Half the students in Damri Hongrak and Sunantha Chanrod’s 8^th grade class at Ratchaburi’s Krub Yai school have their hands raised.

It is they, who having agreed to a night of unprotected sex with their adolescent paramours, have contracted HIV and are possibly pregnant?

They laugh.

Their mirth is not completely unreasonable, though; half of those “expecting” are boys, and this - parents of Ratchaburi will be glad to know - is only a class decision-making exercise where the students’ fates as STD-carriers were sealed, not when they agreed to unsafe sex, but when they randomly chose a red (over blue, green, and yellow) piece of paper.

(The blues - the next largest contingent - got lucky once, twice, three times and eek by, their teacher informs them, with just an orgasm. They also laugh.)

The idea is, of course, that in addition to laughs, these lessons will also wake students up to the consequences of unsafe sex and serve them with the life and decision-making skills they need for growing up.

Those that work with adolescents and in public health say these skills are particularly critical now, at a time when culture is trending towards casual sex and teens face rising Aids and STD rates, as well as the persistent problems of unplanned pregnancy and unsafe abortion.

Experts agree that Thai teens are generally having sex earlier, and for various reasons - ignorance, trust, heat-of-the-moment-ness, reliance on morning-after pills, preference for arcane withdrawl and 7-day counting methods, and association of condoms with sex workers (a leftover from the days of the 100% condom campaign) - too rarely with the protection needed to prevent such incidents.

A string of recent news stories and studies would suggest this as well - a student in Ayutthaya experienced a horrifically well-documented first day of school last month, when she began bleeding from abortion complications during student line-up, while officials in Bang Kapi recently began investigating underground abortion clinics after aborted fetuses were repeatedly found floating in an area canal this April (residents claim over 30 in the past two years).

Because of its illegality, harm from abortion is hard to quanitfy, but according to a 2002 report, more than half of the hospital patients that sought medical care for complications from induced abortions were adolescents. Meanwhile a study issued earlier this year on emergency contraception, showed that Thai teens dangerously misunderstand and misuse the drug - often relying on it to prevent pregnancy by taking it before and long after sex, and sometimes up to 9 or 10 times per month (the drug is powerful, designed for rare and limited use and only 85% effective when it is taken twice within 72 hours after sex).

“Adolescent health should be a priority. Unwanted pregnancies are a problem, yet it gets little concern from the Ministry of Public Health (MOPH),” says Surasak Taneepanichskul, dean of Chulalongkorn University’s Sexology programme.

He is critical of the MOPH, which he says tends to squander resources and prioritise “nonsense diseases” and “trendy international” issues (avian flu, drug licensing - “look at all the problems that caused us”, and vaccine factories among them) over matters, like sex education, that would have real impact on the general population’s health.

Dr Surasak sees this as illogical and as a disservice to people. “It’s cheaper to give people basic knowledge. Let’s make this a knowledge-based society. Sex education can be a social vaccine.”

Yet while efforts to be candid with kids about sex and self-protection would seem a welcome and overdue development, programmes like Krub Yai’s also come at odds with the country’s current conservative climate (amorous billboards and bare-bottomed cartoon characters, be gone) and its traditionally, more shuttered approach to sexuality education.

Rarely a matter addressed in Thai homes, sex education until recently was - and in most cases still is - “academic in nature” and limited to a few biology lessons in which students learn about the physical changes one can expect with puberty.

“Thailand needs a stronger sex ed programme,” says Simon Baker, chief of UNESCO’s Asia-Pacific HIV/Aids Coordination and School Health Unit, noting that because sex education is not compulsory nor subject to time or content guidelines, it is taught (or not taught) at the discretion of teachers who often lack training and comfort with the subject.

“Scientific research that shows a good sex ed programme delays first experience and when it starts, on average, sex is safer.”

 SIGNS OF CHANGE

While medical practitioners regularly advocate sex education for its positive impact on adolescent health and international studies routinely prove it a valuable public health tool, the students at Krub Yai are among the relative few that are receiving sexual education in Thai schools.

There are signs this is changing, though. As more and more Thai educators find basic health classes fail to meet the needs of modern adolescents, they are turning to new techniques and a more upfront approach to communicating about sex.

For example, in 7^th grade classes at Thai Niyom Songkroh, a Bangkok Metropolitan Administration (BMA) school in Bangkhen, students learn their sex education lessons with the help of Niam and Yum, the “digital peer educators” that MC the computer programme designed to help real teachers deliver the district’s “World Starts with Me” sex education curriculum.

