Sexual Risk Perception among Women at Reproductive Age ...

Journal of Public Health, May-August 2008 Vol. 38 No. 2Sexual Risk Perception among Womenat Reproductive Age, Bangkok, ThailandWanapa Naravage* Joachim Oehler*ABSTRACTSexual health behaviour depends very much on each person’s sexual perceptions, thus itis necessary to understand sexual risk perceptions of people as baseline data for determining theirsexual health status. The present study aims at describing sexual risk perceptions among women,who are of reproductive age, towards consequences of sexual activities including STIs/HIV and unplannedpregnancies and to understand how they interact to prevent the risks. The study focused on bothquantitative and formative research utilizing qualitative data. The study was a descriptive study usingpurposively sampling. Samples are white collar workers, women shopping at the downtown shoppingmalls and women from the university. The data collection was conducted in November 2005 to January2006 using quota sampling. A total of 200 completed self-administration questionnaire were usedfor descriptive statistics analysis. Moreover, total of 35 women, aged 21-35 participated in 4 FocusGroup Discussions. The qualitative data were analyzed using content analysis. The quantitative dataindicated that a majority of both single and marriage women, or 63.5% and 56.5%, did not perceivethemselves to be at risk of contracting the HIV infection. Many of the participants did not believethey were at risk at all, and if so, that the risk was minimal. In fact, most of the participants weremore concerned about pregnancy once they engaged in unplanned sexual relations rather than aboutcontracting HIV. Most women know about the route of sexually transmitted diseases. However,some women felt that they were not at risk because they knew the men and their history and thereforetrusted them not be infected. This finding proves that knowledge did not relate to actual perceptionand behaviour. From this evidence, the women could easily engage into unprotected sex, puttingthemselves at risk of contracting HIV.Key words: Sexual risk perception, women at reproductive age, BangkokJ Public Health 2008; 38(2): 148-164.Correspondence: Dr.Wanapa Naravage, Program Manager, Concept Foundation, Thailand Science Park, Pathum Thani 12120,Thailande-mail : wanapa@conceptfoundation.org* Concept Foundation, Thailand Science Park, Thailand

150 «“√ “√ “∏“√≥ ÿ¢»“ µ√åpregnancies, it is important to understand theirperception towards risk and unsafe sexualbehaviour. Women are more susceptible to STIs/HIV than men and are alone in having unplannedpregnancies, so, the present study selected womenwho are of reproductive age, both married andsingle, to explore on their sexual risk perceptionstowards consequences of unsafe sexual activitiesincluding, STIs/HIV and unplanned pregnanciesand to understand how they interact amongthemselves to prevent the risks. The assumptionfor this study is that perception might predictbehaviour; moreover, it sometimes assumes thatperception modification is a necessary prerequisiteto any behavioural change.The expected outcomes of the study arethat the results may provide in-depth informationto explain women’s perception towards STIs/HIV/Unplanned pregnancy, as well as ways to preventthe risks. Finally, this valuable information canlead to filling the knowledge gaps regardingimproving or adapting negative perception thatinfluence women to engage in risk-taking behaviour.Also, the results of the study will be useful forhealth promoters to help them to integrate riskperception modification with their planning,existing interventions and implementation andevaluation of their health promotion program.Materials and MethodsThis present study was a descriptive crosssectional study designed as a combination ofqualitative and quantitative approaches. The studydesign was based on the assumption that bothapproaches can provide sufficient insights and ideasregarding the reasons behind the study samples’risk perception towards STIs/HIV and unplannedpregnancies. The most important aspect of thisresearch is the inter-relationship between thequalitative and quantitative approaches. Thequantitative research helps us identify theinfluencing variables, which emerge from the study.Subsequently, we used the qualitative results toexplain the identified variables, which influencethe women’s perception towards sexual relations.The samples were voluntarily recruited andthe number was based on quota sampling. Theyconsisted of females both married and single, aged15-45. The study was conducted at workplaces,shopping malls located at the outskirt of Bangkokand in downtown Bangkok, Thailand. Datacollection was conducted in November 2005 toJanuary, 2006.Quantitative research. The quantitativeapproach was a self-administered questionnaireintended to assess individual risk perception towardsHIV/STIs and unplanned pregnancies. It wasconducted at the beginning of the study to assessthe magnitude of the self-risk assessment. A totalof 200 completed, self-administered questionnaireswere used for analysis, 100 questionnaires werefrom women in the workplace and another 100questionnaires from women at shopping malls.Descriptive statistics, using frequency and percentdistribution, mean, and standard deviation (S.D.)will be calculated to depict the distribution of riskperception among these women.The average age of the study sample was28.4 years old, which included a maximum of 45and a minimum of 17 years. A majority of therespondents’ educational background was

