HIV-1 Seroprevalence, Risk Factors, and Preventive Behaviors Among Women in Northern Thailand:

Burden of communicable diseases and cost of illness: Asia pacific region

BACKGROUND

Communicable diseases such as AIDS/HIV, dengue fever, and malaria have a great burden and subsequent economic loss in the Asian region. The purpose of this article is to review the widespread burden of communicable diseases and related health-care burden for the patient in Asia and the Pacific.

AREAS COVERED

In Central Asia, the number of new AIDS cases increased by 29%. It is more endemic in the poor population with variations in the cost of illness. Dengue is prevalent in more than 100 countries, including the Asia-Pacific region. In Southeast Asia, the annual economic burden of dengue fever was between $ 610 and $ 1,384 million, with a per capita cost of $ 1.06 to $ 2.41. Globally, 2.9 billion people are at risk of developing malaria, 90% of whom are residents of the Asia and Pacific region. The annual per capita cost of malaria control ranged from $ 0.11 to $ 39.06 and for elimination from $ 0.18 to $ 27.

EXPERT OPINION

The cost of AIDS, dengue, and malaria varies from country to country due to different health-care systems. The literature review has shown that the cost of dengue disease and malaria is poorly documented.

Keep talking about it: HIV/AIDS-related communication and prior HIV testing in Tanzania, Zimbabwe, South Africa, and Thailand

Informal, interpersonal communication within a community about HIV and AIDS, or lack of such communication, may influence community members' uptake of voluntary counseling and testing. Drawing from Noelle-Neumann's spiral of silence theory, this study examined the association between communication about HIV/AIDS and prior HIV testing in communities in Tanzania, Zimbabwe, South Africa, and Thailand. Participants (N = 14,818) in 48 communities across five sites throughout the four countries completed a behavioral survey assessing communication, prior voluntary counseling and testing (VCT) uptake, social norms, stigma, and sexual risk. Site-specific logistic regression models demonstrated that frequent conversations about HIV were significantly associated with prior HIV testing at every site. Odds ratios for each site ranged from 1.885 to 3.085, indicating a roughly doubled or tripled chance of past VCT uptake. Results indicate that verbal communication may be an important mechanism for increasing health behaviors and inclusion in future interventions should be considered.

HIV risk behaviors in sub-Saharan Africa and Northern Thailand: baseline behavioral data from Project Accept

BACKGROUND

Of 2.5 million new HIV infections worldwide in 2007, most occurred in sub-Saharan Africa and southeast Asia. We present the baseline data on HIV risk behaviors and HIV testing in sub-Saharan Africa and northern Thailand from Project Accept, a community-randomized controlled trial of community mobilization, mobile voluntary counseling and testing (VCT), and posttest support services.

METHODS

A random household probability sample of individuals aged 18-32 years yielded a sample of 14,657, with response rates ranging from 84%-94% across the 5 sites (Thailand, Zimbabwe, Tanzania, and 2 in South Africa). Individuals completed an interviewer-administered survey on demographic characteristics, HIV risk behaviors, and history of VCT.

RESULTS

In multivariate analysis, females, married individuals, less educated with 1 sexual partner in the past 6 months were more likely to have had unprotected intercourse in the previous 6 months. Rates of lifetime HIV testing ranged from 5.4% among males in Zimbabwe to 52.6% among females in Soweto.

CONCLUSIONS

Significant risk of HIV acquisition in Project Accept communities exists despite 2 decades of prevention efforts. Low levels of recent HIV testing suggest that increasing awareness of HIV status through accessible VCT services may reduce HIV transmission.

Late HIV diagnosis and delay in CD4 count measurement among HIV-infected patients in Southern Thailand

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.

Women's reports of condom use in Thai couples under intensive and regular STI/HIV risk reduction counseling

The objective of this study was to determine factors affecting condom use and condom use rates among Thai couples. A cohort of 1,391 reproductive aged women who attended seven family planning clinics in all regions of Thailand and met study eligibility were followed at 3-month intervals for 15-24 months. At each visit, the woman was interviewed about sexual risk behaviors and counseled for sexual risk reduction and condom use. Condoms were provided free of charge. The women were classified into 3 groups according to contraceptive use at baseline: single contraceptive method group, dual methods consisting of contraceptives with condoms, and condoms only. We found that condom use rates were generally low in all contraceptive groups. Significant factors affecting condom use in multivariate analyses included, contraceptive method at baseline, polygynous marriage, higher education, engaging in commercial sex work, multiple sex partners, sex during menses, more frequent sex, laboratory confirmed STIs, husbands spending nights away from home, husbands having sex with other women, and penile ulcers or sores.

Patterns of HIV and syphilis infection in Northern Thailand 1998-2001

Northern Thailand has been the epicentre of a largely heterosexually transmitted HIV epidemic that has recently involved married women. In preparation for HIV-prevention trials, we investigated patterns of HIV and syphilis risk through annually measured HIV and syphilis prevalence among northern Thai, peri-urban, community-dwelling men (n=2564) and women (n=3907) aged 18-35 years between 1998 and 2001. Crude HIV and syphilis prevalence were 3.3% and 2.7% for men and 2.3% and 2.1% for women, respectively. In logistic regression models of HIV and syphilis, compared with married men/women, widowers and widows were at increased risk (odds ratio; 95% confidence interval) of syphilis (7.86; 1.56-39.6 and 3.3; 1.14-9.61, respectively) and HIV (12.68; 3.23-49.8 and 41.3; 24.3-70.3, respectively). The oldest women were at lower risk of HIV (0.43; 0.22-0.85). For men and women, those with syphilis were approximately three times more likely to have HIV. These unique population data illustrate evolving sex parity of HIV burden in northern Thailand.

