Sexual Initiation, Substance Use, and Sexual Behavior and Knowledge among Vocational Students in Northern Thailand
Liu, Alice, Kilmarx, Peter, Jenkins, Richard A., Manopaiboon, Chomnad, Mock, Philip A., Jeeyapunt, Supaporn, Uthaivoravit, Wat, van Griensven, Frits, International Family Planning Perspectives
CONTEXT: Thailand has undergone dramatic social changes in the last two decades, yet little is known about factors related to sexual initiation among adolescents.
METHODS: A survey using the audio computer-assisted self-interviewing method was conducted to assess social and demographic characteristics, substance use, sexual behavior, and knowledge of HIV and STIs among 1,725 vocational school students aged 15-21 living in northern Thailand. Gender differences for these factors were evaluated using chi-square and Mann-Whitney U tests. Multivariate survival analysis using Cox proportional hazards models assessed associations between these variables and sexual initiation for each gender.
RESULTS: Males initiated sexual intercourse at an earlier age than females (median ages of 17 and 18, respectively). At any given age, sexual initiation was associated with having a nonagricultural background and using alcohol or methamphetamine (adjusted rate ratios, 1.3-2.9). For males, initiation was also associated with having parents who did not live together, having a friend as a confidant, tobacco use, high perceived risk for HIV and high STI knowledge (1.3-1.7). For females, other factors associated with earlier initiation were younger age at interview, living away from family, lacking a family member as a confidant, high perceived risk for STIs and ever having smoked marijuana (1.3-2.4).
CONCLUSIONS: Interventions to ameliorate the adverse consequences of early sexual initiation need to address social influences such as parents and peer groups. Programs should identify and target high-risk subgroups, such as those who are sexually experienced at an early age and those engaged in patterns of generalized risk-taking.
International Family Planning Perspectives, 2006, 32(3):126-135
Among unmarried young people in Thailand, sexual behavior norms have changed substantially over the last two decades. One important change has been the increased acceptability of premarital sex among young women, which has resulted in a trend toward earlier sexual initiation for Thai females. A nationwide partner relations survey conducted in 1990 found that 13% of female participants aged 15-19 reported having had sexual intercourse, compared with 34% of males. (1) Other studies from the same period found that young Thai women had higher levels of experience, though they were still less likely to be sexually experienced than their male counterparts. (2)
Thai cultural norms generally have granted sexual freedom to males, but imposed constraints on female sexual behavior. In the past, unmarried males often experienced sexual initiation with female sex workers, and young unmarried females were expected to maintain premarital chastity.
Studies over the last decade have suggested that the norms governing sexual practices among Thai adolescents and young adults have changed. (3) A growing proportion of adolescent females report having had sexual intercourse, while male patronage of sex workers has decreased substantially. Most Thai men now have their early sexual experience with noncommercial partners. (4) Males' age at sexual initiation in Thailand does not appear to have changed in recent decades; however, as social controls have eased, young women appear to be having sex earlier. Yet a key difference remains: Young unmarried males usually have more partners, particularly more casual partners, than their female counterparts. (5)
These shifts in sexual behavior have potentially adverse consequences for Thai youth, particularly for young women. In other countries, sexually active young people have an increased risk of HIV infection and other STIs, as well as elevated rates of unplanned teenage pregnancy and pregnancy termination. (6) Understanding the factors associated with initiation of sexual intercourse is crucial in trying to design and deliver interventions for Thai youth (particularly females) who are likely to have sex at ages earlier than the norm. …