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August 25, 1993

Risk Factors for HIV Infection Among Young Adult Men in Northern Thailand

Author Affiliations

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

JAMA. 1993;270(8):955-960. doi:10.1001/jama.1993.03510080059032

Objective.  —To determine the sociodemographic and behavioral risk factors associated with human immunodeficiency virus (HIV) infection in two cohorts of young men selected for military service in northern Thailand.

Design.  —Military conscripts were studied cross-sectionally after conscription in May 1991 and November 1991. Risk factors were assessed by interview with trained nonmilitary interviewers.

Setting.  —Two military training bases in Chiang Mai, Thailand.

Participants.  —A total of 2417 young men aged 19 to 23 years (mean age, 21 years) conscripted by lottery into military service in the Royal Thai Army or Royal Thai Air Force from six provinces in northern Thailand.

Main Outcome Measures.  —Human immunodeficiency virus seroprevalence by enzyme-linked immunosorbent assay confirmed by Western blot and univariate and multivariate analyses of sociodemographic and behavioral risk factors associated with HIV seroprevalence.

Results.  —Overall, 289 (12.0%) of 2417 men were HIV-seropositive at baseline. The strongest associations with being HIV positive were heterosexual activities. History of sex with a female commercial sex worker (CSW) was frequent (96.5% of men who were HIV-positive and 79.0% of men who were HIV-negative) and strongly associated with HIV infection on univariate and multivariate analyses (adjusted odds ratio, 1.60 to 2.07, depending on the frequency of CSW contact). Also, sexually transmitted diseases were common and associated with HIV infection in both univariate and multivariate analyses (adjusted odds ratio, 3.36). Sex with other males and injection drug use were uncommon and not associated with HIV infection. Condom use was reported in 61.5% of men at last sex with a CSW but was not shown to be protective of prevalent HIV infection.

Conclusion.  —The epidemic of HIV infection has spread widely among young men in northern Thailand, despite reported frequent and recent use of condoms during sex with female CSWs. Control of HIV infection in this population will probably require more regular and effective use of condoms, prevention and treatment of sexually transmitted diseases, and reduction in the frequency of CSW contact.(JAMA. 1993;270:955-960)