E-Title2">2.1. Study Design
This study was performed by cross-sectional study with one selected location, as defined by the mapping of ART regions, in Naresuan-Troop, Phisanulok Province, Thailand. This study was approved by Naresuan University, the Royal Thai Army, the Ministry of Public Health, Thailand and the Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, P. R. China
2.2. Settings and Participants
Recruitment of Thai males (mostly 21-year-olds) for conscript service to RMT/ RTA occurs in April every year by lottery method. Placement takes place twice a year in May and November, and there is a two-year period of service in the Thai army. The participants were the conscripts into the military and the study was performed as a sampling plan by two stages selection stratifying. In the first stage, the selection commissions were stratified by geographical macro RTA region and selected with probability proportional to size, which was defined by the frequency of conscripts presented in the previous year (2015). In the second stage, conscripts were selected at the moment of their presentation, in a number proportional to the size of the selection commission. The sample size was confirmed by two location sampling with 95% confident interval (95%CI) and the anticipated relative precision of 30% HIV prevalence  with the power of 80%.
The self-administered questionnaire was developed based on a literature review. The questionnaire which was initially written in English format and then translated into Thai, consisted of background characteristics, sexual history, HIV and STDs , knowledge, practice, and attitudes towards HIV/AIDs and STDs and other ideas, suggestions or recommendations. The variables included in this paper were selected from among these questions. After permission from the RTA, all conscripts in year 2 were selected and were asked to fill out the self-adminis- tered questionnaire. The staffs were trained to distribute and collect the questionnaire. All conscripts were informed of the study’s purposes and invited to participate in the study, then were asked to sign the consent form. The participants were also told that the survey was anonymous and the data was presented only in an aggregate manner, so that the participants’ privacy and confidentially would be protected.
2.4. Statistical Analysis
The measurement of condom use was defined as “yes” or “no” for the last sexual intercourse in the last six months. In addition to the knowledge and attitude variables, this study created abinary scale (“yes” or “no” scale) for statistical analysis. Participants were categorized into low and high score groups based on the distribution of the total score in each scale. The data was analyzed using computer program, and the descriptive statistics including percentage, mean, standard deviation and median was performed to identify characteristics of the participants. Logistic regression was used to determine the odds of selected sexual risk-behavior. Analysis was to adjust for the potential effect of variables.
The/A total of 159 conscripts aged 20 - 27 years (mean = 21.01) was employed in this study. The majority of the respondents completed secondary education (74.2%) and had income of 5000 - 10,000 Baht per month. More than half never drank alcohol (60.4%) while, 22.5% reported drinking once a week. More than one-fourth of the respondents used to take drugs/used drugs (25.8%) and 6.9% reported injection of drugs. Moreover, more than three-fourths were unmarried and the youngest were married at 15 years (Table 1).
3.1. Sex History
Among respondents, 90.6% experienced first sex with a female and 9.3% had first sex with a male and the youngest age at the first sex of 11 years and the oldest of 20 years (mean = 15.8). Meanwhile, nearly half of the respondents were unmarried and living alone (44.7%) and 33.9% living with a sex partner. For sexual intercourse in the past six months, the majority of the respondents had sexual intercourse with only female (83.2%), 14.8% had sexual intercourse with both female and male, while 4.0% had sex with only male. For sex with female, the respondents reported the highest of 15 sex partners, 41.8% used a condom for the last sexual intercourse, and among these 65.1% of the respondents offered to use a condom, while 9.5% were requested to by a sex partner. Nevertheless, the respondents showed that the reasons for not using a condom were: didn’t like it, didn’t think of it, not available and didn’t think it was necessary (64.4%, 62.2%, 35.6% and 30.00%, respectively). For the frequency of condom use, a half of the conscripts reported condom use sometimes (50.3%), 17.6% reported almost every time, 12.6% indicated every time and 19.5% reported never
Table 1. Characteristics.
used. The majority of the respondents knew the place or person to obtain the condom from (93.7%). For sex with men, 15.7% of the respondents had sex with men. Among those, one-third of them had oral sex activity (36.0%), 20.0% had anal sex and nearly a half of them had both oral and anal sex activities, three-fourths of them did not use a condom when having sex with men(76.0%) and only 16.0% used a lubricant such as KY jelly, lotion and saliva (Table 2).
