Young Thai Men Research Articles

Prevalence and Risk Factors for Chlamydia trachomatis Infection Among Young Thai Men in 2008–2009

Asymptomatic Chlamydia trachomatis (CT) infection and other sexually transmitted infections in men potentially contribute significantly in sustaining the spread of the infection. To describe the distribution and related sexual behaviors, we conducted a cross-sectional study among young Thai men using a (1:30) systematic sampling of all newly inducted military conscripts in Thailand. In November 2008 and May 2009, participants' urine and serum samples were tested for CT and Neisseria gonorrhoeae, using a multiplex polymerase chain reaction technique, and serologic testing for Treponema pallidum and HIV-1 was done. Information on demographic data and risk behaviors was obtained by a self-administered questionnaire. The overall prevalence rates of CT, N. gonorrhoeae, HIV-1, and syphilis infection were 7.9%, 0.9%, 0.5%, 0.05%, respectively. The risk factors for CT infection were living in the upper north region (adjusted rate ratios [95% confidence interval], 2.13 [1.39-3.26]), having had 4 or more sexual partners (2.14 [1.48-3.09]), graduation from a vocational school (1.66 [1.14-2.41]), inconsistent condom use (1.48 [1.05-2.08]), unemployment (1.82 [1.06-3.12]), and age 21 years or younger (1.63 [1.01-2.63]). The prevalence of CT infection among young male military conscripts was high, especially among men from upper northern Thailand. Multiple sexual partners, graduation from a vocational school, inconsistent condom use, unemployment before the military induction, and younger age were independently associated with the CT infection among young Thai men. These data will be useful to develop more effective public health interventions to prevent, detect, and treat sexually transmitted infections among young men in Thailand.

Prevalence and Risk Factors for Hepatitis C Virus Infection among Young Thai Men

Epidemiologic studies of hepatitis C virus (HCV) infection are unusual in developing countries, especially Thailand. We evaluated the prevalence and risk factors for HCV among military conscripts, including a sample of 5,246 men (1:30 sample), and human immunodeficiency virus (HIV)-1 positive men (N = 500) between 2005 and 2008. The HCV prevalence was 2.2% in the sampled group and 8.4% in HIV-1 sero-positives. Among the sampled group, HIV-1 infection, injection drug use (IDU) history, and unsafe injections were associated with HCV infection; adjusted prevalence rate ratios [RRs; 95% confidence intervals (CIs)] were 3.7 (1.04-12.77), 1.9 (1.04-3.54), and 1.8 (1.02-3.11), respectively. Among HIV-1 sero-positives, an IDU history and residence in southern Thailand were associated with HCV prevalence; adjusted RRs (95% CIs) were 3.5 (1.71-7.24) and 2.6 (1.18-5.61), respectively. Public health measures to prevent HCV in Thailand should focus on reducing injection drug use and other exposures to unsafe injections among young Thai men.

Spatialising Thai masculinities: negotiating dominance and subordination in Southern Thailand

This paper explores the entanglement of gender with class and national identities by investigating the politics of intra-national migration in Thailand. Focusing on the experiences of a group of young Thai men who have migrated from the Thai mainland to the island of Koh Pha-ngan in Southern Thailand, this research outlines the ways in which these young men are able to resist wider Thai discourses that seek to position them as marginal national subjects through their work in the tourism industry. I argue that the economic importance of the tourism industry opens up possibilities for the performance of masculine subjectivities which would otherwise be subject to surveillance and censure. This greater freedom enables experimentation with new gendered identities as well as access to sexual encounters with women that the men would not ordinarily meet: comparatively wealthy, educated, middle-class tourist women. Such encounters can open up possibilities which enable the men to re-negotiate their positioning in wider Thai society, and thereby challenge the marginalised identity labels that are ascribed to them.

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...

