The Research on Training Methodologies for AIDS Education and Counselling in Thailand (Phrase II)

Som-arch Wongkhomthong, M.D Kishio Ono, M.D

ASEAI{ Institute for Health Development

Mahidol University
1996

Funded by Japanese Foundation for AIDS Prevention

'

#W

The Research on Training Methodologies for AIDS Education and Counselling in Thailand
(Phrase II)

Som-arch Wongkhomthong, M.D Kishio Ono, M.D

ASEAN Institute for Health Development

Mahidol University
1996

Funded by Japanese Foundation for AIDS Prevention

ffi

The Research on Training Methodologies for AIDS Education

Counselling in Thailand

and

By Som-arch Wongkhomthong, Kishio Ono ISBN: 974-611-588-4

First Edition t996 Printed by Printing Division ASEAN Institute for Health Development Mahidol University, Salaya Nakompathom 7 3170, Thailand

Som-arch Wongkhomthong The research on training methodologies for AIDS education and counselling in Thailand (Phrase ll/Som-arch Wongkhomthong, Kishio Ono Acquired Immunodeficiency Syndrome+ducation-Thailand 2. Counselling. 3. Research.I. Ono, Kishio.IL Title. WC503 56931 1996

ISBN :974-6ll-588-4

Acknowledgements

We would like to express our gratitude to the Japanese Foundation for AIDS Prevention for their support of the third year of the research project on The Research on Training Mahodologiies

for

AIDS Edrcaion and Counselling in Thailand.

We would like to take this opportunity tho thank all those that contributed valuable iruights and
ideas to this research

project. Especially, helpful has been the many discussions that have taken

place between us and members of both government and non-government organizations that are

involved in the management of the HIV/AIDS situation in Thailand. They ilre too many to
mention by name but their contributions have been invaluable to our work.

It is our hope that the contents of this research as well as the educational material produced by the research grant will contribute to the prevention and control of AIDS in Thailand and the
developing countries of the region.

Som-arch Wongkhomthong

Kishio Ono

Table of Contents

Acknowledgements

P.

Chapter

I 2

Stnnmary of the Research Project

Results ofliterature Survey and Research for Chapter ^AppropriateTrainingMethodologiesforTraining

Education and Counselling for HIV/AIDS

Chapter 3

Results ofthe ExPert WorkshoP

3l

Chapter 4

Results ofthe Two Training Workshops for AIDS Education and cotrnselling for Field workers and

Community Volunteers

Chapter

Bibliography of Materials on Training Methodologies 58 for Triining, Education and Counselling for HIV/AIDS

Chapter

Summary of the Research Project

1.

Title of the Research Project

The Research on Training Methodologies for AIDS Education and Counselling in
Thailand.

2.

Main Researchers

Dr. Som-arch Wongkhomthong

Director ASEAN Institute for Health Development Matridol University
Phuttamonton, Nakornp atom 73170, Thailand

3.

Background and Rationale

AIDS is considered as one of the most important social problems in Thailand because it is a deadly communicable disease that has infected many people. Moreover,
there is no drug or vaccine to cure the disease and the current drugs used to lengthen the

life of patients are very expensive. All these factors contribute to a greater problem of
prevention and control of AIDS in every community in Thailand.

On the other hand, Community Based Approach (CBA) has drawn a lot of
attention from researchers and sbholars, because it is one of the most effective measures

to work with people to educate and solve their problems. CBA is also considered as an appropriate means to solicit sustainable development. Therefore, the attempt to apply

CBA on AIDS prevention and control in Thailand is interesting not only in terms of its
direct contribution to solving the AIDS problem in Thailand but also for

is

community

development possibilities that address the socio-economic causes and effects that surround the disease.

In the frst year, the researchers studied activities on Community Based Actions for AIDS
prevention and control in Thailand. Needless to say, Community Based Actions are very

important not only to prevent and control

patients. However, the success

volunteers.

HIV infection, but to provide care for AIDS of Community Based Action on AIDS relies on

knowledge, perception, training and education

for field

workers and community

As a consequence of this understanding, in the second year the research focused on

appropriate training methodologies for AIDS education and counselling for field workers and commuhity volunteers. The research, therefore, was considered necessary not only

in terms of academic challenge but because of its contribution to the enhancement of

community based actions for the prevention and control of

HIV infection

and care for

AIDS patients in Thailand.

In the third year we make further explorations of the literature which we report in our
literature review, and tested other possible training approaches.

4.

Objectives of the Research

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General Obiectives

To study appropriate training methodologies for AIDS education and counselling for field workers and community volunteers in Thailand.

Soecific Obiectives

4.1

To' study principles, methods, and

appropriateness

of

various training

methodologies for training, education, and counselling for AIDS.

4.2

To organize two training workshops for AIDS education and counselling for field workers qnd community volunteers to test the appropriateness of the training
methodology.

4.3

To give recommendations to the Japanese Foundation for AIDS prevention about

appropriate training methodologies for AIDS education and counselling for field workers and community volunteers in Thailand and other developing countries.

5.

Research Methodologies

5.1

Literature survey to review principles, methods and appropriateness of various

Eaining methodologies for training, education and counselling for AIDS.

5.2

Implementation

of an expert workshop to brainstorm an appropriate

training

methodology for training, education and counselling for AIDS.

5.3

Implementation of two training workshops for AIDS education and counselling

for field workers and community volunteers.

6.

Research Period

6.1

Literaturb survey and research for appropriate training methodology during

April 1, 1995 to September'31,

1995.

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6.2 The expert workshop on innovative approaches to training education and counselling for HIV/AIDS on January 26
and March 3,1996.

6.3 Training workshop for field workers and community volunteers. The fint workshop during 22-26 April 1996 and the second during 9-11
October 1996.

7.

Benefits of Research proiect

The Research project provides appropriate training methodologies with some recommendations for the training of field workers and community
volunteers concerning

AIDS education and counselling.

These training

methodologies can be used to enhance community based activities for the prevention and control of HIV infection, management of AIDS project at the district level and care for AIDS patients in Thailand as well as in other developing countries.

8.

Maior Output of the Research proiect

8.1
8.2

Research on training methodologies for AIDS education and counselling

(see details

in Chapter 2)

Expert workshops to brainstorm on innovation approaches to training education and counselling for AIDS on January 26 andMarch 3,

196(see details in Chapter3).

8.3

The

fint training workshop for AIDS

education and counselling during

April22to26 ,1996 ( see details in Chapter 4).

-4-

8.4 The second tnaining worlcshop

during October 9-11,

for AIDS education and counselling 1996 (see details in Chapter 4 ).

8.5

Fifty sets of training materials for the first training program ( see details in Chapter 5) . Boolcs ( document numbers l-3 ) 50 sets x 3 books
Handouts ( document numbers 4-6 ) 50 sets x 3 handouts Video T"p" ( document numbers 7 ) 50 pieces

8.6

Two hundred and fifty sets of training materials for the second training
Program.

Books (documentnumbers 8-t?)zfr sets x4books Handouts ( document numbers 13-14) 250 sets x 2 handouts

Chapter 2
THE RESEARCH ON TRAINING METHODOLOGMS FOR AIDS EDUCATION AND COIJNSELLING IN THAILAND

Literature Review:
In response to the increasing prevalence of HIV/AIDS in Thailand, numerous strategies
have been employedto decrease the pace

of

the advent of disease. The important

strategies developed and advocated in Thailand

is

included in the National AIDS

Prevention and Control Plan 1992-1996 (Office of the Prime Minister,l992) which
emphasises disease prevention through public information and education that provide
exact knowledge and correct understanding of

HIV/AIDS,

at the same time encouraging

modification of relevant behaviours and attitudes through motivation of behaviours which are less likely to be at risk of catching infection, and preventing discrimination
against those already infected

with the HIV virus.

Some of the measures/guidelines suggested in national plan include acceleration of co-

ordination between the government, religious organisations, non govemmental

organisations Q.{GOs), public service agencies, businesses, communities and families in

providing public education in all forms to improve the knowledge and understanding of

HIViAIDS

across all age, geographic and occupational groups of the population,

acceleration of dissemination and provision of knowledge and understanding about AIDS and STDs including appropriate sex education in schools; providing support activities or educational programs about AIDS and the prevention of

HIV infection for all

govemment civi{servants and employees through training and various media

approaches; emphasising the use bf appropriate media messages for different groups and

applying the principles of marketing by involving the business and advertising

-6-

community to help design and produce media by using local and simple language;
accelerating the dissemination of knowledge and understanding by involving role models

or influential peers to expand the impact of consistent messages which are continuous,
sincere and widespread both in the general population and target audiences; accelerating

the dissemination of information and training in the use of condoms and expanding the

supply of condoms for use in entertainment establishments to prevent HIV and venereal
diseases; supporting the role of the

family and local leaders in villages, religious,

entertainment and other groups in promoting knowledge and understanding and

motivation in order to reduce or eliminate risk behaviours in the population; and other
regulations, support services and enforcement measures employedby the govemment

in relation to public information and education

on

HIV/AIDS.

The guidelines, in the national plan included in the program on public information and
education, lay emphases on promoting correct knowledge and appropriate attitudes conceming HIV/AIDS and sexually transmitted diseases(STDs); accelerating the

dissemination of information and training for men and women, adolescents, parents and

community leaders to help them to recognise the negative psychological, social, cultural
and hiafth related repercussions of prostitution; supporting and promoting values and

norms which encourage morality, family intimacy, honesty and faithfulness between
spouses

with the ultimate

goal of reducing

promiscuity and prostitution; instilling

motivation in the population to reduce or eliminate risk behaviours; promoting correct

knowledge and attitude of the proper use of condoms and informing the population

about condom quality and other

effective prevention measures; promoting the

understanding of the public, community, family and other institutions that they can live

normally with HIV infected individuals; supporting knowledge, understanding outlook

and motivation of infected individuals to look after their health and prevent them from

infecting others and also promoting non-discriminatory practices and supporting human

-7-

rights issues in this area. With respect to sex education in schools, the national plan
emphasises the need of including sexual decision making, family life, prevention of STDs
and

HIV/AIDS, moral values and norms in the cuniculum at the primary school level

and upwards.