ªï∑’Ë 38 ©∫—∫∑’Ë 2 ª√–®”‡¥◊Õπ情¿“§¡- ‘ßÀ“§¡ 2551 151concentrated at the bachelor degree level. Foraccommodation, nearly half of the single womenlived with their parents or relatives, which were47%, 26% lived alone.Qualitative research. The qualitativeapproach aimed at gathering a wide range ofinformation, which was used to explain the women’sperception towards STIs/HIV and unplannedpregnancy. The qualitative method employed inthe study was evaluation of Focus GroupDiscussions (FGDs). FGDs guides or questionswere used in this study to explore a range of topicsrelated to sexual behaviour and risk perception.All FGDs were tape-recorded and notes weretaken to ensure that all the key dialogues werecaptured. Content analysis was used for dataanalysis.There were a total of 35 women, age 21-35, who participated in 4 FGDs. Nineteen womenwere university students and the remaining 16women were white-collar company workers/employees participating in the study.Ethical standards and confidentiality.All information was kept confidential accordingto standard human subjects’ protection guidelines.Anonymity was emphasized and maintained duringthis study. No names or other information thatcould identify participants were recorded duringany portion of the study. All field notes, tapedtranscripts, or any other field data and collectionforms used during this research were destroyedafter the completion of this report.FindingsPart 1 : Sexual Risk PerceptionMore Than Half of Women Perceived No RiskAt All From HIV InfectionOverall, results from the rapid surveyindicated that the majority of single women or63.5% and 56.5% of married women perceivedthemselves to be at no risk at all from catchingHIV. However, there were a few, or 2.7% ofthe single and 3.8% of married women whoperceived themselves to be at high risk of catchingHIV (Table 1). Moreover, married women reporteda higher percentage of individual risk perceptionthan single women (Table 1).Perception Towards Which Groups Are Mostat RiskPerception towards: “STIs/HIV was an issueof whom or which groups are most at risk”, wasassessed. Findings revealed that a majority ofsingle women perceived that HIV was an issueof the commercial sex sector (94.6%), of intravenousdrug users (94.6%), of gay sex (97.3%) and ofextramarital sex (83.8%), whereas the issue ofpremarital sex (64.9%) was reported as a lowerissue than the other groups.Moreover, about 43% and 37% of singleand married women, respectively, reported thatthey perceived their close friends to be at no riskof contracting HIV infection at all.

152 «“√ “√ “∏“√≥ ÿ¢»“ µ√åTable 1Number and percentage of risk perception towards HIV/AIDS/ unplanned pregnanciesclassified by marital statusRisk Perception Single MarriedChances that respondents might catch HIVNo chance 94 (63.5) 19 (56.5)Little chance 36 (24.3) 17 (32.7)Moderate chance 5 (3.4) 5 (9.6)High chance 4 (2.7) 2 (3.8)Don’t know 9 (6.1) 9 (17.3)Already infected 0 (0.0) 0 (0.0)Total 148 (100) 52 (100)Chances that respondents might have unplanned pregnancyNo chance 95 (64.2) 25 (48.1)Little chance 36 (24.3) 17 (32.7)Moderate chance 12 (8.1) 4 (7.7)High chance 4 (2.7) 0 (0.0)Don’t know 1 (0.7) 4 (7.7)Had unplanned pregnancy 0 (0.0) 2 (3.8)Total 148 (100) 52 (100)Do you think most of your close friends are at risk of getting the AIDS virus?Yes 23 (15.5) 12 (23.1)No 65 (43.0) 19 (36.5)Don’t know 60 (0.6) 0 (0.0)Total 148 (100) 52 (100)STI especially HIV, is an issue of the following groups: (%yes)Commercial sex sector 70 (94.6) 20 (76.9)Intravenous drug users 70 (94.6) 25 (96.2)Gay sex 72 (97.3) 20 (76.9)Premarital sex 48 (64.9) 15 (57.7)Extramarital sex besides commercial sex 62 (83.8) 19 (73.1)Sexual activities in all segments of population 56 (75.7) 21 (80.8)

