International Journal of

IJMS Original Article

Me dical S
Stu
t u dents

Attitude towards New Packaging to Reduce Condom-

carrying Embarrassment among Thai Youth, A Cross-
sectional Study
Apinut Wongkietkachorn,1 Kunathip Nissaipan,1 Narin Hiransuthikul.2

Abstract
Background: Human Immunodeficiency Virus (HIV) incidence has been increasing in Thai youth, mostly from unsafe sex. Embarrassment
with carrying condom was one of the main reasons. This study aims to evaluate attitude towards condom use, sexual behavior and the
new condom packaging that merges with daily life products in Thai youth. Methods: A cross-sectional study was conducted among volun-
teers aged 15-24. New packaging were demonstrated and the volunteers were provided with questionnaires to complete in privacy booth
and submit anonymously. Results: Of 680 participants with mean age of 19.7±2.7 years and 59.9% females, half of them thought condom
should be carried and used. However, the same group did not actually do. Two-thirds of participants were interested and would use the
packaging, citing these reasons charming, convenience, and disguise of condom. Females preferred the packaging significantly more than
males. Conclusion: Disguising condom packaging, as phone charm and key ring, might be another safe and practical way to encourage
youth to carry condoms around.

Keywords: Condoms, Product Packaging, Adolescent, HIV, Sexual Behavior (Source: MeSH-NLM).

Introduction
Human Immunodeficiency Virus (HIV) is a retroviruses founded Despite a huge collaboration, the HIV incidence has not decli-
in 1980s.1 This virus infects and depletes CD4+ T cell, which is ned but increased in youth and adolescents, which could be
a lymphocyte serving in immunological response. After getting illustrated by an increase in HIV prevalence of military recruits
infected, the person is known as HIV-positive. When the CD4+ (18-24 years old), blood donors (21-30 years old), and sexually
T cell count is less than 200/μL, the current Centers for Disease transmitted infection (STI) clinics (15-24 years old).8-11 Despite
About the Author: Apinut
is currently a 6th year me- Control and Prevention (CDC) classification system defines this good HIV knowledge and negative attitude towards risky beha-
dical student of Chulalon- person to have Acquired Immunodeficiency Syndrome (AIDS), vior, a large number of youth have unsafe sex; almost 50% had
gkorn University, Bangkok, sex without condoms and several of them have multiple part-
which might further develop opportunistic infection such as
Thailand of a 6 year pro- ners.12,13 This trend could lead to an even higher HIV prevalence
gram. He is a recipient of Pneumocystis jiroveci, atypical mycobacteria, and Cytomega-
a creativity award in the lovirus.1 among young people.
celebration of His Majesty
the King Bhumibol Adul- In 2007, it was estimated that there were 546,578 people li- Male condom is a barrier tool used during sexual intercourse
yadej 7th Cycle Birthday for contraception and prevention of sexual transmitted disea-
Anniversary 5th December
ving with Human Immunodeficiency Virus (HIV) in Thailand.2
The significant modes of transmission include spouse trans- se.14,15 It prevents male ejaculated semen from entering part-
2011, hosted by the Coun-
cil of University Presidents mission, male sex with male (MSM), injecting drug user (IDU), ner’s body and also block secretion from partner to enter his
of Thailand. sex worker, and casual sex.3 Most of them get infected from own body. It was reported that the pregnancy rate was 2% per
unsafe sex.3 Somehow, these population tend to have more year and the rate of sexual transmitted disease was significant-
risky behaviors.4 ly decreased if condom was used properly.16,17

Because most Thai people have better HIV education, they ac- There are many HIV preventive programs which promote the
cept living with AIDS victims more than the past.2,5 However, use of condom including campaigns such as “100% Condom
the infected people feel that the stigma is still strong and they Program”.10,13-15 One of the main reasons why youth do not use
are discriminated from the society.2 This stigma was reported condom is the embarrassment of carrying condom.18-20 The re-
to cause depression, social isolation and shame.6,7 asons against carrying condom were reported that males are
Submission: Feb 2, 2014
Acceptance: May 31, 2014
Process: Peer-reviewed

1
Medical Student, Chulalongkorn University, Thailand.
2
Director of department of Preventive and Social Medicine, Chulalongkorn University, Thailand.

