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Zhang K, Chen S, Zhu S, Fang Y, Zou H, Cai Y, Cao B, Cao H, Chen Y, Hu T, Wang Z. Multifaceted Determinants of Sexual Intercourse with Non-Regular Female Sex Partners and Female Sex Workers among Male Factory Workers in China-A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16008. [PMID: 36498089 PMCID: PMC9736560 DOI: 10.3390/ijerph192316008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
With a stratified multi-stage sampling approach, 1361 male factory workers in the Longhua district of the Shenzhen Municipality of China were selected to investigate the multifaceted determinants of sexual intercourse with non-regular female sex partners (NRP) and female sex workers (FSW) among them. The results showed that 24.5% and 21.2% of participants had sexual intercourse with NRP and FSW in the past 6 months, respectively. More specifically, at the individual level, perceived higher job stress and maladaptive coping styles were linked with a higher likelihood of having sexual intercourse with NRP and FSW (adjusted odds ratios [AOR] ranged from 1.06 to 1.17). At the interpersonal level, those who had higher exposure to information related to sexual intercourse with NRP or FSW were more likely to have sex with these female sex partners (AOR: 1.08 & 1.11). At the social structural level, perceived social norms supporting multiple sex partnerships were linked with a higher likelihood of having sexual intercourse with NRP and FSW (AOR: 1.10 & 1.11). No interaction effects were found between the variables at different levels. Providing pre-employment training to clarify roles and job duties, introducing adaptive coping strategies, and addressing misconceptions of social norms are useful strategies to reduce sexual intercourse with NRP or FSW.
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Affiliation(s)
- Kechun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen 518110, China
| | - Siyu Chen
- Centre for Health Behaviors Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Shiben Zhu
- Centre for Health Behaviors Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Yong Cai
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen 518060, China
| | - He Cao
- Longhua District Center for Disease Control and Prevention, Shenzhen 518110, China
| | - Yaqi Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen 518110, China
| | - Tian Hu
- Longhua District Center for Disease Control and Prevention, Shenzhen 518110, China
| | - Zixin Wang
- Centre for Health Behaviors Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Ayele WM, Tegegne TB, Damtie Y, Chanie MG, Mekonen AM. Prevalence of Consistent Condom Use and Associated Factors among Serodiscordant Couples in Ethiopia, 2020: A Mixed-Method Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9923012. [PMID: 34631890 PMCID: PMC8497122 DOI: 10.1155/2021/9923012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/26/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Heterosexual transmission within serodiscordant relationships is the core source of new HIV infections. Although consistent condom use can significantly reduce HIV transmission risk among serodiscordant couples, it has not been extensively studied in Ethiopia. Consequently, the current study looked at the proportion of serodiscordant couples in Ethiopia who used condoms consistently and the factors associated with that. METHODS A cross-sectional was conducted from October 2019 to June 2020. For the quantitative findings to be more robust and reliable, a qualitative design was incorporated. An interviewer-administered questionnaire was used to collect the data. Qualitative data were collected using gender-matched four focus group discussions. Multivariable logistic regression was conducted to identify factors associated with consistent condom use. The statistical significance of the variables was declared at a P value of less than 0.05. RESULTS This study confirmed that the proportion of consistent condom use was 58.4% [95% CI: 53.1-63.1%]. After controlling for all other variables, unmarried partners, adjusted odds ratio (AOR) = 0.44 [95% CI: 0.229-0.877] and students and employees, AOR = 0.33 [95% CI: 0.130-0.846] and AOR = 0.39 [95% CI: 0.165-0.939], respectively, were less likely consistently use condoms, whereas couples living together, AOR = 1.86 [95% CI: 1.197-2.195], receiving counseling about condom use, AOR = 1.90 [95% CI: 1.182-3.076], and having more knowledge about HIV, AOR = 1.61 [95% CI: 1.031-2.525] were more likely to use condoms consistently. CONCLUSION Despite its importance, the proportion of consistent condom use among serodiscordant couples was significantly low. To improve condom use consistently, planners, policymakers, and health care practitioners should consider the factors listed above when making decisions. There should be an increased focus on student and employee intervention as well.
