Intimate Relationships Among Adolescents in Different Social Groups in Northern Thailand
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INTIMATE RELATIONSHIPS OF ADOLESCENTS IN DIFFERENT SOCIAL GROUPS INTIMATE RELATIONSHIPS AMONG ADOLESCENTS IN DIFFERENT SOCIAL GROUPS IN NORTHERN THAILAND Arunrat Tangmunkongvorakul1, Gordon Carmichael2, Cathy Banwell2, Sam-Ang Seubsman3 and Adrian Sleigh2 1Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; 2National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia; 3 School of Human Ecology and Thai Health Promotion Center, Sukhothai Thammathirat Open University, Nonthaburi, Thailand Abstract. With the influence of modernization, there is evidence of increasing Thai adolescent sexual activity. The purpose of this study was to describe and compare the intimate relationships of adolescents in different social groups in northern Thai- land, and to note the health implications of their behavior. Quantitative and quali- tative data from more than 1,750 unmarried young people aged 17-20 years re- vealed that adolescents from different social and educational backgrounds had significantly different types of intimate relationships. In the Thai context, social class differences are mostly based on young people’s educational backgrounds and their families’ financial power. Perceptions of love and relationships were interpreted according to social strata and sex. Notably, less well-off young people were likely to engage in much riskier sexual relationships. The present study pro- vides detailed and constructive information to help plan and improve sexual and reproductive health counselling, programs and services for young people in north- ern Thailand. Key words: intimate relationships, dating, adolescents, socio-economic status, Thai- land INTRODUCTION Vuttanont et al, 2006) and many young men and a growing percentage of young Sexual norms among young Thai women report premarital sexual experi- people are shifting rapidly (Jenkins and ence (Podhisita and Pattaravanich, 1995; Kim 2004; Liu et al, 2006). Young Thais Baker, 2000; van Griensven et al, 2001; now enjoy frequent social interaction be- Srisuriyawet, 2006). Some urban Thai tween the sexes (Soonthorndhada, 2002; men no longer discriminate against women who have had premarital sexual Correspondence: Dr Arunrat Tangmunkong- relations with other men, although oth- vorakul, Research Institute for Health Sci- ers still prefer to marry a virgin (Gray, ences, Chiang Mai University, PO Box 80 CMU, 1999; Knodel et al, 1999). Chiang Mai 50202, Thailand. Tel: +66 (0) 53 945055; Fax: +66 (0) 53 221849 Modernization in Thailand is occur- E-mail: [email protected]; Arunrat.Tang ring within the bounds of a longstanding @anu.edu.au traditional system. This makes it difficult Vol 41 No. 6 November 2010 1475 SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH for young people to embrace these changes et al, 2004). while older generations have attitudes Little research in Thailand has explored rooted in the past. Consequently, young the sexuality of adolescents in different so- people face new and unfamiliar risks re- cial groups. Studies of this nature in this lated to sexual and reproductive health. heavily socially stratified population are Many are ill-equipped to make sexual and needed, especially in northern Thailand, a reproductive choices (Allen et al, 2003; region deeply affected by epidemic AIDS Tangmunkongvorakul et al, 2005). and linguistically distinct from the rest of As most acts of premarital sexual in- the country. To enhance understanding of tercourse in Thailand are unprotected intimate relationships among young north- (Jenkins et al, 2002; Srisuriyawet, 2006), ern Thais we conducted a multi-method sexually active adolescents are increas- study of sexual behavior, relationships and ingly at risk of contracting STIs, including lifestyles among adolescents in Chiang Mai HIV/AIDS. Young women are particularly City, the cultural, economic, communica- vulnerable to coerced sexual intercourse tion and tourism center of northern Thai- as a result of gender-based power imbal- land. This city has become a major destina- ances and the sharp move away from com- tion for migration of rural residents, to mercial sex workers as debut and subse- which young people from country areas quent sexual partners for adolescent Thai and surrounding provinces move for edu- males as a result of the AIDS epidemic cation and work (Vaddhanaphuti, 1999; (Manopaiboon et al, 2003; Im-em et al, 2005; Vuttanont et al, 2006). Our results yield im- Rasamimari et al, 2008). Sexually experi- portant information that can inform the enced female adolescents are relatively planning and implementation of health powerless to avoid the potential conse- policy, and help improve sexual and