Choti Theetranont

HIV-1 infection among lower class commercial sex workers in Chiang Mai, Thailand

Objective:To determine risk factors for HIV-1 infection in female commercial sex workers (CSW) in northern Thailand. Methods:A cross-sectional survey of female CSW from 11 sex establishments frequented by military conscripts that included an interview and serological testing for HIV-1. Results:The HIV-1 seroprevalence in 230 CSW was 65%; the rate was lower among CSW from Chiang Mai than from rural areas. Multivariate logistic regression analysis for HIV-1 included the following significant factors: non-urban location of the sex establishment, ethnic Thai lowlander, lower price, history of genital warts and dysuria. Condom use, number of partners and duration of employment were not significantly associated with HIV-1 prevalence after adjustment for other risk factors. Conclusions:The high level of HIV-1 seroprevalence in this sample demonstrates the risk of transmission in lower cost commercial sex encounters in northern Thailand. Non-Thais (ethnic Hill tribes and Burmese) had lower HIV-1 prevalence than ethnic Thais. Type of establishment (‘direct’ brothel-based or ‘indirect’ establishments) was not predictive of HIV-1 seroprevalence. However, rural establishments were less vigilant in promoting condom use, suggesting the need for renewed efforts to enforce the Ministry of Public Healths ‘100% Condom Campaign’ in commercial sex establishments.

Epidemiologic risk factors for incident sexually transmitted diseases in young Thai men

Background and Objectives: Prospective studies of incidental sexually transmitted diseases in developing countries rarely have been reported. As the human immunodeficiency virus epidemic widens, knowledge of the epidemiology of sexually transmitted diseases as co‐factors for human immunodeficiency virus infection is viewed as vitally important. Goal: To determine epidemiologic risk factors for incidental sexually transmitted diseases in young men in northern Thailand. Study Design: A cohort of 2,417 men selected by lottery for military conscription was followed an average of 22 months, with epidemiologic risk factors and sexually transmitted disease histories assessed semiannually. Sexually transmitted diseases were determined by physician or symptom histories obtained by interview. Results: Sexually transmitted disease incidence was 17.04 per 100 person‐years. Gonorrhea and chancroid were commonly reported, whereas incident syphilis was rare. Sexually transmitted disease incidence declined significantly in the 2‐year period. Most sexually transmitted diseases were acquired through commercial sex patronage. However, among men who did not report visiting a brothel, there was a significant increase in sexually transmitted diseases among men reporting sex with a girlfriend. Other risk factors included inconsistent condom use, drug use, and low educational level. Frequent alcohol use was associated with incident sexually transmitted diseases in bivariate analysis, but drinking at the time of last brothel visit was not associated with increased sexually transmitted diseases. Conclusions: Sexually transmitted disease control in Thailand is based on an integrated sexually transmitted disease clinic system. Many commercial sex workers are examined and treated routinely, but too infrequently to reduce sexually transmitted disease transmission between them and their male clients. Condom‐use levels in commercial sex settings still may be too low to reduce sexually transmitted disease transmission. More consistent and effective sexually transmitted disease treatment of commercial sex workers and their clients and education of men on the effective and consistent use of condoms is required to reduce the risks of sexually transmitted disease transmission in this population.