The natural history of HIV-1 subtype E infection in young men in Thailand with up to 14 years of follow-up

We evaluated the progression to AIDS and death among 228 men who seroconverted within a 6-month window when in the Royal Thai Army between 1991 and 1995. Men (N = 228) who seroconverted to HIV at 21-23 years of age between 1991 and 1995 were evaluated up to 14 years after HIV seroconversion. The seroconverters were matched with men who were seronegative when they were discharged from the military. In 2005-2006, the vital status was determined through the national mortality database and survivors were contacted for follow-up clinical and immunological assessment. Death certificates, medical records and next of kin interviews were used to evaluate the causes of death. As of March 2006, among 228 seroconverters, 56 (24.6%) were alive, 171 (75.0%) had died and one (0.4%) had undetermined status. Among 255 HIV-seronegative individuals at baseline, 15 (5.9%) had died. The median time from HIV seroconversion to death was 7.8 years. The median time to AIDS death was 8.4 years. The median times from seroconversion to clinical AIDS and a CD4 cell count less than 200 cells/mul were 7.2 years and 6.5 years, respectively. The median time from seroconversion to World Health Organization criteria for antiretroviral therapy was 6.3 years. Our data indicate a more rapid progression to AIDS and death after HIV-1 infection among young Thai men than has been reported in similar aged men who were HAART-naive in western high income countries.

Changes in HIV prevalence among young Thai men as defined by hepatitis C co-infection as a marker for mode of transmission

To obtain a better understanding of the evolving HIV-1 epidemic in Thailand, we utilized antibody to hepatitis C virus (HCV) to indicate the mode of HIV-1 transmission. Although the proportion of men with HCV co-infection increased between 1995 and 2000, the prevalence was similar, whereas the prevalence of men not co- infected decreased (1.93-0.46%). This suggests that HIV-1 infection associated with parenteral transmission has been stable despite a dramatic reduction in the sexual transmission of HIV-1.

The natural history of HIV-1 infection in young Thai men after seroconversion.

The natural history and progression of HIV-1 infection in Thailand and other developing countries in Asia and Africa have not been well defined. Nevertheless, valid data are needed to evaluate the effects of interventions, which are designed to delay progression. We evaluated the progression to AIDS and death in 235 men who seroconverted during their 2 years of service in the Royal Thai Army. The men were conscripted at age 21 and seroconverted within a 6-month window during follow-up while in the military. The seroconverters were matched with men who were seronegative when discharged. Of the HIV-positive men, 156 (66.4%) were alive, 77 (32.8%) had died, and 2 (0.8%) could not be located 5-7 years after their seroconversion and discharge from the military. The 5-year survival rate was 82.3%; the median times to clinical AIDS and a CD4 cell count of <200/microL was 7.4 years and 6.9 years, respectively. The mortality rate was 56.3 deaths per 1000 patient-years for HIV-positive men and 6.1 deaths per 1000 patient-years for HIV-negative men. Our data suggest a more rapid progression to AIDS and death after HIV-1 infection in young men in Thailand than has been reported for similarly aged cohorts in developed countries.

Influence of body iron store status and cigarette smoking on cadmium body burden of healthy Thai women and men

The influence of cigarette smoking, body iron store status and gender on cadmium (Cd) body burden was examined in a group of 197 healthy Thais with overall mean age of 30.5 year (19–47 year). The lowest, geometric mean, and the highest urinary Cd excretion rate was 0.04, 0.46 and 3.84 μg/g creatinine, respectively. The prevalence of low iron stores (serum ferritin <20 μg/l) was 16% and 2% in women and men, respectively. All women ( n=99) were non-smokers, but they had the same Cd body burden as did men ( n=47) who on average smoked 8.7 cigarettes per day for 9 years. These women and men had 1.9-fold greater body Cd burden than did non-smoking men ( t=4, P<0.001). In addition, the women Cd body burden was found to be inversely correlated with serum ferritin ( r=−0.39, P<0.001) and those with low iron stores showed a 3.4-fold greater Cd body burden than did women whose serum ferritin being between 101 and 200 μg/l ( F=6.2, P=0.003, one-way ANOVA). In contrast, men’s Cd body burden did not show a significant correlation with serum ferritin, but it did show a positive correlation with cumulative cigarette smoking index ( r=0.29, P=0.02). Thus, iron status and cigarette smoking were found to be determinants of Cd body burden in young adult Thai women and men.

