Author(s): Celentano DD, Nelson KE, Suprasert S, Wright N, Matanasarawoot A,
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Abstract 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.
This article was published in AIDS
and referenced in Epidemiology: Open Access