Knowledge, Attitudes, and HIV/AIDS Risk Behaviors of Myanmar Migrant Workers in Thailand Indonesian Scholars’ Alliance GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 Open Access Original Research The 4th Interna onal Conference on Applied Science and Health (ICASH 2019), 23-24 July 2019, Faculty of Graduate Studies, Mahidol University, Thailand Knowledge, Attitudes, and HIV/AIDS Risk Behaviors of Myanmar Migrant Workers in Thailand Nitchamon Rakkapao1* , Pradabduang Kiattisaksiri1 , Ronnapoom Samakkekarom2 1Faculty of Public Health, Thammasat University, Lampang Campus, Lampang, Thailand 2Faculty of Public Health, Thammasat University, Rangsit Campus, Patumthani, Thailand *Corresponding author’s email: nitchamonbt@fph.tu.ac.th ABSTRACT Background: HIV/AIDS is s ll a problem in the health care system of developing countries. Migrant workers are consideredavulnerablepopula onforHIV infec on.Thecurrent informa ononHIV/AIDSandmigrantworkers is useful to provide suitable effec ve health interven ons for the preven on of HIV/AIDS. This study aims to describe knowledge, a tudes and HIV/AIDS risk behaviors among Myanmar male migrant workers in Thailand. Methods: Across-sec onal studywasconducted inMyanmarmalemigrantworkersaged18-60yearscollected fromFebruary toMay2018.Atotalof400migrantworkerswho live inPatumthaniprovinceswereselectedbya convenience sampling method. Descrip ve sta s cs were used to explore knowledge, a tudes and HIV/AIDS risk behaviors of par cipants. Results: The mean age of the par cipants was 33 years, ages ranged from 18 to 60 years old, achieved pri- mary school (40.40%), and married (54.30%). An average living in Thailand was 3.25 years and monthly income was 9,166 baht (∼286 USD), respec vely. A majority of par cipants had a poor level of HIV/AIDS knowledge (55.25%) and a fair level of an a tude about HIV/AIDSdisease and preven on (61.25%). Riskbehaviors related to HIV/AIDS of par cipants who had sex with non-partners were 40.58%. Conclusion: Most par cipants had poor knowledge and a fair a tude of HIV/AIDS. Risk behaviors related to HIV/AIDS of the par cipants were rela vely high. Moreover, most of par cipants had less access to health care services. This results confirmed that an urgent need to provide health interven on to increase knowledge on HIV/AIDS of Myanmar migrant workers in Thailand. Keywords: Myanmar migrant workers, HIV/AIDS, risk behavior, Thailand Received: 19 May 2019 Reviewed: 8 June 2019 Revised: 24 June 2019 Accepted: 1 July 2019 DOI: 10.35898/ghmj-33452 Selec on and peer-review under responsibility of the scien fic commi ee and the editorial board of The 4th Interna- onal Conference on Applied Science and Health (ICASH 2019) © Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars’ Alliance). This is an open-access following Crea ve Commons License Deed - A ribu on-NonCommercial-ShareAlike 4.0 Interna onal (CC BY-NC-SA 4.0) 1. Introduc on HIV/AIDS is still a major public health problem around the world. Although the number of new cases HIV infections globally continued to decline from 3.40 million in 1996 to 1.80 million in 2017, progress is far slower than what is required to reach the 2020 milestone of less than 500,000 new infections. In 2017, epidemiology of AIDS around the world is 36.90 million and a majority was found in adults and Africa region. Approximately 5.20 million people in Asia-Pacific region (mostly China, India, Indonesia, Malaysia, Myanmar, Pakistan, Papua New Guinea, Vietnam, and Thailand) were infected with HIV (UNAIDS, 2018b). In 2017, the prevalence of HIV in Thailand aged 15 to 49 years was 1.10 per 84 mailto:nitchamonbt@fph.tu.ac.th https://dx.doi.org/10.35898/ghmj-33452 Rakkapao N et al. GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 100,000 persons (UNAIDS, 2018a). Although an overview of HIV prevalence decreased more than 10 years, HIV prevalence has been increased or stable in some groups, in particular, a vulnerable group like migrant workers (Thepthien et al., 2015). Migrant workers are considered a