ªï∑’Ë 38 ©∫—∫∑’Ë 2 ª√–®”‡¥◊Õπ情¿“§¡- ‘ßÀ“§¡ 2551 153Focus Group Discussions Indicated ThatMajority of The Respondents Perceived ThatThey Were Not At Risk of HIV InfectionWhen participants were asked to compareamong the general women, who or which groupsare at risk of getting HIV infection, majority ofthe respondents perceived that teenage womenwere taking more risk both due to lifestyle andto value changes from the past. Presently, teenagersare more concerned about acquiring material itemsrather than protecting their virginity because theyare influenced by the media, by peer pressure anda free lifestyle, which results in more risk-taking.“I think studenst, while they are studying,lived at the dormitory, and they have morefreedoms” (white collar worker).The participants were asked to comparetheir risk-taking with other women. A majorityof them revealed that they had little chance ofgetting HIV infection or unplanned pregnancybecause of their lifestyles. For example, mostwomen hurry back home after work and go tobed early, which results in having no time to goout at night. These women also believe that, dueto their knowledge and goal setting, they areseparated from the “high risk” teenage generation.The result is consistent with the quantitative datafrom self administration questionnaire.“At the workplace, people hurry up backhome after work and then go to bed”(white collar worker)“We have more information because westudied in the sciences field. So, we learnedand knew about it since when we werein high school” (white collar worker)Unplanned Pregnancy Was Seen More Common ThanHIV/AIDS Reported by RespondentsParticipants were asked to estimate, outof every 10 people in their office, how many theythink would have HIV/AIDS and unplannedpregnancies? Comparing single and marriedwomen, it was notable that single women reportedthat they had seen slightly more HIV/AIDS casesthan married women, reporting at 16.3% and13.4%, respectively (Table 2). The perceivedaverage case of HIV/AIDS as seen in every 10people, for both single and married women, was0.3, with a maximum of 4 cases and a minimumof “Zero”. Moreover, the same group of participantsreported that they had seen more unplannedpregnancies than HIV/AIDS cases. The averagecases of unplanned pregnancies seen were 1.1,of which the minimum case was 0 and themaximum was 8 (Table 2).

154 «“√ “√ “∏“√≥ ÿ¢»“ µ√åTable 2Number and percentage of perception towards quantity of HIV/AIDS/ UnplannedPregnancies classified by marital statusRisk Perception Single MarriedIn every 10 people in your office how many do you think would have HIV/AIDS?Mean = 0.3 Min = 0 Max = 40 96 (64.9) 2 (48.1)1 16 (10.8) 5 (9.6)2 6 (4.1) 2 (3.8)3 1 (0.7) 0 (0.0)4 1 (0.7) 0 (0.0)Don’t know 28 (18.9) 20 (38.5)Total 148 (100) 52 (100)In every 10 people in your office how many do you think would have Unplanned pregnancy?Mean = 1.1 Min = 0 Max = 80 60 (40.5) 10 (19.2)1 22 (14.9) 10 (19.2)2 19 (12.8) 9 (17.3)3 6 (4.1) 5 (9.1)4 3 (2.0) 0 (0.0)5 5 (3.4) 0 (0.0)8 0 (0.0) 1 (1.9)Don’t know 33 (22.3) 17 (32.7)Total 148 (100) 52 (100)Focus Group Discussion Results Indicated thatMajority of Respondents Are Less Concernedabout HIV Infection Than About UnplannedPregnancyFGDs results indicated that majority of therespondents revealed that once engaged in anunplanned sexual relationship, most of the womenwould worry about pregnancy. They emphasizedthat they felt more relaxed regarding the HIVinfection. The reasons were that: 1) they believedthey were free from HIV infection and theirboyfriend was as well; 2) the threat was veryremote because every man had sperm but not everyman had HIV; 3) they perceived that they wereentering into a sexual relationship as first timers.“I think HIV is too remote, I feel that itis less important compared to unplannedpregnancies” (university student)

