Partying in Thailand: Never Testing Among Men Who Have Sex With Men Who Attend Sexualized (Drug) Parties.

BACKGROUND: Human immunodeficiency virus (HIV) testing for Thai men who have sex with men (MSM) is suboptimal, which undermines their linkage to care and subsequent HIV preexposure prophylaxis (PrEP) uptake. METHODS: We analyzed a cross-sectional survey conducted in 2021 among Thai MSM who attended any private sex parties or circuit parties in the past 3 years ("sexualized parties"). RESULTS: Of the 424 men included in our analysis, 47.6% had been recently tested for HIV in the past 1 year, 30.2% had not recently been tested, and 22.2% had never been tested. In our multivariable analysis, relative to participants who had recently tested for HIV, those who have never tested were more likely to have lower education or to live outside of Bangkok, and to have attended both circuit and private sex parties (vs. private sex party only) but were less likely to report any sexually transmitted infection diagnosis or to have heard of PrEP. Participants who had an HIV test more than a year ago were more likely to have attended both circuit and private sex parties (vs. private sex parties only) but were less likely to have any sexually transmitted infection diagnosis, meet sexual partners online, or have heard of PrEP. Rates of condomless anal sex and willingness to use PrEP were similar across groups. CONCLUSIONS: Despite the high rates of sexual risk-taking, sexualized party attendees reported suboptimal HIV testing uptake. The joint promotion of HIV testing and PrEP is warranted-especially on-premise HIV testing at circuit parties and outreach at online platforms to reach sexualized party attendees.

Pride-based violence, intoxicated sex and poly-drug use: a vocational school-based study of heterosexual and LGBT students in Bangkok.

BACKGROUND: In Thailand, drug use is widely observed, especially among vocational-school students, who are more inclined to use various types of drugs and to experience pride-based violence (violence based on institutional pride, honor, or on seniority status) than any other groups of students. Drug use contexts differ based on sexual orientation and gender identity (e.g., clubs). This study aims to examine the prevalence and correlates of poly-drug use (the use of at least three types of drugs) among vocational-school students, with a focus on sexual orientation and gender identity. METHODS: In this study, 638 vocational school students living in Bangkok metropolitan area participated in a three-year longitudinal survey of four vocational schools. Experiences of violence, sexual behaviours, and poly-drug use were assessed and analyzed using multivariable logistic regression. RESULTS: About one tenth of all students (11.3%) reported poly-drug use, a fifth among Lesbian, Gay, Bisexual and Transgender (LGBT) students (20.2%) and almost a tenth of heterosexual students (9.8%). In the multivariable logistic model of LGBT students, GPA, pride-based violence, intoxicated sex, and counseling needs were significantly associated with poly-drug use (AOR = 4.62; 95% CI 1.17-18.29, AOR = 6.01; 95% CI 1.31-27.32, AOR = 5.17; 95% CI 1.10-24.28, AOR = 4.64; 95% CI 1.16-18.54, respectively). Likewise, among heterosexual students, GPA and intoxicated sex were significantly associated with poly-drug use (AOR = 2.02; 95% CI 1.09-3.75, AOR = 5.31; 95% CI 2.81-10.04, respectively). CONCLUSIONS: LGBT vocational-school students have significantly higher prevalence of poly-drug use than their heterosexual peers. Correlates include lower GPA, having experienced pride-based violence and intoxicated sex. School-based intervention programs should also address pride-based violence and intoxicated sex in their harm reduction programs.

Willingness to Use HIV Self-Testing With Online Supervision Among App-Using Young Men Who Have Sex With Men in Bangkok.

ABSTRACT: An online assessment among social media-using young men who have sex with men found that 87% were willing to use HIV self-testing with online supervision. Correlates included never tested, having higher numbers of sexual partners, and seeking partners online. HIV self-testing with online supervision may be appropriate for young men who have sex with men who have high risks and may not access venue-based settings.

"Kids these days pretend to be grownups" (dekkaedaet): sexual control and negotiation among young Thai female students.