Correspondence:
Apinut Wongkietkachorn.
Address: 254 Phayathai Road, Pathumwan, Bangkok 10330, Thailand.
Email: apinutme@[Link]

44 The International Journal of Medical Students Int J Med Students • 2014 Mar-Jun | Vol 2 | Issue 2
Original Article

afraid of being publicly exposed and humiliated while females sexual behavior, and attitude towards AIDS and new condom
are afraid of parent disapproval, gossiping, or being considered packaging, respectively.
as anticipating having sex and being promiscuous.21,22 To solve
the problem, new male condom packaging merged with daily With 95% confidence interval, the estimated proportion deri-
life products, such as phone charm and key ring, was develo- ved from pilot study which students liked the new packaging
ped to promote carrying condom. This study aims to assess 71.2%. The desired precision was 0.07. The sample size requi-
Thai youth’s attitude towards condom use and sexual behavior, red was 161.
evaluate the new condom packaging in encouraging youth to
carry condom, find the key factors in good condom packaging, Data analysis was conducted by using SPSS© software (ver-
and find the association between the findings. sion 16.0 for Windows, copyright 2007, SPSS Inc.). Percentage
was used for descriptive data. Because the participants could
Methods choose not to answer any questions that they felt uncomfor-
The Strengthening the Reporting of Observational Studies in table with, missing values were omitted and the percentage
Epidemiology (STROBE) Statement is followed in writing this ar- calculation was based on the total amount of answers, which
ticle.23 This was a cross sectional study using self-administered was not similar to the total number of participants. Open ques-
questionnaire which took place in Siam Square, which was the tion answers were grouped into categories and reported as
most famous and crowded youth center in Bangkok, the capital frequency. Cross tabulation and Chi-squared test were used to
city of Thailand, August 2009. find the association between categorical variables. Fisher exact
test was used in the paired categorical variable with expected
Participants were chosen by purposive sampling. Inclusion cri- value less than 5. A p value less than 0.05 was considered
teria was youth, which is defined as aged 15-24 years old by statistically significant.
the United Nations.24 They also had to be Thai and hang out in
Siam Square. The study was announced in the national and lo- Table 1. Socio-demographic characteristics of participants.
cal television channels, radios, and newspapers a week earlier
to invite Thai youth to participate in the study. Participating in Characteristic Freq. (%)
this study, the participants were emphasized that their parti- Gender
cipation was voluntary. They did not have to answer questions Female 406 (59.9)
they did not want to and their information would be confiden- Male 272 (40.1)
tial. The study objectives were explained to the participants
Sexual preference
and the new condom packaging demonstrated. Later, they were
asked to completed questionnaire in privacy booths and sub- Heterosexual 497 (75)
mitted anonymously. Homosexual 70 (10.5)
Bisexual 96 (14.5)
New condom packaging was designed to merge with daily life
Current Education Study level
products, such as mobile charm, earrings, and bag accessory
because they were things youth love to use in their daily life Undergraduate 438 (64.9)
and condom could be in disguise, or designed beautifully des- High school 220 (32.6)
pite seeing condom in these products. The packaging was made Postgraduate 17 (2.5)
by students at the Faculty of Medicine, Chulalongkorn Univer- Occupation
sity, Thailand. This packaging was piloted in 111 1st – 3rd year
Student 549 (81.5)
volunteer medical students because their age fell in the range
Employee 84 (12.5)
of the study participants (Figure 1). The packaging was de-
monstrated by five volunteers. After seeing the demonstration Business people 28 (4.2)
of carrying condom, the subjects were asked for their opinions Merchants 7 (1)
about the condom products. Their responses were grouped and Government officer 6 (0.9)
used to develop the questionnaire. Other history
Drinking alcohol 380 (56.4)
The questionnaire development was based on previous litera-
Smoking 294 (18.6)
tures and the mentioned student responses. The questionnaire
was piloted in 20 volunteer medical students. It consisted of Drug user 39 (5.8)
four parts: general information, attitude towards condom use,
Figure 1. Condoms Packaging Designs.

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 International Journal of
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M e dical S t
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Results Table 2. Summary of results.