ªï∑’Ë 38 ©∫—∫∑’Ë 2 ª√–®”‡¥◊Õπ情¿“§¡- ‘ßÀ“§¡ 2551 155“Sometimes we think that the man is freefrom HIV, and is having sex with us forthe first time. Also, because of love isblind... something like this” (universitystudent)Focus Group Discussion Indicated that MostParticipants Who Were Single Feel LessConcerned about HIV Infection Due to Lackof Early Symptoms, Unlike PregnancyThe question was asked why women feltless concerned about contracting HIV than dealingwith an unplanned pregnancy. A majority revealedthat if they were not married but they were pregnantthey would have no future and be ridiculed bytheir parents and society. This is unlike the HIVinfection, which they perceive themselves as havingless chance of getting, and believe that if theydo contract it there will be no symptoms, so noone will know. Moreover, some mentioned thatHIV cannot kill them but pregnancy would havea more psychological effect.“Pregnancy is the greatest concern if notyet married, but if married, HIV infection”(white collar worker)“We would have no future. It is similarlike we expose ourselves to the public whichwill be blamed because pregnant withoutmarriage” (white collar worker)Part 2 : Sexual Risk Prevention Ways to PreventConsequences of Unplanned SexualityWhile knowledge and perception onconsequences of unplanned sexual relations areimportant, the most important question is howwomen are protecting themselves against HIV/AIDS/unplanned pregnancy. Thus, this sectionexplores what participants say about preventionof unplanned pregnancy and HIV infection.NegotiationWhen group participants were asked: “Ifa man feels like making love to you, but you donot want to, what can you do?” In answer, majorityof women feel that if they were in this situation,it would be difficult to avoid having sex becausethe man might not listen to and follow her request.They revealed that the most effective way wastrying not to be alone with the boyfriend/malefriend.“If we need to protect from havingunplanned sex, avoid staying alone withhim in a private place” (university student)“If at that situation, I could not prevent(from having sex)” (white collar worker)The next question asked was: “if a womanwants avoid having sex with a man, what sheshould do?” Half of the women revealed thatthey would take two-steps. The first, was that theywould ask the man to think more and not to forcethem, they would try to delay the process as longas possible by taking a bath, crying, talking aboutthe future and the consequences of having unplannedsex, as well as using personal skills and fightingto protect themselves if necessary. By negotiating,they decrease the emotion and are therefore lesssexually desirable. Secondly, the women wouldask the man to consider the risks of HIV andunplanned pregnancy and take steps to preventit by using a condom or the emergency contraceptivepill.

156 «“√ “√ “∏“√≥ ÿ¢»“ µ√å“...If I can talk to the man. I will talk tohim directly and ask him to wait until bothof us are ready” (white collar worker)“If negotiation does not success, I will askhim to protect by purchasing condom orusing emergency contraceptive pills beforehaving sex. If he follows, then I am OK”(white collar worker)Condom and Oral Contraceptive Pills UsagePerceived As a Gender IssueResults from focus group discussionsrevealed that most of the respondents understoodand knew that using a condom could prevent HIVinfection where as oral contraceptive could not.Moreover, more than half of the participantsrevealed that the use of a condom was the malesresponsibility whereas oral contraceptive (pills)was the females. The rationale was thatcontraceptive methods are divided by function andgender. If the contraceptive was developed formales i.e.; condoms, then men should be responsiblewhereas oral contraceptives are different as theyare the responsibility of the women. The use ofa condom is not only a contraceptive method, butit is also attached to a larger gender issue becausewomen perceived it to be purely for men. Thussome women mentioned that they did not dareto, and were uncomfortable when buying thembecause they felt shy.“Women feel shy to buy condoms; insteadmen should buy and put it by themselves”(white collar worker)“It is the man’s responsibility, if womenbuy condoms, it is strange” (white collarworker)In response to the question why womenwere aware of HIV risk but still they do not usea condom. Many women revealed several issuesas to not using condoms, these including:1) Women were shy and avoided condomshelves.2) Woman was afraid that the man wouldthink she was accusing him of havingthe infection, should she ask him towear a condom.3) If no condom is used, women perceivethis as trust as well as him believingthat she is a virgin.4) In emergencies.5) Partner did not want to use it.“I think majority of men do not want touse condom” (white collar worker)“When walking into the shop, actually, welike to see it (condom), but we dare not”(white collar worker)“(If using condom) women would feel thatmen may afraid that he might get infectionfrom the women” (white collar worker)