The two characters, who were carefully designed to be relatable, but also slightly older and wiser incarnations for their 8^th grade audience, are visibly popular and navigate students through 14 lessons that range from learning basic human rights to knowing how to negotiate the terms for protected (or no) sex with their partners.

Programme coordinators say students particularly enjoy lesson three, a physical development exercise where students use the computer cursor to drag mature body parts (chest and leg hair for Niam, breasts and wide hips for Yum) onto their prepubescent forms and take the two characters to maturity in minutes.

The BMA began implementing the curriculum last year with the support and curriculum development efforts of the Association for the Promotion of the Status of Women, whose director Maytinee Bhongsvej started it in response to the number of unplanned pregnancies and sexual health issues she was seeing in adolescents.

Both the BMA curriculum and the PATH (Programme for Appropriate Technology in Health) programme, which operates in 680 schools and youth centres, including Krub Yai, reflect the new pragmatism in sex education, and the idea that if students don’t find the information at school, they will find it somewhere else - usually less reliable, like movies, internet, or friends.

“It used to be, teach no sex,” says Office of Basic Education Commision Secretary-General Kasama Voravan na Ayudhya. “Now they realise they must teach safe sex.”

Despite the warm reception from students and educators alike, these more pragmatic programmes are slow to materialise in Thai schools.

This is not for lack of effort, or even programmes - Thailand has no less than 5 - but for the lack of momentum, commitment and uniformity in them.

The Ministry of Education introduced its Aids and Sex Education Curriculum in 2005, while PATH, a separate programme run in collaboration with the Ministries of Public Health and Education and partly funded by the Global Fund, provides comprehensive “sexuality education” at secondary, vocational, and non-formal education centres with progressive administrators in 68 provinces.

The BMA has its tech-savvy “The World Starts with Me” curriculum, aimed at Matthyom 2 students in 20 schools, and many of the nation’s Catholic schools use a value-based programme developed with the help of Chulalongkorn’s Sexology Studies department.

Perhaps the widest-reaching efforts are those of family values and virginity-saving champion, Rabiebrat Pongpanich, whose Happy Family Association runs abstinence-inspiring youth camps and school clubs across the country that have drawn a league - 10,000-strong, she says - of teens willing to wait til marriage.

Most of these programmes are in small-scale, introductory phases, but certainly the slowest of them to develop, belongs to the Ministry of Education, which with 8.5 million students and more than 32,000 schools around the country, would be the one with the greatest impact.

While the ministry developed its HIV and sex education programe in 2005, the curriculum, which took a year to develop and which consists of 4 manuals targetting the nation’s 7-18 year olds (written by Thais, for Thais, and in Thai, the manuals strangely picture Caucasian children on the cover), has reached only a small number of them.

Piloted at 20 schools in 2005 and an additional 30 last year, sex education was theoretically taught at 0.1% of ministry schools in 2006.

This year, OBEC hopes to expand the programme to 5,000 more schools, though officials regard the plan as ambitious and unlikely.

Khunying Kasama explains that the programme is in an exploratory phase and while 5,000 is the target, it is an optimistic one.

In announcing the 5,000 school number, Khunying Kasama, who believes the programme is roundly beneficial - “good for students, necessary for teachers, and important for parents” - explains the ministry hopes to spark an everybody-is-doing-it effect, where administrators begin to think the programmes are common and instituting them is inevitable.

“We realise we may only reach 300 or 400 schools this year,” she says, adding that the nation’s schools and communities are at different levels of readiness for sex education.

 HISTORIC STRUGGLE

This view is based on the struggle the minstry has encountered in past efforts to institute sex education in its schools. Khunying Kasama explains that in the past, efforts have been met with much backlash from parents who hold a narrow view of sex education and believe that teaching kids about sex will translate to kids having sex.

“The Thai belief is that Thai teens know very little about sex, and that if you give them knowledge, you will raise their curiosity and their likelihood to enter into such behaviours.”

For this reason, the ministry is careful to attach words like “broad-based” and “comprehensive” to its new curriculum (which it is - sexual health and behaviour are covered, but so are social relationships, life skills, gender roles, and the chastity-heavy moral component) and in an effort to pre-empt protest, introduce the sex education programme at schools with teacher training sessions and parent meetings.

The ministry’s cautiousness is also reflected in its “diversifed approach” to implemention, which allows for school administrators to decide how best to introduce the programme. In some schools, this means integrating sex education into many subjects, while in others it means offering youth camps which cater to students whose parents enroll them in the programme.