Socio-demographic Characteristics of Participants Topics Freq. (%)
There were 1,104 participants in this study; 324 were excluded Condom attitude (What participants thought)
because they were out of age range (15-24 years). Six hundred
Using condom
eighty participants were included in the analysis. Their mean
age was 19.7±2.7 years. Their socio-demographic characteristics Always use before marriage 486 (72.1)
were described in Table 1. Only with casual partners 42 (6.2)
Would try to use 77 (11.4)
Attitude Towards Condom Use
Would not try to use 46 (6.8)
Most of participants (72.1%) thought it was necessary to
always use condom no matter whom they had sex with while Not use at all 23 (3.4)
3.4% said they would not use condom in any circumstances. Why not use condom?
When the participants were asked about their attitude towards Embarrassment by buying 308 (49)
carrying condom, 10.8% thought the condom should not be
Laziness to buy 110 (17.5)
carried. Three major reasons were given including; they could
go and buy (44.8%); carrying condoms made them look bad Embarrassment by carrying 79 (12.6)
(26.0%) and they did not intend to have sex before marriage Decrease in pleasure 72 (11.5)
(19.8%), respectively. However, embarrassment about buying Unnecessary to use 59 (9.4)
condoms was reported to be the main reason why the partici-
Carrying condom
pants did not use condoms (49.0%).
Should carry 602 (89.2)
Sexual Behavior Should not carry 73 (10.8)
It was found that 30.4% of participants had already had sex. Sexual behavior (What participants really did)
Among the participants that had already had sex, majority of
Frequency of sexual intercourse per week
them (44.7%) had sex less than once a week and 33.5% used
condom every time. About 13% had multiple partners; over a <1 88 (44.7)
third of them thought there were differences between having ~1 47 (23.9)
sex with their partners and casual partners. An open question 2-3 36 (18.3)
was used to assess the differences. They reported that the di-
>3 26 (13.2)
fferences were difference in sexual emotion between loved and
unloved partners (77.5%) and difference in physical appearan- Condom use
ce (12.5%). Only 6.7% reported safety issues to be the reason Every time 65 (33.5)
for the difference. On the other hand, 88.2% said that there >50% 50 (25.8)
was an increased risk in getting infected from casual partners,
<50% 62 (32)
while the other 11.8% said there was no increased risk.
Never 17 (8.8)
The age of first sex experience ranged from 9-23 years with a Condom use with casual partners
mean of 17.9±2.5 years. About 40% did not used condom during Always 81 (75)
their first sex. Only 8.9% of the participants actually carried
Occasionally 20 (18.5)
condoms, while most of them (91.1%) did not.
Never 7 (6.5)
Attitude Towards AIDS and the New Packaging If there was no condom at the time they were going to have sex
Most participants thought that AIDS was a very important pu- Stop having sex 28 (26.2)
blic health problem and sexual transmission was the major
Go to buy condoms 51 (47.7)
way to get infected.
Continue having sex 28 (26.2)
A lot of participants (85.1%) found that the new condom pac- Condom use in first sex
kaging was interesting. Among the interested respondents, the Yes 122 (60.4)
first three products they liked most were mobile charm, key
No 80 (39.6)
ring, and accessory that attached to belt, neck tie, shoes or
hat. The first three reasons were the product’s charming de- Carrying condom
sign, the disguise of condom, and the convenience of carrying, Yes 18 (8.9)
respectively. No 185 (91.1)
Attitudes toward AIDS
The products that the participants did not like were earrings,
and other accessory such as bracelet and necklet. The reasons AIDS problem
were the obviousness of the condom and the bad design. Very important 583 (86.8)
Important 79 (11.8)
Most respondents (66.4%) said that they would be confident in
Not much important 9 (1.3)
using the products and 33.6% said they would not. The reasons
why they were confident were similar to the reasons why they Not important at all 1 (0.1)

