Educational interventions for AIDS prevention among single migratory female factory workers in Thailand
Presented by Ms Bupa Anasuchatkul, Chiang Mai University, Chiang Mai, Thailand.
The AIDS epidemic has been spreading with alarming speed in Thailand in recent years, and is increasingly affecting women. The northern region has consistently shown the highest rate of HIV infection. Heterosexual intercourse is now the predominant mode of transmission. Between 1986 and 1990, the gender ratio of people with HIV rose from one woman to every 17 men, to one woman to five men, and in 1991 this ratio was halved to one HIV positive woman to 2.3 HIV positive men.
In Thailand, particularly in the north, young unmarried women are expected to provide economic support for their rural families. Over 70% of the female population works in the productive labour force before marriage, and many of these are young women migrating to work in cities, where male factory and construction workers comprise the largest group of infected persons. Not surprisingly, therefore, the highest rates of HIV are found in this region of Thailand, where young migrating single women may be channelled unknowingly into the AIDS epidemic because they are away from the protection of their parents and the village environment, no longer bound by traditional norms that control prenuptial sex, and exposed to urban peer culture as well as uncertain and often exploitative working conditions.
In order to find an effective intervention for preventing HIV infection among this migratory population of young women (between ages 14 and 24), a quasi-experimental research study was designed to determine the knowledge, attitudes, beliefs and behavioural intentions of the 240 participating women and to develop and compare the relative effectiveness of three educational interventions: materials for self-study only, materials discussed in groups with a health promoter, and materials discussed in groups with a peer educator. A control group was also included.
The educational materials were produced in three different styles - a short novel, a comic book and two workbooks. Their main messages were based on information gained from focus-group discussions and in-depth interviews. For example, ‘good persons can get AIDS, and you cannot tell if someone has HIV just by looking at them’ (the novel tells the story of a young woman who migrates to Chiang Mai and falls in love with a young man who is infected with HIV) or ‘women can assert themselves in their sexual relationships’ (cartoon). General knowledge about STD/HIV, modes of transmission and how women protect themselves from STD/HIV is provided in a workbook, as are facts about male and female condoms, how to put on a condom, how to communicate with companions about STD/HIV/AIDS, what to do when a partner refuses to wear a condom, and what to talk about with friends with HIV/AIDS. Six health promoters and nine peer leaders were trained to lead the 12 two-hour group sessions.
Pre- and post-intervention questionnaires were administered to girls working in the five participating factories, the majority of whom lived by themselves in dormitories, and had education to the sixth grade. The sets of variables measured included: knowledge about HIV/AIDS, perceived susceptibility to infection, attitudes towards people with HIV/AIDS, perceived ability to protect oneself (self-efficacy), intention to adopt protective behaviours, and knowledge about condoms and their proper use. On all scales, the three intervention groups showed change in comparison to the control group, but the ‘materials for self-study only’ group far less so than the peer and health promoter led intervention groups. For example, as shown in Figure 2, only 13.3% of the ‘materials-only’ group intended to talk to their boyfriends about condoms, as opposed to almost 60% in the peer education group. Thus, while the materials-only intervention did achieve some degree of success in improving participants’ knowledge, it was not effective in significantly changing attitudes, beliefs and intentions to change behaviour.
Reported intention of single migratory female factory workers in Thailand to talk to boyfriends about condoms, by intervention type
Although there were no significant differences between the health promoter and peer leader groups in the categories of attitudes and beliefs, the latter showed greater improvement on knowledge of prevention methods, in condom usage skills and on some of the intents related to HIV prevention that were investigated. For example, the peer leader group demonstrated higher proportions of participants who correctly performed a number of tasks related to using condoms, (e.g. squeezed the top of condoms while putting it on). Figure 3 shows the percentages by intervention type. There were 71% and 37% increases in the peer leader and health promoter groups, respectively, in the number of women who intended to buy a condom themselves if they planned to sleep with their boyfriends for the first time.
Percentage of single migratory factory workers in Thailand who correctly performed four condom use steps, by intervention type
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