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May 22, 1996

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

Author Affiliations

Johns Hopkins University School of Hygiene and Public Health Baltimore, Md

JAMA. 1996;275(20):1543-1544. doi:10.1001/jama.1996.03530440021020

In Reply.  —Dr Brody raises several issues about our elicitation of HIV-1 infection among young male conscripts in northern Thailand. These concerns reflect common difficulties in conducting HIV research, principally that the reliability of self-reports of stigmatized or socially undesirable behaviors such as anal intercourse and injection drug use may be subject to some doubt. Some reports of unsafe behaviors may be underestimated. However, the inference that the hierarchy of risk factors from developed country settings is relevant to the Thai epidemic is not supported by the situation or the data we presented. Brody suggests that our conclusion that the Thai epidemic is heterosexually spread and is largely attributable to frequent contact with female commercial sex workers is unwarranted and that unreported anal intercourse with men or injection drug use is the purported culprit.The Royal Thai Ministry of Public Health estimates that more than 70% of cases of AIDS