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Thailand. Situational Analysis of Young People at Higher Risk of HIV Exposure in Thailand Petchsri Sirinirund Advisor to the Department of Disease Control MOPH, Thailand Updated from slides prepared by Mara Steinhaus (Data Management Technical Advisor)

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    1. Thailand Situational Analysis of Young People at Higher Risk of HIV Exposure in Thailand PetchsriSirinirund Advisor to the Department of Disease Control MOPH, Thailand Updated from slides prepared by Mara Steinhaus (Data Management Technical Advisor) and Catherine Lee (Principal Investigator)

    2. Study Background • Organizations involved: • National AIDS Management Center (users) • UNICEF/UNFPA/UNESCO (donors) • Thammasat University (research team) • Community-Based Organizations (implementing partners) • Study timeframe: Scoping mission (March 2013) and research project (May 2013-April 2014)

    3. 2012-2016 HIV new infections projected by AEM Of the 38,883 new cases reported, 89% are among key populations 33 provinces contain 66% of all new HIV infections

    4. Study Aims “To assist in strengthening national capacities for improved policy advocacy and informed decision-making on issues of equity, social inclusion, and protection of youth at higher risk of HIV exposure by offering an evidence base.” • Review the situation of young key affected populations (YKAP) • Review the present policy and programmatic response for YKAP • Identify gaps and needs, as well as promising practices for YKAP • Determine strategic future policy and programming interventions for YKAP

    5. YKAP Groups (aged 15-24 yrs) • Females who exchange sex for money/goods (FSW) • Men who have sex with men (MSM) • Non-Thai migrants • Transgendered youth (within FSW and MSM networks and in FGD and network on their own) • Youth who inject drugs (within all networks and in FGD on their own)

    6. Ethics and Safety Considerations • Approved by the ethical review committee at Thammasat University • To minimize social risks • Consultation with local organizations and key stakeholders prior to the start of data collection • Meeting with YKAP to discuss the study background, purpose and procedures as well as measures to ensure confidentiality and privacy of the respondents • Data collected by using respondent-controlled mobile devices • Respondents aged 15-17 yrs were asked to state reasons why parental/guardian consent could not be obtained

    7. Methods • Literature review • Secondary analysis of existing national and provincial-level datasets • Key-informant interviews • Identification of common key factors relevant to service delivery for YKAP • Primary data collection • Focus groups • Identification of common factors related to behaviors, access to and use of services • Individual surveys using Respondent Driven Sampling

    8. Study objectives • The study includes three units of analysis and combines qualitative and quantitative measures: • (a) an analysis of factors related to HIV exposure risk using primary and secondary data • (b) a health and social service needs assessment starting with a mapping of existing services at each site location and information from primary data collection on specific needs to highlight gaps and needs • (c) an ecological approach to integrate findings on the situational analysis of young people at higher risk of HIV exposure

    9. Formative Research • Scoping Exercise Feb. 5th – March 5, 2013 • Literature review • Service mapping • Face to face meetings (22 total across four provinces) • Areas of investigation (Johnston, Whitehead, Simic-Lawson, & Kendall, 2010) • Social network properties • Acceptability of RDS • Seed selection • Survey logistics • Technical preparation • Check sample size calculations • Discussion of confidentiality issues and incentives • Planning for data management and analysis

    10. Preparation for RDS

    11. RDS Data Collection • Chiang Mai (3) • July 24 – Aug. 30, 2013 • Aug. 26 – Sept. 30, 2013 • Oct. 12 – Nov. 11, 2013 • UbonRatchathani (1) • Nov. 14 – • Songkhla (1) • Nov. 27 - • Bangkok (2) • Dec. 6 - Image source

    12. RDS survey results Network descriptive statistics • MSM from Chiang Mai (8 seeds; 9 waves; 272 surveys) • MSM from Bangkok (6 seeds; 10 waves; 273 surveys) • Non-Thai migrant from Chiang Mai (5 seeds; 8 waves; 280 surveys) • Transgender from Songkhla (6 seeds; 7 waves; 272 surveys) • FSW from Chiang Mai (6 seeds; 6 waves; 268 surveys) • FSW from UbonRatchatani (6 seeds; 21 waves; 273 surveys) • FSW from Bangkok (6 seeds, 6 waves, 270 surveys)

    13. A/Y MSM Network Location: Chiang Mai Sample Size: 272 Seeds: 8 Maximum waves: 9 Key Challenges: Location of interview site Reaching youth who were not enrolled in university/school Wording of inclusion criteria Seeds that did not lead to further interviews Ending the survey

    14. A/Y Non-Thai Network Location: Chiang Mai Sample Size: 280 Seeds: 5 Maximum waves: 8 Key Challenges: Location of target population (effect on planned teams) Understanding the network size questions

    15. FSW Network • Location: Chiang Mai • Sample Size: 268 • Seeds: 6 • Key Challenges: • Building trust of “research” among CBO partners • Dislike of questions involving counts (ex. number of sexual partners) • Reaching people who exchange sex informally/non-venue based

    16. Main findings • Higher odds of condom use at last sex with higher levels of social support (transgender, female sex workers) • Decreased reported frequency of using drugs or alcohol before sex with higher levels of social support (non-Thai migrant, MSM, transgender) • Higher HIV knowledge scores among adolescents with higher levels of social support (MSM, non-Thai migrant, transgender, FSW)

    17. Main findings (cont.) • Increased odds of ever testing for HIV with higher levels of social support (MSM, FSW) • Higher odds of receiving services or information related to HIV with higher levels of social support (MSM, FSW Chiang Mai); however, also see lower odds of receiving information or services if higher levels of social support (FSW Bangkok)

    18. Limitations of the study • Primary data collection was limited to 4 provinces. Findings may not be able to be directly applied to provinces not included in this study. • Largely lacks inclusion of respondents under the age of 17 yrs - needed data reported does capture information on higher risk behaviors during their younger years. • General young people were not included in primary data collection – lack of direct comparison between YKAP and general population youth. • Social support – the study cannot provide more specific information – how social structure in which YKAP find the support is made up

    19. Recommendations for future RDS surveys with YKAP • Relationships with local CBOs are key • Understanding geographic location and social connectedness of target population • Asking meaningful questions in appropriate way • Finding data collectors and seeds • Plan for intensive and ongoing monitoring of the data • Coupon numbers, waves, number of coupons given out • Questions with unexpected answers or high numbers of refusals • Know what networks can and cannot be effectively reached using RDS

    20. Acknowledgements • Entire research team Co-Principal Investigator: Assoc. Prof. Dr. NitayaVajanapoom Co-Principal Investigator: Dr. Catherine Lee (Team Leader) Co-Investigators: Mr. Adam Tousley Mr. PongthornChanlearn Ms. Jessica Nhkum Research Coordinator: MetheeSriphyttha Project Assistant: PetcharaBanditnopparat Financial Officer: YasminaAules Consultants Assoc. Prof. Dr. Marc Van der Putten Ms. Sarah Meyer • Partner organizations MPlus Adolescent Reproductive Health Zone (ARHZ) Empower • Donors – UNICEF/UNFPA/UNESCO