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May 22, 1996

Risk Factors for HIV-1 Seroconversion May Not Be What They Seem

Author Affiliations

University of Tübingen Tübingen, Germany

JAMA. 1996;275(20):1543. doi:10.1001/jama.1996.03530440021019

To the Editor.  —Dr Celentano and colleagues1 conclude that seroconversion among male Thai soldiers is largely attributable to contact with female prostitutes, and they advise increased use of condoms for all. However, there are several problems with their inferences.In most national epidemiologic tabulations of risk categories (such as those from the Centers for Disease Control and Prevention),2 there is a hierarchy of risk factors, with homosexual activity (and injection drug use) justifiably taking priority over supposed heterosexual transmission. Beyrer and coworkers3 noted that Thai men often do not consider sex with male transvestites (katoey) to be sex with men (which the authors implied may reduce estimates of Thai homosexual behavior by 80%) and likely underreport anal intercourse and injection drug use. Misinformation from respondents about anal intercourse and drug use plagues studies of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) risk factors.4,5 Denial of these