3.2. HIV, STDs History and Knowledge and Attitude
The majority of the respondent knew about HIV and STDs (88.7%), more than half of those have been tested for HIV and STDs (59.1%) and more than two-thirds of them don’t know the result, while 20.8% reported negative results. Moreover, respondents also reported their STDs as follows: gonorrhea of 15.1%, chlamydia of 5.7%, syphilis of 4.4% and hepatitis B of 3.1%. When their knowledge and attitude of HIV and STDs were asked, more than half of the respondents had a high score of 57.2% (Table 3).
3.3. Factors Effecting with Condom Use
Of all the participants, 96.2% had sexual intercourse during the past 6 months. Among those 41.2% had used a condom and 58.8% had not used condom for the last sexual intercourse. The older ages in the conscripts were more likely to use a condom (Adjust OR = 2.1, 95%CI = 1.2 - 9.4) and those with a higher education level (adjust OR = 8.9, 95%CI = 1.2 - 19.1). The participants who frequently drank alcohol, took drugs and had injected drugs used condoms less. The unmarried group used condoms more than the married group (OR = 1.4, 95%CI = 0.45 - 3.9) and the participants who had sex with men used condoms less than those who had sex with a woman (Adjusted OR = 2.2, 95%CI = 0.3 - 9.1). Condom use was more significant with those who had tested for HIV and STDs (Adjusted OR = 1.6, 95%CI = 0.8 - 3.9) and had higher knowledge of and [a more aware] attitude towards HIV and STDs (adjusted OR = 1.5, 95%CI = 0.6 - 2.6) (Table 4).
This study documented condom use among conscripts in Thailand and also factors associated with it. We examined the extent to which characteristics of Thai male youth/conscripts aged 20 - 27 years chosen randomly by lottery method to serve in the RTA. The difference, according to the results of the analysis, was understood in terms of different characteristics. The younger male group needs to take appropriate measures from conducive factors specific to individuals and protect themselves from STIs/HIV based on self-assessment of perceiving risk.
This study was conducted overall 159 conscripts who serve in the RTM/RTA. Among those, 96.2% reported sexual experience and nearly half of the respondents reported use of condom for the last sexual intercourse (44.2%). This study found that reported sexual intercourse among male military youth indicates a lower rate of frequent condom use (12.6%) and among this group, while they
Table 2. Sex experience and condom use.
Table 3. HIV and STDs history and knowledge and attitude.
Table 4. Factors associated with condom use.
sometimes used condoms the levels of use were never high (50.3% and 19.5% respectively). The participants also mention the reasons for not using a condom were that it was not available, they didn’t like it, they didn’t think of it or they didn’t think it was necessary.
Our study found that the youngest of the participants had first sex at a low of 11 years, while previous study has shown at 12 years  . The timing of sexual debut also affects the risk of infection with HIV and STDs. One reason why the early onset of sexual activity is a risk factor for acquiring an STI is that the period of potential exposure to infection is longer and previous study also confirmed that the lower the age the lower is HIV and STDs prevention  . Furthermore, this study revealed that male youth who were unmarried used condoms less than the married group, a finding also confirmed by the previous study  . It can be said that the pattern of condom-use was more critical among the younger people compared to the older ones within the considered age-group of the youths. However, The Ministry of Public Health has many health-education programs, peer-group programs, youth leadership programs, and friend corners program in Thailand  . Nowadays, condom-promotion programs should be targeted at the young people, because young people are curious about new experiences, including sexual experience. At the same time, they are also likely to be more apprehensive of HIV/STDs and unwanted pregnancy that affect their lives for the long term  .
