Bangorn Sirirojn

Sexually transmitted infections and sexual and substance use correlates among young adults in Chiang Mai, Thailand.

Background: Data on the prevalence of and associated behavioral risk factors for sexually transmitted infections (STI) in young adults in Asia have not been widely studied. Study Design: We conducted a cross-sectional study in Chiang Mai, Thailand in 2005–2006 among 658 sexually active participants aged 18 to 25 years, the majority having a history of recent methamphetamine (MA) use. Data were collected by interview and STI were detected using standard laboratory assays. Results: Overall, 38% of participants had at least one laboratory confirmed STI. Herpes simplex virus and Chlamydia were significantly more common among women, whereas hepatitis B virus was significantly more common among men. Men reported a greater number of sexual partners than women, and condom use at last sex was infrequent. Most participants reported using MA at least weekly, with men more frequent users than women, and more often giving reports of frequent drunkenness and lifetime arrests. Behavioral correlates of prevalent STI were similar to the published literature. In multivariate analysis, women ≥20 years of age, with ≥2 heterosexual partners in the past year and a younger age at sexual debut were significantly more likely to have a prevalent STI. Men ≥20 years of age, with ≥2 heterosexual partners in the past year and who enrolled both sex and drug network members were significantly more likely to have a prevalent STI, whereas men who used a condom at last sex were significantly less likely to have a prevalent STI. Substance abuse was associated with behavioral risks but not with prevalent STI. Conclusions: Sexual risks and substance abuse are substantially elevated among young Thai MA users, but only sexual risks are associated with prevalent STI.

Incidence of HIV and Sexually Transmitted Infections and Risk Factors for Acquisition Among Young Methamphetamine Users in Northern Thailand

Background: Southeast Asia is experiencing an epidemic of methamphetamine use, a drug associated with risky sexual behaviors, putting a large segment of the population at increased risk for sexually transmitted infections (STIs) and HIV and in need of prevention efforts. Incidence estimates of STIs are rare in Southeast Asia, especially among newer risk groups. Study Design: We enrolled methamphetamine users aged 18 to 25 years in a 12-month randomized behavioral intervention trial in Chiang Mai, Thailand in 2005. Behavioral questionnaires were administered at visits every 3 months, and biologic specimens were collected at baseline and 12 months to test for common STIs (chlamydia, gonorrhea, HSV-2, and HIV). Poisson regression with robust variance was used to determine risk factors for incident STIs. Results: Overall, 12.7% of 519 participants acquired at least 1 STI. Chlamydia was the most common (10.6%), followed by HSV-2 (4.0%), gonorrhea (2.9%), and HIV (0.6%). Risk factors for both men and women included self-reported incarceration and having a casual sex partner during follow-up, and having a prevalent STI at baseline. Additionally, among women, having 2 or more heterosexual partners, and among men, having a greater frequency of drunkenness were risk factors for STI acquisition. Conclusions: Although HIV incidence is low in this population, incidence of other STIs is high compared with previous studies of young Thai adults. Risk factors for acquisition emphasize the need for new prevention strategies targeted toward current populations at risk.

A qualitative study of sexual behaviours among methamphetamine users in Chiang Mai, Thailand: a typology of risk

INTRODUCTION AND AIMS Methamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study explores the relationship between sexual behaviours and MA. DESIGN AND METHODS Between March 2002 and January 2003, 48 in-depth interviews with young MA users aged 15-2 years in Chiang Mai. Interviews were transcribed verbatim in Thai and translated into English. Data were analysed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management. The current analysis was stratified by gender. RESULTS Participants were 44% male and the median age was 20 years. At the time of the interviews, 70% were not using MA. A typology of experiences with and feelings about MAs relationship to sexual activity emerged: (1) enhanced libido--individuals who found that MA enhances their sexual experiences (n = 13); (2) decreased libido or no effect--individuals who found that MA detracted from sexual desire (n = 22); and (3) virgins (n = 13). DISCUSSION AND CONCLUSIONS Participants reported several distinct patterns of relationship between MA and sex. Tailored interventions are needed that address specific patterns of sexual behaviors among youth in order to promote sustainable safer sex behaviours in this population.