vulnerable population for HIV infection. Most migrant workers separated from their families and familiar social. They may face language barriers, substandard living conditions, and working conditions and a lack of social protection, such as health insurance and other social security benefits. The resulting isolation and stress may lead migrant workers to engage in risky behaviors, such as unsafe sex (UNAIDS, 2019). In 2015, according to the report of The International Organization for Migration (IOM) found that there are approximately 257.7 million people worldwide (IOM, 2017). Mobility of migrant workers directly affects to health care system of origin and destina- tion country. Previous studies were also found that HIV infection was high among migrant workers who moved back to their former homeland (Alvarez-del Arco et al., 2017; Fakoya et al., 2015). Thailand has had continued economic growth for more than twenty years and has combined with international policy of ASEAN Community that aims to cooperate in 3 main issues (political-security, economic, and socio-cultural). This has a result of the increased movement of migrant workers in Asia, especially Thailand where migrant workers come from neighboring countries like Myanmar, Laos, and Cambo- dia. In 2018, Thailand has about 39 million migrant workers, most of which are from Myanmar (2.06 million) following Cambodia (720,000) and Lao PDR (220,000) (IOM, 2019). A majority of migrant workers are young and separated from spouses and their family that mak- ing them feel isolated or stress and may lead to a high risk of HIV/AIDS (Weine and Kashuba, 2012). Mostly they lack HIV. In addition, knowledge (Amirkhanian et al., 2011; Sena et al., 2010; Mullany et al., 2003) in accordance with the report from Bureau of Epidemiology Department of Thailand in 2013 shows that the morbidity rate of HIV/AIDS of Myanmar migrant workers has not decreased and the prevalence of HIV/AIDS was 1% (BoE, 2013). Besides, most migrant workers faced with the lan- guage or finance barriers (particular in migrant workers with irregular legal status) that make them less access to health care services. Little information is known about HIV/AIDS risk behaviors in Myanmar migrant workers in Thailand because of the language barrier and access to migrant work- ers. Understanding knowledge, attitudes, and HIV/AIDS risk behaviors in migrant workers is very important in planning HIV/AIDS at the national and international levels of the health care system. Therefore, the objective of this study is to describe knowledge, attitudes, and HIV/AIDS risk behav- iors among Myanmar male migrant workers in Thailand. 2. Method 2.1 Study design and sample This cross-sectional study was conducted among Myanmar male migrant workers living in Patumthani province, Thailand. The data were collected from February to May 2018. A total of 400 male migrant workers aged 18-60 years who have lived in Thailand over 6 months were selected based on conve- nience sampling at one private market of Patumthani province. Myanmar male migrant workers who were diagnosed with HIV/AIDS and not literate in the Myanmar language were excluded. Permission to collect the data was obtained from the head of the private market, and all participants provided in- formed consent. The study protocol was approved by the ethics committees of Thammasat University (082/2560). 2.2 Instruments The questionnaire was developed in the Thai version and was proved for content validity by three experts with extensive experience working in the HIV/AIDS field. The next step was translated to Myanmar version by the certified language institute of Mahidol University. The questionnaire con- sists of four parts. Part 1 was data about sociodemographic characteristics. Part 2 was knowledge of HIV/AIDS containing statements about transmission and prevention. It was 12 items that had an an- 85 GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 Rakkapao N et al. swer as ”yes”, ”no”, and ”don’t know”. The correct answer was given 1 scores