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THAILAND
Situational Analysis of Young People at Higher
Risk of HIV Exposure in Thailand
Petchsri Sirinirund
Advisor to the Department of Disease Control
MOPH, Thailand
Updated from slides prepared by Mara Steinhaus (Data Management Technical Advisor)
and Catherine Lee (Principal Investigator)
Study Background
• Organizations involved:
• National AIDS Management Center (users)
• UNICEF/UNFPA/UNESCO (donors)
• Thammasat University (research team)
• Community-Based Organizations (implementing partners)
• Study timeframe: Scoping mission (March 2013) and
research project (May 2013-April 2014)
2012-2016 HIV new infections projected by AEM
Of the
38,883 new
cases
reported,
89% are
among key
populations
33 provinces
contain 66%
of all new HIV
infections
Study Aims
“To assist in strengthening national capacities for improved
policy advocacy and informed decision-making on issues of
equity, social inclusion, and protection of youth at higher
risk of HIV exposure by offering an evidence base.”
1.
2.
3.
4.
Review the situation of young key affected populations (YKAP)
Review the present policy and programmatic response for YKAP
Identify gaps and needs, as well as promising practices for
YKAP
Determine strategic future policy and programming interventions
for YKAP
YKAP Groups (aged 15-24 yrs)
• Females who exchange sex for money/goods (FSW)
• Men who have sex with men (MSM)
• Non-Thai migrants
• Transgendered youth (within FSW and MSM networks
and in FGD and network on their own)
• Youth who inject drugs (within all networks and in FGD on
their own)
Ethics and Safety Considerations
• Approved by the ethical review committee at Thammasat
University
• To minimize social risks
• Consultation with local organizations and key stakeholders prior to
the start of data collection
• Meeting with YKAP to discuss the study background, purpose and
procedures as well as measures to ensure confidentiality and
privacy of the respondents
• Data collected by using respondent-controlled mobile
devices
• Respondents aged 15-17 yrs were asked to state reasons
why parental/guardian consent could not be obtained
Methods
• Literature review
• Secondary analysis of existing national and provincial-
level datasets
• Key-informant interviews
• Identification of common key factors relevant to service delivery for
YKAP
• Primary data collection
• Focus groups
• Identification of common factors related to behaviors, access to
and use of services
• Individual surveys using Respondent Driven Sampling
Study objectives
• The study includes three units of analysis and combines
qualitative and quantitative measures:
• (a) an analysis of factors related to HIV exposure risk using primary
and secondary data
• (b) a health and social service needs assessment starting with a
mapping of existing services at each site location and information
from primary data collection on specific needs to highlight gaps and
needs
• (c) an ecological approach to integrate findings on the situational
analysis of young people at higher risk of HIV exposure
Formative Research
• Scoping Exercise Feb. 5th – March 5, 2013
• Literature review
• Service mapping
• Face to face meetings (22 total across four provinces)
• Areas of investigation (Johnston, Whitehead, Simic-Lawson, &
Kendall, 2010)
• Social network properties
• Acceptability of RDS
• Seed selection
• Survey logistics
• Technical preparation
• Check sample size calculations
• Discussion of confidentiality issues and incentives
• Planning for data management and analysis
Study existing scales
Preparation for
RDS
Develop initial questionnaire
Feedback from CBO partners
Questionnaire finalization
Pre-survey meetings with CBO partners
Data collector training
Launch seeds
RDS Data Collection
• Chiang Mai (3)
• July 24 – Aug. 30, 2013
• Aug. 26 – Sept. 30, 2013
• Oct. 12 – Nov. 11, 2013
• Ubon Ratchathani (1)
• Nov. 14 –
• Songkhla (1)
• Nov. 27 • Bangkok (2)
• Dec. 6 Image source
RDS survey results
Network descriptive statistics
• MSM from Chiang Mai (8 seeds; 9 waves; 272 surveys)
• MSM from Bangkok (6 seeds; 10 waves; 273 surveys)
• Non-Thai migrant from Chiang Mai (5 seeds; 8 waves;
280 surveys)
• Transgender from Songkhla (6 seeds; 7 waves; 272
surveys)
• FSW from Chiang Mai (6 seeds; 6 waves; 268 surveys)
