Prevention of HIV/AIDS Among Migrant Workers in Thailand

Strategies & Activities

Condoms, Condoms, Condoms


	Condom distribution is one of the PHAMIT Project’s core activities. Over the course of the project, more than 5 million condoms have been distributed to migrant workers and entertainment workers. Condom distribution is more than simply handing out condoms, though. Promoting condom use requires strategies to overcome the main obstacles to using condoms among migrants – knowledge, attitudes and access. Accordingly, PHAMIT partners use complimentary activities to influence condom use and get condoms to these hard-to-reach populations. Vulnerability and risk Migrants from Burma (Myanmar), Cambodia and Laos are coming at younger ages, with many only in their mid-teens. Yet, they enter into a very adult situation. As most migrants come from rural areas where there are conservative values or limited access to information, many arrive without a clear understanding of how HIV is transmitted or prevented, and may have never seen a condom before coming to Thailand. Some have misconceptions about condoms, such as using two layers is safer than one, or even that HIV is on the inside of condoms… Being placed in a new environment, these migrants are faced with new challenges and opportunities that they may not be prepared for. For example, loneliness or fear can lead to seeking out relationships and sexual contact, while others may want to explore their sexuality.
	However, finding themselves released from the social constraints of their traditional community and being placed in the liberal lifestyle of Thailand, they may be unaware of the risks involved, including HIV, STIs or unplanned pregnancy. Oftentimes there is little consideration for a partner’s sexual history, and issues of intimacy and trust reduce the use of condoms in relationships. This means that it is important to diminish the potential for HIV transmission through transactional or casual sex so as to lower the chance that people are bringing HIV or STIs into their relationships.

	Beyond behavioral and attitudinal obstacles, the limited mobility of migrants also acts as a barrier to accessing condoms. For many migrants, their workplace is located in remote areas that makes it difficult to travel and purchase condoms. Some may be undocumented migrants and are thus afraid of being arrested, while even those who are documented may fear harassment or may not be able to afford the time or extra expense of transportation.
	Active and passive distribution PHAMIT partners use two main condom distribution strategies: passive distribution through condom boxes, and active distribution through outreach activities, volunteers and employers. Between these two strategies combined, migrants can currently access condoms at 1,500 distribution points. Condom boxes provide migrant populations convenient locations where they know they can get a condom at any time and that are in close proximity to their residence or en route to engaging in sexual activities. These boxes are placed in various strategic locations ranging from drop-in centers, dormitories, snooker halls, general stores, barber shops, motorcycle taxi stands and boat piers. Placement of distribution boxes needs to consider minimizing embarrassment associated with requesting condoms, which is important for youth and those who adhere to traditional values, as well as other practical considerations of storage and visibility.
			Getting migrants to actively take or seek out condoms requires overcoming the embarrassment of youth and the constraints of traditional cultural upbringing. It takes exposure over time through repeated activities that discuss issues of sexual and reproductive health and demonstrate condom use in groups. Once a comfort level is established, these people will be more likely to seek out and use condoms.

	The first step in familiarizing migrants with condoms is done through outreach activities. In these small group activities migrants are informed of the benefits of condoms, they are encouraged to touch condoms and there are demonstrations on how to put on and dispose of a condom properly using penis models. Volunteers and employers who are already in regular contact with migrants reinforce these lessons by distributing IEC and BCC materials along with condoms. Some condom boxes are maintained and refilled by volunteers as a way of ensuring that the condoms are properly stored. Having volunteers distribute condoms is also important in entertainment venues where owners are wary of having condom boxes publicly available for fear of police using it as evidence of prostitution, which is illegal. Now, migrants regularly deplete condom boxes and come to volunteers to request condoms without embarrassment. Notably, women in these communities approach field officers to request condoms and women in entertainment venues always know who they can get a condom from.
		PHAMIT brand PHAMIT realized that distributing the standard grade condoms from Public Health would not contribute to condom use, as these condoms are often perceived as uncomfortable and lacking sensation. Instead, PHAMIT went and developed its own brand of “premium” condoms that have more lubricant and greater sensation than the MOPH condoms, but were not quite as expensive as real brand name condoms. They were generally well received. Over time, valuable lessons were learned about quality control, including making sure there was user feedback to identify reasons for breakage as well as for honing “marketing” issues such as identifying preferences for color and scents.
	Remaining gaps Some remaining groups among migrants that need to be targeted with condom promotion strategies include: condom use with spouses; increased use in relationships where there is “trust” but not necessarily monogamy; young women who are in serial monogamous relationships; and among men who have sex with men. Another aspect that has yet to be fully addressed is the promotion and use of lubricant, especially among sex workers and men who have sex with men.