Thailand community
about safer sex practices can begin. As in the article, State of Condom Use in HIV Prevention
Science and Practice, the Condom Culture program plans to spin the use of female and male
condoms with lubricants as a way to enhance sexual pleasure with the added benefit of
decreasing HIV transmission. By focusing on the experience of how sexual encounters can be
more satisfying to the individuals involved, the participants will be more likely to use a condom
(Crosby, 2013).
Another aspect that will need to be addressed is the politics of this culture. It is important
for the Condom Culture program to interact with leading members of the community who

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understand how things work. This program will network with local government officials and
community leaders, who want to promote a healthier Thailand and understand the need to
promote new educational ideas. The coordinators in charge of different sections of the program
will meet monthly with the community leaders and sponsors to ensure that goals, timelines, and
deadlines are met.
One of the most common obstacles to overcome is funding. How will Condom Culture
be able to supply these education materials, condoms, and fund the mass media? The
government, schools, local and private businesses will help fund Condom Culture. By letting
local and private businesses advertise, within reason, on Condom Cultures educational
materials, they will pay for these items. The government-run website will help ensure that the
information is correct and not tampered with. High school students will help design and
distribute information to the rest of the Thailand community. World-known organizations, such
as WHO and the United Nations will help promote and fund Condom Culture due to the valuable
research this program will gather from the Thailand community in the surveys they have filled
out.
Monitor and Evaluation
The purpose of monitoring and evaluating a program is to ensure accountability and
inform progress improvements, to secure future funding, to monitor progress of a program in
comparison to original goals, to motivate staff, and to learn and evaluate the experience (Energy
Saving Trust, 2014). Therefore, it is important to assess where the program is evolving in the
projected 10 years. By the end of the first year, headquarters should be established in six major
cities of Thailand: Bangkok, Nonthaburi City, Pak Ket, Hat Yai, Korat, and Chiang Mai. In
making sure that rental buildings will be equipped and ready for service, there is timeline set and

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collaboration with the constructors and office supply companies and written contracts will be
established. The contract will be reviewed with the construction company every two months to
ensure that contract agreement is still intact and goals will be met.
In order to ensure that each part of the program is appropriately monitored, there will be
coordinators for each program: School Education and High Risk Program, Mass Media Program,
and Condom Availability Program. The coordinator of each program is responsible to monitor
and evaluate their assigned programs and report to the Condom Culture monitor and evaluator
lead. Each program will have a schedule of deadlines and dates as to when they are to
accomplish specific tasks and will meet with the monitor and evaluator lead every month to
discuss any issues that develops and the status of the program.
Recruitment will be held by the human resource staff and will be required to hire staff
within three months. Job postings will be available through newspaper ads, workforce agencies,
and online. To monitor which source is the most effective for future employments, applicants
will be asked about the source of knowledge of the position on the application. Human resource
will report to the monitor and evaluator lead on a weekly basis of the number of applicants and
interviewees. By the end of the second month of recruitment, human resource will report the
final number of applicants who meets requirements and will be contracted for hire. Staff will be
trained in a classroom setting where they will have opportunities to practice teachings to clients.
In order to ensure that training is adequate and staff is providing efficient information, they will
be assessed by taking an assessment on the training materials at the end of the training. With the
minimum passing score of 80% will determine that staff is competent. Those who do not pass
assessment with the minimum score are subject for additional training until a score of 85% is
achieved. Additionally, before being approved to do teachings to the public the staff will deliver

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teaching to trainer. During the program, evaluator will shadow each instructor during a teaching
every six months to ensure that curriculum is being followed and quality of the teaching is being
met.
The School Sex Education and High Risk Program will prepare school staff with
adequate HIV and sex education. At the end of training, school staff and health aids will be
assessed on knowledge with an assessment test. A passing score of 80 % determines that
teaching has been effective and school staff has adequate knowledge to teach students. If
passing score is not met with initial assessment test, additional teaching will be provided. To
make sure that the program is being used in 20% of school in Thailand, schools will be given a
survey where they can state if they are effectively using the program and how often.
Furthermore, students who participate in the program will be given a survey to determine how
much they have learned, the effectiveness of the program, and how likely will they use a
condom. The High Risk Outreach Program will use the same standards to determine the
effectiveness of the program.
The effectiveness of mass media will be monitored and evaluated through surveys given to
individuals who participate in the programs. Questions will verify if they have seen any
advertisements, commercials, media news, and how they learned or heard about the program.
Surveys will be collected by the Mass Media Program coordinator and used to determine how
effective the mass media is exposing the program to the public. It will also help establish the
percentage of Thailands population that is being reached through media (The Presidents
Emergency, 2013). Once surveys are evaluated, they can determine the percentage by dividing
the numbers of people who have seen any form of mass media by the total population.