ªï∑’Ë 38 ©∫—∫∑’Ë 2 ª√–®”‡¥◊Õπ情¿“§¡- ‘ßÀ“§¡ 2551 157ECP can kill germs and sperm. When groupparticipants were asked what the meaning of safersex was, the most frequent response was the useof a condom. However, some of them revealedthat an emergency contraceptive pill was also anoption, unlike a condom; it can be used after havingsex. Some of the participants perceived thatemergency contraceptive pill could prevent bothHIV infection and pregnancy at the same time.“One of the contraceptive pill which wasdissolved very fast. It was told to takeafter sex” (university student)“Should use this one (ECP) if we are notsure that we would get infection, orpregnancy” (university student)Effect of ECPs. Many of the participants perceivedthat ECP would dissolve the virus or bacteria.However, some of them added that it could dissolvethe endometrial layer and destroy the uterus ifused over long periods of time, adding that it couldalso affect the delivery of a baby, making theprocess more difficult.“I was head that it would dissolve theuterus” (university student)“It seemed to affect the endometrium layerby weakening it and later fallout” (whitecollar worker)Terminating PregnancyMany of the participants said that if anunplanned pregnancy happened to any of theirrelatives or close friends, they would accept it andtry to support the woman. However, attemptingto solve the problem by terminating the pregnancywas not a solution. This resulted in an equalproportion of participants for and against terminatingpregnancy.The participants who agreed withterminating pregnancy said that if women knewthat there was a solution like abortion, it wouldencouraging them to think more about their futureas most women believe that their future is gonewas after falling pregnant. Moreover, by selectingabortion as a solution, women can avoid socialstigmatization and disapproval from their parents.“I think if the woman is studying, highpercentage that their parents or relativesboth the woman and the man side wouldlike to ask the women to terminate pregnancyto avoid gossip. It is due to social,student status, and future career”(university student)“To inform the young women that thereis a solution for unplanned pregnancy thatis terminating pregnancy is not bad. Onthe other hand, I think that it will be goodbecause it will be a solution for the youngwomen. Otherwise, some of them wouldsuicide...or something similar... I think itis a solution” (white collar worker)The participants who did not agree withterminating pregnancy as a solution said that thewomen should consult with her parents first. Theyreferred to a case about a fellow student whorevealed that to her parents and family would takecare of the baby so that she could return to school.