It

also supports extra-curricular activities non-formal education and sports

that promote values, norns and behaviour leading to reduction of risk behaviour. In
addition, the national plan promotes assessing knowledge, understanding and prevention

of STDs and AIDS in entrance examin ations to educational institutions and for employmentand also supports the establishments of clubs/groups in educational institutions which promote knowledge and understanding about AIDS to eliminate the
contempt for HIV infected individuals.

Numerous studies have been conducted in Thailand in conjunction and co-ordinatron

with the national plan. A project on HIV/AIDS peer educationfor Thai military
conscripts was developed, pilot tested and implemented on a large military base in 1993,

with the aim of decreasing high risk behaviour among 2l-year-old

entering the Royal Thai

male conscripts

Army

Q.tropkesorn, Sangkaromya, Mastro, Chinvarasopak,

Laosakkitiboran, Teppa & Buadit, 1994).In this project, to educate 955 new conscripts,
ZO medical

corps conscripts were selected and trained by professional trainers to

.

become peer educators(PE). Teams of 3-5 peer educators met with groups of 30-40 new

conscripts for 3-hour sessions during basic training. The process consisted of group
discussions, games, video shows, pre- and post-education evaluation questionnaires.

The results showed that after education, g0olo of conscripts indicated that peer education was an appropriate method andglYo thought that they had leamed a moderate to large amounf about HIV/AIDS .88% indicated that they would either use condoms every time(67%) or not have sex with female prostitutes(21%). 640/oindicated that they would
use condoms every time with female acquaintances. Only 446/o felt sure they would avoid

HIV infection. This project concluded that peer education could be regarded

as an

-8*

appropriate, acceptable and feasible intervention for influencing behaviour change for youngmen at military bases.

Bangkok:
Several projects and research studies have been conducted in Bangkok.

A study on

behaviour change intertention among factory workers throttgh outreach commtmication

by graduate volunteers ( Porapakkham, Wongkhomthong

& Chuchat, 1995) in Bangko(

found that behaviour change communication can alter risk behaviour when it is well
designed and conducted. In this project, 35 graduate volunteers were trained in three

phases over a period

of

one and a half years. The volunteers were trained for one

month and then 2-3 of them were placed in a factory for 4-5 months. The graduate volunteers selected peer leaders and trained them to enharrce their skills and confidence

in delivering AIDS information to other factory workers. In addition, they also

conducted large group campaigns and peer education intervention in small groups to

reach majority of target factory workers in order to expose them to AIDS education
activities directly. Results from pre and post survey indicated positive changes in sexual
behaviour among employees in the project factories. The proportion of male and female employees reported having non-regular sex partner after the intervention decreased from

Zl3%to
243%to

14.9Yo.

Proportion of male reported having sex with CSWs decreased from

15.4o/owhile those who had sex with'CSWs reported increased condom use

fromTZ.}Yoto 83.3%. Self-reported STDs also decreased from 3.8o/oto 0.6% for both
sexes and changed from

6.2Yoto l.3Yo among male employees.

A project was undertaken in the slum areas of Bangkok to help low-income housewives
to
assess and reduce

their risk of STD/HIV infection and to evaluate the effectiveness of

slum outreach project as a part of a larger comprehensive prevention program in a large

urban environment ( Pekanan, Pitakthepsombat & Pattawichaiporn, 1995). In this

-9-

project, 9 full{ime outreach staff and 5 supervisors were recruited, trained and deployed

to 100 slum areas. Outreach staff

were trained in the principles of AIDS communication

and outreach to wlnerable populations in low-income

areas- especially manied

with

women whb work out of the home. Methods to reach these women included links

community volunteers, ad hoc small group sessions, and home visit follow-ups to women with special outreach needs. Educational materials included cartoon booklet, flip
chart and video. In this project,

till the end of

1gg4, g outreach workers conducted 257

small group sessions and 1449 individual outreach contacts.

A total of 12,100 materials

were distributed and 15% of the population in 100 slum areas were covered by the outreach workers. This project concluded that maried women were at moderate risk due

to the behaviour of their husbands and condom use could be increased in marital
relationships.

In Bangkok,

the

role of the local government's involvement is demonstrated by the

Bangkok Metropolitan Administration

(BMA)

initiated 'Friends HelpingFriends'

project in which volunteers actively promote behaviour modification of safer practices

to those around them by direct contact which would later expand to have indirect impact
on othirs. A bimonthly newsletter provides volunteer with news and information
updates about AIDS and has stimulated the expansion of the volunteer network

(Kampanartsanyakorn, I 99 5).

An intervention on the promotion of STD service and AIDS prevention among CSWs in
Bangkok, a part of the project called 'Upgrading BangkokMetropolitan Administration

(BMA) STD semices', employed outreach education as a method of educating over 80% of commercial sex establishments in Bangkok (Sreshthaputra, Jijwatanapate, Pengsri &
Wienrawee, 1995). Outreach educationwas conducted by 195 health workers to 20,00025,000 CSWs during June 1993 to January 1994. Based on the audience research

-10-

conducted during the planning stage, outreach activities were designed in three rounds and each round was designed

with different content emphasis. In the first round, FilV as well

as

knowledge of STDs as a critical factor for receiving

proper STD services

was highlighted. In the second round, promotion and reinforcement of unconditional use

of condoms in every sexual encounter and correction of common misconceptions about

condoms, partner selection and STD self-treatment was highlighted. In the last round, peer education and peer support amdng CSWs was promoted. District

AIDS

committees were involved in mobilising co-operation from sex establishment owners to

enable recruitment of peer leaders. Need-based training

for peer leaders was provided in

an interactive style to enhance participation and commurication skills among the peer leadeis. Variety of educational materials tailor-made to the tluee emphasised themes targeting CSWs, clients and their gate-keepers. This study concluded that working

with

owners of sex establishments to gain entryto CSWs was crucial to the success of the program. Also, tailor-made IEC materials to best suit lifestyles and alter misconceptions

of the target groups with careful pre-testing proved to be much more effective in
conveying messages than general AIDS teaching as practised.

A pilot study was undertaken in Bangkok to develop and evaluate the impact of an
HIV/AIDS education course combinedwith Wpassana meditation on knowledge,
attitudes and intended behaviours of Thai university students (Amawattana, Mandel & Ekstrand, 1994). In this study, Thai university students were recruited from a required
social science course. Group

A (120 students) was given a 10-session AIDS education

course only. Group B (57 students) attended training in meditation prior to AIDS education course. Both Groups

A & B were given self administered questionnaires on

AIDS KAP and altruism pre- and post-intervention. Group C (l I I students)

participated neither in the course nor the meditation training but completed a self
administered questionnaire on AIDS

KAP

and altruism. The results showed that all the

-11*

three groups differed significantly in AIDS knowledge post-intervention

(GroupA>B>C). Comparison of pre- and post- intervention scores showed significant

improvements in both Groups A & B on all AIDS KAP measures (p<.01). On altruism
measure post-intervention, Group

A scored lower than Group B. Groups B & C did not

a

differ significantly on altruism scores. This study concluded

positive impact of a

school-based AIDS education course. The impact of Vipassana meditation as a catalyst

to learning about HIV/AIDS was unclear. Also, this study found that students were
most likely to receive AIDS education from impersonal sources like television in contrast to interpersonal sources that may foster altruism.

N ortheastern Thailand

In northeast Thailand, the multi-sectoral AIDS prevention strateg(MAPS), an actionoriented prevention

program,

has focused on increased access and utilisation

of

existing govemment programs as well as on the development of culturally+ailored education and training programs specific to target populations in the communiSr @lkins,

Kuyyakanond, Stam, Rujkorakarn, Haswell-Elkins & Moonkaen 1995). This was done

by broadcasting of five daily episodes

of

research-based audio-drama about AIDS and

arranged meetings in the district, subdistrict and villages.

In MAPS, the major risks

identified by the communities included family members migrating outside the

community for work, specific holidays when CSWS come into the communities and
local cattle markets where CSWs are available. Therefore, the prevention activities recommended by the communities included a program to send letters of concem to loved
ones migrating outside for

work, a community-based condom promotion and

distribution campaign, a community-based delivery of AIDS education using the public

address system and a mobile high school

AIDS exhibition rotated between communities

and presented to parents by students. Since the MAPS is in the strategy

implementation stage, evaluation of each activity is not yet available though careful

-L2-

evaluation and fine-tuning of the MAPS process has led to the expansion of the program

to the level of the district, while ensuring that community empowerment and input into
the district-based strategy is maintained.

In another project, anAIDS educational programfor preteenagers ( I l-13 years ) was

undertaken over a period

of

two days ( Rujkorakarn & Kiewying, 1995) in the rural

uea. 1287 preteenagers participated ih this program. The program consisted of various activities such as recreational games, small group discussions, demonstrations and
discussion with

HIV infected persons. This study found that the knowledge and

attitudes were significantly changed (p< .001) and that preteenagers enjoyed learning
about AIDS throughvarious games and fun activities.

In Khon Kaen, a pilot study was conducted in a factory to design models for AIDS
education and intervention for prevention of

HIV/AIDS (Sakondhavat,l994). With two

rounds of trials and revisions, the project discovered the best kinds of media for AIDS
education and prevention were video and informational cartoons. This study also found

that the groups of factory workers who were not involved in AIDS prevention had a

differint level of knowledge, attitudes and behaviour related to AIDS prevention than
the groups which received the intervention and attained a defined level of success.

Northern Thoiland:
In northem Thailand, numerous educational, training and evaluation programs have
been undertaken.

A study on experimental educational interventions for AIDS

prevention among northern Thai single migratory workers found that peer education, by self- and group-selected peer leaders, was an effective way for reaching single female migratory adolescents prior to or in the beginning of sexual experimentation ( Cash & Anasuchatkul, 1995). Furthermore, a study was conducted to find out whether AIDS

-13-

prevention peer education interventions were most effective in mixed groups(girls and

boys) or girls only groups(Cash, Sanguansermsri, Chuamanoahan & Busayawong, 1995).

This study also determined the changes in adolescents' beliefs about, expectations and
experiences of sexuality, communication,, understanding of sexual health associated

with

risks for and prevention of HIV/AIDS and STDs; the sexual and social context
adolescent communication styles and ways to incorporate these into

of

HIV/AIDS

prevention; and ways peer education'influences and changes behaviour. This study was
based in Chiang

Mai and predicted that the most effective

means for influencing beliefs,

behavioural intentions and behaviour is by improving communication and understanding in mixed group peer education programs and that migratory adolescents were at high risks because of socio-cultural beliefs about sexuality that guide behaviours like lack
condom use associated

of

with alcohol consumption, beliefs of

being brave and shameless,

fears about sexual performance and condom use, association of cleanliness or appearance

with morality and non use of condoms with girlfriends defined as good/clean.