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Affiliation(s)
- Wolde Melese Ayele
- Department of Epidemiology & Biostatistics, School of Public Health, Wollo University, Ethiopia
| | - Tesfaye Birhane Tegegne
- Department of Reproductive and Family Health, School of Public Health, Wollo University, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, Wollo University, Ethiopia
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Techasrivichien T, Darawuttimaprakorn N, Punpuing S, Musumari PM, Lukhele BW, El-Saaidi C, Suguimoto SP, Feldman MD, Ono-Kihara M, Kihara M. Changes in Sexual Behavior and Attitudes Across Generations and Gender Among a Population-Based Probability Sample From an Urbanizing Province in Thailand. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:367-82. [PMID: 25403321 PMCID: PMC4706588 DOI: 10.1007/s10508-014-0429-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/12/2014] [Accepted: 09/21/2014] [Indexed: 05/17/2023]
Abstract
Thailand has undergone rapid modernization with implications for changes in sexual norms. We investigated sexual behavior and attitudes across generations and gender among a probability sample of the general population of Nonthaburi province located near Bangkok in 2012. A tablet-based survey was performed among 2,138 men and women aged 15-59 years identified through a three-stage, stratified, probability proportional to size, clustered sampling. Descriptive statistical analysis was carried out accounting for the effects of multistage sampling. Relationship of age and gender to sexual behavior and attitudes was analyzed by bivariate analysis followed by multivariate logistic regression analysis to adjust for possible confounding. Patterns of sexual behavior and attitudes varied substantially across generations and gender. We found strong evidence for a decline in the age of sexual initiation, a shift in the type of the first sexual partner, and a greater rate of acceptance of adolescent premarital sex among younger generations. The study highlighted profound changes among young women as evidenced by a higher number of lifetime sexual partners as compared to older women. In contrast to the significant gender gap in older generations, sexual profiles of Thai young women have evolved to resemble those of young men with attitudes gradually converging to similar sexual standards. Our data suggest that higher education, being never-married, and an urban lifestyle may have been associated with these changes. Our study found that Thai sexual norms are changing dramatically. It is vital to continue monitoring such changes, considering the potential impact on the HIV/STIs epidemic and unintended pregnancies.
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Affiliation(s)
- Teeranee Techasrivichien
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Yoshida-Konoe cho, Sakyo Ku, Kyoto, 6068501, Japan.
| | | | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Patou Masika Musumari
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Yoshida-Konoe cho, Sakyo Ku, Kyoto, 6068501, Japan
| | - Bhekumusa Wellington Lukhele
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Yoshida-Konoe cho, Sakyo Ku, Kyoto, 6068501, Japan
| | - Christina El-Saaidi
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Yoshida-Konoe cho, Sakyo Ku, Kyoto, 6068501, Japan
| | - S Pilar Suguimoto
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Yoshida-Konoe cho, Sakyo Ku, Kyoto, 6068501, Japan
| | - Mitchell D Feldman
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Masako Ono-Kihara
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Yoshida-Konoe cho, Sakyo Ku, Kyoto, 6068501, Japan
| | - Masahiro Kihara
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Yoshida-Konoe cho, Sakyo Ku, Kyoto, 6068501, Japan