and incorrect answer was given 0 scores. The scores of HIV/AIDS knowledge were categorized into three levels (poor, fair, and good). A total of scores less than 60% (less than 8) was considered as a poor level of knowledge, score 60-79% (8 and 9) was considered as a fair level of knowledge, and score 80% and over (10-12) were considered as a good level of knowledge. Part 3 was an attitude about HIV/AIDS disease and prevention. It was comprised of 15 items of pro and con attitude about disease and prevention. Each item was Likert scale rating from strongly agree, agree, neutral, disagree and strongly agree, with 5, 4, 3, 2, and 1 score, respectively. In terms of negative items, the score was reversed. Scores of attitudes were categorized into three levels include poor, fair, and good. A total of a score less than 60% (15-44) was considered as a poor level of attitude, score 60-79% (45-59) was considered as the fair level of attitude, and score 80% and over (60-75) were considered as a good level of attitude. Part 4 was risk behaviors related to HIV/AIDS and accessibility to health care services. The questionnaire was pre- tested on thirty male Myanmar migrant workers in another province (Phra Nakhon Si Ayutthaya) close to Patumthani province. The results from pre-tested were used to improve the questionnaire. Data was collected using a self-administered questionnaire. 2.3 Sta s cal analysis Epidata version 3.1 was used to enter the data, and the logic check mode was used to check for data errors. Descriptive statistics were summarized using means and standard deviations, for continuous variables, and frequencies and percentages for categorical data. 3. Results 3.1 Demographic characteris cs of par cipants A total of 400 Myanmar male migrant workers completed the questionnaire (Response rate : 100%), and their ages ranged from 18 to 60 years old (Mean=33.42). Most participants achieved primary school education (40.40%), married (54.30%), an average living in Thailand 3.25 years, an average monthly income 9,166 baht ( 286 USD). Half of participants did not understand The Thai language. The demographic characteristics of the participants are presented in Table 1. Table 1. Demographic characteris cs of par cipants (n=400) Characteris cs Frequency % Age group (years) 18-24 63 15.8 25-40 259 64.7 41-60 78 19.5 mean=33.42, SD=8.07 Educa on level Unschooled 89 22.3 Primary school 162 40.4 High school 144 36.0 Bachelor degree 5 1.3 Marital status Single 164 41.0 Married 217 54.3 Widowed/Divorced/Separated 19 4.7 Have children 86 Rakkapao N et al. GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 Yes 224 56.0 No 176 44.0 Occupa on Labor 186 46.5 Seller 108 27.0 Others 106 26.5 Living in Thailand Alone 44 11.0 Wife 144 36.0 Rela ve 146 36.5 Friend 36 9.0 Employer 20 5.0 Others 10 2.5 Average living 3.25 years, SD 1.86, Max 15 years, Min 6 months Understand Thai language Do not understand 200 50.0 Mild understanding and can not speak 115 28.7 Moderate understanding and can speak some issue 69 17.3 Good understanding and can speak on every issue 16 4.0 Average income 9,166 baht per month, Max 22,400 baht, Min 1,240 baht Family income Enough 240 60.0 Not enough 160 40.0 Other history diseases Yes 57 14.2 No 343 85.8 Smoking Never 241 60.3 Quit 37 9.3 Smoking someday 39 9.7 Smoking everyday 83 20.7 Drinking alcohol Never 226 56.6 Quit 47 11.7 Drinking someday 67 16.7 Drinking everyday 60 15.0 Table 2 reveals The HIV/AIDS knowledge of participants. The result found that a majority of participants have a poor level of HIV/AIDS knowledge (55.25). Only 13.75% have a good level of HIV/AIDS. An average score is 6.97 (SD=2.71) and a range of 0-12. In some essential questions, the result found that participants answered correctly less than half. For example, ”HIV people who do not have symptoms cannot spread HIV to other people” and ”AIDS can be cured”. Table 2. SDIA/VIH Knowledge 87 GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 Rakkapao N et al. Yes(%) No(%) Do not know(%) 1. HIV /AIDS transmits