Teacher Resources for Aids in Thailand

Target Audience

This learning module is intended for undergraduates and graduate students with an interest in international relations, international development, public health, psychology, marketing and/or communications. This module is well suited for students interested in learning more about practical skills used in human-centered design, behavior change campaigns, social marketing, public health and/or international development careers.

Suggested Teaching Approach

This learning module is best used to discuss the Learning Themes / Topics for Consideration. The Reflection section offers students an opportunity to discuss the ethics of influencing behavior and working in communities outside of their own tradition. Deeper consideration of how Mechai demonstrated best practices in overcoming obstacles to implementing campaigns can be found in the Deep Dive section.

At a minimum, students must understand that Thailand was plagued by the HIV epidemic in the 1990s and continues to struggle with poverty, STIs and HIV stigmas today.

The instructor can choose which Discussion Questions to focus on as well and whether to assign the Reflection and Deep Dive question. Depending upon the choices made, and the depth of discussion desired, this module might occupy up to an hour of class time.

What is unique about Mechai’s approach to behavior change campaigns, beyond humor, is that he and his team identified opportunities that leveled the playing field for their audience/beneficiaries to encourage true agency and true choice. This is a valuable lesson that he undoubtedly learned from his overpopulation work in the 1970s.

For example, is it truly a choice for a sex worker and a client to use a condom if condoms are not readily available in their village?

By making sure condoms are inexpensive and available, Mechai and his team are not just educating someone that safe sex is best, but lowering the barriers that are discouraging people from operationalizing that choice. This encourages true behavior change, not just changing someone’s mind. Ultimately, this human- centered problem solving demonstrated by Mechai and his team has become a model for behavior change programs around the world.

Answers to Questions

  1. What changed in terms of the treatment of HIV in Thailand between the first installment of Under-Told Stories (Thailand’s AIDS Struggle) and the second (Government of Thailand Battles AIDS Epidemic)? In your opinion, did this change affect the type of social interventions Mechai and the Monastery pursued? Why or why not?
    The first video, which was produced in 1998 (and re-aired in 2002), was created before antiretroviral drugs were widely available in Thailand. By the second installment, in 2007, Thailand had integrated HIV services into its universal health coverage scheme and HIV became a status for many, instead of a death sentence.
    From the videos, it appears that the Monastery continued to pursue two primary missions. One was to care for those who were abandoned by their family due to their HIV status. A second was to educate outsiders on HIV and AIDS. By the second installment, and the introduction antiretroviral drugs, the monastery workers referred to the hospice as a “temple of life” instead of a hospice, however the educational interventions of the monastery seem to remain the same, to shock people into HIV awareness.
    In contrast, in the case of Mechai, it appears from the videos, that his social programming evolves around humor and engagement and seems to have changed over time and is moving towards eliminating HIV stigma.

  2. How would you describe the tactics used by the Monastery to encourage AIDS awareness in the videos? How did the Monastery’s educational tactics differ from the methods used by Mechai? Is there value in using different tactics for different audiences? Why or why not?
    Students might use words such as “shock” to explain the tactics used by the monastery to educate people on the effects of HIV. Walking through an active hospice “museum” and mausoleum, standing toe to toe with the dying, is one way to educate people regarding a disease. However, it can backfire when it comes to changing behavior. In contrast, Mechai often uses humor to encourage education on the taboo topic of stopping the spread of STIs.  Neither is the “right” way. Both type of tactics encourage understanding of a misunderstood topic. According to research on this topic, both shock and humor have a place in educating and raising awareness. But behavior change campaigns are not interested in raising awareness alone. It additionally aims to change habit or behavior. Sometimes shocking people into awareness backfires and encourages fatalistic attitudes which discourages a person’s understanding of choice and agency, and so their behavior does not change in the long run. (source) Links to an external site.