HIV epidemiology update and transmission factors: risks and risk contexts--16th International AIDS Conference epidemiology plenary

The contexts in which the human immunodeficiency virus (HIV) pandemic is occurring are increasingly diverse. Individual-level risks for HIV infection are at the core of these epidemics and are powerfully impacted by social, structural, and population-level risks and protections. The emerging epidemics among injection drug users across Eurasia are largely the result of needle sharing, but the drivers of disease spread include increases in opiate availability, limited HIV infection prevention and programs for drug users, and undermining policy environments. An emerging epidemic of HIV infection among men who have sex with men in developing countries is primarily spread through unprotected anal intercourse but is also driven by limited HIV infection prevention services, social stigma, and the lack of human rights protection. The epidemic in southern Africa, which is spreading largely through heterosexual exposure, is driven by high rates of labor migration, concurrent sexual partnerships, gender inequalities, and the limited availability of male condoms. We need to do much more to control HIV infection, and social and structural risks are crucial intervention targets.

HIV/AIDS in Asia

HIV (ie, HIV-1) epidemics in Asia show great diversity, both in severity and timing. But epidemics in Asia are far from over and several countries including China, Indonesia, and Vietnam have growing epidemics. Several factors affect the rate and magnitude of growth of HIV prevalence, but two of the most important are the size of the sex worker population and the frequency with which commercial sex occurs. In view of the present state of knowledge, even countries with low prevalence of infection might still have epidemics affecting a small percentage of the population. Once HIV infection has become established, growing needs for care and treatment are unavoidable and even the so-called prevention-successful countries of Thailand and Cambodia are seeing burgeoning care needs. The manifestations of HIV disease in the region are discussed with the aim of identifying key issues in medical management and care of HIV/AIDS. In particular, issues relevant to developing appropriate highly active antiretroviral treatment programmes in the region are discussed. Although access to antiretroviral therapy is increasing globally, making it work effectively while simultaneously expanding prevention programmes to stem the flow of new infections remains a real challenge in Asia. Genuine political interest and commitment are essential foundations for success, demanding advocacy at all levels to drive policy, mobilise sufficient resources, and take effective action.

High rates of pregnancy among vocational school students: results of audio computer-assisted self-interview survey in Chiang Rai, Thailand

Unplanned pregnancy among young people can lead to adverse social, psychological, and health outcomes, particularly when it results in abortion. In 1999, we examined the prevalence of and factors associated with pregnancy and abortion among 1725 consenting vocational school students in northern Thailand. Results from an audio computer-assisted self-interview showed that 48% of the male and 43% of the female students reported ever having had sexual intercourse. Among those who had had intercourse, 27% of the women and 17% of the men said they or their partner had ever been pregnant. Among the last reported pregnancies that resulted in delivery or abortion, 95% were aborted. Age, current contraceptive use, early initiation of sexual intercourse (</=16 years), alcohol and drug use, and sexual coercion were associated with self or partner pregnancy. The high rates of pregnancy and abortion in this population indicate the need for better sexual health education and access to effective contraceptive methods.

Rapid assessment of sexual behavior, drug use, human immunodeficiency virus, and sexually transmitted diseases in northern thai youth using audio-computer-assisted self-interviewing and noninvasive specimen collection

BACKGROUND

Drug use, unwanted pregnancy, human immunodeficiency virus (HIV) infection, and sexually transmitted diseases are serious health problems among Thai youth. The gravity of these problems demands high-quality data to direct public health policy and prevention programs. Previous studies of stigmatized behaviors have been hampered by participation bias and underreporting. To evaluate sexual behavior, disease, and drug use, we used audio-computer-assisted self-interviewing (ACASI) and noninvasive specimen collection methods. We also evaluated effectiveness of these methods in minimizing participation bias and underreporting.

METHODS

In late 1999, students aged 15 to 21 years attending 3 vocational schools were invited to participate in a cross-sectional survey. Consenting students completed a classroom-based ACASI interview using a confidential code number system. Oral fluid specimens were tested for HIV antibodies, and urine was tested for chlamydial and gonococcal nucleic acids, methamphetamines, and opiates.

RESULTS

Of 1736 invited students, 1725 (99%) agreed to participate. Of these, 48% of the male students and 43% of the female students reported ever having had sexual intercourse. Overall, the mean number of lifetime sexual partners was 4.6 among male participants (median: 2) and 2.8 among female participants (median: 1). Consistent use of condoms with steady partners was reported by 16% of male participants and 11% of female participants who had such partners. Of all male participants, 7% had ever paid for sex, 3% had ever sold sex, and 7% had ever been coerced to have sex. Of all female participants, 3% had ever sold sex and 21% had ever been coerced to have sex. Among women with a history of sexual intercourse, 27% reported at least 1 pregnancy. Of these pregnancies, 83% were terminated. Among those with sexual intercourse experience, the prevalence of HIV infection was 0.5%; of infection with Neisseria gonorrhoeae, 0.4%; and of infection with Chlamydia trachomatis, 5%. Twenty-nine percent of students reported ever having used methamphetamines. Ten percent had a methamphetamine-positive urine test. In the ACASI interview, 16% of these denied ever having used methamphetamines. The prevalence of opiate positive urine tests was low (0.2%).

CONCLUSION

This study shows that adolescents and young adults in Chiang Rai are at high risk for having unprotected intercourse, being coerced to have sex, unwanted pregnancy, sexually transmitted diseases, and drug use. The high enrollment rate demonstrates the feasibility and acceptability of using ACASI and noninvasive specimen collection methods in a developing country. ACASI use may lead to increased, but not to complete, self-reporting of sensitive behaviors.