158 «“√ “√ “∏“√≥ ÿ¢»“ µ√å“I can raise the baby if it happens to mysister. After she delivers I want her to goback to school, if she can hide it, or negotiatewith the school. I do not want herto lose her future” (white collar worker)Part 3 : Knowledge and Sources of HIV/AIDS/Pregnancy InformationIn this part of our study we used a rangeof questions to explore the knowledge of HIV/STIs/pregnancies and particularly causes thereofits prevention. FGD participants were also askedabout the sources from which they learned aboutmatters concerning sex, contraception and HIV/STIs/unplanned pregnancies. The intention forthis section was to examine the roles of varioussources and their messages as well as understandwhat is learnt from these sources, thus enablingus to communicate more effectively in the future.Knowledge of HIV/Unplanned PregnancyMost of the women interviewed werewell informed about HIV/unplanned pregnancies.When asked how HIV is acquired, not only theFGD participants chorus “sexual intercourse”, butthey also added that it was contracted throughunprotected risky sexual relations, particular withmultiple sex partners. Moreover, most of the FGDparticipants revealed that the use of a condom wasa must to prevent HIV/unplanned pregnancy. Thecontraceptive pill was also mentioned butparticipants believed that the pill was used forpreventing pregnancy only. However, regardingthe emergency contraceptive pill, the women allegeddifferently.“Contraceptive pills can not preventinfection. It can protect only pregnancy.The best method is condom because it canprevent both diseases and pregnancy”(white collar worker)“If we talked about diseases, condom isthe solution. But if we talked aboutprevent pregnancy, there are manymethods” (white collar worker)Sources of Sexual Health InformationIt was found that most of the FGDparticipants gained information regarding sexualhealth from printed materials including studyingbooks, women’s magazines and websites. Apartfrom printed materials, some women mentionedthat they learned about sexual health from studying,personal experiences and friends. However, a fewFGD participants mentioned mass media i.e., radioor newspapers as resources for sexual healthinformation.“I am talking among surrounded peopleincluding friends, elder friends, or experiencesfriends” (white collar worker)Topics That Women Like to KnowThe question regarding what women wouldlike to know about sexual matters was raised toFGD participants. Responses from the whitecollarworkers were varying and included waysto prevent HIV/Unplanned pregnancies, basic carefor their own body, lower abdominal pain duringmenstruation, normal and abnormal vaginaldischarge, basic principle to manage abnormalsymptoms and general health tips for women ateach stage of their life. This group also mentioned

ªï∑’Ë 38 ©∫—∫∑’Ë 2 ª√–®”‡¥◊Õπ情¿“§¡- ‘ßÀ“§¡ 2551 159that information from media sources did notemphasise the “how to”, which they consideredan important part of the message.“The first issue is ways to preventpregnancy...then ways to prevent sexuallytransmitted diseases” (white collar worker)“Messages should emphasis on basic caresuch as pain during menstruation,abnormal vaginal discharge. It shouldprovide information on how to managewith the abnormal signs; at what level ofsymptoms should we see doctors. For sure,most of us do not like to see doctors forvaginal examination” (white collar worker)The same question: “what women wouldlike to know about sexual matters”, was raisedto the university students, however, responseswere rather different from the white-collar group.As far as this study goes, university students werecurious about topics on sexual health and sexualrelations, the latter proving to be a very popularrequest. The students mentioned that thisinformation would guide them in their relationshipsand assist them in behaving appropriately.“I feel that knowing about this information(sexual relation) is the best way. Before,I did not have boyfriend so I am not serious.At that time, I would listen to others;however I could remember some messagesonly. Now I have boyfriend, so I wouldlike to get more accurate information”(university student)Feeling Towards Acquiring Sexual InformationFGD participants were also asked abouttheir feelings towards acquiring sexual informationfrom various resources, as discussed above, andmost of them felt shy and embarrassed and wouldprevent reading or looking at information regardingsex in front of others, especially the opposite sex.They were adamant that while learning about thesetopics, women need privacy“I do not dare (reading sexual healthinformation). I am afraid that other willthink what we are doing” (universitystudent)“At present, we dare to read sexual healthinformation (posted on the board). In thepast, when we were studying at high school,I feel that we did not dare to read. If wewanted to read we would go with femalefriend, if there were boy, we did not dareto read” (university student)Sexual Heath CommunicationsMost of the FGD participants revealed thatthey would discuss sexual relations, sexual mattersor any matters that they could not discuss withothers, with their friend. They gave reasons thatthey believed friends shared a commonality andtherefore felt comfortable and relaxed. Moreover,friends did not blame each other instead they feltsympathetic. Many of the participants said theywould not discuss or talk to their parents regardingthese matters as their parents were old fashioned.