repro- quences of unprotected sexual intercourse, ductive health counselling, programs and and are poorly informed about their sexu- services for young people in northern Thai- ality and means of protecting themselves, land. often leading to unwanted pregnancies and abortions (Allen et al, 2003). However, MATERIALS AND METHODS the actual vulnerabilities stemming from adolescent lifestyles and relationships re- Study population main poorly understood; it is only over the We studied young people aged 17-20 last decade that policymakers have begun years. The subjects were literate males and to shed their traditional reticence to dis- females who were not yet married, who cuss these issues and have started search- were either in or out of school or univer- ing for information to develop appropri- sity, and if out of school, were either em- ate services. ployed or unemployed, reflecting the full Over the last 15 years, well-founded range of adolescent social groupings fears about the risk of contracting HIV in- within the population. fection from commercial sex workers have The sampling frame incorporated ac- influenced young men in Thailand to find cessible sites in urban Chiang Mai where other ways of satisfying their sexual needs. 17-20 year-old youths congregate. Three Increasingly, they are having sex with girl- educationally defined samples were se- friends in committed romantic relation- lected: 1) an out-of-school urban adoles- ships (Kilmarx et al, 2000; Taywaditep cent sample, 2) a vocational school student 1476 Vol 41 No. 6 November 2010 INTIMATE RELATIONSHIPS OF ADOLESCENTS IN DIFFERENT SOCIAL GROUPS sample, and 3) a general school and uni- private high-schools and the two public versity student sample. For each educa- and two private universities in Chiang Mai tional group subsamples of males and fe- City. One public and one private high- males were obtained as follows. school were chosen, along with Chiang The out-of-school sample was re- Mai University, representing all compo- cruited from two broad sources – the six nents of this educational group. At the largest of 22 non-formal education centers general schools samples of respondents and four youth-focused NGOs in Chiang were drawn from the pure and applied sci- Mai City. Non-formal education centers ence and language study groups. At the provide tutorial classes for young people university the sample was drawn from the outside the formal education system, health sciences, science and technology, which they generally attend for three and humanities and social sciences groups. hours on weekends. Selected centers were All respondents volunteered after being is- approached on teaching days and all age- sued an invitation. eligible youth invited to participate. The The sample size estimate was calcu- NGOs through which the respondents lated with an error of ±7% at the p<0.05 were recruited were the Harm Reduction significance level when measuring key Youth Program, the Street Youth Outreach indicators (eg, percent with experience of Team, the Adolescent Sex Education Out- sexual intercourse). These were applied reach Team, and the MSM (men who have separately in males and females in each sex with men) Sexual Health Outreach educational group (ie, six samples). If the Team. Field staff worked with these NGOs expected prevalence was 50% (the propor- at various times of the day and night, re- tion requiring the largest sample for esti- cruiting as many age-eligible respondents mation with a given level of precision), the as possible from an array of public gath- required sample size was 192, and the to- ering places, including playing fields, tal sample size was 1,152 (ie, 6 x 192). We shopping malls and public gardens. therefore aimed to sample about 200 The vocational school sample was young people in each sex/education group, drawn from the two public and 10 private for a total of around 1,200. In five groups vocational schools in Chiang Mai City. One this sample size was exceeded; for out-of- public technical, one private technical and school females the sample reached only one private commercial school were cho- 169 because relatively few females were sen at random. At each of these schools encountered at the facilities and locations age-eligible students from three depart- visited. Overall, the final total sample was ments were invited to participate until the 1,749: 909 males and 840 females, com- target sample size (about 70 per school - prised of 262 male and 459 female general see below) was exceeded. Selected depart- school and university students, 409 and ments were electronics, mechanics and 212 vocational school students, and 238 computer technologies at the two techni- and 169 out-of-school adolescents, respec- cal schools, and marketing, hotel manage- tively. ment and finance, at the