Young Thai women who use methamphetamine: Intersection of sexual partnerships, drug use, and social networks

BACKGROUND Given high rates of methamphetamine (MA) use among young people in Thailand and evidence of an association between MA and increased sexual risk behaviour, we examined the association between womens recent sexual partnerships, social network characteristics and drug and alcohol use. METHODS Female participants (n=320) in an HIV behavioural trial among young (18-25 years) MA users in Chiang Mai completed a drug and sexual behaviour survey and social network inventory. Multinomial regression analyses accounting for clustered data examined individual and network characteristics associated with recent sexual partnership category. We compared women with only one male partner in the past year (39%) to those with multiple male partners (37%) and those with only female partners (24%). RESULTS Differences in levels of drug and alcohol use and social and sexual network characteristics were dependent on recent sexual partnership profiles. The multiple partner group reported an average of five male partners in the past year; 12% reported consistent condom use in the past 30 days. Compared to both groups, women with multiple male partners used MA more frequently, had larger non-sex networks with more MA users, were more likely to have an MA-using sex partner, and received less emotional support from their partners. Women with multiple male partners and only female partners reported more frequent alcohol use. CONCLUSIONS Policy and intervention efforts targeting drug use and sexual behaviour among young Thai women are drastically needed and may benefit from consideration of the diversity within the population. These data point to the need for targeted prevention approaches that take into account the varying characteristics and social influences of these different groups of women.

Penile modification in young Thai men: risk environments, procedures and widespread implications for HIV and sexually transmitted infections.

Objectives: To determine the prevalence and types of penile modification and describe the circumstances surrounding this practice among a sample of young methamphetamine users in Thailand. Methods: A mixed methods study was conducted in Chiang Mai, Thailand, in 2005–6. One hundred young men were surveyed for the quantitative study and in-depth interviews were administered to 9 men, 11 women and 1 transgender. Results: The prevalence of penile modification was 51%, with the most common type being inlaying with muk(s) (61%). The majority of modifications were performed in prison or juvenile detention (80%) by a friend (90%). Motivations for penile modification included peer pressure and perceived enhanced female sexual pleasure. In prison, the practice was veiled in secrecy, the conditions under which modification was performed were unhygienic, sometimes leading to infection, and sharing equipment was common. Men and women reported that condom use was more difficult post modification as condoms were more likely to break or leak and less likely to fit correctly. In addition, sexual intercourse was often painful for the female partner. Conclusion: Penile modification is prevalent in this group of young methamphetamine users and is associated with behaviours and consequences that could facilitate the spread of HIV and other sexually transmitted infections.

Correlates of Incarceration Among Young Methamphetamine Users in Chiang Mai, Thailand

OBJECTIVES We examined correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand in 2005 to 2006. METHODS We conducted a cross-sectional study among 1189 young methamphetamine users. Participants were surveyed about their recent drug use, sexual behaviors, and incarceration. Biological samples were obtained to test for sexually transmitted and viral infections. RESULTS Twenty-two percent of participants reported ever having been incarcerated. In multivariate analysis, risk behaviors including frequent public drunkenness, starting to use illicit drugs at an early age, involvement in the drug economy, tattooing, injecting drugs, and unprotected sex were correlated with a history of incarceration. HIV, HCV, and herpes simplex virus type 2 (HSV-2) infection were also correlated with incarceration. CONCLUSIONS Incarcerated methamphetamine users are engaging in behaviors and being exposed to environments that put them at increased risk of infection and harmful practices. Alternatives to incarceration need to be explored for youths.

Associations of substance abuse and sexual risks with self-reported depressive symptoms in young adults in northern Thailand.

Depression among young adults is a significant mental health issue worldwide. Withdrawal from amphetamine and chronic alcohol use is associated with significant increases in depressive symptoms. Young adults with depressive symptoms are more likely to engage in sexual risk behaviors than peers who are not depressed. We investigated the association between substance abuse and sexual risk behaviors with recent depressive symptoms (using the Centers for Epidemiologic Studies Depression Scale [CES-D] scale) in a sample of 1189 young adults aged 18 to 25 years in Chiang Mai, Thailand, who were recruited based on recent methamphetamine use or were sex partners of a methamphetamine user. High reports of depressive symptoms, based on CES-D scores ≥22, were seen in 45% of women and 31% of men (P < 0.0001) and were associated with alcohol problems (Cut down, Annoyed, Guilty, Eye-opener [CAGE] score and frequency of drunkenness) and frequent methamphetamine use in men but not women. For women, higher depressive symptoms were associated with greater numbers of reported sexual partners during the past year where condoms were infrequently used. These results point to the importance of identifying substance abuse among young adults in Thailand and its contribution to depressive symptoms and the importance of recognizing depression as a significant public mental health problem in this population.