160 «“√ “√ “∏“√≥ ÿ¢»“ µ√å“Any sexual matters, because there is aminimal gaps among friends. Moreover,we can speak in the same language. Inmy opinion, if we can talk with friend onthese matters, then for other matters, wecan share and talk with friend. I feel thatfriend do not blame us, friends share thesame commonality. There are differences,but it is minimal” (white collar worker)“It is...old-fashion... and ...they might notlike to discuss about these matters”(university student)However, on the topic of sexual healthmatters, some of FGD participants, from bothuniversity and the work place, said they woulddiscuss these with their mothers. None of themwould discuss sexual health matters with theirfathers.“I also can talk these matters with mother,but for the small and general issues. Forthe in-depth information on this regard,I will not share with her” (universitystudent)“To talk with mother, I do not feel shy.But I do not know how to say; becausethere is some limitation in some sexualhealth matters i.e., if I do something wrong(having sexual relation with boyfriend), Ido not want to talk to mother, instead Iwill keep it by myself” (white collar worker)DiscussionsMany of the women at reproductive agedid not perceive themselves to be at risk ofcontracting the HIV infection, especially amongthe white-collar workers. Many of the participantsdid not believe they were at risk at all, and ifso, the risk was minimal. In fact, most of theparticipants were more concerned about pregnancyonce they engaged in unplanned sexual relationsrather than contracting HIV. This lowered levelof feeling at risk was particularly based on theparticipants perception that the HIV risk groupwere promiscuous women, women who hadmultiple partners, IV drug users and others,especially younger people who were “not likethem” i.e., the private university student who residesaway from his/her parents. Many of the participantsclaimed that they were not at risk or less likelyto be at risk because they knew the history ofthe man that they had established the relationshipwith, they trusted that man and believed he wasfree from disease. The participants felt that thereason of “love” was the most important and meanttrusting him totally.Most women know about the route ofsexually transmitted diseases. However somewomen felt that they were not at risk because theyknew the men and their history and therefore trustedhim to not be infected. Women tended to linksexual intercourse with love and romance. So thisperception resulted in unsafe sexual intercourse.This proves that knowledge did not relate to actualperception and behaviour.

ªï∑’Ë 38 ©∫—∫∑’Ë 2 ª√–®”‡¥◊Õπ情¿“§¡- ‘ßÀ“§¡ 2551 161Women were confused about the conceptof risk taking. In Thailand, even though thereis a lot of mass media campaign on HIV/STIs,some participants were confused by the idea thatcertain groups are more at risk of contracting HIVe.g., intravenous drug users, gay men, or commercialsex workers. Some women understood the conceptof risk but still believed that they stood a minimalchance of contracting the disease compared toothers.There were gaps in the women’s knowledgeand belief towards emergency contraception(EC). Some participants believed that ECcould dissolve womb because it was really strong,hence, it could kill the sexually transmitted bacteriaand/or virus as well. From this evidence, thewomen could easily engage into unprotected sex,putting herself at risk of contracting HIV.Condom usage and preparation wasconsidered a gender role. Many women felt thathaving or preparing condoms is the man’s responsibility,whereas acquiring and using contraceptivepills was the woman’s responsibility. If thisperception were accurate, the women could be atrisk of getting STI/HIV infections if her partnerrefused to carry or use condoms.Most of the women were aware that goingout alone with a boy was a risky situation. Mostwomen were aware of situations that lead tounplanned sexual relations, i.e.; going out at nightwith their boyfriend or staying alone with himin a private area. Majority of women felt thatonce the man started being sexual it was hard toask him to stop, purely because it is perceivedthat accepting a date with a man is an indicationthat she is fond of him. It was established thatthe only way to avoid this circumstance was tonot go out with the man unaccompanied. However,in saying that, the participants also felt that thislifestyle is not sustainable and therefore they wouldalternatively ask the man to use a condom. Afew ladies did mention that they would use theEC pill as pregnancy prevention.Many of the participants mentioned thatthey would talk and discuss sexual and reproductivehealth communication with their friends. It isbelieved that some women prefer to discuss sexualissues with friends they trust, however, theysometimes feel that these sources are unreliableand naïve and therefore rely on printed materials,websites, hotlines and health personnel at clinics/hospitals. With this selection of information, womencan choose their medium by the severity of theproblem.The present study, therefore, suggests that1) findings from self administration questionnaireand FGDs raised a number of program andpolicy issues, especially an inconsistency ofknowledge, risk perception and on sexual riskbehaviour. Findings suggest that information thewomen receives may not address her needs fora behavioural change. Moreover, the findingsshowed that women have a distorted perceptionof risk, believing that they where at a lesser riskcompared to others as they “Know their PartnersHistory”. However, it remains unclear how andto what extent women could evaluate and makesure about the actual sexual history of theirpartner. It is interest to change attitudes regardingcondom usage and it’s gender distinction. Thekey messages should emphasise that using acondom is a responsible act for both partners and