  3. Links to an external site.Two benchmarks of a successful behavior change campaign are effective promotion and overcoming competition. From the reading, identify at least one unique and novel way Mechai’s behavior change campaign overcame the white noise of competition.
    These two benchmarks are important to a successful behavior change campaign because only by capturing the audience’s time, attention and inclination can there be hope in modifying a community’s decision making and ultimately their behavior. As Mechai says regarding a successful campaign, “Don’t be dull. Don’t stand up there and preach. Make it fun, make it interesting, make it culturally relevant, and let people participate” (Melnick, 2007, p. 676).”

    Examples of Promotion/Overcoming Competition
    • Overcame lack of doctors available to prescribe birth control by enabling nurses/midwives to prescribe oral contraceptives. (Melnick, 2007, p. 670)
    • Used community members to distribute condoms (e.g., shopkeepers, hairdressers, golf caddies). (Melnick, 2007, p. 671)
    • Condom blowing championships for teachers as an attention gathering strategy and a way to reduce taboo. (Melnick, 2007, p. 671)
    • Cops and Rubbers program had police distributing condoms. (Melnick, 2007, p. 671)
    • The Mechai Story runs in the press and leads to a satirical response of “If this guy likes condoms so much, let’s call a condom a ‘Mechai” and we see how he likes it.” This is a public relations windfall and now condoms are often called Mechais in Thailand. (Melnick, 2007, p. 671)
    • Mechai advocates for becoming Thailand’s first “AIDS Czar”. (Melnick, 2007, p. 672)
    • Multi-sectoral alliances between business, education, government. (Melnick, 2007, p. 672)
    • Radio and television have compulsory 30-second AIDS education messaging every hour. (Melnick, 2007, p. 672)
    • Subsidies paid to production houses that included AIDS education in their regular entertainment programming. (Melnick, 2007, p. 672).
  4. One of the criticisms of behavior change campaigns is that they are heavily resource dependent and expensive. Based on the reading, name at least one way that Mechai was able to save resources and still promote his message.
    Again in the interview by Melnick (2007), there are several ways that Mechai was able to save resources and still promote his message. For example,
    • In one case Mechai used some negative press regarding his work on sexual education and redirected it towards the positive, when he embraced (and wasn’t embarrassed) to have his own first name be a nick name for condoms. In this way he took a public relations nightmare for his work and made it a windfall (Melnick, 2007, p. 671). 
    • Later in the Melnick article, Mechai recommended changing out children’s games or songs with AIDS education lyrics. (Melnick, 2007, p. 677)

Reflection Questions

If you are not a native of Thailand, how might your experience be different than Mechai’s in encouraging behavior change in Thailand? In your opinion, would your non-local status affect your success in implementing a behavior change campaign in Thailand? Why or why not?

There is an opportunity here for students to discuss bias and cultural understanding. Deep understanding of audience found via research or experience is an important step before any intervention. There is also the responsiveness to a local celebrity versus an outsider that could alter effectiveness if this tactic if used in a different country.

To Take a Deep Dive, You Might Consider These Questions

Mechai identifies a number of formal and informal barriers that had the potential to derail his work. Identify at least three specific challenges mentioned by Mechai in Under-Told Stories and/or the Melnick interview and explain how Mechai was able to overcome each. Are any of the challenges examples of Mechai turning resistance into opportunity? Rank the challenges you selected in order of perceived difficulty, and explain why you selected your particular order.

[Alternative In-Class Activity: Instructor asks the entire class to list as many unique examples of barriers that they can identify from the Under- Told Stories videos and the required reading. How was each barrier overcome? How many examples did the classroom identify? Are there examples of turning resistance into opportunity? Why is overcoming barriers to service, products, and communication so important to a successful social marketing campaign?]

There are literally more than a dozen examples from the article and video; here are a few:

Informal Barrier - Sensitive Conversations: In the video Mechai discusses how at first people were hesitant to discuss condoms and he teased, “Is it because of the rubber? Because if rubber is the issue you should be embarrassed by a tennis ball”. He also encouraged condom blowing championships for teachers to desensitize.

Formal Barrier - Lack of Doctors to Prescribe Oral Contraceptives: Changed rules to enable community-based distribution.

Informal Barrier - Bad PR: Made bad PR good PR by embracing calling a condom a “Mechai.”