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January 10, 1996

Risk Factors for HIV-1 Seroconversion Among Young Men in Northern Thailand

Author Affiliations

From the Departments of Health Policy and Management (Dr Celentano) and Epidemiology (Drs Celentano and Nelson and Ms Kuntolbutra), The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md; Department of Family Medicine (Dr Matanasarawoot and Ms Suprasert) and Office of the President (Dr Theetranont), Chiang Mai (Thailand) University; Royal Thai Army (Dr Eiumtrakul), Royal Thai Air Force (Dr Tulvatana), Ministry of Public Health (Dr Akarasewi), Chiang Mai; Robert Wood Johnson Medical School, Piscataway, NJ (Dr Wright); and the Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand (Dr Sirisopana).

JAMA. 1996;275(2):122-127. doi:10.1001/jama.1996.03530260036028

Objective.  —To identify behavioral and sociodemographic risk factors for incident human immunodeficiency virus—1 (HIV-1) infection among healthy young men in northern Thailand.

Design.  —Men inducted into military service in northern Thailand in May and November 1991 were followed at 6-month intervals until discharge 2 years later. Trained nonmilitary interviewers identified risk factors for HIV-1 infection through interviews with the men.

Setting.  —Thirteen military bases in northern Thailand.

Participants.  —A total of 1932 seronegative men, aged 19 to 23 years (average age, 21 years) at enrollment, conscripted into the Royal Thai Army and Air Force from six upper-northern Thai provinces.

Main Outcome Measures.  —Human immunodeficiency virus—1 seroincidence as determined through enzyme-linked immunosorbent assay and verified by Western blot, and univariate and multivariate analyses of risk factors related to HIV-1 incidence.

Results.  —A total of 85 men seroconverted to HIV-1 over the period of observation, giving an incidence rate of 2.43 per 100 person-years. Factors strongly associated with HIV-1 seroconversion were frequency of visits to female commercial sex workers (CSWs), sex with men, and incident sexually transmitted diseases (STDs). High frequency of condom use showed a significant (P<.001) protective effect for HIV-1 incidence among men with a history of recent sex with female CSWs in univariate analysis, but a multivariate model demonstrated no difference in HIV-1 seroconversion rates by consistency of condom use. Multivariate analysis incorporating condom use showed that having sex with men (adjusted relative risk [RR], 2.59; 95% confidence interval [CI], 1.08 to 6.25), having sex with CSWs (adjusted RR ranged from 2.54 [95% CI, 1.81 to 3.58] to 2.74 [95% CI, 1.56 to 4.81]), and incident STDs (adjusted RR, 2.38 [95% CI, 1.31 to 4.32]) to be predictors of incident HIV-1 infection. Substance use was not associated with HIV-1 seroconversion rates in multivariate analysis.

Conclusion.  —The HIV-1 incidence in this cohort of young men appears to be primarily attributable to having sex with female CSWs. Condom use provided some protection, although not in multivariate analysis; however, condom use has previously been shown likely to be useful in preventing HIV-1 transmission. Thus, programs to increase effective condom use in brothels are essential. Efforts to extend condom use to non-CSW partners are especially needed. More effective prevention and treatment of STDs may also be necessary to decrease HIV-1 infection in this population.(JAMA. 1996;275:122-127)