BACKGROUND: Young Thai women are growing up amidst conflicting influences of globalization and traditional Thai culture. They experience confusion about which aspects of their sexuality they can express and must hide. This study examined forms of sexual control and sexual negotiation among young Thai women in secondary and vocational schools. METHODS: Semi-structured interviews and focus group discussions were conducted among 13-to 18-year-old female students attending secondary and vocational schools in six regions of Thailand. Additional semi-structured interviews were conducted with instructors of sex education, school administrators, and parents of students. NVIVO 10 was used to manage, code and assist with data analysis. RESULTS: Socio-cultural control on young women's sexualities was found from members of their families, schools, communities, and other students. Young women expressing their sexualities openly through verbal expressions, clothing, and behaviors were deemed negatively and stigmatized as dekkaedaet or "kids pretending to be grownups" as it is believed that they are too young and too immature to be responsible for their own decisions on their bodies and sexuality. This dominant discourse subsequently stigmatize and embarrass sexually active women. However, some young women try to negotiate and create options, by utilizing strategies that ensure secrecy. CONCLUSION: Comprehensive sexuality education is needed and should be based on the respect for human dignity and sexual and reproductive rights.

Group sex, suicidality and online partners: implications for HIV and suicide prevention: a short report.

HIV-related factors and suicide-risk status were assessed among YMSM aged 18-24 years recruited through various MSM-related online social apps in Bangkok (N = 1394). The online survey assessed demographic characteristics, sexual behaviours and suicide-risk status. Measure of suicide risk was taken from the Suicidal Behaviors Questionnaire-Revised (cut-off score of seven or higher). Among participants, 249 (17.9%) reported suicide-risk. In multivariable logistic regression, correlates of suicide-risk status included having sometimes or often ever participated in group sex (AOR=1.58, 95% CI: 1.17-2.14), having received money or opportunities for sex (AOR=1.54, 95% CI: 1.09-2.17), often seeking partners online (AOR=1.59, 95% CI: 1.05-2.39), inconsistent condom use (AOR=1.67, 95% CI: 1.26-2.21), and self-assessed as having "medium" or "high" HIV risk (AOR=2.53, 95% CI: 1.61-3.98 and AOR=3.35, 95% CI: 1.92-5.82, respectively). Findings suggest that HIV risk behaviours shown by YMSM are significantly associated with higher risk of suicide.

Peer victimisation and depression among gender conforming and non-conforming Thai adolescents.

Like most low- and middle-income countries, Thailand is facing an increasing burden of depressive disorders among adolescents, but research and services for them are largely neglected. This study explored the association between types of peer victimisation, gender non-conformity, health risk behaviours, and depressive symptoms among Thai students aged 13-18 years. Overall, prevalence of depressive symptoms was 14.7% (95% CI: 12.6-15.6), 12.2% (95% CI: 9.5-13.9) among male students and 16.5% (95% CI: 13.8-18.0) among female students. Among both sexes, social and sexual victimisation in the past month were strongly associated with depressive symptoms in the past week. Gender non-conforming female adolescents, as well as male and female adolescents who had experienced sexual and social victimisation, had a high burden of depressive symptoms. Mental health professionals and educators working with young people in Thailand should consider assessment for clinically significant depressive disorders.

Comprehensive sexuality education in Thailand? A nationwide assessment of sexuality education implementation in Thai public secondary schools.

Background The purpose of this nationwide study was to assess implementation of comprehensive sexuality education (CSE) in Thai public secondary schools, with a view to reveal its strengths and weaknesses. METHODS: This was a mixed-methods study using a cross-sectional survey of 8837 students and 692 teachers at 398 public secondary schools, selected by multistage cluster sampling from six regions of Thailand, along with participatory focus group discussions with 150 students, and semi-structured in-depth interviews with 30 students and 70 teachers. RESULTS: Sexuality education was provided in most schools, but its implementation was incomprehensive and inconsistent across different types of schools. Topics covered were broad, but emphasis was primarily on biology and negative consequences of sex, in particular preventing adolescent pregnancy. Topics related to human rights, gender equality, and sexual and gender diversity were not addressed sufficiently. Pedagogy was found to be heavily lecture-based, while class environment was not comfortable for many students. CONCLUSION: Gaps recognised in this study reflect the challenges of providing sexuality education in school settings where society's political and sociocultural norms are imposed and traditional pedagogical ways have remained dominant. Strategies are needed to address implementation shortcomings to make sexuality education more comprehensive in Thailand.