Another study based in rural brothels of northern Thailand found that many women had limited
reproductive health knowledge despite high awareness of HIV ( Bond,

Phonsophakul, Chachawan, Leepreecha, Vaddhanaphuti & Celentano, 1995). This study employed three approaches to HIV risk reduction: reproductive and safe sex education,
vaginal lubricant distribution

with condoms and handicraft production to supplement

current and future income. These approaches were developed in collaboration of 24

brothel owners, 50 brothel workers and other local organisations. When combined, these
models offered a wide range of strategies for risk reduction to decrease

HIV and STD

transmission and improve social support.

In Ban Dong Laung, subdistrict of Lumphun province of norlhem Thailand, focus group
discussion and peer

education were used to develop community co-operation and

-t4-

establish clear understanding of

HIV/AIDS. This was done with the

aim of developing a

model of community-based HIV/AIDS care for rural communities ( Natpratan, Apasorntanasombat, Piyano, Moonchai & Kunawararak, 1995). For achieving the goal,

l5 volunteers performed the role of village

care providers(VCP) and 5

ofthem also

performed the role of village counsellors. Training and materials were provided for this purpose, The results showed that correct AIDS knowledge increased along with
decreased discrimination against

HIV/AID

S infected indivi duals.

In Chiang Mai,

project was undertaken to train tribal people to develop educational

materials that promote acceptance of home-care for those with HIV/AIDS ( Brown,

Jirakun & Pornsakunpaisan, 1995). In this

project, tribal people without previous

health education were trained to do surveying of their unique ethnic group and develop pictures to teach how to care for HIV infected individuals within the context of one's
home in the village. This was done and beliefs in the care of

by identi$ing and incorporating traditional practices

HIV infected individuals. Ttrough rigorous pre-testing of the

pictures,

booklet was developed that covered HIV related illness on a system basis, as

well as pictorially teaching about how to handle pregnancy, child birth, death and some
other counselling issues, The study concluded that tribal people with their
understanding of their trnique ethnic groups, could be trained to produce AIDS homecare materials that would be accepted and used in the tribal villages-

Another study, conducted in the upper northern region of Thailand, estimated the
impact of a behavioural intervention among conscripts in the Royal Thai Army (Bond,
na Chiang Mai, Vaddhanaphuti, Eiumtrakul, Nelson & Celentano, 1994). In this study, a behavioural intervention, focusing on reducing alcohol use, brothel patronageand

improving negotiationand condom skills, was provided to fwo out of four cohorts of the study, in intensive, small group discussion sessions. Serial blood draws and personal

-15-

interviews were conducted to determine behavioural risk factors for HIV infection. The

study concluded that while secular norrns were slowly changing, the results suggested
that an intensive behavioural intervention may lead to important behaviour changes and
continuing interventions were needed to prevent relapses.

Role of NGO's:

Several NGO's

have also taken an iiritiative in the fight against AIDS. The European

Commission(Ec) has taken particular interest in this area. The 'Working as Partners' project is funded by them. In this project, seven non governmental organisations have
come together to develop a series

of

workplace training cunicula

covering all aspects

of

a comprehensive workplace

HIV/AIDS education and prevention program (The

Thailand Business Coalition on AIDS, 1995). The curricula focuses on interactive and experiential leaming. They are tailored for specific target groups such as: peer educators,
counsellors, trainers, blue and white collared workers. Each training draws on the expertise and experience of each partnerNGO in prevention and training as well as

provides for a vital complementarity between the private and public sectors' approach

to AIDS prevention.

The EC has also been involved in l1D,S education at marriage registration in two provinces (Chiang Rai and Buriram) of Thailand. This is a 3-year ongoing project and
aims at reducing transmission of

HIV among married Thai couples and their offspring's

by providing them with AIDS education at maniage registration. These provinces were
chosen based on the volume of couples registering their marriage. During this project,36

district office staff

(DOS) from l2 districts in the two provinces were trained.

Retraining was also provided because of the high rate of transfer among government

officials. Since this is an on-going project, results are yet not available in this project.

-16-

The EC AIDS program has also funded a project on school based community action for

AIDS/STD prevention (Tanskul,l99a). This project was initiated with the objective of
establishing a network for peer counselling to encourage behaviour change for

AIDS/STD prevention among out of schoolyouth in rural communities. In this project

a

group of student volunteers were recruited and trained by the teacher colleges and then

dispatched to the target communities to provide peer education training. The training

provided skills for informal peer couriselling and interactive education in the village environment to initiate safer practices regarding sex and intravenous drug use among the

yoqth.

AnotherNGO co-ordinated project is the Bangkok Fights AIDS project. In this

project, PATFI/Thailand

provided technical assistance, in the form

of

formal and

informal training to outreach workers

(ORWs), in the capacity building of five

outreach agencies in the area of behavioural change (Chinworasopak & Wienrawee, 1995). These frve organisations involved seventy full-time ORWs, aiming to reach over

fifly

thousand workers at about four hundred worksites of both institutional based

workplaces such as small and large factories and non institutional based workplaces such

ms

transportation workers, construction workers and motorcycle taxi drivers.

Relubtance of ORWs to discuss sexual matters relating to observed including

a

HIV risk-taking decisions was

tendency for moral judgements in discussion of safe sex. Therefore,

learning activities regarding desensitisation of sexual.issues and non-judgmental approaches were applied in training and retraining ORWs to design their communication

activities with the target audiences in the worksite. Also, special emphasis was laid on the socio-cultural traits of the ORWs. Qualitative evaluation was done through analysis

of records of periodic meetings of ORWs to assess their problems and performance. And quantitative analysis of results were collected from the pre and post surveys of the
target groups of each intervention. The results showed improved performance of ORWs

-r7-

after training and r'etraining since this considered the importance of desensitisation and neutralisation of the ORWs attitudes towards human sexuality and equipped them with

skills necessary to deal with sexual discussion on a one-to-one or Also activities designed by ORWs for the target

a small

group basis..

groups

incorporated more relevant

content regarding sexual norm change e.g. women's participation in sexual decisions and
condom use, more open discussion between sexual partners on sexual satisfaction. The

results from pre and post survey amdng factory workers showed an increase in condom
use

with non-regular partners, non-CSW partners from33Yoto 42yo and consistent

83%o.

condomuse with CSWs fromTZYoto

Medicines Sans Frontieres, aNGO, has initiated

model of care in Chiang Mai.

The program provides three levels of care: a care centre, community-based care and
home based care. Existing health and community structures are being used to facilitate home based care

by increasing awareness and knowledge among health staffand training

volunteers ( O'Keeffe, C., Bitar, D., Woodtli, M., Chapiyalertsak, S. & Weiland, P.,
1ee5).

A non governmental organisation, Support the Children Foundation, in Chiang Mai,

has

been involved in providing direct

education to villagers ( Vithayasai, Puatana

&

Ruankham, 1995). The information that is provided to villagers include some clinical manifestations of HIV/AIDS, perinatal transmission, prospect of effective drug and
vaccine, how to live mental support.

with or assist }IIV/AIDS infected individuals and necessity of

The Christian Outreach to AIDS Affected Children in Thailand (CO-AACT), aNGO,

has been involved in providing home based care in the slum areas of Bangkok. The

services provided include home visits, counselling, training and education on health and

-18-

hygiene, medical help and bereavement counselling. As a result of these efforts, the

families in these areas have developed a positive attitude towards the family's future, especially their children, relatives have become aware of HIV/AIDS and learnt to live
and care for those infected; families have stayed together

till the

end and the

HIV

infected people have been able to die at home in the company of their families.

A NGO operating from Bangkok: Hotline Centre Foundation, through its Hotline Mobile Project has been involved since June 1994, in providing sex and AIDS education
at schools (Ornanong & Narin, 1994). In this project, a staff member from the Foundation visits schools throughout the week and imparts knowledge and shares
experiences

with students. This is an ongoing project. Another project of the Hotline

Centre Foundation is the House of Tomorrow. The House of shelter as well as a training centre in northern Thailand.

Tomorrow

serves as a

Psychotherapy,HlV/AlDs HIV/AIDS and is

education, occupational training are provided to the people with harmonised

with daily living in this centre (Narin & Omanong,1994).

The Thai Red Cross Society (TRCS) has initiated several programs to educate the public
and piomote behaviour change to prevent AIDS (The Thai Red Cross Society,lggl).

Professionals from the Program On AIDS, TRCS, have contributed to several rounds
lectures, seminars and conferences for the general public as well as for the high risk

of

population. In addition, TRCS has organised several HIV counselling training courses

with the aim of explaining concepts and imparting the skills of HIV counselling for
medical personnel and social workers dealing with the

HIV problem. Training for

counselling on HIV/AIDS for non-formal counsellors is another major program using

traditional community leaders and peer groups. These persons after training, disseminate information on AIDS, promote behaviour change, teach how to live with AIDS and
provide psychological support for those affected by AIDS. For people with

-19-

psychological diffrculty, the Program on AIDS, TRCS, has initiated aBuddhist meditation training for HIV/AIDS persons. For people who are very poor and cannot

afford the costs, the Anonymous Countelling and Testing Centre provides free
counselling and free testing services for such people. Also, an AIDS prevention program

for children and adolescents has been developed by TRCS with the collaboration of the

Minisfiy of Public Health and

the Bangkok Metropolitan Administration. This program

aims at providing knowledge on how'to prevent AIDS and promoting compassion for

HIV/AIDS persons. AIDS prevention and living with AIDS in factories is still another
program of the TRCS designed to reach an important and growing segment of the young

low educated people who work in factories. Several sets of education materials have
been produced and distributed to factory workers and strategies have been developed

to

mobilise co-operation from the factory owners. Besides, TRCS, through its Program on

AIDS has developed an outreach program working with a community based organisation to promote and assist in family care for babies from HIV infected mothers. This
program creates understanding and compassion in parents, family members, relatives
and neighbours and also provides social welfare

for poor families taking care of the

babies. The program assists in adoption of the baby in case the parents die from the

disease. Furthermore, the Wednesday Friends' Club, an organisation subsidised by the

Thai Red Cross Society, conducts activities which are created from the needs of people

with AIDS. For example, formation of support groups, promotion of AIDS

awareness

and other general needs of such persons are addressed by this organisation (Phirasak

&

Sakda 1994).