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Low incidence of HIV infection in an anonymous HIV counselling and testing clinic cohort in Bangkok, Thailand despite high HIV prevalence and self-report of high-risk behaviour. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)30487-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Phanuphak N, Paris R, Colby D, Pinyakorn S, de Souza M, Teeratakulpisarn N, Chomchey N, Sutthichom D, Sukjitpaiboonphol A, Pankam T, Kim JH, Ananworanich J, Phanuphak P. Low incidence of HIV infection in an anonymous HIV counselling and testing clinic cohort in Bangkok, Thailand despite high HIV prevalence and self-report of high-risk behaviour. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)30486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Patel SA, Bangorn S, Aramrattana A, Limaye R, Celentano DD, Lee J, Sherman SG. Elevated alcohol and sexual risk behaviors among young Thai lesbian/bisexual women. Drug Alcohol Depend 2013; 127:53-8. [PMID: 22770462 PMCID: PMC3486947 DOI: 10.1016/j.drugalcdep.2012.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/21/2012] [Accepted: 06/07/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little empirical data have been published about drinking or sexual behaviors among Thai lesbians. We examine the association of sexual identity with established indicators of alcohol- and sexual-related health behaviors among female bar patrons. METHODS We conducted a cross-sectional study among women (N=121) aged 18-24 who frequented popular drinking establishments in Chiang Mai, Thailand. We used general linear modeling techniques to estimate associations between sexual identity and positive alcohol expectancy, harmful drinking, age at sexual debut, and number of lifetime sexual partners. RESULTS Nearly one-third of women aged 18-24 recruited from Chiang Mai drinking venues identified as lesbian/bisexual. As compared to their heterosexual counterparts, lesbian/bisexuals reported higher positive alcohol expectancy scores, more harmful drinking, earlier age at sexual debut, and higher number of lifetime sexual partners. In adjusted models, lesbian/bisexual identity was associated with higher positive alcohol expectancy (β=1.94 points; 95% CI: 0.75, 3.13), earlier age at sexual debut (β=-0.85 years; 95% CI: -1.46, -0.23), and higher number of lifetime sexual partners (rate ratio=1.70; 95% CI: 1.22, 2.37). CONCLUSION Lesbian/bisexual women in this study engaged in multiple behaviors that are potentially harmful to health, which may in turn place this group at heightened risk for alcohol abuse and sexually transmitted infections in Thailand. The clustering of alcohol- and sexual-related risk behaviors, and its consequences for health outcomes in this population, should be explored in future research and may be an important point of intervention.
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Affiliation(s)
- Shivani A. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore Maryland, 21205, USA
| | - Sirirojn Bangorn
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavarorose, Muang, Chiang Mai, 50202, Thailand
| | - Apinun Aramrattana
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavarorose, Muang, Chiang Mai, 50202, Thailand
| | - Rupali Limaye
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore Maryland, 21205, USA
| | - David D. Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore Maryland, 21205, USA
| | - Jennifer Lee
- Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287
| | - Susan G. Sherman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore Maryland, 21205, USA
- Corresponding author: Susan G. Sherman, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore Maryland, 21205, USA, Phone: 410-614-3518, Fax: 410-955-1383,
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Janepanish P, Dancy BL, Park C. Consistent condom use among Thai heterosexual adult males in Bangkok, Thailand. AIDS Care 2011; 23:460-6. [DOI: 10.1080/09540121.2010.516336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Poolsuk Janepanish
- a Department of Nursing, Faculty of Medicine , Mahidol University, Ramathibodi Hospital , Bangkok , Thailand
| | - Barbara L. Dancy
- b Department of Health Systems Science, College of Nursing , University of Illinois at Chicago , Chicago , IL , USA
| | - Chang Park
- b Department of Health Systems Science, College of Nursing , University of Illinois at Chicago , Chicago , IL , USA