Illicit Drug Use and Social Victimization among Thai Sexual and Gender Minority Adolescents.

Objectives: We examined the prevalence of lifetime illicit drug use and social victimization, and their association, among sexual and gender minority (SGM) and non-SGM Thai adolescents. Methods: In 2013, we conducted a school-based national survey among students grades 7-12 (aged 13-20 years) from 15 secondary schools (n = 2,070) around Thailand. We classified adolescents with same-sex attraction, sexual or gender non-conforming identities as SGM. Generalized estimating equations were used to estimate the odds of illicit drug use by SGM and non-SGM status. Results: Prevalence of lifetime illicit drug use was significantly higher among SGM adolescents than non-SGM adolescents (10.3 vs. 5.3%), but did not differ between those with same-sex attraction and SGM identity (10.3 vs. 10.8%). Among non-SGM adolescents, general social victimization, sexual experience and any school truancy were associated with lifetime illicit drug use (OR = 2.59, 95% CI: 1.53, 4.38; OR = 6.59, 95% CI: 4.90, 8.86; and OR = 4.93, 95% CI: 3.13, 7.75, respectively). Among SGM adolescents, SGM-based social victimization, depressive symptomology and suicidal ideation were associated with lifetime illicit drug use (OR = 3.17, 95% CI: 2.03, 4.95; OR = 5.03, 95% CI: 2.32, 10.90; and OR = 5.03, 95% CI: 2.76, 9.16, respectively). Conclusions: SGM adolescents have higher burden of illicit drug use. Moreover, illicit drug use among SGM adolescents is indicative of depressive symptomology and suicidal ideation. Tailored and comprehensive programs are needed to reduce the gap in burden of illicit drug use between SGM and non-SGM adolescents.

Investigating online harassment and offline violence among young people in Thailand: methodological approaches, lessons learned.

Violence in the physical (offline) world is a well-documented health and social issue among young people worldwide. In Southeast Asia, online harassment (defined as intentional behaviours to harm others through the Internet or through mobile devices) is less well documented. In this paper, we describe and critically discuss the mixed-methods data collection approach we used to build a contextualised understanding of offline violence and online harassment among 15- to 24-year-old students and out-of-school youth in Central Thailand. We mapped linkages between offline violence and online harassment, and with their possible correlates including gender, sexuality, and mobile media or Internet use. Data collection methods included in-depth interviews, focus group discussions and a custom-built, self-administered computerised survey. Using mixed methods enabled us to collect holistic qualitative/quantitative data from both students and out-of-school youth. In our discussion, we focus on gender, sexuality, class and ethnicity issues in recruiting out-of-school youth; definition and measurement issues; technical issues in using a computerised survey; ethical issues surrounding data collection from minors as well as privacy and confidentiality concerns in collecting data in both in-school and out-of-school settings; and the general implications of using mixed methods.

'She met her (boy)friend online': Negotiating gender identity and sexuality among young Thai women in online space.

This paper focuses on the experiences of women 15-24 years old living in one suburban district in Bangkok. Its objectives are to analyse processes of building and negotiating social identity and femininity in online spaces by young women; the ways in which young women express their sexuality using online technologies; connections between the 'online' and 'offline' worlds in terms of emotions as well as social and sexual networks; and traditional values regarding female sexuality reproduced through online media and how young women negotiate and resist these. Content and narrative analyses were conducted using qualitative data from 9 focus-group discussions and 14 narrative interviews. Findings indicated that the online media serve as tools that help young women develop and express their gender identities. Mobile phones and the Internet facilitate communication in order to express love, responsibility, intimacy and sexual desires. Discourse on women's chastity, which puts pressure on women to maintain their virginity, still influences online and mobile contents, messages and images among young women. However, women also exerted agency in negotiating and expressing their sexuality, both online and offline.

Revisiting the 'Thai gay paradise': Negative attitudes toward same-sex relations despite sexuality education among Thai LGBT students.