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Participating vendors will be asked the quantity of condoms that is in-stock and how much
they sell monthly. The data will help evaluate the increase in sells and the condom availability in
various areas. The amount purchase can help determine the percentage of Thais that are able to
get condoms on their own. Increase in number of sells will validate the purpose of the program
and its effectiveness (The Presidents Emergency, 2013). All data will be collected by
Condom Availability Program coordinators and reported to the monitor and evaluation expert
during their monthly meetings.
To monitor and evaluate the goal of having 98% of Thais who participate in the program
correctly use a condom on a model; we will have to provide teaching and education. Before the
teaching, participant will be given a questionnaire that asks about their knowledge about
condoms and how often do they use condoms. Once teaching has been provided, clients will be
asked to demonstrate how to properly place a condom on a model. Depending on the results, if
additional teaching is required, the client will receive further teaching until client feels content
and has a good understanding of the information. To evaluate teaching, clients will be given the
same questionnaire after teaching to modify their knowledge level and the likelihood that they
will use condoms with each sexual encounter. Clients who participate and complete a survey
regarding the teaching and the efficacy of the program will receive free condoms as an incentive.
In order to ensure that we will decrease HIV transmission by 30% in the general
population by the 10 year goal, statistics and data will be monitored and evaluated on a yearly
basis. By the end of each year, staff will evaluate and go through health records of prevalence
and transmission rates of HIV in Thailand from local health facilities and Centers for Disease
Control. The records should indicate that since the initiation of the program, there is a decline of
HIV transmission rate in Thailand. However, if records conflicts with the programs goal, there

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should be further evaluation for modification and improvements in the program. Additionally,
the general public will receive free condoms as an incentive to complete a survey regarding the
satisfaction and attitude about the program and condom usage.
School Education and High Risk Program, Mass Media Program, and Condom
Availability Program coordinators will monitor and report statistics and numbers from each of
their program with the monitor and evaluation lead during their monthly meetings. The School
Education and High Risk Program coordinators will determine through surveys if there is a
decrease in satisfaction ratings in school sex education teaching, school curriculum, and outreach
programs and if they should be re-evaluated for more effective approaches. The Mass Media
Program coordinator will monitor the percentage of Thais population that has been reached with
media which will determine which media source is effective; therefore, we should turn our effort
to the media source that is proven to be most successful. When monitoring condom access and
availability, the Condom Availability Program coordinator will report the number of condom
purchases that will help determine the percentages of Thais that are able to afford condoms and
how to make condoms more assessable to the public. Continuous and frequent monitoring of
these programs is crucial in providing data that can be used to modify and maintain efficiency of
the program.
Surveys and HIV statistics will help the program determine the modifications and
improvements needed to make the program as successful as possible. After evaluating the
programs and goals, every three months, meetings amongst headquarters leaders should be
established in discussing the findings. Any modifications or improvements to the program
should be initiated in the months to follow and re-evaluated in continuation of meeting the goal.

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References
Crosby, R. (2013). State of condom use in HIV prevention science and practice. Current
HIV/AIDS Reports, 10(1), 59-64. doi:10.1007/s11904-012-0143-7