The study also identified education level as one of the major factors to increase the condom use among male youth. The level of education increases response to perception of risk and promotion of condoms and highlights the need for special efforts to reach men with educational attainment. The gap between the highly-educated and the low-educated is significant with condom use. Also, the consumption of alcohol, oral use of drugs and use of injection drugs are factors that impede risk of condom use among the youth/young conscript population. The study of Tunyarak  reviewing high HIV infection among people who used drugs, also confirmed that sexual risk behavior under the influence of drugs, injection drugs alcohol drinking was the most probable cause of non- condom use and high prevalence of HIV infection was the major result.
However, our finding on sexual behaviors was that nearly one-fourth of the participants were report having had sex with both female and male (14.8%) and this finding is also confirmed by previous studies that this is due to the lack of proper women/appropriate female sex partners.   . However, the survey found that some participants had sex with males (4.0%) and this finding was the same a Chinese study  in which Cong reported nearly 3.7% of Chinese male university students experienced, at least once, same-gender sexual contact. Nevertheless, our finding reported lower than a study of Jianknng Chao who found that 7.5% of conscripts in Taiwan have had homosexual intercourse  . This result demonstrates that homosexual and/or bisexual people are becoming more visible in Thailand, and there is a growing gay liberation movement in there. Another reason is that there is no policy that prohibits homosexual or bisexual individuals from serving in the military, so subjects feel free to disclose their sexual history. Meanwhile, the Royal Thai Military has a regulation prohibiting transgender or she-male personnel serving in the Thai Military. Surprisingly, the groups of homosexuals and bi-sexual in this study reported the percentage of condom use of 33.3% that was lower than previous studies in Thailand in which van Griensven found 65.6%, Tareerat reported 63.3% and Mansergh G documented 55.0%,    . While our finding was similar to the study of Cong L’s study in China which reported 33.8% of males in university used condoms  , this was because the study of homosexuals and bisexuals are limited in Thailand due to the culture context and gathering information from this population is difficult, as being homosexual is taboo in Thai culture and many other societies  and is a sensitive issue in the military   .
This study shows slightly half of the respondents had a high level knowledge of sexual and HIV/STDs issues. Beside this, the statistical analysis also confirmed that the higher knowledge of HIV and STDs significantly affected condom use. Knowledge is the most important factor to achieve a behavioural change. The Government of Thailand has launch a 100% condom use program, in combination with other prevention efforts, and this has proved very effective in discouraging unprotected intercourse in establishment-based sex work   . It now needs to strengthen and increase prevention efforts or specific programs, especially among youth who still exhibit high risk sexual behaviors. The results of this study suggest that an individual’s knowledge of risk of STIs/HIV infections has crucial effects on condom use in sexual union/intercourse. Knowledge of risk is to be considered the first stage toward safer behavior. Hence, future sex education programs can enhance their effectiveness by using a mix of mass media and interpersonal communications to repeatedly expose younger people to key campaign messages. In conclusion, the results of the analysis showed that age, education level, alcohol drinking, use of drugs both through injection and amphetamines, married status, testing for HIV/STDs and knowledge were significant factors that affected condom use.
A few limitations of this study should be noted. First, the authors did not run the sampling methods for selecting the study samples, because the conscripts who served in the RTA were randomly selected by lottery method twice a year, so it can be confirmed that the conscripts who join the military have already been randomly selected. Second, a bias introduced by under-reporting is possible as premarital sex is a sensitive issue. And third, the data may be biased because the questionnaire was a self-administered questionnaire with 1.2% of participants not responding to the survey. However, an attempt was made to minimize this bias by ensuring privacy during the completion of the questionnaire and using the anonymous self-administered survey.
We would like to thank the peer interviewers for their dedication and support, all participants who supported the benefit data and The 3rd Army Area Headquarters, Naresuan Fort, Muang District, Phitsanulok Province, Thailand. This study was partly supported by Naresuan University, Thailand and Shanghai Center for Disease Control & Prevention (SCDC), P.R. China.
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