School settings are volatile and often violent for LGBT teens who are first coming to terms with their sexuality. We explored the attitudes of LGBT students in Thai secondary schools towards homosexuality. Students aged 12-19 years were surveyed in 393 public institutions providing secondary-school education in six regions of Thailand, selected by a multistage cluster sampling. Among 1088 LGBT-identified students, 378 (35%) reported negative attitudes toward homosexuality. Factors associated with homonegative attitudes in a multivariable logistic regression analysis were identifying as a transgender (Adjusted Odds Ratio [aOR] 2.5, 95% CI 1.5-4.1), having low academic performance (GPA scores of 2-3 [aOR 2.6, 95% CI 1.7-4.1] or less than 2 [aOR 2.1, 95% CI 1.5-2.]), and attending sexuality education classes covering topics such as bullying LGBT students (aOR 1.9, 95% CI 1.2-3.1) and safe homosexual practices (aOR 2.1, 95% CI 1.7-4.1). Sexuality education in its current form in Thai public schools may not be effective in reducing homonegative attitudes of LGBT-identified students. A more comprehensive sexuality education emphasising gender and rights along with strategies addressing social disparities due to sexual orientation is needed to enable Thai LGBT teens to accept their sexuality without shame and self-disrespect.

Social violence among Thai gender role conforming and non-conforming secondary school students: Types, prevalence and correlates.

BACKGROUND: Gender role non-conforming behaviors are a significant risk factor for school-related violence. The objective of this study is to describe the types, prevalence and correlates of social violence among Thai secondary school students, with a focus on gender role non-conformity. METHODS: This article uses secondary data from a national study of 2070 secondary school students aged 13-20 years representing Bangkok and all four regions of Thailand. Students were asked about their gender/sexual identity, self-perception of their masculinity or femininity, and experiences of social violence. Correlates of social violence were examined using multivariable logistic regression models. RESULTS: Prevalence of social violence victimization was high (57%). Most students considered themselves to be as masculine or as feminine as other members of their sex (82.6%), while 9.1% thought that they were less masculine/less feminine, and 8.3% thought they were more masculine/more feminine. Students who considered themselves less masculine or less feminine than others of their sex (AOR = 1.59, 95% CI: 1.13, 2.25) were more likely to experience social violence, compared to students who considered themselves equally masculine/feminine. Students who self-identified as lesbian, gay, bisexual or transgender (LGBT) (AOR = 1.37, 95% CI: 1.01, 1.86) were also more likely to experience social violence, compared to students who did not identify as LGBT. However, students who considered themselves more masculine or feminine than other students of their sex (AOR = 0.62, 95% CI: 0.44, 0.88) were less likely to experience social violence. DISCUSSION: Students who identified as LGBT, or considered themselves to be less masculine or less feminine than other students of their sex, had higher odds of social violence victimization. Anti-bullying campaigns need to emphasize that perpetrating social violence is not tolerated, and gender-based violence needs to be included in comprehensive sexuality education curricula.

Connections between online harassment and offline violence among youth in Central Thailand.

Increasing evidence indicates that face-to-face (offline) youth violence and online harassment are closely interlinked, but evidence from Asian countries remains limited. This study was conducted to quantitatively assess the associations between offline violence and online harassment among youth in Central Thailand. Students and out-of-school youth (n=1,234, age: 15-24 years) residing, studying, and/or working in a district in Central Thailand were surveyed. Participants were asked about their involvement in online harassment and in verbal, physical, sexual, and domestic types of offline violence, as perpetrators, victims, and witnesses within a 1-year period. Multivariable logistic regression was used to assess independent associations between different kinds of involvement in offline violence and online harassment. Perpetration and victimization within the past year were both reported by roughly half of the youth both online and offline. Over three quarters had witnessed violence or harassment. Perpetrating online harassment was independently associated with being a victim online (adjusted odds ratio [AOR]=10.1; 95% CI [7.5, 13.6]), and perpetrating offline violence was independently associated with being a victim offline (AOR=11.1; 95% CI [8.1, 15.0]). Perpetrating online harassment was independently associated with perpetrating offline violence (AOR=2.7; 95% CI [1.9, 3.8]), and being a victim online was likewise independently associated with being a victim offline (AOR=2.6; 95% CI [1.9, 3.6]). Online harassment and offline violence are interlinked among Thai youth, as in other countries studied so far. Interventions to reduce either might best address both together.