through blood 337 (84.3) 24 (6.0) 39 (9.7) 2. HIV /AIDS transmits through sex 326 (81.4) 33 (8.3) 41 (10.3) 3. HIV /AIDS transmits through ea ng 189 (47.3) 136 (34.0) 75 (18.7) 4. HIV /AIDS transmits through contact e.g. hug, hold hand 214 (53.4) 101 (25.3) 85 (21.3) 5. HIV /AIDS transmits through mosquito bite 109 (27.3) 207 (51.7) 39 (9.7) 6. HIV people who do not have symptoms cannot spread HIV to other people 152 (38.0) 133 (33.3) 115 (28.7) 7. AIDS can be cured 170 (42.5) 134 (33.5) 96 (24.0) 8.Havingsexwithtemporarypartnerwithoutcondomusethat will be high risk to HIV /AIDS 249 (62.3) 57 (14.2) 94 (23.5) 9. HIV /AIDS transmits thought using of sharp objects with people, such as razor blades 259 (64.7) 61 (15.3) 80 (20.0) 10. Drinking alcohol before having sex that maybe led to un- safe sex 226 (56.5) 58 (14.5) 116 (29.0) 11.Usingcondomwithnon-partnercanreduceHIV/AIDSrisk 248 (62.0) 68 (17.0) 84 (21.0) 12. Having mul ple partners that may be led to a high risk of HIV /AIDS 310 (77.4) 25 (6.3) 65 (6.3) 13. Level of the HIV knowledgeof samples fromoverall scales Poor (<8) 221 (55.25) Fair (8-9) 124 (31.00) Good (10-12) 55 (13.75) An average score was 6.97 (SD=2.71) and the range was 0-12 Table 3 presents the results of an attitude about HIV/AIDS disease and prevention. It was found that a majority of participants have a fair level of HIV/AIDS attitude (61.25). Only 33% have a good level of HIV/AIDS attitude. The average score is 54.53 (SD = 8.64) and the range of 23-75. More than third-one of the participants still had the wrong attitude in some questions. For example, ”I think that have to use a condom with a temporary partner”, ”I think that if I take medicine to prevent sexually transmitted diseases (STDs) before having sex with a sex worker that will prevent HIV/AIDS”, and ”I think that using a condom is cumbersome”. Table 3. A tude about HIV/AIDS disease and preven on I think that... Frequency (%) Strongly agree Agree Not sure Disagree Strongly disagree 1.Havingmul plepartners increaserisk of HIV/AIDS 230 (57.5) 107 (26.7) 25 (6.3) 18 (4.5) 20 (5.0) 2. Drinking alcohol increase risk of un- safe sex 184 (46.0) 122 (30.4) 31 (7.8) 31 (7.8) 32 (8.0) 3. Using razor blades with people in- crease risk of HIV/AIDS 172 (43.0) 116 (29.0) 63 (15.8) 29 (7.2) 20 (5.0) 4. If your hand is wounded and touches thebloodorsecre onsofHIV/AIDSpa- ent that increases risk of HIV /AIDS 147 (36.7) 129 (32.3) 75 (18.7) 24 (6.0) 25 (6.3) 5. I have a risk of HIV /AIDS 83 (20.7) 89 (22.3) 86 (21.4) 73 (18.3) 69 (17.3) 6. AIDS is a disgus ng disease and can- not be cured 171 (42.8) 91 (22.7) 62 (15.5) 52 (13.0) 24 (6.0) 88 Rakkapao N et al. GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 7. HIV/AIDS pa ent will suffer both physically and mentally 159 (39.7) 111 (27.7) 77 (19.3) 40 (10.0) 13 (3.3) 8. HIV/AIDS disease has high cost 190 (47.5) 71 (17.7) 64 (16.0) 54 (13.5) 21 (5.3) 9. HIV/AIDS pa ent will have reduced ability to work 186 (46.5) 98 (24.5) 69 (17.3) 27 (6.7) 20 (5.0) 10.Havetousecondomwithtemporary partner 154 (38.5) 101 (25.3) 70 (17.5) 46 (11.5) 29 (7.2) 11.Havetousecondomwithsexworker 171 (42.7) 123 (30.7) 51 (12.8) 28 (7.0) 27 (6.8) 12. If I take medicine to prevent HIV/AIDS before having sex with sex worker that will prevent HIV/AIDS 97 (24.3) 99 (24.8) 70 (17.5) 71 (17.7) 63 (15.7) 13. I can buy condom conveniently 143 (35.8) 81 (20.2) 110 (27.5) 28 (7.0) 38 (9.5) 14. Using condom is cumbersome 85 (21.1) 59 (14.8) 129 (32.3) 66 (16.5) 61 (15.3) 15. Wearing a condom reduces sexual feelings 100 (25.0) 55 (13.7) 114 (28.5) 62 (15.5) 69 (17.3) 16. Level of an a tude of HIV/AIDS disease and preven on from overall scales Poor (23-44) 23 (5.75) Fair (45-59) 245 (61.25) Good (60-75) 132 (33.00) An average score was 54.53 (SD=8.64) and the range was 23-75 Table 4 exhibits results on risk behaviors related to HIV/AIDS and access to health services. The results found that participants who did not use a condom with non-partners were 40.58%. Accessing health care service after getting