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SHERMAN SUSANG, GANN DONALD, GERMAN DANIELLE, SIRIROJN BANGORN, THOMPSON NICHOLAS, ARAMRATTANA APINUN, CELENTANO DAVID. A qualitative study of sexual behaviours among methamphetamine users in Chiang Mai, Thailand: a typology of risk. Drug Alcohol Rev 2009; 27:263-9. [DOI: 10.1080/09595230801956520] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Thanawuth N, Chongsuvivatwong V. Late HIV diagnosis and delay in CD4 count measurement among HIV-infected patients in Southern Thailand. AIDS Care 2008; 20:43-50. [PMID: 18278614 DOI: 10.1080/09540120701439303] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objectives of this study were to evaluate timeliness of HIV testing and of getting CD4 count measured and their associated factors in Southern Thailand. Between July 2004 and February 2005, consenting HIV-positive patients from seven public hospitals in Songkhla province, Southern Thailand were interviewed. Outcomes were late HIV diagnosis (having HIV-related symptoms at the time of first positive test) and the time between HIV diagnosis and first CD4 count being measured. Of 402 study patients, 55% were late HIV-diagnosed. Factors independently associated with late HIV diagnosis were age above 30 years, male and being unemployed with respective odd ratios (95% CI) of 3.10 (1.90-5.07), 7.95 (4.52-13.99), and 2.14 (1.22-3.76). Only 34% and 47% received CD4 assessment within 6 and 12 months of HIV diagnosis, respectively. Median of first-known CD4 count was 73 (IQR 16-169) and 22 (IQR 9-85) cells/microl among asymptomatic and symptomatic HIV-diagnosed patients, respectively. Common predictors for shortened delay of CD4 count measured among symptomatic and asymptomatic HIV-diagnosed patients were: infection through sexual contact (HR=1.61; 95%CI 1.12-2.33) and receiving posttest counseling (HR 1.71; 95%CI 1.15-2.52). Among the asymptomatic, those aged >25-30 years had significantly shortened delay (HR=2.18; 95%CI 1.50-3.18) compared with the younger age group as did those aged >30 years (HR=1.94; 95%CI 1.32-2.85). Such age effect on the delay was absent in the symptomatic group. Attempts to diagnose HIV at an earlier stage and timely CD4 count measured are needed.
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Affiliation(s)
- N Thanawuth
- Faculty of Medicine, Prince of Songkla University (PSU), Songkla, Thailand.
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German D, Sherman SG, Latkin CA, Sirirojn B, Thomson N, Sutcliffe CG, Aramrattana A, Celentano DD. Young Thai women who use methamphetamine: intersection of sexual partnerships, drug use, and social networks. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:122-9. [PMID: 18191393 PMCID: PMC2715012 DOI: 10.1016/j.drugpo.2007.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 11/14/2007] [Accepted: 11/19/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Given high rates of methamphetamine (MA) use among young people in Thailand and evidence of an association between MA and increased sexual risk behaviour, we examined the association between women's recent sexual partnerships, social network characteristics and drug and alcohol use. METHODS Female participants (n=320) in an HIV behavioural trial among young (18-25 years) MA users in Chiang Mai completed a drug and sexual behaviour survey and social network inventory. Multinomial regression analyses accounting for clustered data examined individual and network characteristics associated with recent sexual partnership category. We compared women with only one male partner in the past year (39%) to those with multiple male partners (37%) and those with only female partners (24%). RESULTS Differences in levels of drug and alcohol use and social and sexual network characteristics were dependent on recent sexual partnership profiles. The multiple partner group reported an average of five male partners in the past year; 12% reported consistent condom use in the past 30 days. Compared to both groups, women with multiple male partners used MA more frequently, had larger non-sex networks with more MA users, were more likely to have an MA-using sex partner, and received less emotional support from their partners. Women with multiple male partners and only female partners reported more frequent alcohol use. CONCLUSIONS Policy and intervention efforts targeting drug use and sexual behaviour among young Thai women are drastically needed and may benefit from consideration of the diversity within the population. These data point to the need for targeted prevention approaches that take into account the varying characteristics and social influences of these different groups of women.
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Affiliation(s)
- Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA.