• FSW from Ubon Ratchatani (6 seeds; 21 waves; 273
surveys)
• FSW from Bangkok (6 seeds, 6 waves, 270 surveys)
A/Y MSM
Network
Location: Chiang Mai
Sample Size: 272
Seeds: 8
Maximum waves: 9
Key Challenges:
• Location of interview
site
• Reaching youth who
were not enrolled in
university/school
• Wording of inclusion
criteria
• Seeds that did not
lead to further
interviews
• Ending the survey
A/Y Non-Thai
Network
Location: Chiang Mai
Sample Size: 280
Seeds: 5
Maximum waves: 8
Key Challenges:
• Location of target
population (effect
on planned teams)
• Understanding the
network size
questions
FSW Network
• Location: Chiang Mai
• Sample Size: 268
• Seeds: 6
• Key Challenges:
• Building trust of “research” among CBO partners
• Dislike of questions involving counts (ex. number of
sexual partners)
• Reaching people who exchange sex informally/nonvenue based
Indicator
Age at first sex
<= 15 years
16 years
17 years
18 years +
Proportion
who used a
condom at last
sex
Frequency of
alcohol or drug
use before sex
-Never
-Rarely
-Sometimes
-Most of time
-Always
MSM
Chiang Mai
N = 272
MSM
Bangkok
N = 273
Non-Thai
Migrants
Chiang Mai
N = 280
Trans-gender
Songkhla
N = 272
FSW
Chiang
Mai
N = 268
0.36
0.15
0.18
0.28
0.55
0.13
0.16
0.12
0.11
0.21
0.28
0.37
0.50
0.22
0.15
0.10
0.70
[0.63,0.78]
0.95
[0.93,0.98]
0.37
[0.28,0.45]
0.94
[0.91,0.97]
0.79
0.95
[0.74,0.85] [0.93,0.98]
1.00
0.37
[0.33,0.40]
0.09
[0.05,0.14]
0.42
[0.33,0.50]
0.07
[0.01,0.13]
0.03
[-0.03,0.10]
0.28
[0.26,0.31]
0.19
[0.14,0.23]
0.35
[0.29,0.41]
0.11
[0.05,0.16]
0.04
[-0.01,0.11]
0.35
[0.35,0.36]
0.13
[0.01,0.24]
0.44
[0.36,0.51]
0.06
[-0.03,0.17]
0.00
0.43
[0.40,0.46]
0.04
[-0.02,0.11]
0.36
[0.28,0.45]
0.11
[0.08,0.15]
0.02
[-0.02,0.08]
0.20
[0.18,0.22]
0.01
[-0.10,0.14]
0.54
Not asked
[0.44,0.63]
0.22
[0.18,0.25]
0.01
[-0.05,0.08]
0.10
[0.08,0.12]
0.15
[0.06,0.24]
0.37
[0.28,0.47]
0.33
[0.24,0.42]
0.02
[-0.06,0.11]
Not asked
FSW
Ubon
N = 273
FSW
Bangkok
N = 270
0.18
0.13
0.21
0.45
0.10
0.12
0.53
0.21
Main findings
• Higher odds of condom use at last sex with higher levels of
social support (transgender, female sex workers)
• Decreased reported frequency of using drugs or alcohol
before sex with higher levels of social support (non-Thai
migrant, MSM, transgender)
• Higher HIV knowledge scores among adolescents with
higher levels of social support (MSM, non-Thai migrant,
transgender, FSW)
Main findings (cont.)
• Increased odds of ever testing for HIV with higher levels of
social support (MSM, FSW)
• Higher odds of receiving services or information related to
HIV with higher levels of social support (MSM, FSW Chiang
Mai);
however, also see lower odds of receiving information or
services if higher levels of social support (FSW Bangkok)
Limitations of the study
• Primary data collection was limited to 4 provinces. Findings
may not be able to be directly applied to provinces not
included in this study.
• Largely lacks inclusion of respondents under the age of 17 yrs -
needed data reported does capture information on higher risk
behaviors during their younger years.
• General young people were not included in primary data
collection – lack of direct comparison between YKAP and
general population youth.
• Social support – the study cannot provide more specific
information – how social structure in which YKAP find the
support is made up
Recommendations for future RDS
surveys with YKAP
• Relationships with local CBOs are key
• Understanding geographic location and social connectedness of
target population
• Asking meaningful questions in appropriate way
• Finding data collectors and seeds
• Plan for intensive and ongoing monitoring of the data
• Coupon numbers, waves, number of coupons given out
• Questions with unexpected answers or high numbers of refusals
• Know what networks can and cannot be effectively
reached using RDS
Acknowledgements
• Entire research team
Co-Principal Investigator: Assoc. Prof. Dr. Nitaya Vajanapoom
Co-Principal Investigator: Dr. Catherine Lee (Team Leader)
Co-Investigators:
Mr. Adam Tousley
Mr. Pongthorn Chanlearn
Ms. Jessica Nhkum
Research Coordinator: Methee Sriphyttha
Project Assistant: Petchara Banditnopparat
Financial Officer: Yasmina Aules
Consultants
Assoc. Prof. Dr. Marc Van der Putten
Ms. Sarah Meyer
• Partner organizations
MPlus
Adolescent Reproductive Health Zone (ARHZ)
Empower
• Donors – UNICEF/UNFPA/UNESCO