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

Abstract

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 (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).

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.

PIP: In northern Thailand, baseline interviews with and blood testing for syphilis and HIV-1 antibodies of military conscripts were conducted during May-November 1993. Researchers also examined conscripts discharged in April 1993. They interviewed and tested a total of 2047 men. 134 men (6.5%) had had at least one male sex partner. (These men are referred to as MSM.) Only 4 (2.9%) had had sex with only men. The remaining 130 (97.1%) had also had female sex partners. The 134 MSM men were more likely than heterosexual men to be married (odds ratio [OR] = 2.67) and to have a girlfriend with whom they had sex (OR = 1.6). They were also more likely than heterosexual men to have ever had any sexually transmitted disease (STD) (OR = 2.71), gonorrhea (2.05), syphilis (OR = 3.17), nongonococcal urethritis (OR = 4.54), penile discharge with pus (OR = 2.47), watery penile discharge (OR = 6.24), and dysuria (OR = 2.43). The overall HIV prevalence was 12.1% (247 men). MSM men were only somewhat more likely to be HIV infected (PR = 1.51). MSM men with more than one male lifetime partner were significantly more likely to be infected with HIV than those with only one male partner (OR = 2.89). Same-sex behavior was more common among discharged men who had returned to civilian life than those were still in the military (9.3% vs. 6.5%). Discharged bi/homosexual men was the only group of Royal Thai Army current or former conscripts in which sex with men was independently associated with HIV infection (27.3% vs. 12.4% for HIV-infected heterosexual former conscripts; OR = 2.54). Among all subjects, HIV infection was associated with ever visited a female commercial sex worker (OR = 4.16) and ever had any STD (OR = 5.47), gonorrhea (OR = 3.08), syphilis (OR = 3.81), genital herpes (OR = 3.54), genital warts (OR = 3.56), and genital ulcer disease (OR = 5.59). These findings show that MSM in Northern Thailand are at high risk of STDs and HIV. HIV/STD prevention efforts should target all young Thai men and try to change high risk sexual practices.