ACCESS, a Thai

NGO,

has had wide ranging experiences in operating counselling and

other support services in both urban and rural settings. The results of their operations show that counselling and support groups play an essential role in providing people
affected by HIV/AIDS

with long-term support to cope with their situation especially in

-20-

settings where social stigma and discrimination are high. Many clients require

anonymity as well as confidentiality. They have also found that services can well be run

by volunteers within the community, provided they have appropriate attitudes and
training (Ungphakorn, I 994).

CARE, Thailand, has also been involved in AIDS education and prevention. One of the
projects, Living with AIDS, began in 1993 with the objective of creating a conducive environment at the village level i.e. understanding and accepting of families affected by

HIV/AIDS. The first phase of the project covered 40 villages in Chiang Mai, Chiang Rai
and Phayao. Volunteers and team leaders were used in this project

to provide

information and support to individuals affected by

team leaders were

HIV/AIDS.

160 volunteers and 40

trained in this project. Training was also provided

on home based

care and a manual on home based care was developed during this intervention. The

volunteers had added responsibility of working with the community, conducting

community meetings and lectures, in an attempt to change behaviour so as to reduce the

stigma associated

with people suffering from HIV/AIDS. Another project undertaken by

CARE Thailand, is the ,Sanut Prakarn AIDS prevention project for tndustrial workers

(SAM;.This project created HIV/AIDS awareness among industrial workers at Samut

Prakarn; promoted participation and support of factory management towards factory
based

AIDS prevention and awareness programs and developed an effective network of

organisations dealing

with AIDS prevention in factories. The activities

and interventions

in this project included training of trainers, training of industrial workers at the factory, exhibitions at the factory and establishing an AIDS information centre for industrial workers. This project achieved the success of organising effective and brief training
sessions at an industrial environment

with the co-operation of the factory

management.

Social

work relating to HIV/AIDS is an important aspect of holistic care of people with

-21-

AIDS (PWA). A project conducted nation-wide on the development of social services

co-ordination for people with AIDS and their families started with training of social workers from 3 participating organisations from each of the 12 selected provinces (Thanprasertsuk, Chantcharas, Rerks-ngarm, Paowanaporn, Samitrakasaetrin &

Kraus,l994). Prior to training, brainstorming sessions were conducted among experts in

the field of medical and social services involved in AIDS leading to the development of a
manual on social work involved

in

HIV/AIDS. After training, the social workers were for people with AIDS and their families.

assigned to co-ordinate their services

Performance activity from each organisation was reported on a monthly basis.

After

implementation for 6 months, social workers were invited to participate in a meeting to

evaluate the project. The results showed that the project supported 3,107 people

with

AIDS. Of this number, 68.zyo were counselling done to provide psychological and
emotionalsupport, 28.6% were financial support and the rest were refenal and other support. This project concluded that social services for people with AIDS@WA) and
families were necessary and could be integrated into the existing infrastructure.

Regarding counselling in HIV/AIDS, pre-test as well as post-test counselling services are

provided by health care settings encountering such cases. A study, based in Bangkok, on
assessment of video group pre-test

HIV counselling of pregnant women at

1st antenatal

visit indicated that pregnant women had good general knowledge about HIV but limited
knowledge about perinatal

HIV infection ( Chaiyakul, Hemaouppatum, Jaichuen,

Neeyapun, Prasert, Henchaichon & Laosakkitiboran, 1995). The counselling was

conducted in groups counselling followed

of

l0-15

pregnant women, who attended a video pre-test

by group discussion and questions. Group counselling, while not

ideal, is a suitable and practical method of counselling large numbers of patients in a

busy hospital setting and providing information to allow informed consent for testing.

-22-

In

busy hospital setting, due to increasing workloads in counselling and limited time,

need for a good booklet containing essential information on

HIV/AIDS for self study by

infected persons, has always existed. Addressing this problem, a participatory development of counselling media was undertaken (Ngamvitayapong, Uthaivoravig Sawanpanyalert & Takahashi, 1994). A booklet was designed by inputs from clients and professionals and excluded stigmatising and threatening language. It also excluded frightening pictures of opportunistic infections. It was written in simple language

without usage of medical jargon

as

well as English language. Such targeted media to

convey HIV/AIDS information are being used by clients(HlV infected persons) and their
counsellors and

it is concluded that to ensure maximum utilisation of the medi4 it

is

essential that active participation be sought from the target audience.

A study on post-test counselling of HIV positive pregnant women attending

an

antenatal clinic in Bangkok ( Pinyovanichkul, Tothong, Phurksakasamesuk, Jetsawang, Jalanchavanapate, Klumthanom, Manopaiboon,

& Siriwasin, I 995) concluded that

there

were major concerns voiced during post-test counselling: the chances of the child being

infected; the decision to continue pregnancy; partner notification and its consequence;
and social support needs. Since the goals of post-test counselling were to assess

HIV/AIDS knowledge and attitudes, notifo test results, clarify and address problems
and provide emotional support, approximately 30-60 minutes were spent on each

individual post-test counselling session.

Counselling services are also provided, though limited, by the private health sector in Thailand. The Association for Strengthening Integrated National Health (ASI|0,
conducted a counselling intervention program and also determined the impact
a

NGO,

of

STD/HV counselling services in

100 private hospital

(Murphy, 1994). The STD/tilV

counselling program provided a six day training course in five geographic regions. The

-23-

course was participatory and interactive to convey necessary interpersonal

communication and counselling skills. Trainers conducted follow-up site visits to hospitals to meet administrators, counsellors and to facilitate initial operations of clinics

providing counselling and testing. The program evaluated counsellorskills (symptom

recognition, patient recall of important messages), service accessibility (service hours,
available staff), client behaviour (health seeking behaviour, safe sex practices, client

attitudes, perception of counselling b'enefits). The study concluded that private hospitals faced an immediate profit loss by investing stafftime to provide free services.

Also, an increasing number of inquiries from clients had prompted some hospitals to
seek assistance from the public sector

for counselling training but few hospitals were

willing to advertise services. Apart from this project, ASIN also conducted the

COMPACT (communities promoting AIDS counselling and testing) project

(Sapanuchart, 1994). In this project ASIN co-ordinated outreach activities in the villages

of rural districts and factories of Lampang province with government health offrcials at
the district and sub-district levels. The outreach teams identified peer group educators
among three target populations: married women, teenagers and factory workers. The

peer group educators received training and educational materials

firstly, to create
prompt

awareness about STD/FIIV among their respective populations and secondly, to

these populations to make use of counselling and testing services offered at medical

institutions in Lampang. Regular follow-up visits were conducted by the outreach team

to monitor safer sex indicators among community groups and to support peer group
educators

with refresher meetings. This project attempted at enabling individuals to

to utilise services which could support their

recognise their own risk behaviours and

adaptation of safer sexual practices.

To evaluate the success of different intervention programs, efforts have been put in by
several organisations as well as individuals. One such study conducted in northern

-2 4-

Thailand ( Sombathmai, Dumrongggittigule, Taywaditep & Mandel, 1995) found that 25% of villagers who had attained the conventional AIDS education programs were

likely to be more knowledgeable than the others ( p=.0001). Although, the trained
villagers were more knowledgeable than the other villagers, they were not different from

other villagers in terms of HIV transmission from asymptomatic infected individuals. 54% of the sexually active men and women in the studied village had misconception that asymptomatic HIV infected personsbould not transmit the virus and they believed that people who were HIV positive must always have symptoms.

Though evaluations have been conducted in AIDS prevention and control prograrns,

svr&l problems and difficulties have been faced

by numerous evaluators. Among them,

an evaluation program of research and development project on AIDS prevention and

control in the workplace ( Ramasoota et al, 1995) encountered several baniers and
obstacles during the entire research process. Some of the diffrculties experienced were:

operation according to workplan; sample drawing; access to informants and information; time and duration of evaluation; and acceptance of feedback and findings.

*25*

REF'ERENCES

Amawattana, T., Mandel, J. & Ekstrand, M. (1994). A pilot study of AIDS education
combined with Vipassana meditation among Thai university students. Proceedings:

Tenth International Conference on AIDS, Z, 344.

Bond, K., na Chiang Mai, C., Vaddhanaphuti, C., Eiumtrakul, S., Nelson, K.E. &
Celentano, D.D. (1994). Behavioural intervention for Thai
reduce

Army conscripts may

15.

HIV incidence. Proceedings: Tenth International Conference on AIDS, !,

Bond, K., Phonsophakul, S., Chachawan, S., Leepreech4 p., Vaddhanaphuti, C. &
Celentano, D. (1995). Lessons from

HIV risk reduction models in rural brothels in

northem Thailand. Proceedings: Third International Conference on AIDS in Asia and

the Pacific. 57.

Brown, K., Jirakun, A. & Pornsakunpaisan, K. (1995). Development of home-care

materials for tribal people in northern Thailand. Proceedings: Third International

Coniirence on AIDS in Asia and the-pacific. 82.

Cash,

K. & Anasuchatkul, B. (1995). Experimental educational interventions for AIDS

prevention among northern Thai single migratory female factory workers. Proceedings:

Third International Conference in Asia and the Pacific. 199.

cash, K., sanguansermsri, J., chuamanoahan,p., & Busayawong,

w. (1995). AIDS

prevention peer education for northern Thai single fenrale and male migratory factory workers. Proceedings: Third International Conference on AIDS in Asia and the Pacific.
52.

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Chaiyakul, P., Hemaouppatum, W., Jaichuen, S., Neeyapun, K., Prasert, C., Henchaichon, S. & Laosakkitiboran, J. (1995). Assessment of video group pre-test

HIV counselling of pregnant women dt lst antenatalvisit, Bangkok. Proceedings: Third

International Conference on AIDS in Asia and the pacific

. ZlO.

Chinworasopak,

W.

& Wienrawee, P. (1995). Values training for NGOs in preparation

for behavioural change: Communication interventions in workplace. Proceedings: Third

International Conference on AIDS in Asia and the Pacifiq. 56.