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Rasamimari A, Dancy B, Talashek M, Park CG. Predictors of sexual behaviors among Thai young adults. J Assoc Nurses AIDS Care 2008; 18:13-21. [PMID: 17991595 DOI: 10.1016/j.jana.2007.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
To identify correlates of sexual behaviors among Thai young adults between 18 and 24 years, the authors used a cross-sectional survey of 405 young adults from eight randomly selected Thai urban and rural vocational schools. The young adults completed self-report questionnaires. Logistic regressions were used to determine the correlates between a Thai young adult's ever having had sexual intercourse and the correlates of the number of sexual partners and consistent condom use among those who were sexually active. The independent variables were age, gender, socioeconomic status, geographic residence, parental residence, parental-young adult communication, HIV knowledge, and negotiation for safer sex. The results showed that geographic residence and negotiation for safer sex were related to a young adult's ever having had sexual intercourse; gender, HIV knowledge, and negotiation for safer sex were related to the number of sexual partners; and geographic residence was related to condom use. HIV prevention programs should incorporate HIV knowledge and negotiation skills for both genders and for all geographical areas.
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Affiliation(s)
- Amnuayporn Rasamimari
- National Institutes of Health, National Institute of Nursing Research, Reducing Health Disparities in Underserved Populations, USA
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Kobori E, Visrutaratna S, Kada A, Wongchai S, Ono-Kihara M, Kihara M. Prevalence and correlates of sexual behaviors among karen villagers in northern Thailand. AIDS Behav 2007; 11:611-8. [PMID: 17053856 DOI: 10.1007/s10461-006-9167-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A cross-sectional survey was conducted in two mountainous villages of the Karen, a major ethnic minority in Thailand. The participants were 566 villagers aged 15-54 years (371 in Village A, 195 in Village B; response rate=81.9%). Premarital/extramarital sex was experienced by 10-20% of the sexually active respondents and sex with a female sex worker (FSW) by 12.6% of males. Premarital sex was independently associated with being a Christian and occupational experience in town; extramarital sex was associated with Village A and drug use; sex with a FSW was associated with being unmarried, a nonfarmer, and occupational experience in town. Approximately 80% of the married participants never used a condom with their spouse, and nearly one-third never did so with a boy/girlfriend or a FSW. A history of sexually transmitted infections (STIs) was associated with sex with a FSW. These findings suggest that nontraditional sexual practices are prevalent and could potentially threaten Karen communities with the spread of HIV.
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Affiliation(s)
- Eiko Kobori
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health , Yashida-konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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Carael M, Slaymaker E, Lyerla R, Sarkar S. Clients of sex workers in different regions of the world: hard to count. Sex Transm Infect 2006; 82 Suppl 3:iii26-33. [PMID: 16735289 PMCID: PMC2576731 DOI: 10.1136/sti.2006.021196] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To estimate the proportion of the male population that reports having paid for sex in different regions. METHODS Clients of sex workers were identified from representative samples of men asked in face-to-face interviews whether they had had sex in exchange for money or whether they had paid for sex, in the last 12 months. A total of 78 national household surveys and nine city based surveys were selected for inclusion. Where such surveys were not available, results of behavioural surveillance surveys and of research studies were also used. Using national estimates, a median percentage of men who reported paying for sex was calculated for each region. RESULTS The median percentage of men who exchanged sex for money in the last 12 months in all regions was around 9-10%, with estimates from 13% to 15% in Central African region, 10 to 11% in Eastern and southern Africa, and 5-7% in Asia and Latin America. Estimates for men who paid sex were much lower at around 2-3% with ranges from 7% in the South African region to 1% in Asia and West Africa. CONCLUSIONS Although errors of measurement and critical issues of definitions and interpretation exist, this compilation represents a first attempt to obtain reasonably coherent estimates of the proportion of men who were clients of sex workers at regional level. Large discrepancies between regions were found. Further improvements in national estimates will be critical to monitor coverage of HIV prevention programmes for sex workers and clients, and to improve estimates of national HIV infection prevalence levels in low and concentrated HIV epidemics.
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Affiliation(s)
- M Carael
- Free University of Brussels, Brussels, Belgium.