sexually transmitted diseases, mostly they bought medicine at the pharmacy and visited private clinics. The annual average to see doctor is 3.67 times. Mostly, they got information about STDs from friends (38.93%). Table 4. Risk behaviors related to HIV /AIDS and access health services Frequency (n) % 1. Age at first having sex (average 21.77, SD = 3.01, Min 15, Max 40) 2. Have more than one partner in last year (n =398) Yes 77 19.3 No 321 80.7 3. Have sex with sex worker in last year Yes 75 18.7 No 325 81.3 4. Partner-have sex with non No 331 82.75 Yes 69 17.25 4.1. Use condoms Yes 41 59.42 No 28 40.58 5. Used to check blood tests for HIV /AIDS (n=397) Yes 169 42.56 No 228 57.44 89 GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 Rakkapao N et al. 6. Use drugs or alcohol drinking before having sex (n=397) Yes 101 25.44 No 296 74.56 7. Previously had other STDs (n=399) No 368 92.23 Yes 31 7.77 7.1 How to treat? (n=23) Not cured 3 13.04 Went to government hospital 4 17.39 Went to private hospital 1 4.35 Went to private clinic 5 21.74 Went to pharmacies 7 30.44 Others 3 13.04 8. Average to see doctor per year 3.67, SD = 2.03 min 1 , max 5 *9. Source of informa on about STDs Friends 197 38.93 Health personal 148 29.25 Family or rela ve 70 13.84 Media 59 11.66 Others 32 6.32 *can answer more than one op on Table 5 provided results about an association between potential risk factors and risk behaviors related to HIV/AIDS and did not use a condom, which in this study refers to having sex with non- partner. In this research, we could not demonstrate statistically significant associations between risk behaviors related to HIV/AIDS and potential risk factors. However, perusal of Table 5 shows relation- ships between these variable in our sample. For example, younger men had a considerably higher rate of not using condoms in our sample demonstrated worse behavior compared to older men (30.8%). Also, married men (44.6%) with 51.2% men not wearing condoms compared to 30% and 16.7% for single and widowed/sperated/divorced men, respectively. Interestingly, other history of disease was also a major factor obseved in our sample for lack of condom use (57.1% vs 38.2%). Table 5. Cross-tabula on analysis of condom use and poten al risk factors (n=69) Independent variables Having sex with non-partner Used condoms Not using condoms χ2 p-value Age group (years) 0.833 0.535+ 18-40 38 (55.4) 25 (44.6) 41-60 9 (69.2) 4 (30.8) Educa on level 0.925 0.646 Unschooled 12 (66.7) 6 (33.3) Primary school 13 (52.0) 12 (48.0) High school 15 (57.7) 11 (42.3) Marital status 3.982 0.164+ Single 14 (70.0) 6 (30.0) Married 21 (48.8) 22 (51.2) 90 Rakkapao N et al. GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 Widowed/Divorced/Separated 5 (83.3) 1 (16.7) Have children 0.941 0.237 Yes 23 (53.5) 20 (46.5) No 17 (65.4) 9 (34.6) Occupa on 0.796 0.699 Labor 20 (58.8) 14 (41.2) Seller 11 (64.7) 6 (35.3) Others 9 (50) 9 (50) Living in Thailand 0.495 0.831+ Wife 22 (61.1) 14 (38.9) Rela ve 14 (56.0) 11 (44.0) Others 4 (50.0) 4 (50.0) Understand Thai language 2.365 0.320 Do not understand 15 (70.0) 6 (30.0) Mild understanding and can not speak 17 (48.8) 22 (51.2) Moderate understanding and can speak some issue 8 (80.0) 2 (20.0) Family income 1.169 0.202 Enough 21 (52.5) 19 (47.5) Not enough 19 (65.5) 10 (34.5) Other history diseases 1.647 0.235 Yes 6 (42.9) 8 (57.1) No 34 (61.8) 21 (38.2) Smoking 0.513 0.940 Never 16 (59.3) 11 (40.7) Quit 11 (52.4) 10 (47.6) Smoking someday 5 (62.5) 3 (37.5) Smoking everyday 8 (61.5) 5 (38.5) Drinking alcohol 0.802 0.877 Never 14 (51.9) 13 (48.1) Quit 8 (61.5) 5 (38.5) Drinking someday 4 (66.7) 2 (33.3) Drinking everyday 14 (60.9) 9 (39.1) Level of HIV knowledge 3.774 0.175 Poor (<8) 28 (62.2) 17 (37.8) Fair (8-9) 5 (35.7) 9 (64.3) Good (>9) 7 (70.0) 3 (30.0) Level of a tude of HIV/AIDS 4.259 0.156 Poor (15-44) 3 (50.0) 3 (50.0) Fair (45-59) 30 (66.7) 15 (33.3) Good (60-75) 7 (38.9) 11 (61.1) p-value from Fischer’s exact test 91 GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 Rakkapao