Elkins, D.8., Kuyyakanond,T., Stam, K., Rujkorakarn, D., Haswell-Elkins, M., & Moonkaen, S. (1995). The multi-sectoral AIDS prevention strategy (MAPS): Putting communities to work against AIDS in NE Thailand. Proceedings: Third International
Conference on AIDS in Asia and the

Pacific.

48.

Kampanartsanyakorn,C. (1995). 'Friends Helping Friends' Project BMA's volunteers

model. Proceedings: Third International Conference on AIDS in Asia and the Pacific.

247.'

Murphy, M.J. (1994). STD^{IV counselling services development for private hospitals
in Tha iland. Proceedings: T enth International_Q.onference
o

n AIDS, 2, 389 .

Narin, K. & Ornanong,I. (1994). The House of Tomorrow-Chiang Mai. Proceedings:

Tenth International Conference on AIDS, l, 410.

Natpratan, C., Apasorntanasombat, T., Piyano, T., Moonchai, S. & Kunawararak, P.

(1995). "Ban Dong Laung" a model develop of community-based HIV/AIDS care,

-27-

northern Thailand. Proceedings: Third International Conference on AIDS in Asia and

the Pacific.

77.

Ngamvitayapong, J., Uthaivoravit, W., Sawanpanyalert, P. & Takahashi H. (1994).

Participatory development of counselling media for HIV infected persons. Proceedings: Tenth International Conference on AIDS ,2,392.

Nopkesorn, T., Sangkaromya, S., Mastro, T.D., Chinvarasopak,W., Laosakkitiboran, J.,

Teppa, T. & Buadit, N. (1994). HIV/AIDS peer education for Thai military conscripts.
Proceedings: Tenth International Conference on AIDS

, t,72.

Offrce of the Prime Minister, AIDS Policy and Planning Co-ordination Bureau. (1992). Thailand National AIDS Prevention and Control Plan (1992-1996). Bangkok:
Prachachon Co. Ltd.

O'Keeffe, C., Bitar, D., Woodtli, M., Chapiyalertsak, S. & Weiland, P. (1995). Care in
the community, Chiang Mai, Northern Thailand: A model for the future. Proceedings:

Third International Conference on AIDS in Asia and the Pacific. 77.

Ornanong,I. & Narin, K. (1994). Hotline Mobile to schools for AIDS education.
Proceedings: Tenth International Conference on

AIDS,

1, 356.

Pekanan,

M., Pitakthepsombat, P. & Pattawichaiporn,

S. (1995). Helping low-income

housewives reduce risk of STD and HIV. Ptoc-eedings; Third International Conference

on AIDS in Asia and the Pacific.204.

Phirasak, P.

&

Sakda, S. (1994).

Activities of the Wednesday Friends' Club.

-28-

Proceedings: Tenth International Conference on AIDS , 1,3g4.

Pinyovanichkul, S., Tothong, P., Phurksakasamesuk, S., Jetsawang, 8.,

Jalanchavanapate, S., Klumthanom, K., Manopaiboon, C.

& Siriwasin, W. (1995).

Post-test counselling of HIV positive pregnant women attending antenatal clinic, Bangkok. Proceedings: Third International Conference on AIDS in Asia and the Pacific.

27t.

Porapakkham, Y., Wongkhomtong, S, & Chuchat, A. (1995). Behaviour change

intervention among factory employees in Bangkok through outreach communication by

graduate volunteers. Proceedings:

Third International Conference on AIDS in Asia and

the Pacific. 201.

Ramasoota, P., et al.

( 1995). Lessons leamed from evaluation of R & D project on

AIDS prevention and control in workplace. Proceedings: Third International

Conference on

ADS in Asia and the Pacific.2l8.

Rujkoiakarn, D. & Kiewying, M. (1995). Challenges in AIDS education for

preteenagers:

A study in a rural district of Thailand.

Proceedings: Third International

Conference on AIDS in Asia and the Pacific. 227.

Sakondhavat, C. (1994). AIDS education and intervention trials among youth in

factories: A pilot project. Proceedings: Tenth International Conference on AIDS,2,74.

Sapanuchart,

T. (1994). Communities promoting AIDS counselling and testing project.

,

Proceedings: Tenth International Conference on AIDS ,2,393

-29-

Sombathmai, S., Dumronggittigule, P., Taywaditep,

K. & Mandel, J. (1995). Evaluation

on AIDS education programs in a village: A study from northern Thailand.

Proceedings: Third International Conference on AIDS in Asia and the Pacific

.217.

Sreshthaputra, C., Jijwatanapate, L., Pengsri, S. & Wienrawee, p. (1995). promotion

of

STD service and AIDS prevention among CSWs in Bangkok. Proceedings: Third
International Conference on AIDS in Asia and the Pacific. 309.

Tanskul, P. (1994). School based community action for AIDS/S

Proceedings: Tenth International Conference on

ID prevention.

AIDS,2, 45.

Thanprasertsuk, S., Chantcharas, P., Rerks-ngarm, S., Paowanaporn, V.,

Samitrakasaetrin, S. & Kraus, S.J. (1994). The development of social services co-

ordination for PWAs and their families in Thailand. Proceedings. Tenth International
Conference on AIDS, 2, 239.

The Thailand Business Coalition on AIDS, et al. (1995). Working as Partners.

Proceedings: Third International Conference on AIDS in Asia and the Pacific. 48.

The Thai Red Cross Society. (1991). The program on AIDS. Bangkok: TRCS Printing Office.

Ungphakorn, J. (1994). Models of counselling and support in resource poor countries.

Proceedings: Tenth International Conference on AIDS,

f,

5.

Vithayasai, P., Puatana,C. & Ruankham, J. (1995). Village education, Proceedings:

Third International Conference on AIDS in Asia and the Pacific, 205.

-3 0-

Chapter 3

Results of the Expert Workshop on Innovative Approaches to

Training, Education and Counselling for HIV/AIDS

1..

Background and Rationale

In recent years the concern for the management of HIV/AIDS has switched from concern about
groups of people that participate in high risk behavior that leave them open to infection with

HIV and subsequently the development of AIDS to more broader concerns. The
:

original

concern was for female commercial sex workers, male homosexuals and injecting drug users.

Now the epidemic has moved into the general population. There has been an increase in the
number of heterosexual men with the disease and this has been accompanied by the appearance

of HIV/AIDS among women that are not commercial sex workers. The growth among

such

women, furthermore appears to be more rapid than the growth among heterosexual men. The
spread

of the infection among womsn has also been accornpanied by the occulrence of HIV
the disease

among newborn children. The change in the type of people that are now becoming infected with

HIV is causing concern about the spatial distribution of the disease. Until recently,

was frequently seen as being concentrated in two locations. These are the urban-industrial core

of the counffy in and around Bangkok, and the provinces that make up the Upper North of Thailand. The reasons for the concentration of the number of people with HIV, especially in
the Upper North of Thailancl relate to the large number of commercial sex workers that have
come from this region and associated socio-economic characteristics of the region.

Now, with the spread of the disease into the general population with socio-economic conditions
that are different to those of the two previous centers there is an increased concern among people

concerned with the management of HIV/AIDS in this country that new centers

will spring up

in other locations. Furthermore, it has been recognized that although there is an existing

-31*

organizational srructure to manage the HIV/AIDS situation at the district and sub-district level

that it is either too centralized or too weak to effectively deal with the expected increase in the
number of people living with HIV or

AIDS. The realization that this situation

exists has lead

to an increase in the call for the strengthening of the organization to manage HIV/AIDS at the

district level. So far in Thailand, there is not a single tried methodology or organization that is attempting to do

this. Although implicitly, if not explicitly, it is a goal of the Ministry of

Public Health in Thailand

In the previous report, the researcher

has already brainstormed and identified several methods

for training and education for AIDS pievention and control activities. However, for effective
implementation of the projects/programs after such training activities, continuous action at the

community level seems to be important. Therefore, in this year's research, the researcher tried to identify education and training methods appropriate for continuous action at the district level.

There do exist however guidelines issued by the World Health Organization that deal with
strengthening various components of the health system. The one that appears to best fit the need

for a method of strengthening the management of HIV/AIDS at the district level. That
Thorne.

is,

M., S. Sapirie and H. Rejeb,

1993, District Team Problem Solving Gutdelines for

Maternal and ChiM Health, Family Planning and other Public Health Services, World Health
Organization, Geneva
guidelines

( 114 pages )[ Subsequently

referred to in this chapter as WHO

l.

To test the suitability of using this document as the core of a twelve month long

project to strengthen HIV/AIDS prevention in one province in Thailand, a two part workshop
was held.

For the Japanese Foundationfor AIDS Prevention these guidelines can be useful for work inside
Japan to strengthen the Stop AIDS

capacity of people working at the sub-prefecture level in the Seven Year

Plan that is at the core of the attempt to manage HIV/AIDS inside Japan. With the
for HIV/AIDS management to places outside of Japan, such as through

expansion of the concern the Programme

for

the Development of International Medical Cooperation Experts

Perspective,

or through initiatives under the Common Agenda for Cooperation tn GIobaI

familiarity with this work could be useful when the Japanese Foundation for AIDS Prevention

-32-

is called on to work outside of Japan.

2.

Objectives

2.t 2.2 2.3 3.

To brainstorm an innovative approach to HIV/AIDS prevention. To explain in detail about World Health Organization I WHO J guidelines.

To identify actions to be carried out after the workshop was finished.

Major Topi.r of the Workshop

3.1 3.2 3.3 3.4 4.

Presentation of the WHO guidelines. Concerns

matters.

of field workers about the application of the guideline to HIV/AIDS

Discussion of necessary modifications.

Suggested guidelines

for Thailand.

Workshop Participants

The twenty-four participants in the workshop came from the Ministry

of Public Health I

Thailand ] at both the provincial and Bangkok levels, representatives from international agencies, and from the ASEAN Institute for Health Development at Mahidol University.

5.

Date and Location

The two parts of the workshop were held on:

a) January 26, t996 and

b) March 3, 1996 The first part (a) above was attended by fifteen people and the second part (b) above
attended by nine people. The

was

first serninar included people from the center of Thailand and the

second included people from the south of Thailand. Both seminars were held at the ASEAN Institute for Health Development at Mahidol University, Salaya Campus just outside of Bangkok. Each seminar lasted for one complete day.

-33*

6.

Discussion and Results of the Workshop

The bvaluation of the suitability for the use of the WHO guidelines was done as follows.