162 «“√ “√ “∏“√≥ ÿ¢»“ µ√åthat it prevents pregnancy, diseases as well ascervical cancer which is caused by HPV (HumanPapiloma Virus). However, if women don’t perceivetheir partners to be promiscuous the HPV risk canalso be perceived to be low; 2) sexual healthmessages should be available through a varietyof sources. All the information should be up todate, accurate, consistence and distribute to variousoutlets so that women can easily access theinformation based on their needs and situation.It is important to separate the availability ofexplicit information from the widely held beliefthat this encourages promiscuous behaviour amongteenagers and young women; 3) there should bean ongoing educational campaign for women ofall ages and various social groups starting withindividual, families, communities, and school.These information and key messages should beconsistent and reliable.AcknowledgementsThe authors are grateful to the studyparticipants for sharing their time and perspective.We also appreciate the editorial works supportingby Tarynn Hatton - Jones.References1. Thai demographic data. Available from:www.dopa.go.th/cgi-bin/people2_sta.exe?YEAR=49&LEVEL=1&PROV.2. UNESCO regional clearing house on populationeducation and communication Asia andthe pacific regional bureau for educationBangkok, Thailand. Package of research briefsseries 2: Adolescent reproductive health,December, 2001.3. Boonmongkon P, Jaranasri C, and ThanaisawanykoonS, et al. Thai adolescentsexually and reproductive health: Implicationsfor developing adolescents’ health programsin Thailand. Centre for health policy studies,Faculty of social sciences and humanities,Mahidol university at Salaya, Thailand:Charuendiigaanpim, 2000.4. Ford N, Kittisuksathit S. Youth sexuality: Thesexual awareness, lifestyle and related-healthservices needs of young, singles, factoryworkers in Thailand. Institute for populationand social research, Mahidol university atSalaya, 1996.5. Soonthorndhada A. Sexual attitude andbehaviours and contraceptive use of late femaleadolescents, Bangkok: A comparative studyof students and factory workers. Institute forpopulation and social research. Mahidoluniversity, Thailand, 1996.6. Havanon N, Markmee K. Understandingsexuality in adolescence: A study in low incomecommunity in Thai society. A preliminarydata analysis submitted to PATH, unpublishedpaper, 1997.7. Ministry of public health. AIDS update-Thailand. Ministry of public health, Bangkok,2002.8. Chayovan N, Nodel J. Coital activities amongmarried Thai women: evidence from the 1987Thailand demographic and health survey.Population studies centre report No. 91-221.Ann Arbor, Michigan, University of Michigan,Population studies centre, 1991.

ªï∑’Ë 38 ©∫—∫∑’Ë 2 ª√–®”‡¥◊Õπ情¿“§¡- ‘ßÀ“§¡ 2551 1639. Boonpakdee N. Relationship betweenpregnancy intention and outcomes ofpregnancy : An in-depth study of twocommunities. A thesis submitted in partialfulfilment of the requirement for the degreeof Master of Arts, Faculty of graduate studies,Mahidol university, Thailand, 2006.10. Gray A, Punpuing S. Gender, sexuality andreproductive health in Thailand. Institute forpopulation and social research, Mahidoluniversity, Thailand, 1999.11. Edlin G, Goluntry E, Brown KM. Health andwellness. 4 th edition, New York: Jones andBartlett Publishers, 1996.12. Jenkinson C, and contributors. Measuringhealth and medical outcomes. London: UCLPress Limited, 1994.13. °—𬓠ÿ«√√≥· ß. ®‘µ«‘∑¬“∑—Ë«‰ª. °√ÿ߇∑æ-¡À“π§√: ∫”√ÿß “√— πå, 2532.14. Akwara AP, Madise JN and Hinde A.Perception of risk of HIV/AIDS and sexualbehaviour in Kenya. J. biosoc. Sci 2003; 35:385-411.

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