N et al. 4. Discussion Although an overview of HIV/AIDS new cases globally decreased and the number of AIDS patients related deaths also decreased due to the development of antiretroviral therapy (UNAIDS, 2018b), HIV/AIDS problem in the vulnerable group like migrants is still a serious problem in many coun- tries. Besides, HIV/ AIDS problem has changed from individual problem to social problem as a result of population mobility. Epidemiology of HIV/AIDS in migrant workers is a national and an interna- tional problem of developing countries. In South-East Asia like Thailand, HIV prevalence among migrant workers from neighboring countries was four times higher than that among the general pop- ulation (UNAIDS, 2018b; Thepthien et al., 2015). Limited access to health information and health care services of migrant workers were the main barrier in managing HIV/AIDS problems. The update information on HIV/AIDS and migrant workers are very necessary to set a good health intervention, to decrease HIV/AIDS prevalence in this population. A vast majority of epidemics of HIV/AIDS are among predominantly males, leading this study to focus on male migrant workers working in Pathumthani. The demographic characteristics of the participants in this study were similar to other studies (Fuller and Chamratrithirong, 2009; Zafar et al., 2014). Mostly migrant workers are adult, single, and low education. Regarding personal factors of migrant workers that make them have a high risk of HIV/AIDS (Weine and Kashuba, 2012). Moreover, this study found that most Myanmar male migrant workers have a low level of HIV/AIDS knowledge. Similar to other studies (UNAIDS, 2018b; IOM, 2017; Akinsulure-Smith, 2014; Amirkhanian et al., 2011; Weine et al., 2008), correct knowledge leads to correct behavior. Therefore, health intervention aims to raise HIV/AIDS knowledge as an urgent need in this group. A fair level of an attitude about HIV/AIDS of participants was found in this work. However, wrong attitudes still found in some essential questions. Attitude or belief of a person affects their health behaviors. These results confirmed that an urgent need to provide HIV/AIDS intervention in migrant workers in Thailand. Another aspect in terms of attitude about HIV/AIDS that maybe will consider less importance or concentrated when migrant workers want to seek new sex experience in the destination country. 40.58% of participants who had sex with non-partners has risk behaviors re- lated to HIV/AIDS. Using a condom with safe sex was accepted the best way to protect HIV/AIDS. Similar to several studies that found that there is limited condom use among labor migrants (Weine and Kashuba, 2012; Weine et al., 2008). The prevalence of risk behaviors related to HIV/AIDS in this study is relatively high. This may explain by the Acculturation theory about adapted to a new cul- ture of migrants. Individuals from one culture integrate into a different culture either from birth or through immigration, forcing the individuals to modify their self-identity and relationship to each culture (Berry, 1997). Sexual values from the origin country of migrants will gradually reduce con- centration and will combine new values from destination countries because of available and more convenient resources (UNAIDS, 2018b,a; Lee and Hahm, 2010). For access to health care service, most of the participants in this study bought medicine from the pharmacy, went to a private clinic, and received information about STDs from friends and family. These suggested that HIV/AIDS intervention should cover not only migrant workers but also their friends and family. HIV/AIDS intervention should be integrated with Thai in their workplace or community. Moreover, HIV/AIDS knowledge should be available on social networks or social media for migrant workers. Although there are some health strategy and intervention of Thai government, specialized NGO, and United Nations which aimed to prevention HIV/AIDS by increasing knowl- edge among migrant workers such as standard management