1.

Selected parts
language.

of the WHO guidelines were translated from English into Thai

2.

The translations of the WHO guidelines were sent out to.the members of
seminar in order to give them time to read and digest the material.

the

3.

The people that received the selected parts of the WHO guidelines met as two
separate groups to discuss the approach suggested in the guidelines and to modify

them to suit the particular situation in Thailand and their own provinces.

4.

The recommendations from the seminars was taken back to the provinces for

further discussion. Recommendations were then sent back to the ASEAN

Institute for further use in planning subsequent work.

5.

Sites were selected for further work and agreements were made with them to

carry out the work.

The following description relies heavily upon the WHO guidelines referred to in an earlier part

of this.chapter. The
development

concept

of

team problem solving is a result

of health planning methodology. The first description

because

of over thirty years of of this approach can be

the

found in World Health Organization, 19'74, Health Project Evaluation, WHO Offset Publication

No.12. The idea became more significant

of the policy of Health for All through

Primary Health Care approach. This meant that there was a need for re-orientation and retraining

of health providers

ideas and practices. Associated

with the Primary Health care

approach is the decentralization of management of health services. This also called for the re-

orientation and re-training of health workers at the district and sub-district level. By the mid1980s it was not only obvious that people would have to undergo changes

if they were to fit

into

the new ideas about the provision of health services but that the ways training would have to

-34-

change

too. This

included changes in the way health staff should be trained in management

concepts and techniques. This view lead to the birth

of 'action learning' and the Team Problem

Solving approach. This was first tried in Gujarat State in India in the mid-1980s. Essentially

district level teams were asked to analyze the situation in their district from a variety of

aspects

and to come up with a proposal to improve the existing situation. The teams were then expected

to evaluate their proposal, implement it and evaluate the proposal and its implementation. The
results in Gujarat State were deemed to be successful and so the WHO extended the approach

to training District Medical Officers in other states in India such as Flimachal Pradesh, Madhya
Pradesh, Karnataka and Orissa.

In 1985 the Public Health Institute in Kuala Lumpur

created a formal training program with

four teams, and a structured analysis and planning process. This formal training program was
implemented in eleven countries during the period 1987 to 1994 in various applications.

In the formal training program the district team commits itself to be involved for about one year during which they will be guided by facilitators from outside their team I after this referred to
as the

KL guidelines

l.

In this case the facilitators were from the ASEAN Institute for

Health

Development, and other units of Mahidol University. The program consists of two workshops

with a structured sequence of assignments. The workshops help the participants to analyze

priority health issue in their district, devise solutions and carry out the proposed solutions over
a one year period of

time. The first workshop is a planning workshop, last for about nine to ten days and takes place early in the program. In the planning workshop the participants
formulate an action plan that they months

will try to implement over a period of about ten to twelve

I Table 1 shows the suggested schedule for the planning workshop and Table 2 the sessions, tasks and products from each session of the planning workshop ]. The second
workshop is the evaluation workshop which last three days and takes place ten to twelve months

after the planning workshop

Table 3 shows details of this worlcshop

].

Essentially this

workshop is a time for the participants to evaluate themselves and their success or otherwise in implementing their action plan. I See Tables 4 and 5 for more on objectives and scheduling.]

In the course of the complete program of ten to twelve months it is expected that the participants

-35-

will

themselves evaluate their attempts to implement their proposed solutions, present the results

of their evaluation of the implementation in terms of progress, constraints, service improvement

and health impact. They

will also develop the ability to collect and use data. In the process

they will develop team work and improved managerial skills.

The strengthening of the team results from:

1.

the development of problem solving skills and the capacity to implement

solutions,

2.

a results oriented dialogue between outside facilitators

I in this case from AIHD

]
4

and various levels of staff within the appropriate ministry, and

J-

improved communications and team work.

The proposed solution to the selected problem is done within the existing resource constraints.

It is expected that the former will force team members to consult with

each other and to consult

with other sectors to activate them and hence build collaboration and community participation.
The program allows team members to exert leadership in a structured planning situation. The staff are challenged by more senior managers who must then listen to the solutions proposed by their staff. This helps to build the dynamic required for effective delegation and decentralization

of responsibilities. There is also an improvement in communications and team work.

approach when more traditional ones fail is because:

the

overall result is to strengthen management of district level health services. The success of this

1. 2.

as the team

work together they build a mutual support group,

a feasible solution is proposed for a real problem and there is a detailed work
plan I action plan

] to help implement it, and

3.

from the start teams know that they will have to evaluate their proposed solution.

-36*

To ensure that the proposal is actively worked on the facilitators make three or four visis to the
site to ensure that the plan is being carried out, to offer advise and listen to changes that arise
because

of changing conditions and to provide support for teams when progress seams to have slowed or stopped. Ideally , according to the guidelines developed in Kuala Lumpur, there should be four teams with five to ten members. Selection of team members will be by the
district and/or provincial medical officer.
The facilitators/coordinators should be people that are familiar with local ministry of health or

it equivalent and have experience in fields of interest that will be useful in helping the program
move ahead. In general they

will be people at the level of:

1.

senior program managers, trainers from institutions, and people that are already experienced with this kind of organizational strengthening

2.

3.

exercise.

The district to participate in the program can be selected on criteria that suite the needs of the

country, region, organization or a level of

acceptable

it, staff

needs and

in fact on any criteria that are

to management.

The problem that is chosen to be the focus of a groups concern must be:

1. known to be particularly important in the district, and 2. the most senior health officer I in the guidelines ] referred to as the Director
worked

General

of Health Services (DGHS) I must be involved in the decision about the problem to be

on. Even though this may not be given as a direct

of health

command to the teams.

If

the DGHS chooses the problem then all ministry

members

will

see

it

as being

important and worth contributing their time and effort to including those at the most senior levels.

it.

This includes people at all levels,

The members of the two workshops having reviewed the documents that they had been

sent

agreed that the project was appropriate to the situation in Thailand. Some modifications were

-3 7-

considered important to reflect the particular circumstances of the country.

1.

The idea that team strengthening results from problem solving, increased dialogue,

and greater communications between team members was accepted as the basis for the

project.

2.

The phases of the project were considered appropriate but the time frame would have
the

to be more flexible to accommodate conflicts in previously arranged plans by

come

districts. Each district does not act in a vacuum or wait for a project such as this

to

along.

Consequently,'

this kind of project must

fit

into existing

plans.

Furthermore, the guidelines did not take into account problems because of climate. The rainy season can and usually does cause disruptions in timetables. This is especially true in Thailand where flooding is to be expected in the late part of the year. Therefore, it
was planned that the project would run for more than the suggested twelve months.

3.

The Ministry of Public Health would be given the task of choosing the province. The

choice of districts would be left to the Provincial Chief Medical Officer I PCMO ] of the

province that was chosen. The role assigned to the DGHS

in the Kuala Lumpur

guidelines would be performed by the PCMO of the province in question.

4.

The size and composition should be similar to the suggestions in the guidelines but

s.hould be an attempt to keep teams at around seven members.

5. It was recommended

that the Planning Workshop should be shortened and divided

into two parts. The first part would cover sessions

session cover problem analysis, survey

I to 6 in the guidelines. These

a

of

existing data that can contribute to

understanding and describing the problem, collection of additional data to supplement that

which already exists, and analysis of the data. It was decided that this could be done outside the framework
methodology used

of a formal workshop once the teams were oriented to

the

in this strengthening program. The removal of this part of

the

workshop was possible because:

-38-

a)

the team members lived in their district or close by and had worked there for

a considerable length of time,

b)

the problem was clearly identified as strengthening the teams' ability to

manage HIV/AIDS in there district and the members were already part

of

the

ministries structure for doing this,

d)

the necessary data was in the offices of the people that were in
project, and

the

e) all the members of the teams

had attended formal education in public health,

had extensive training in their field, and had a wealth of experience.

Adopting this position also leads to less disruption in work and family schedules which

in turn encourages managers to want to be involved and families to give their

perform within existing resource constraints.

consent

more readily. Secondly, it cost less to run a shorter workshop and makes it easier to

The second part of the workshop, sessions 7 to 15 in the guidelines should be held as a workshop over a number of days but it should be in the district again to reduce burdens

on managers and families, and to help keep within existing budget constraints. Plans
that were drawn up by the teams based upon their problem analysis and data collection would be presented at this workshop. The remainder of the workshop would be devoted to revising and refining the plans with the help of facilitators from the ASEAN Institute

for Health Development, and other parts of Mahidol University. The final outcome of
the workshop should be an action plan to be carried out over the approximately
months.
ten

6.

Monitoring and evaluation should be carried out according to the guidelines, and this

should mean at least three visits of about two day duration. The schtdule should be set

in collaboration with the teams but should be flexible.

-3 9-

7.

Facilitators/coordinators should be drawn from both Mahidol University and the

Ministry of Public Health at the provincial and district level of the project site.
The WHO guidelines also appear useful to the rapancseFoundation for AIDS Prevention in ia
future work. The guidelines should not be seen as a rigid format that must be applied as written

but as a flexible tool to be modified to suit the particular conditions. The usefulness of these
guidelines depends upon the basic idea for team strengthening and to a lesser degree upon the

time table and number of activities. Consequently while the discussions focused on

the

application of the WHO guidelines to Thailand it is our recommendation that they are useful in
the context of other developing countiies and projects done by the rapancse'Fottndaionfor AIDS Prevention whether in Japan or elsewhere.