Heart rate variability in patients with sudden unexpected cardiac arrest in Thailand

Sudden unexpected death syndrome (SUDS) is a leading cause of death in young Southeast Asian men. An epidemiologic survey of young Thai men living along northeastern border of Thailand found that the annual SUDS death rate was 26 to 38 per 100,000 men.1,2 Ventricular fibrillation (VF) is the rhythm leading to cardiac arrest.3–5 Episodes mainly occur at night. Typically, the victim wakes up at night with breathing difficulty, in cardiac arrest. Since 1981, there have been reports by the Center of Disease Control that a significant number of young male Southeastern Asian refugees in the United States died suddenly and unexpectedly.6,7 The pathophysiology of SUDS is still unknown. Because VF episodes in patients with SUDS usually occur at night, which is different from the timing of sudden death episodes in patients with structural heart disease that usually occur during the morning. Alteration of autonomic modulation may have an important role in the occurrence of VF episodes in these patients. It may also be a guide as to whether certain medications may have beneficial effect or may aggravate VF. We analyzed heart rate variability (HRV) in SUDS survivors compared with controls to determine whether there are changes in autonomic modulation in these patients.

Dynamics of HIV epidemics in sub-Saharan Africa: introduction.

For many years the differing rates of HIV morbidity in various parts of Africa were attributed mainly to different timing of the introduction of the virus into the general population--as if the level of HIV should inevitably as a sort of natural evolution reach prevalences of about 30%. This is particularly true in sub-Saharan Africa where HIV spreads heterosexually in adults and shows little or no sign of decline. However a multicenter study published in this special UN Joint Progam on AIDS (UNAIDS) supplement was carried out in four African cities specifically to help understand why HIV spreads at different rates and reached different prevalences in these cities. Variations in vulnerability leading to increased HIV sexual exposure and greater efficiency of transmission [related to different patterns of sexual networking and differing prevalences of sexually transmitted diseases for example] were believed to be major epidemiological factors explaining more generalized HIV epidemics in some regions. Targeting children before they initiate sexual activity circumcising males and combating genital herpes are all suggested interventions.

Willingness to participate in HIV-1 vaccine trials among young Thai men

Objectives: Willingness to participate in HIV-1 vaccine trials and associated factors were investigated in a sample of 2670 Royal Thai Army conscripted recruits. Methods:Self administered questionnaires were used. Data were...

Nationwide surveillance of HIV-1 prevalence and subtype in young Thai men.

As part of routine surveillance, an HIV-1 serosurvey of 366,074 members of successive cohorts of young Thai men entering service with the Royal Thai Army (RTA) was conducted between November 1989 and November 1995. We analyzed regional and temporal trends in HIV-1 seroprevalence in young men in Thailand and determined the proportion of infections resulting from subtypes E and B in this population in 1992 and 1995. The prevalence in 1992 was compared with that in 1995 by region and demographic group. The HIV-1 subtype was determined in a random sample of HIV-1-positive specimens in 1992 and 1995 using a V3 peptide enzyme immunoassay. From a peak of 3.7% in 1993, overall seroprevalence declined to 3.0% in 1994 and further in 1995 to 2.5%. Between 1992 and 1995, the absolute decrease in seroprevalence was greatest in the upper North (from 12.5% to 5.3%), where the prevalence has been the highest. Overall, 96.9% and 95.9% of typable specimens were determined to be subtype E in 1992 and 1995, respectively. Decline in HIV-1 seroprevalence among young men in Thailand has continued, which suggests that HIV control programs in Thailand may have been successful in decreasing spread of HIV-1. Almost all HIV-1 infections resulted from subtype E.

Decreasing incidence of HIV and sexually transmitted diseases in young Thai men: evidence for success of the HIV/AIDS control and prevention program.

To determine whether HIV and sexually transmitted disease (STD) incidence rates among young men in northern Thailand have declined since the establishment of the '100% Condom Program', and to prospectively document changes in the association between behavioral risk factors and incident HIV and STD infections. Thirteen military bases in northern Thailand. Serial prospective cohorts of 19-23-year-old male conscripts (n = 4086) inducted into military service from six northern Thai provinces between 1991 and 1993 were followed at 6-month intervals for incident HIV and STD through May 1995. HIV incidence was determined by serology, and incident STD were reported by conscripts as diagnosed by health-care providers. HIV incidence declined from a rate of 2.48 per 100 person-years during 1991-1993 to 0.55 per 100 person-years during 1993-1995. STD incidence showed an even greater decline, with a 10-fold decrease from 1991-1993 to 1993-1995. Behavioral risk factors for incident STD infections included a history of prior STD and sex with girlfriends and sex workers. Inconsistent condom use remained a strong predictor of incident STD among brothel visitors. Other previously-reported risk factors in 1991-1993 such as illicit drug use, frequency and cost of brothel visits, and low socioeconomic status were not associated with incident STD or HIV in 1993-1995. Although several studies have recently reported decreased prevalence of HIV and STD infections in Thailand, these data demonstrate that a dramatic decrease in the incidence rates of STD, including HIV infection, has occurred among young men in military service in northern Thailand. The Thai AIDS prevention and control program might be implemented by other countries experiencing major epidemics of heterosexually transmitted HIV infections. Similar prevention programs targeted at other populations in Thailand and elsewhere in Asia are needed to decrease the spread of the HIV epidemic.

