Seroprevalence of HIV antibodies and risk factors in healthy young males from upper north Thailand.

In the Spring of 1991 a random sample of young men from Upper Northern Thailand (mean age = 21 years) was interviewed by trained medical students from Chiang Mai University, serum samples were obtained and analyzed for prevalence of HIV-1 antibodies and for syphilis, and risk factors for HIV infection were assessed. It was found that Commercial Sex Workers (CSW) were the principal risk factor, that consistent condom use is rare, and the rates of HIV infection are rising rapidly. Sociodemographic background, homosexual behavior, drug use, and history of STD's were found to be not significant risk factors. The conclusions are that the education campaigns should be intensified to reduce the frequency of contact with CSW and to encourage consistent use of condoms.

Behavioral and sociodemographic risks for frequent visits to commercial sex workers among northern Thai men.

OBJECTIVE: The transmission of HIV-1 in Thailand has recently been attributed to exposure to infected commercial sex workers (CSW). We sought to identify risk factors for patterns of CSW visits among northern Thai men. DESIGN: Retrospective recall of lifetime and recent CSW visits and associated risk factors were obtained by interview. SETTING: Two military bases in northern Thailand. PARTICIPANTS: We enrolled two cohorts (n = 2417) of young men, aged 19-23 years, who were conscripted into the Royal Thai Army and Air Force from six provinces in northern Thailand in May and November 1991. MAIN OUTCOME MEASURES: Frequency of self-reported lifetime and recent sex with CSW. RESULTS: Multivariate results showed that lower socioeconomic status, early first intercourse and substance-use factors (alcohol, marijuana, other drugs, and smoking) associated with lifetime and recent sex with CSW. Sexual intercourse with other female partners, lower price paid at last CSW visit and frequency of condom use with CSW did not differentiate frequent from infrequent CSW visitors. CONCLUSIONS: Limits in the frequency of sex with CSW, improved condom practices and reduction of drinking prior to CSW visits would all appear to provide substantial protection from exposure to HIV-1 in this setting.

PIP: At least 400,000 Thais are believed to be infected with HIV-1 and the principal route of infection is heterosexual intercourse. Given that the transmission of HIV in Thailand has recently been attributed to contact with infected prostitutes, the authors set out to identify the risk factors for patterns of prostitute visits among northern Thai men. 2417 male conscripts to the Royal Thai Army and Air Force aged 19-23 years who enrolled in 2 military bases in northern Thailand in May and November 1991 were recruited for the study. In interviews, 454 reported never having visited a prostitute, 1385 reported at least 1 episode of sexual activity with a prostitute in the preceding year, and 578 reported having had sex with a prostitute in the past. The multivariate analysis found lower socioeconomic status, early first intercourse, and the use of alcohol, marijuana, smoking, and other drugs to be associated with lifetime and recent sex with prostitutes. Sexual intercourse with female partners, lower price paid at last prostitute visit, and frequency of condom use with prostitutes, however, did not differentiate frequent from infrequent prostitute visitors. With the goal of reducing the degree of HIV transmission among these young men, steps should be made to encourage a reduction in the frequency of sex had with prostitutes, to improve condom use, and to reduce drinking before visiting prostitutes.

Risk factors for HIV infection among young adult men in northern Thailand.

OBJECTIVE: To determine the sociodemographic and behavioral risk factors associated with human immunodeficiency virus (HIV) infection in two cohorts of young men selected for military service in northern Thailand. DESIGN: Military conscripts were studied cross-sectionally after conscription in May 1991 and November 1991. Risk factors were assessed by interview with trained nonmilitary interviewers. SETTING: Two military training bases in Chiang Mai, Thailand. PARTICIPANTS: A total of 2417 young men aged 19 to 23 years (mean age, 21 years) conscripted by lottery into military service in the Royal Thai Army or Royal Thai Air Force from six provinces in northern Thailand. MAIN OUTCOME MEASURES: Human immunodeficiency virus seroprevalence by enzyme-linked immunosorbent assay confirmed by Western blot and univariate and multivariate analyses of sociodemographic and behavioral risk factors associated with HIV seroprevalence. RESULTS: Overall, 289 (12.0%) of 2417 men were HIV-seropositive at baseline. The strongest associations with being HIV positive were heterosexual activities. History of sex with a female commercial sex worker (CSW) was frequent (96.5% of men who were HIV-positive and 79.0% of men who were HIV-negative) and strongly associated with HIV infection on univariate and multivariate analyses (adjusted odds ratio, 1.60 to 2.07, depending on the frequency of CSW contact). Also, sexually transmitted diseases were common and associated with HIV infection in both univariate and multivariate analyses (adjusted odds ratio, 3.36). Sex with other males and injection drug use were uncommon and not associated with HIV infection. Condom use was reported in 61.5% of men at last sex with a CSW but was not shown to be protective of prevalent HIV infection. CONCLUSION: The epidemic of HIV infection has spread widely among young men in northern Thailand, despite reported frequent and recent use of condoms during sex with female CSWs. Control of HIV infection in this population will probably require more regular and effective use of condoms, prevention and treatment of sexually transmitted diseases, and reduction in the frequency of CSW contact.