-40-

Table

1:

Schedule for District Team Problem Solving

t DTPS I planning workshop (l)

ATTERNOON

DAY
I
Session
1

MORNINC
Session 2 OPening

Review of available data

Assignmsnl of the problem

)
5

Session 3

Session 4

Problem analysis
Session 4 cont'd

Design field data collection

Session 4 cont'd

Design field data collection

4 Session 5 Field data collection Session 6

Organize field data collection

Session 5 cont'd Field data collection Session 6 cont'd

)
6
1

Analysis of field data

No
Session 7
Sessions

Analysis of field data

Session 7 cont'd

Problem definition and description

8

Problem definition and description

Session 9

Session 8

Idea generation and selection

9

Formulation of objectives and targets

Session 10

Session 10

Solution description
10

Solution description
Session 12

Session 11

Implementation planning

Evaluation plan and indicators

Session

1l

Session 13

l3
Proposal preparation (and prepare
presentation)

Proposal preparation

12

Session 14

Session 15

Presentation of proposals

Workshop evaluation and closure

(1)

Source:

Thorne. M.S., S. Sapirie and H. Rejeb, 1993, District Team Problem Solving Guidelina for Maternal'an^d Child Heakh, Family Phnning and other Public Health Senices, World Health Organization, Geneva I WHO/MCH-FPP/MEP/93.21 p.19, Figure 4: Schedule for the DTPS

plrnning workshop

-41-

T'able

2:

Sessions, tasks and products

of the District Team Problem Solving planning workshop (l) MAIN PRODUCTS
Team given responsibility by DGHS to solve the problem

SESSION

PROBLEM SOLVING TASKS

Opening - Assignment of health problems

Reviewing available data

Initial problem table

and

Identify problem indicators Identify missing data

3

indicators List of additional data required Problem diagram Final list of additional data
needed

Analyze problem variables

Design field data collection

Data collection instnrments Prrmmy tables for data

presentation

Collect Field Daa Analyze field data

Redefi ne/describe the problem

Completed data instnrments Initial data tabulation Completed data summary

tables

Final problem diagram Final table of problem

indicators

Generate and select ideas for solving

List of selected

ideas

the problem
9

Formulate and set objectives and targets

Table ofobjectives and targets

10
11.

Design and describe the solution Plan implementation of the solution

Brief solution description

Implementation plan (activity
schedule and responsibilities)

r2t.

Develop monitoring and evaluation plan

Table of evaluation indicators Description of evaluation

method

1:i

Write proposrl

d6grrmnts

Proposal docrment
Prepared presentation

l4l
1l;

Present proposal

Decision makers reaction to the proposal Summary of participant

evaluations

Evaluate and close the planning

process

Closing challenge by DGHS

(1)

Source:

Asfortablel,p.l8,Figure3:Sessions,tasksandproductsoftheDTPSplanningworkhop

-42-

Table

3:

Schedule for the District Team Problem Solving evaluation worlahop (1)

DAY
1

MORNING
Session

AFTERNOON
Session 3 cont'd team presentations and plenary discussion Session 4 Tearn evaluation of service achievement and difficulty

I
Opening

Session 2

Overview of project and main

'success story' of each team

briefing (plenary)
team preparation teem presentation (plenary) Session 3

reduction

briefing team prepantion

Team evaluation of project implementation

briefing (plenary)
ggam

preparation

Session 4 cont'd team preparation (continued) lgam presentation and plenary discussion Sessiod 5

Session 5 cont'd team preparation (continued) tearn presentations aud plenary discussion Session 6

Team evaluation of project

effectiveness

Team selfappraisal of working relationships during implementation

briefing
team preparation

Session 6 cont'd

Session 8 cont'd Session 9

presentation of focus group

results Session 7

Evaluation of the DTPS process and evaluation of workshop

tle

Team assessment of tearr performance

team preparation

panel presentation and plenary

discussion Session 8

evaluation by individual staff panel discussion (team representation and decision

makers)

plenary discussion sunmary of evaluation results

Closure

Planning the next steps of eacb

district team
p

rgure

):

-43-

Table

5:

Objective for the District Team Problem Solving ptanning workhop (1)

At the

ena' of the planning worl<shop, the panicipants

shoud;

1.

be able to funcrion in a multi-disciplinary, problem-solving team within their district with the ability to;

a) b) c) d) e) 2i,. , il.

apply basic epidemiological nnalysis in the planning, malugement and control of MCH, family planning and other public health sewices; define and diagnose health, organizational and operational problems at various lcvels: formulate practical solutions for such problems, solutions which can be implemented with existing resources and organizational set-ups; strengthen supervision in their districts;

monitor the progress and evaluate the effect of changes resulting from the implementation of their solutions;

have in hand a.proposal for solving, within their district, the assigned health problem; zuch proposal to havtbe;n reviewed by decision makers and their support and guidance received in order that implementation of the proposed solution or its revision be undertaken immediately

tollowing the Planning

Phase;

be able to evaluate the effectiveness of their district problem solving effort sometime in ... I the futurel, according to indicators and methods prescribed in the proposal, and to report the rcslts

evaluation to decision makers within participants to be held at that time.

of their

a follow-up

evaluation process

of the same

At the enl of the planning phnse, the decision mokers and facilitators should:
be in a position to tentatively assess the effectiveness and practicality

of this type of action learning and ,rhether the approach should be more broadly applied in the future. (An in-depth assessmcnt of the process). ltroblem solving effort will be undertaken at the time of the evaluation

(1)

Source:

As for table 1, p.16, Figure 2: Objectives of the DTPS planning workhop

-44-

Table

5:

Phases and facililation

of the DTPS Process (1)

TASK

PHASES Phase

NAMES
Setting-up for DTPS

t. Senior health managers decide to apply DTPS

1 - 2 month

Appoinmrent and briefing of an in+harge and a core DTPS working group (facilitators)

5. Selection of participating districts 4. Visit district for briefiug on DTPS assignment or selection of the problem and identification of team members
5. Teams assemble available data related to the hcalth

problem

6. Workshop syllabus prepared and other

administrative
process

arrangements for the planning

Phase 2

DTPS Planning
Workshop

l.

Required equipment and secretarial zupport in place

11 days

2. All facilitators available futl time

3. High level decision makers participate
day of the workshoP
1st and last

4. Logistics for field dau collection arranged

5. Plan for follow-uf in the district by facilitators
Implementation Team Solution

Phase 3

of

1. Facilitators visit district teams 2 - 3 times

r0-12
morrths

2. Facilitators support team evaluations

Phase 4 3 days

DTPS Evaluation
Workshop

1. DGHS and programme nnnagers listen to teams present their evaluations

2. Teams plan DTPS follow-up in their district

Follow-up of
Results of DTPS
Process

Phase 5

none
speciified

1. National mechanism for the follow-up of progress in participating districts

2. Institutionalization of DTPS
p.

l),

t lgure

process

-45-

Chapter 4

I.

Counselling
Rationale
:

During recent years , although many organization have put so much their effort in public education on AIDS , one still see the widespread of AIDS in
Thai.land . Nowadays , AIDS did not only affect IV drug users or prosdnrtes

, but also housewives and children. Therefore , there is an

in the area of education
,
,

urgernt need to train.more and more personnel

counselling and care for AIDS patient. In the previous years of study
AIFI:D had already tried to combine some games and participatory

educational techniques for training for AIDS. Therefore, in this year we

ty

to

mLake

another focus on training on AIDS by combining audio-visual

procluction techniques and training techniques for AIDS. We

hopr: thatthis new approach

will help the participants to perform theirjob

more effectively in AIDS education and counselling.

Genenal Objective

of the Training Program

To r:nhance the participants knowledge and skill in training and

in prrrrduction of AIDS educational materials and counselling techniques.

At the end of the training the participants will be able to select, and
procluce educational materials appropriate to the target groups and the

problems, as well as to integrate new training techniques in to their AIDS training programs.

-46-

Specific objectives:
1. To train participants on planning and management of AIDS Project

which is appropriate to the target groups. 2. To train participants on training of trainer ( TOT) techniques. 3. To train participants on appropriate educational and counselling
ta:hniques for AIDS.

Content of the training

This is a 5 day training program which based on participatory uaining

tectuniques, Three aspects

of knowledge and skills will be integrated in the

training. These are ;

1. Knowledge aboutAIDS

2. Training techniques by using appropriate educational materials, appropriate methods

and favourabl e personality.

3. Hiuman relationship skills as necessary for trainers and consultants.

Duration of The Training Period

22-26April 1996

Place-:

ASEAN Institutefor Health Development, N{ahidol University

Participants i There were24

participants from several organizations such as provincial

health offices, community hospitals, non-government organizations and the center for
comrn'unicable disease controls. social welfare workers, nurses,

They posses different careers such as field workers,

leaders etc.

health promotion workers, community

-47-

Framework onTraining Process

Training process

Competency in Innovative Techniques

and organizing Activities

for volunftprs and

trainers

Ability
to be

Training Lerture &

Study Tour Competency in Communications practice

of
Trainer

for
AIDS
Education
and Corurselling

&

Micro Traching

hovision of
Equipments
,

Activities
Competency in Consultation

Material and Support'from Facilitators

-48-

Schedule

Training of Trainers for AIDS Education and Counsellig

Apil22-26,1996
ASEAN Institute for Health Development,
lvlahidol University, Thailand

Apnl?-, L996
08.01 - 09.00

hr. 09.01 - 09.30 hr.

Registration
Opening Address by

Dr. Som-arch Wongkhomthong

Director, AIHD
09.45

- 12.30 hr. Group Activitiesand Individual Activitiesby

Mr. Peerasakdi Buranasophon and Mr. Ruji Amrit
Lectures, Sukhothai Thammatirat Universi ty

13.30

- 17.00 hr. PresentationTechniques by

Mr. Damrong Chaisomkon
Lecture, Sukhothai Thammatirat University

April23,
09.CO

1996

- 12.00 hr. Current AIDS Situation

Techniques by

and Counselling

Ms.Anchalee Insriyong

Training Director, Thai NGO's Coalition for AIDS

13.C10

- 16.30 hr.

Techniques of

AIDSTrainingfor the Community

Educationby

Ms. Wilaiwan Koekaewpring and staff

Training Division, AIHD

-49-

Api\2/1,1996
09.00 - 12.@

hr.

Educational lv{aterials for AIDS and

Publ ic Presentation Techniques

Mr. WiratKamsri Chan

Audio-Visual Production Division,

AIHD
13.00 - 17.00

hr.

Practical

fraining for Production of

Rlucational Materials for AIDS

Education and Counselling

by AIHD Audio' Visual Production staff

April25,

1996

Gr.00 - 17.00

hr.

Study Tour to Pharabat Nampu Temple

April26, 1996
09.00 - 12.00

hr.

hesentation of Self-Produced Educational lv{aterials for AIDS Education and Counselling

13i.00

- 15.00 hr.

Presentation Continued.

15.30

hi.

Closing Session
End of Training Program

-50-

Resuls of The Training Program All participants had spent 5 days working together days and nights. Participans
opporlunities
had

to

receive new information concerning the current status

of

AIDS,

methodologies for taining and counselling and available materials on education for AIDS.