46 The International Journal of Medical Students Int J Med Students • 2014 Mar-Jun| Vol 2 | Issue 2
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Table 2 (continue). Summary of results. attitude and behavior, resulting in embarrassment with buying
Topics Freq. (%) or carrying condom; thus, decreasing this stigma was the key
to success for all the HIV campaigns in Thailand. This is also in
Major mode of transmission
concordance to previous studies.28,29
Sexual transmission 639 (96.5)
Intravenous drug use 16 (2.4) Although almost all respondents knew that the major mode
Vertical transmission 7 (1.1) of HIV transmission was sexual intercourse, only part of them
Attitudes towards the new packaging
had safe sex or use condom every time. This result is similar to
other study findings.30,31 One study showed that although Thai
Most interesting packaging
people knew about HIV and its burden, only about a quarter
Mobile charm 283 (45.2) of the adult and 20% of youth realized that they were at risk
Key ring 153 (24.5) of the infection, resulting in the high rate of unsafe sex (Uni-
Accessory 110 (17.6) ted Nations Development Programme, UNDP, Opinion poll on
HIV/AIDS Thailand. 2004. Available from: [Link]
Least interesting packaging
content/thailand/en/home/library/hiv_aids/AIDSOpPoll/, upda-
Earrings 318 (50.8)
ted 2004 May 1; cited 2014 Mar 30). Similarly, UNGASS Country
Other accessory 204 (32.6) Progress Report Thailand indicated that despite high aware-
ness of safe sex and the condom effectiveness in preventing
liked the products. If this new packaging were launched, 72.9% HIV and STI, there is still lack of concern and skill in condom
said it would not affect their daily lives. Moreover, 78.3% of use; therefore, only 20-40% of students reported using condom
the participants said that the government should promote the every time they had sex (United Nations Programme on HIV/
idea of new packaging, and 66.5% said they would buy if the AIDS, UNAIDS, United Nations General Assembly Special Session,
products were on sale. UNGASS, country progress report Thailand. 2010. Available from:
[Link]
Attitude and Behavior in Condom Carrying countryprogressreports/2010countries/thailand_2010_coun-
There were two significant associations between attitude and try_progress_report_en.pdf, updated 2010; cited 2014 Mar 30).
behavior. Concerning carrying a condom, only 10.1% of the Moreover, this study showed that even though the participants
participants, who thought they should carry condom, actually knew that they should carry and use condom, they did not
carried condoms and 89.9% of them did not carry condom; actually do it. This showed that, apart from social stigma, there
however, all of the participants, who thought they should not was also a lack of personal concern, which might cause many
carry condom, did not carry condom (p<0.001). Concerning campaigns to fail.
using condom, only 54.5% of participants, who suggested using
condom every time, actually used condom every time, while Most participants appreciated the new condom packaging. The
6.0% of participants, who suggested not to use condom every beautiful design is the main reason why they like the pac-
time, really used condom every time (p<0.001). kaging. Clement explained that packaging design had an in-
fluence on purchasing the products.32 The more attractive they
Females were significantly more interested in the products are, the more likely the consumers would buy the products.
than males. Females were interested in the products 86.0%, Since female participants were interested in the products more
while males were interested 80.7% (p=0.025). However, there significantly than the males, further studies were highly recom-
were no associations between gender and the intention to use mended to find the reason why males were less interested in
the product (p=0.204), gender and the intention to buy the the product than females and how to encourage them to carry
products (p=0.053), and gender and the effect of condom pro- condom more.
ducts to daily lives (p=0.292). Summary of results is described
in Table 2. Limitation of this study includes the fact that it was conduc-
ted at Siam Square which was a youth center of Bangkok, the
participants had their uniqueness. They were well educated,
Discussion
medium to high socioeconomic group of the population. Mo-
Most participants thought that condom should be carried and
reover, there were differences between Thais and other country
used. However, they did not actually carry and use. The new
citizens as such this study result might cannot be generalized.
packaging was also interesting and attractive to use, especially
for female.
There are discordances between attitude and behavior in using
and carrying condom. A new condom packaging could redu-
In this study, there is discordance between attitude and beha-
ce embarrassment of carrying condom. In dealing with youth,
vior. This might be resulted from social stigma. Sarkar, revealed
charming and disguising condoms are important. Disguising
that the main factors contributing to the failure in promoting
condom packaging as phone charm and key ring, might be
condom use in Thailand were social and cultural factors, es-
another safe and practical way to encourage youth to carry it.
pecially the life style, prostitutes and brothel system and the
stigma to HIV/AIDS.25 This study also showed that the emba-
rrassment with buying or carrying condom is the main fac-
tor why Thai people did not carry condoms. Carrying condoms
makes young women look like desiring sexual intercourse.26,27
To sum up, social stigma might cause the discordance between

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Stt u dents

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Acknowledgments
We would like to thank volunteer medical students at the faculty of Medicine, Chulalongkorn University (MDCU 64) for their help in
conducting this research.

Conflict of Interest Statement & Funding

The Authors have no funding, financial relationships or conflicts of interest to disclose.

Author Contributions
Conception and design the work/idea: AW KN. Collect data/obtaining results: AW KN. Analysis and interpretation of data: AW KN NH. Write
the manuscript: AW KN. Critical revision of the manuscript: AW KN NH. Approval of the final version: AW KN NH. Statistical advice: NH.

Cite as:
Wongkietkachorn A, Nissaipan K, Hiransuthikul N. Attitude towards New Packaging to Reduce Condom-carrying Embarrassment among Thai
Youth, A Cross-sectional Study. Int J Med Students. 2014 Mar-Jun;2(2):44-8.

48 The International Journal of Medical Students Int J Med Students • 2014 Mar-Jun| Vol 2 | Issue 2