Evidence of an explosive epidemic of HIV infection in a cohort of men who have sex with men in Bangkok, Thailand.

Published: November 19, 2012

Abstract

OBJECTIVE:: To assess HIV-prevalence, incidence and risk factors in a cohort of men who have sex with men (MSM) in Bangkok. DESIGN:: Cohort study with 4-monthly follow-up visits conducted between April 2006 and December 2011 at a dedicated study clinic in a central Bangkok hospital. Participants were 1744 homosexually active Thai men, ≥18 years old and residents of Bangkok. METHODS:: Men were tested for HIV-infection at every study visit and for sexually transmitted infections at baseline. Demographic and behavioural data were collected by audio-computer-assisted self-interview. Logistic regression analysis was used to evaluate risk factors for HIV-prevalence and Cox proportional hazard analysis to evaluate risk factors for HIV-incidence. RESULTS:: Baseline HIV-prevalence was 21.3% (n?=?372) and 60 months cumulative HIV-free survival was 76.1% (n?=?222). Overall HIV-incidence density was 5.9 per 100 person-years (PY). Multivariate risk factors for HIV-prevalence were older age, secondary/vocational education (vs. university or higher), employed or unemployed (vs. studying), nitrate inhalation, drug use for sexual pleasure, receptive anal intercourse, history of sexual coercion, no prior HIV-testing, and anti-HSV-1 and 2 and T. pallidum (TP) positivity at baseline. Multivariate risk factors for HIV-incidence were younger age, living alone or with roommate (vs. with a partner or family), drug use for sexual pleasure, inconsistent condom use, receptive anal intercourse, group sex, and anti-HSV-1 and 2 and TP positivity at baseline. Having no anal intercourse partners was inversely associated with HIV-incidence. CONCLUSIONS:: The high HIV prevalence and incidence in this cohort of Bangkok MSM documents an explosive epidemic. Additional preventive interventions for MSM are urgently needed.

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