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Cáceres C, Konda K, Pecheny M, Chatterjee A, Lyerla R. Estimating the number of men who have sex with men in low and middle income countries. Sex Transm Infect 2006; 82 Suppl 3:iii3-9. [PMID: 16735290 PMCID: PMC2576725 DOI: 10.1136/sti.2005.019489] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To collect and analyse published and unpublished surveillance and research data on the prevalence of same sex sexual activity among male adults (including male-to-female transgenders and sex workers) in low and middle income countries. METHODS Key indicators were operationalised (ever sex with a man, sex with a man last year, high risk sex last year (as defined by unprotected anal sex or commercial sex)) and a database was designed for data collection. Searches were conducted (PubMed, databases (US Census Bureau, World Bank, conferences)) and regional informants helped. Reference reports were used to assess the methodology and quality of information in each record. The best data available per region were identified and indicator estimates were used to propose regional range estimates. RESULTS Of 561 studies on male sexual behaviour and/or MSM population characteristics, 67 addressed prevalence of sex between men, with diverse numbers per region and virtual unavailability in sub-Saharan Africa, Middle East/North Africa, and the English speaking Caribbean. Overall, data on lifetime prevalence of sex with men (among males) yielded figures of 3-5% for East Asia, 6-12% for South and South East Asia, 6-15% for Eastern Europe, and 6-20% for Latin America. Last year figures were approximately half of lifetime figures, and prevalence of high risk sex among MSM last year was approximately 40-60% in all regions except South Asia, where it is 70-90%. CONCLUSIONS Data available on the prevalence of male same sex sexual activity across regions are scarce (non-existent in some areas), with validity and comparability problems. In South and South East Asia, Eastern Europe, and Latin America, a lifetime prevalence of 6-20% was estimated, with smaller figures in East Asia. A cross cultural analysis of terminology and practices is needed, as is continued work on epidemiological and social analysis of male-male sexual practices in societies across regions.
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Ngamvithayapong-Yanai J, Winkvist A, Luangjina S, Diwan V. "If we have to die, we just die": challenges and opportunities for tuberculosis and HIV/AIDS prevention and care in northern Thailand. QUALITATIVE HEALTH RESEARCH 2005; 15:1164-79. [PMID: 16204399 DOI: 10.1177/1049732305281616] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In this study, the authors identify opportunities for and challenges in reducing the risks of tuberculosi (TB) and HIV/AIDS transmission in Thailand. They carried out more than six repeated in-depth interviews with each of 13 participants who have been newly diagnosed with TB, 7 of whom were HIV positive, and their caregivers, until the patient recovered from TB or died. They performed extensive observations during relevant private and public activities and analyzed the data using grounded theory, focusing on behaviors affecting risk of transmission. Out of strong virtue, many caregivers felt a responsibility to care for their ill loved ones, thus putting themselves at risk of transmission. For the older generation, this was unimportant, as they had already completed their life cycle ("let it be"). However, strong human bonds encouraged the patients to complete TB treatment until cured or deceased. The authors discuss strategies to build on appropriate behaviors.
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Genuis SJ, Genuis SK. Primary prevention of sexually transmitted disease: applying the ABC strategy. Postgrad Med J 2005; 81:299-301. [PMID: 15879042 PMCID: PMC1743270 DOI: 10.1136/pgmj.2004.026039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Escalating rates of sexually transmitted disease (STD) in many areas of the world necessitate a re-evaluation of current public health STD preventive programmes. Pervasive long term sequelae for many STD afflicted people and the emerging threat, caused by the HIV/AIDS pandemic, to some national infrastructures, suggests that ongoing initiatives focusing primarily on risk reduction through barrier protection have not met their desired objective. Recent strategies to promote non-coital sexual involvement as a means of achieving STD reduction fail to address the transmission of infection that may occur through alternative non-intercourse sexual activities. The demonstrated success of the innovative, comprehensive ABC strategy shows that while risk reduction and treatment of existing infection remain important, the promotion of optimal health may be achieved more effectively through broad based comprehensive and adaptable programmes that include an emphasis on risk avoidance through delayed sexual debut and partner reduction.