Detection of human papillomavirus from self-collected vaginal samples of women in Chiang Mai, Thailand.

IT HAS BEEN SHOWN THAT some types of human papillomavirus (HPV) are the major risk factor for high-grade squamous intraepithelial lesion and invasive cervical carcinoma.1,2 The detection of HPV has been used as an adjunct to cervical cytology to identify women who are at risk of developing cervical cancer.2 Currently, the most widely used method to detect HPV DNA is by obtaining a specimen from cervix. However, some studies have shown that HPV detection by self-collected vaginal swab is comparable to virus detection in swabs obtained directly from the cervix.3,4 The self-collected vaginal samples also offer advantages over endocervical swabs in term of acceptability to clients and in reducing the need for trained personnel and clinical materials required for a cervical sample collection.4,5 The self-collected sample for HPV detection seems to offer a potential opportunity for more widely accessible cancer prevention and for populationbased molecular epidemiologic research. We conducted the study of HPV infection among women from communities in Chiang Mai, Thailand, using self-collected vaginal samples. Five hundred thirty-one sexually active women aged 20 to 65 years participated in the study. They were selected by nonprobability sampling method from 8 communities located within 50 km of Chiang Mai city. Written informed consent was obtained from all women; the protocol was reviewed and approved by the relevant Institutional Review Boards. The women were asked to provide their vaginal sample for HPV testing. The women were given a sample collection kit (swab specimen collection kit, Digene Corp, Beltsville, MD) that was composed of a sterile Dacron swab in a wrapper and a plastic vial containing specimen transport media. Verbal and written instructions for cell collection were provided. In brief, women were asked to insert a collection swab gently into the vagina about halfway in or until meeting with resistance; then they were to rotate the swab 3 turns in the same direction, take the swab out, and put it in the transport vial. The samples were transported to the laboratory and tested for HPV DNA and HPV typing. The DNA of vaginal samples was extracted and amplified using PGMY09-PGMY11 biotinylated L1 consensus primers, generating a 450-base pair amplicon.6 To determine specimen adequacy, the biotinylated -GH20/ -PC04 human -globin target was coamplified, generating a 250-base pair amplicon. The results of amplification were confirmed by agarose gel electrophoresis. The genotypes of HPV were determined by the reverse line blot hybridization method.7 The HPV genotyping strip detects 2 -globin concentrations (high and low) and 38 HPV types: 22 putative high-risk types (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56,58, 59, 66, 67, 68, 69, 70, 73, 82, IS39) and 16 low-risk types (6, 11, 40, 42, 54, 55, 57, 61, 62, 64, 71, 72, 81, 83, 84, CP6108). The classification of highand low-risk types was primarily based on International Agency for Research on Cancer (IARC)8 and also referred to the HPV reference guide provided by Roche. All of the women we approached were interested in collecting their vaginal samples for HPV testing. About 9.4% (50 of 531) of the samples lacked -globin control amplification. We therefore diluted the DNA template of these 50 samples with TE buffer (1:10) (TE 20 mM Tris-HC1, 1 mM EDTA [pH 8.0]) and repeated the polymerase chain reaction (PCR), and subsequently every sample could be amplified and produced a -globin PCR product. Of 531 women tested, 61 were positive for HPV DNA, and the overall HPV prevalence was 11.5% (Table 1). The prevThe authors gratefully acknowledge the Roche Molecular System, USA, for the donation of reagents and supplies for HPV detection and HPV typing. This work was supported, in part, by a fellowship/grant from the Fogarty International Center/USNIH, Johns Hopkins University, Grant 2 D 43 TW000010-18-AITRP. Correspondence: Kanlaya Wongworapat, MSc, 110 Intavaroros Road, Tambol Sriphum, Chiang Mai 50202 Thailand. E-mail: kanlaya@ chiangmai.ac.th. Received for publication November 10, 2006, and accepted August 16, 2007. From the *Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; and †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Sexually Transmitted Diseases, February 2008, Vol. 35, No. 2, p.172–173 DOI: 10.1097/OLQ.0b013e318158af65 Copyright

Risk factors and algorithms for chlamydial and gonococcal cervical infections in women attending family planning clinics in Thailand

Aim:  To identify risk factors associated with and evaluate algorithms for predicting Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) cervical infections in women attending family planning clinics in Thailand.