Yet, if the ministry’s experience with pilot schools is any indication, it may be that this timid approach in instituting sex education is old-fashioned in ways that its students’ parents no longer are.

While Khunying Kasama acknowledges that teachers need coaching and the 10 million baht programme, a larger budget, when asked what lessons have been learned from the piloting period, she comments that, “It’s been easier than we thought it would be.” She says that parents have become the programme’s biggest supporters, and once they know the scope of the material, their reaction is, “Why wasn’t this started long ago?”

The ministry isn’t alone on this - one of the few consistencies among programmes is the effort to shake the “sex education” label for a more general “life skills” one.

While content varies, most of the programmes are as broad as they are advertised to be - touching upon sex, yes, but focussed more on issues of identity, esteem, and how one relates to the social world.

 RIGHTS-BASED APPROACH

Wijit Wongwareetip, who coordinates “The World Starts with Me” programme with the BMA, explains its objective is to help teens “realise they are their own person, with their own values and the potential to contribute to their peers and community.”

She also stresses the importance of its “rights-based approach to information about sexual health,” and the idea, echoed by the PATH programme, that giving students full disclosure and critical thinking skills is the surest way to encourage healthy and safe decisions.

While both the PATH and BMA programmes are designed to equip kids with the knowledge and abilities to make up their own minds about sex and social issues, other programmes like the ministry’s and especially Khun Rabiebrat’s - which is especially bent on saving virginity for the sake of “a good man and a happy family” - have more of a moral component.

Maytinee warns that framing sex education this way can have negative impacts on the esteem of those that may have already lost virginity, particularly rape victims, and tend to place a higher burden on the female.

Often more challenging than earning parent support, though, is grooming teachers that are comfortable with the curriculum and the unique role the course demands of them.

“Heath educators are generally comfortable with handling body development, but when it comes to sexual behaviour, relationships, society and culture, gender roles, they have less comfort and confidence in knowledge,” explains Usasinee Rewthong, a programme officer with PATH.

For this reason, the nearly 4,200 PATH-trained teachers and administrators have undergone intensive instruction and follow-up coaching with the programme’s corps of 497 master trainers (BMA’s teachers face a similar requirement).

She adds that in sex education, the teacher must be less an instructor than a facilitator of discussion - a role that changes classroom dynamics and closes the gap between teachers and students.

This “child-centred” classroom style is critical to inspiring the trust and comfort needed to empower students to ask questions and confront the difficult and often very personal matter of the sex education curriculum, she explains.

Anan Ekpaopun, the principal at Krub Yai school who had all 48 of his staff members (he included) go through PATH training, has noticed that, since starting the programme, his students have a new eagerness and familiarity towards their teachers, as well as a general improvement in personal expressiveness.

This openness is especially important for airing, and dispelling students’ misconceptions, which according to all interviewed teachers, organisations, and Khunying Kasama, are plentiful. While most cited students being mixed up on methods of contraception, Khunying Kasama added that girls often mistakenly associate love with sex.

Usasinee also noted that PATH teachers tend to be impressed by the openness exhibited by their students, as well as in the amount of information students know.

While it may take some extra training and effort, teachers generally find the new closeness with students as rewarding, as they do eye-opening.

This is especially true for Bungorn Shoosoon, Krub Yai’s discipline teacher who, before teaching sex education, had a strict policy - and schoolwide reputation - for quickly kicking uncooperative kids out of class.

Since beginning teaching the PATH programme, though, she says that she has been “softened” by sex education, and that both she and her students have been pleased by her new openness. “I am more flexible now. I listen to the students more, and have a better understanding of young people and their social problems.”

Other teachers at the school report being approached by students, either seeking help in personal matters or answers to sexual health questions, more frequently.

For students that don’t have sex ed classes or teachers to turn to, PATH runs an ask-an-expert forum on its website, which receives considerable traffic and would seem to indicate that questions abound and teen curiousity about sex remains high.

Along with the scores “Could I be pregnant?” and “How can I get an abortion?”-type questions, Usasinee says the site also receives a number of imaginative ones like a recent inquiry about scrotum whitening.

It’s a level of curiosity that Khunying Kasama, a seasoned visitor to youth camps and sex education classrooms finds unsurprising. She says in making such visits she’s been impressed by the universal interest the subject of sex holds with students of all types.

“All students are interested. Whether it’s overt or more covert, you see their reaction. They’re all interested.” she says. “It’s the one class nobody ever misses.”