of HIV/AIDS workplace activities. Pre- vention of HIV/AIDS Among Migrant Workers in Thailand Project (PHAMIT), and Comprehensive HIV-Prevention Among Most at-risk population by Promoting Integrated Outreach and Networking (CHAMPION) (UNAIDS, 2019; IPSR, 2012), knowledge and attitude regarding HIV/AIDS of Myan- mar migrant workers still need to more improve. Besides, our failure to demonstrate an association 92 Rakkapao N et al. GHMJ (Global Health Management Journal) 2019, Vol. 3, No. 3 between risk behaviors related to HIV/AIDS and potential risk factors may be due to the lack of rela- tionship, equally, it may be due to the rarity of the outcome (underestimate). This suggests that future research should focus on these issues. There are some limitations in this study. Firstly, the sample could not be selected with random sampling. Secondly, the findings of this study are based on self-reported data, participants may have avoided participation due to the sensitive nature of these particular health risk behaviors. A third, and perhaps the most important, limitation is that admitting to sexual engagement with a non-partner was not particularly prevalent in our sample with only 69% (17.25) of the 400 participants originally approached admitting to this behavior. The implication of this is that our study was restricted to purely descriptive statistics, as any formal analysis would have been severely underpowered. This is perhaps best demonstrated where we observed quite large differences in the condom use behavior among certain groups (e.g. age, marital status, and history of disease), that could not be demonstrated as statistically significant. However, this cross-sectional survey may provide further insights into cur- rent information about HIV/AIDS among Myanmar migrant workers in Thailand. Future research should focus on culture related to sexual behavior of Myanmar migrant workers living in Thailand. 5. Conclusion This study found that a majority of participants had a poor level of HIV/AIDS knowledge and a fair attitude level of HIV/AIDS .disease and prevention Risk behavior related toHIV/AIDS of participants is relatively high .and also less access to health care services This current information is confirmed that an urgent need to provide health intervention to increase knowledge on HIV/ AIDS among Myanmar migrant workers in Thailand. Acknowledgments The authors would like to thank all the participants and research assistants for data collection .Ap- preciation for the funding from the faculty of Public Health, Thammasat University, Thailand for supporting and all authors declare no conflict of interest. Conflict of Interest There is no conflict of interest. REFERENCES Akinsulure-Smith, A. M. (2014). Exploring hiv knowledge, risk and protective factors among west african forced migrants in new york city. 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GHMJ (Global Health Man- agement Journal). 2019; 3(3):84-94. doi:10.35898/ghmj-33452 94 https://dx.doi.org/10.1186/s12889-015-1852-9 https://dx.doi.org/10.1007/s10903-008-9163-1 https://migrationdataportal.org/?t=2017 https://thailand.iom.int/thailand-migration-report-2019-0 https://thailand.iom.int/thailand-migration-report-2019-0 https://dx.doi.org/10.1007/s10964-009-9495-8 https://dx.doi.org/10.1080/0954012021000039761 https://dx.doi.org/10.1089/apc.2009.0135 https://www.unaids.org/en/regionscountries/countries/thailand https://www.unaids.org/en/regionscountries/countries/thailand https://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf https://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf https://www.unaids.org/sites/default/files/media_asset/04_Migrants.pdf https://www.unaids.org/sites/default/files/media_asset/04_Migrants.pdf https://dx.doi.org/10.1007/s10903-007-9103-5 https://dx.doi.org/10.1007/s10461-012-0183-4 https://dx.doi.org/10.1186/1471-2458-14-437 Introduction Method Study design and sample Instruments Statistical analysis Results Demographic characteristics of participants Discussion Conclusion