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Energy Saving Trust. (2014). How to monitor and evaluate your community project. Retrieved
from http://www.energysavingtrust.org.uk/Communities/Support-and-guidance/How-toguides/How-to-monitor-and-evaluate-your-community-project
Park, L. S., Siraprapasiri, T., Peerapatanapokin, W., Manne, J., Niccolai, L., & Kunanusont, C.
(2010). HIV transmission rates in Thailand: Evidence of HIV prevention and
transmission decline. Journal of Acquired Immune Deficiency Syndromes, 54(4); 430436. Retrieved from http://130.17.174.102/illiad/illiad.dll?
Action=10&Form=75&Value=117530
Pattanaphesaj, J., & Teerawattananon, Y. (2010). Reviewing the evidence on effectiveness and
cost-effectiveness of HIV prevention strategies in Thailand. BMC Public Health, 10(1),
401. Retrieved from http://www.biomedcentral.com/1471-2458/10/401
Rotheram-Borus, M., Ingram, B., Swendeman, D., & Flannery, D. (2009). Common principles
embedded in effective adolescent HIV prevention programs. AIDS & Behavior, 13(3),
387-398. doi:10.1007/s10461-009-9531-4
Tan, J.Y., Huedo-Medina, T.B., Warren, M.R., Carey, M.P., Johnson, B.T. (2012). A metaanalysis of the efficacy of HIV/AIDS prevention interventions in Asia, 1995-2009. Social
Science & Medicine, 75, 676-687. doi:10.1016/j.socscimed.2011.08.038
The Presidents Emergency Plan for Aids Relief. (2013). Next Generation Indicators Reference
Guide. [Data file]. Retrieved from
http://www.pepfar.gov/documents/organization/206097.pdf
Thianthai, C. (2004). Gender and class differences in young people's sexuality and HIV/AIDS
risk-taking behaviours in Thailand. Culture, Health & Sexuality, 6(3), 189-203.
doi:10.1080/1369105031000156379

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Wirtz, A. L., Pretorius, C., Beyrer, C., Baral, S., Decker, M. R., Sherman, S. G., . . . Kerrigan, D.
(2014). Epidemic impacts of a community empowerment intervention for HIV prevention
among female sex workers in generalized and concentrated epidemics. Plos ONE, 9(2),
1-11. doi:10.1371/journal.pone.0088047

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Develop ofcal government

brochures and cards. Develop
partnership with condom
companies. Develop
partnership with vendors.
Create "Condom Awareness"
survey.

General population, sex workers and clients, gays, IV drug users and
youth.

Target Population Defned:

Government schools
WHO/United Nations
Private business/ grocery stores/ retail outlets
Government funded healthcare/social service agencies
Colleges and Universities
Private Schools
Health clinics/ Hospitals
Condom companies

Stakeholders/Partners Identifed

Implement ThisWay

K:Thai's will have knowledge

of condom accesibility. A:
Thai's will be willing to
purchase condoms.

Availability & accessibility of

diferent types of condoms
with prices at vendors,
grocery stores, cosmetic
stores, and shopping malls.
Provide free condoms during
Condom Month for
completing Condom
Awareness survey.

Local businessess. Condom

companies. Graphic design
company. Printing materials.
Management training. Hire
employees for outreach
programs.

K:Thai's will have

knowledge of methods of HIV
transmission. A: Thai's will
aknowledge that HIV can
occur to anyone regardless of P: Thai's of all socioeconomic HIV transmission in general
social status or physical
statuses will make correct use population by 30%in Thailand
attributes.
of condoms.
within 10 years.

Government and the program

will implement a mass media
project including public
service posters, commercials,
and radio advertisements
about HIV risk with every
unprotected sexual act.

Develop media campain.

Funding. Graphic design
Develop posters. Build
company. Radio personalities. services with media agencies.
Celebrities. Contracts for
Contract celebrity
billboards. Local businesses. endorsments. Develop
Local health department.
government program website.

P: Thai's will purchase

condoms more often.

P: Thai's will use a condom

correctly for each and every
sexual encounter.

the %of reported correct

use of condoms amongst
male and female sex workers,
IV drug users, and homosexual
men within 10 years by 35%in
Thailand.

K:Thai's will have increased

knowledge of benefts of
correct use of condoms. A:
Thai's will be willing to learn
about and use condoms
correctly.

Impact

Schools will ofer updated

sexual health curriculum to all
students in high school with
free condom incentives. Free
male condoms, female
condoms, and lubricants to
high risk citizens for the
duration of the program.

Efects
Practices

Establish headquarters for all

aspects of program. Develop
curriculum packet. Guest
speakers. Role playing
activies. Video presentations.
Develop outreach programs
for high risk citizens.

Knowledge/Attidues

Funding. School employees.

Actors/students. Schools.
Educators and trainers. Guest
speakers. Models. Computers
and video equipment.
Publishing company. Sex
education researchers.

Activities

ProgramActivites/Outputs
Outputs

Planning+Support Activites/Outputs
Activities
Outputs

Inputs

Plan ThisWay

Appendix B
Causal Pathway Logic Model - CondomCulture Project - Thailand

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