Sudden unexplained death syndrome in Southeast Asia

would like to discuss the phenomenon of sudden unexplained death among young Thai men and other Southeast Asians. At the end of the Vietnam war, there was a rush of Laotian and Cambodian refugees to the United States. In 1976 and 1977, the US Centers for Disease Control and Prevention (CDC) observed an unusually high death rate among young men who had come from that region. In the CDC summary of the findings on Southeast Asians, the term “sudden unexplained death syndrome” (SUDS) was coined. The rise in mortality figures peaked around 1981-1982 (Figure l), reaching about 25 per 100,000.’ A total of 121 cases were intensively reviewed. Most of the deaths (in contrast to artery-related sudden cardiac death) occurred between 10:00 py and 8:OO AM, i.e., overnight while the victims were asleep. Their mean age was approximately 32 years (range 16-63) and 68% of the victims came from Laos, 18% from Cambodia, and 13% from Vietnam. lS-

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

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. To determine epidemiologic risk factors for incidental sexually transmitted diseases in young men in northern Thailand. 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. 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. 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.

Dynamics of Risk Behavior for HIV Infection Among Young Thai Men

The objective of this investigation was to analyze the dynamics of risk for HIV-1 infection among young men in Thailand. We conducted a prospective study in a cohort (n = 1,236) of young men, aged 19-23 years at conscription into the Royal Thai Army and Air Force from six provinces in northern Thailand in May 1991 who were followed until their discharge in April 1993. The outcome measure was change since conscription in the frequency of self-reported sex with female commercial sex workers (CSW) during military service. Although 42% of conscripts reported no visit to a female CSW in the year prior to conscription, most had a visit during military service. Men who visited female CSWs infrequently at baseline increased their visits somewhat over time, whereas those with high initial rates of CSW visits decreased. Based on an assumed stable distribution over time, change from baseline was not statistically significant. Only marital status and high baseline CSW visit rates were associated with diminished visit frequency in multivariate analysis. No differences were seen in patterns of change in CSW visits by HIV-1 serostatus. More aggressive preventive interventions are needed to reduce the frequency of CSW visits in northern Thailand, a setting where 40-80% of all female CSWs working in brothels are now HIV seropositive.

AIDS awareness among a cohort of young Thai men: exposure to information, level of knowledge, and perception of risk.

Structured interviews and focus group discussions were conducted among 834 young Thai men drafted into military service by random lottery in northern Thailand. Level of AIDS risk, exposure to AIDS information, level of knowledge about AIDS, and perception of risk for acquiring HIV and AIDS were assessed at baseline and six months after induction into the Army in 1991. General fear of AIDS was high, yet personal perception of risk for acquiring HIV was low, even for those at enhanced behavioural risk of infection with HIV. Multivariate PATH analysis shows that exposure to information about AIDS significantly reduced risk taking from baseline to follow-up, but only by first affecting personal risk perception. Focus group discussions revealed that risk perception for acquiring AIDS was low due to never knowing a person with AIDS, because prostitutes had health certificates for STD, and since many believed that AIDS could be cured or prevented with folk medicines. Implications and recommendations for intervention programmes are discussed.

Declining prevalence of HIV-1 infection in young Thai men.

