Intended for healthcare professionals


Sexual health through leadership and “sanuk” in Thailand

BMJ 2000; 321 doi: (Published 08 July 2000) Cite this as: BMJ 2000;321:114
  1. Stephen McAndrew, managing director (smcandrew{at}
  1. Healthcare Risk Resources International, London EC3M 5EA

    EDITOR—In their letters Bellis and Ashton, and van den Akker, comment on the role of the media in supporting the cultural change necessary to promote responsible sexual behaviour. 1 2 Education and service provision as advocated by Yamey are of limited value,3 with much of the target group being resistant to, or outside the reach of, formal education and public health services. The Asian Centre for Population and Community Development in Thailand, under the leadership of Mechai Viravadya (a Thai senator), provides a practical example of success in this area.

    The Thai attitude to sex is typically Asian, discreet and modest (not to be confused with Western mythology regarding concubinage and the small but notorious tourist oriented sex industry). The centre has been remarkably successful in promoting use of condoms by appealing to the Thai sense of “sanuk” or fun. While primarily seeking to address overpopulation, deprivation, and child mortality in rural districts, the centre has also succeeded in other ways: from being an AIDS hotspot, Thailand is now in the World Health Organization's “decrease or no growth” category.4

    The centre is a charity, and among its fundraising efforts is a chain of Cabbages and Condoms restaurants (“our food is guaranteed not to cause pregnancy”). So successful has the centre been that “Mechai” has become a slang word for condom. The centre runs an international training and education programme for healthcare workers, from which many developed countries could learn a lot.

    If we follow the centre's example we must look beyond the attitudes and behaviour of young people and recognise the difficulties caused by the ambiguous attitudes (if not frank hypocrisy) of older people—often reflected in the most puritanical viewpoints contrasted with rather more liberal behaviour. If we admit (as young people already know) that sex is normal and fun, we should also recognise that it must be pursued responsibly and with respect for others, just like any other enjoyable but risky activity. This should be the focus of our education and public health activities and the message that the media is encouraged to endorse.

    Perhaps one of our health policy makers could follow the example of Mechai Viravadya: we will recognise progress when a minister is prepared to appear on television juggling inflated condoms and we get a free packet of “Evettes” along with our afterdinner mints. Perhaps the issue will be whether or not we have a sufficiently well developed sense of sanuk to deal with this seriously.


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