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Affiliation(s)
- S J Genuis
- Department of Obsterics and Gynaecology, University of Alberta, Canada.
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Liu H, Detels R, Li X, Stanton B, Hu Z, Yang H. Risk of HIV Transmission Within Marriage in Rural China: Implications for HIV Prevention at the Family Level. Sex Transm Dis 2005; 32:418-24. [PMID: 15976599 DOI: 10.1097/01.olq.0000170446.01789.4e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about HIV transmission at the family level in China. GOAL : We examined the risks for HIV transmission between husbands and wives and from parents to children in a rural area where HIV spread among former commercial blood donors. STUDY A cross-sectional study was conducted among 605 (302 couples) marriage license applicants. RESULTS More males (64.6%) than females (52.1%) reported having had premarital sex and multiple sex partners (12.6% and 6.9%, respectively). Among those having had multiple sex partners, 8.5% reported often or always using condoms. Only 36.8% of the couples agreed that they would not plan to have a baby after knowing the status of HIV infection. Approximately 43% of the couples agreed that they would use condoms consistently if 1 of them were HIV-positive. CONCLUSIONS There is an urgent need for national programs to prevent HIV infection within couples in rural areas.
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Affiliation(s)
- Hongjie Liu
- School of Medicine, Wayne State University, Detroit, MI 48201, USA.
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Genuis SJ, Genuis SK. Managing the sexually transmitted disease pandemic: a time for reevaluation. Am J Obstet Gynecol 2004; 191:1103-12. [PMID: 15507928 DOI: 10.1016/j.ajog.2004.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The serious implications of the sexually transmitted disease (STD) pandemic that currently challenges educators, medical practitioners and governments suggest that prevention strategies, which primarily focus on barrier protection and the management of infection, must be reevaluated and that initiatives focusing on primary prevention of behaviors predisposing individuals to STD risk must be adopted. Human immunodeficiency virus/acquired immunodeficiency syndrome, human papillomavirus, genital herpes, and Chlamydia are used to illustrate the pervasive presence of STDs and their serious consequences for individuals and national infrastructures. Long-term sequelae are discussed, including the emerging link between various sexually transmitted infections and cancer, and the psychosexual and psychosocial factors which impact infected individuals. Although risk reduction and treatment of existing infection is critical, the promotion of optimal life-long health can be achieved most effectively through delayed sexual debut, partner reduction, and the avoidance of risky sexual behaviors.
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Affiliation(s)
- Stephen J Genuis
- Department of Obstetrics and Gynecology, University of Alberta, 2935-66 Street, Edmonton, Alberta, Canada T6K 4C1.
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Punpanich W, Ungchusak K, Detels R. Thailand's response to the HIV epidemic: yesterday, today, and tomorrow. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2004; 16:119-136. [PMID: 15262571 DOI: 10.1521/aeap.16.3.5.119.35520] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Thailand's comprehensive national response to the HIV/AIDS epidemic has been extensively documented since the beginning of epidemic. Substantial progress in the fight against HIV/AIDS has been made because awareness of the problem was raised. Top-level political commitment and multisectoral strategies mobilized funds and human resources to implement the control program at all levels. Behavioral change resulting in increased condom use in brothels on a national scale rose from virtually nil to more than 95%. This was accompanied by a 90% reduction of the sexually transmitted disease rate. In parallel, the rate of new HIV infections dropped by 80%. Despite these achievements, there remains an urgent need to continue efforts to ensure universal and unfailing condom use. Further, Thailand needs to establish pragmatic innovative approaches to reduce transmission, especially among injection drug users, women, and youth, as well as to develop effective strategies for implementation of antiretroviral treatment. Further strategies also need to consider the changing cultural, social, and economic characteristics of the Thai populations.
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Affiliation(s)
- Warunee Punpanich
- Division of Infectious Disease, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
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