To evaluate trends in HIV-1 seroprevalence in Thailand. HIV-1 serosurvey of successive cohorts of young Thai men entering service with the Royal Thai Army (RTA) between November 1989 and November 1994. In November 1989, the RTA Medical Department began routine HIV-1-antibody screening of men who were selected by lottery for conscription. Between November 1989 and November 1994, 311,108 young men were screened at induction. Demographic data were collected between November 1991 and May 1993 and again in November 1994. The seroprevalence of HIV-1 among conscripts nationwide increased rapidly from 0.5% in 1989 to 3.5% in 1992 and reached 3.7% in 1993. In 1994, the overall prevalence decreased to 3.0%. The decrease was greatest in the upper North (from 12.4% in 1992 to 7.9% in 1994), where the prevalence has been the highest. However, decreases were observed in men from all regions of residence in the country, from both rural and urban areas, and at all educational levels. The decline in prevalence suggests declining incidence and that HIV control programs in Thailand are having an impact on the HIV epidemic.

Same-sex behavior, sexually transmitted diseases and HIV risks among young northern Thai men

To assess the risks for HIV infection and sexually transmitted diseases (STD) among young northern Thai men who have sex with men (MSM), and to examine the possible role of male same-sex behavior in the northern Thai HIV/AIDS epidemic. Two cohorts of northern Thai military conscripts and one cohort of recently discharged conscripts, a total of 2047 men, were studied. Data were collected by interview on behavioral risk factors, and sera were examined for syphilis and HIV-1 antibodies. Univariate and multiple logistic regression analyses were used to determine risk factors associated with HIV and STD, and to assess the frequency and patterns of same-sex behaviors among these men. Of 2047 men, 134 (6.5%) reported one or more male lifetime sex partners. Of these MSM, 130 (97.0%) also had female partners, and four (3.0%) had exclusively male partners. Compared with men who reported only female sex partners, MSM had a higher number of lifetime sex partners, a higher mean number of female sex partners, more female and male commercial sex worker (CSW) partners, and were more likely to be married. MSM were significantly more likely than exclusively heterosexual men to report having had any STD [odds ratio (OR), 2.72], gonorrhea (OR, 2.05), syphilis (OR, 3.17), non-gonococcal urethritis (OR, 4.54) and penile discharges (OR, 6.24). They were at borderline increased risk for HIV infection [OR, 1.51; 95% confidence interval (CI), 0.95-2.41]. Men with more than one lifetime male sex partner compared with those with only one partner were significantly more likely to be HIV-infected (OR, 2.81; 95% CI, 1.09-7.19). Northern Thai MSM are a high-risk population for STD, including HIV. Reported same-sex behavior in this population appears to vary considerably with data collection techniques. HIV and STD prevention strategies aimed at changing unsafe sexual practices may need to be targeted to the general population of young Thai men.

Same-sex behavior, sexually transmitted diseases and HIV risks among young northern Thai men

Objectives: To assess the risks for HIV infection and sexually transmitted diseases (STD) among young northern Thai men who have sex with men (MSM), and to examine the possible role of male same-sex behavior in the northern Thai HIV/AIDS epidemic. Methods: Two cohorts of northern Thai military conscripts and one cohort of recently discharged conscripts, a total of 2047 men, were studied. Data were collected by interview on behavioral risk factors, and sera were examined for syphilis and HIV-1 antibodies. Univariate and multiple logistic regression analyses were used to determine risk factors associated with HIV and STD, and to assess the frequency and patterns of same-sex behaviors among these men. Results: Of 2047 men, 134 (6.5%) reported one or more male lifetime sex partners. Of these MSM, 130 (97.0%) also had female partners, and four (3.0%) had exclusively male partners. Compared with men who reported only female sex partners, MSM had a higher number of lifetime sex partners, a higher mean number of female sex partners, more female and male commercial sex worker (CSW) partners, and were more likely to be married. MSM were significantly more likely than exclusively heterosexual men to report having had any STD [odds ratio (OR), 2.72], gonorrhea (OR, 2.05), syphilis (OR, 3.17), non-gonococcal urethritis (OR, 4.54) and penile discharges (OR, 6.24). They were at borderline increased risk for HIV infection [OR, 1.51; 95% confidence interval (Cl), 0.95-2.41]. Men with more than one lifetime male sex partner compared with those with only one partner were significantly more likely to be HIV-infected (OR, 2.81; 95% Cl, 1.09-7.19). Conclusions: Northern Thai MSM are a high-risk population for STD, including HIV. Reported same-sex behavior in this population appears to vary considerably with data collection techniques. HIV and STD prevention strategies aimed at changing unsafe sexual practices may need to be targeted to the general population of young Thai men.