Later <ln, after lectures and some group processes, participants had real opportunity to
produrie some materials for their own use in educational activities and counselling. During
ttre presentiation, participants also received invaluable comments

from their pair and from

training facilitators as well.

All of them

have finished the training with satisfaction and

produrred educational materials

comp,etency were indicatei
managtement

by

themselves during the training sessions. Several

by the participants as very useful such as competency in

of AJDS project, communication skills, presentation techniques, skills in

selection and identification

of

educational materials appropriate to each specific target

groups and skills

in

production

of

some educational materials

for

education and

counsrllling activities for AIDS. The participants recommended AIHD to conduct ttris kind

of trai;ning program every year since they realized that there are tremendous need for this
type

of taining for people in the fields but AIHD could accpt very few participants for

each y'ear.

-5r-

II. Tiitle of

the Training:

Rationale:
situation of AIDS in Thailand is progressing day by
patients also increase

day.

Number

of

AIDS

rapidly. The majority of

the patients are now receiving care and

support

in

several places such as hospitals, temples, hospices and

in their own

communities. Therefore, there is a need to organize a workshop !o promote education,

care and counselling

for AIDS at the community level and how to live wittr people wittr

HIV

and AIDS in the communiw.

1.

To understand about the AIDS situation in Thailand

To understand how to organize counselling and care for people with HIV/AIDS in
the community

2.

3.

To exchange experiences among the field workers, local officers, community

volunteers and others in the area of AIDS education, counselling and care

Duration of lhe

Wotkshop:

9 - 1l octoberlgg5

Placei:
Parti,:ipants:

ASEAN Institute for Health Development, Mahidol University

Participants consisted of training

of trainers for AIDS education

and

counselling, NGO's field workers, communiry leaders, community volunteers, social

workers. Total of 220 participants

attended the

workshop.

-52-

Schedule of the Training Workshop

Living with AIDS in the Community

9

11 October 1996

9 October 1996 08:00 - 09:00

hr. Regishation 09:00 - 09:30 hr. Opening Sessions by

Professor Athasit Vejjajva, President of Matridol

University

Dr. Som-arch Wongkhomthong, Director of AII{D Dr. Damrong Boonyoen, Director-General of the
Deparhent of Communicable Disease Control, Ministry of Public Health
10:00

- 11:00 hr. - 12:30 hr.

Special Lecture: Trend to Solve AIDS Problems in

next 5 years by Dr. Damrong Boonyoen

11:00 Special Lecture: Enhancing Communify Potentials

for caring for AIDS by Dr. Wiwat Rojannapitayakol,

Chief Medical Officer, Ministry of Public Health

-53-

13:30

- 16:30 hr.

Panel Discussion on Problems of AIDS in Urban

Areas by

Mr. Sombat Tongaram (a representative of

Patana community)

Soi

Ms. Kamolwan Yampayab (a representative of Soi

Patana community)

Mr. Somkiat Yoopnag (a representative of

Chanhasem

Soi

comm*ity)

Dr. Peerayot Trongsawat (Director of AIDS

Div ision, Bangkok Metropol itan Admini shation)

Dr. Boongium Tragoolvongse (Deputy Director of

AIIID)
10 O,ctober 1996

08:45

- 10:00 hr.

Special Lecture on Roles of Monks in Protection

Community for AIDS by Phra Payom Kalayano,

Suan Kaew Temple, Nontaburi Province

10:30

12:00

hr.

Special Lecture on Poverty and Social Welfare in

Free Market Economy System by

Dr. Chalongpop

Susangkorn (Director of Thailand Development

Research Institutes)

-54-

13:00

- 16:00 hr.

Panel Discussion on Problems of AIDS in Rural

Areas by

Mr.

Somran Takan (Chairman of the New

Life

Friend Association)

Mr. Amnnay Intanin (public health officer from

Ban Laem district, Petchaburi province)

Dr. Chawalit Natpratan (Director of the Regional

Center of Communicable Disease Control, Region 10, Chiengmai)

Dr. Pantyp

Ramasoota (Deputy Director,

AIHD)

l1 October L996
08:45 - 10:0O

hr.

Discussionon problems on Education Counsellingfor

AIDS by
Ms. Krisana Kowhakul (Division of Social lVelfare,

Office of Public Welfare, Representative from

Phrabat Nampu Temple)

Dr. Boonyong Kiewkarnka (Deputy Director,

IHD)
10:00

- 11:00 hr.

Songs and Plays

for AIDS by singers and actors

from Phrabat Nampu Temple

-55-

11:30

- 12:30 hr, klucational

point of

Materials and AIDS: from the expert

:

view

Mr.

Sukchai Metavigool (AIDS Coordinating

Division Office)
13;30

15:00

hr. Educational Materials and Drama for

Rlucation
Drama by the Mirror Drama Group and others

15:00:

hr.

Closing of the Workshop

Results

of the Workshop:
in the Community was very successful in

The workshop on AIDS: Uving wittr AIDS

terms of providing information and educational opportunities for participants in the areas

of AIDS education and oounselling. Specifically, education and munselling for filed
worke',rs and community volunteers

for promotion of how to live with HIV + and AIDS discussed. Field workers, local officers and

persons in the community were actively

communiry volunteers from several organizations and communities joined the workshop
and presenled their
are:

works through educational exhibition booths. These organizations

F'hrabat Nampu Temple

|{am-Chivit Project
Care International in Thailand

Ftomotion of AppropriateTechnology for Health (PATff)

Fluman Development Center

Family Planning and Quality of Life DevelopmentAssociation tkevention of AIDS in Urban Area hoject, the Thai Red Cross Association

-56-

EC/AIHDAIDS Project
AIDS Division, Ministry of Public Health

/JDS Division, Bangkok Metropolitan Area

Fbpulation and Community Development Association

Partidpants from various organizations presented the materials and methodologies which they use for ttreir AIDS education and counselling. They also have good opportunities

to.lislen to feed back from representatives

Profesrsional people

of both rural

and urban communities.

their

who produce educational materials for AIDS also gave

comments on those materials and methods.

Several organizations conributed significantly

Japanr:se Foundation

to the success of the workshop.

for AIDS Prevention made substantive financial contibution to the

workshop through the research project on "The Research on Training Methodologies for

AIDS Education and Counselling

in Thailand." ASEAN Instiurte for Healttt

of
the education

Devebpment contibuted on some linancial aspect as well as for management

workshop. Phrabat Nampu Temple contibuted for demonstration on

techniques through drama and

music. It is undoubted that the workshop provided

experiences concerning

participant

with new knowledge, new friends and new

methcdologies for AIDS education and counselling in Thailand.

-57-

Chapter

Bibliography of Materials on Training Methodologies for

Training, Education and Counselling for HMAIDS

The first

training: Traini{rg of Trainers for AIDS

Counselling

Education and

Books: (Document Nos. 1-3)

1.

Alisara Chuchat et

al.

Educational Techniques for Participatory Developmenl

ASEAN Institute for Health Development, Mahidol Univ., Thailand, 1995

(Thai language, 127 pages)

2. 3.

Staporn Manassatit. Questions and Answers on AIDS

Samakkisarn, Thailan d,lggz(Thai langua ge, L62pages) Thai NGO Coalition on

AIDS.

Printed by Thai NGO Coalition on AIDS, Thailand,

1995 (Thai language, 120 pages)

Handouts: (Document Nos. 4-6)

4.

PipitPumkaew. Techniques for Being CapableTrainer

Printed for Training of Trainers for AIDS Education and Counselling by ASEAN Institute for Health Development,lvlahidol Univ., Thailand, 1996 (Thai language,
25 pages)

5.

Division of Audio-Visual Production,

AIHD.

Educational Materialsand

Techniques for Trainers for AIDS Education and

Counselling. Printed for

Tnining of Trainers for AIDS Education and Counselling by ASEAN Institute for
Health Development, Mahidol

Univ., Thailand, 19% (Thai language,

12 pages)

6.

AlongkotTigkapanyo. ThammarakNives: Buddhist AIDS Hospice at Phrabat

Nampu

Temple. Printed for Training of Trainers for AIDS

Education and

Counselling by ASEAN Institute for Health Development, Mahidol Univ., Thailand

1996 (Thai language,2T pages)

-5 8-

Video Tape: @ocument No. 7)

7.

Living wittr AIDS: rffhatThailand Can Tell Us

The original produced by lwanami hoduction Inc. for presentation at thez4th Congress of Japan Medical

Association. Reproduced for educational purpose

by ASEAN Institute for Health Developme,n! 1996 (English, 30 minutes)

-69-

The second training:

Books: (Document Nos. 8-1 1)

8.

Patcharu Tangtulyangkool. Guidelines for Proving Care and Counselling for AIDS

Terminal Patients . Thai Rural Reconstruction Foundation, 1996 (Thai language,

64 pages)

9.

Yawarat Ponapakkham et

al.

AIDS Policies in Thailand during lg8r'- - 19%

ASEAN Institute for Health Development, Mahidol Univ., Thailand,1995

(Thai language, 111 pages)

10.

YawaratPorrapakkham, Som-arch Wongkhomthong and AlisaraChuchat.

The Graduate AIDS Volunteers Project for Prevention of AIDS in Factories in

Bangkok. ASEAN Institute for Healttr Development, Mahidol University,

Thailand,1995 (Ihai language, 63 pages)

11.

Pantyp Ramasoota et al. Evaluation of the Graduate AIDS Volunteen Project

for Prevention of AIDS in Factories in Bangkok. ASEAN Institute for Health

Development, Mahidol

Univ., Thailand,

1995 Cfhai language, 63 pages)

L2.

National Policy for Prevention and Control for AIDS in Thailand for L997-ZC0L
The National Comminee for Prevention and Control for AIDS, Prime Minister

Office, Thailand (Thai langua9e,63 pages)

Handouts: (Document No. 12)

13.

Bulletin for the Training Workshop on AIDS. Living with AIDS in the Community

ASEAN Institute for Health Development, Mahidol Univ., Thailand, 1996

(Thai language, 16 pages)

14. Channfa

Iniamoinit and Somchai Chirarojwatna. Knowledge and high risk

behavior for AIDS of the male factory workers in Banpu Industrial Complex, Samutprakarn

province.

Produced for the workshop by ASEAN Institute for

Health Development, Mahidol

Univ., Thailand (Thai language,12

pages)

-60-