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23 Jul 2010

High HIV incidence for Thai men who have sex with men; many acquiring HIV in their early twenties

Researchers at the AIDS Conference in Vienna report hat 6 in 100 Thai men who have sex with men acquire HIV each year.

Among young Thai men who have sex with men, 6 in 100 acquire HIV each year. With the average age at infection being 26, this explosive epidemic is affecting a far younger group of men than the gay epidemics in Western countries. These are the headline findings of the first three years of a study to monitor HIV incidence, reported by Frits van Griensven to the Eighteenth International AIDS Conference in Vienna on Tuesday.

More encouragingly, a second study from Thailand, reported the same day, suggested that HIV prevalence could be declining in men who have sex with men, after having peaked at about 30% in 2007.

Thailand is often seen as a lesson in early and effective HIV control. However, until recently, efforts have largely concentrated on commercial sex workers, their clients and injecting drug users. The ongoing spread of HIV among men who have sex with men (MSM) was largely ignored until a much overdue study of Bangkok MSM in 2005 found an HIV prevalence of 17%.

In the incidence study, a cohort of 1292 Bangkok MSM was recruited, which is being followed at four-monthly intervals. Recruitment began in April 2006 and was completed by January 2008. Participants are all Thai nationals, male at birth, resident in the Bangkok area, aged 18 or over, and have had anal or oral sex with a man in the six months before recruitment. Participants were recruited from the sexual health clinic where follow-up visits were conducted, through a website, from a range of bars, saunas and parks used by MSM, and through community organisations.

Men recruited were relatively young (73% aged 29 and under), and were frequently born outside of Bangkok (64%). A majority were employed, well educated and identified as homosexual or gay.

In this sample, 22% of men were HIV-positive at baseline but were generally unaware of their infection. After three years of study, another 135 men had acquired HIV. In a 12-month period, the annual rate of HIV acquisition (incidence) was 5.9 per 100 person years. This did not vary between years 1, 2 or 3 of the study.

The mean age at seroconversion was 26.4, and the median was 26. “This means that 50% of the men who became infected during follow-up were younger than 26 years, and we have seen quite a large number of cases where men got infected when they were 18 or 19 years of age,” van Griensven commented. He noted that in cohort studies in other parts of the world, men are typically in their thirties when they seroconvert.

Among those men who were initially HIV-negative, it was the youngest men who were actually most likely to have acquired HIV by the end of the study. Using the Kaplan-Meier method to estimate the chances of remaining HIV-negative after four years, 89% of those aged 30 or over would be negative, in contrast to 71% of those aged 18 to 21 at recruitment.

This suggests that men are most vulnerable to infection when they are younger – men who did not acquire HIV at a young age are less likely to acquire it when they are older. van Griensven said that behavioural surveys showed that on average younger men had more drug use, unprotected sex and sexual partners.

The age difference is also illustrated by the odds ratios for having either prevalent or incident HIV infection. Prevalence relates to an infection acquired at any time in the past, so older men were more likely to have prevalent HIV. A man aged 30 or over was three times more likely to have prevalent HIV than a man aged 18 to 21 (odds ratio 3.2)..

On the other hand, incidence refers only to newly acquired infections. A man aged 18 to 21 was also almost three times more likely to have incident HIV than a man aged over 30 (odds ratio 2.7).

As well as age, other factors associated with incident (new) infections in the multivariate analysis were using drugs for sexual pleasure (primarily crystal meth, odds ratio 2.9); using taking the receptive position (odds ratio 1.9); inconsistent condom use (odds ratio 5.3 but with wide 95% confidence intervals, 1.3 to 21.8); past herpes infection (odds ratio 1.6) and past syphilis infection (odds ratio 2.5).

In response to a question, van Griensven stated that his study could not indicate whether incidence is rising or falling in Bangkok. However, a separate study of HIV prevalence among Bangkok men who have sex with men may suggest that prevalence is in fact falling.

Nonetheless, the survey method (a series of cross-sectional surveys, conducted at two-year intervals) is not the most reliable way of measuring these changes. Slightly different recruitment methods used for each survey could result in a different profile of men being recruited to different surveys, with the result that apparent changes in HIV prevalence may not be genuine.

The surveys have been conducted over an eight-year period, in 2003, 2005, 2007 and 2009. Men aged 15 and over, who report anal or oral sex with another man in the past six months, are recruited at entertainment venues, saunas and parks.

Overall HIV prevalence rates were 17% in 2003; 28% in 2005; 31% in 2007; and 25% in 2009. The increase from 2003 to 2005 was statistically significant, whereas the apparent decrease from 2007 to 2009 was not (p=0.22).

For those under the age of 22, HIV prevalence was 13% in 2003; 22% in 2005; 22% in 2007; and 13% in 2009.

Regarding risk behaviours, almost all 2003 survey respondents reported that they had engaged in anal sex at some point in their life, but only about two-thirds of respondents did so in 2009 (98 vs 62%; p<0.001).

On the other hand, almost no men in 2003 reported using drugs in the three months preceding the survey, but in 2009, one in five had done so (4 vs 20%; p< 0.001). Drug use during last sex also increased, from 0.7 to 4.2% (p< 0.001).

Consistent condom use in the past three months remained steady at around 64% – 68% across survey rounds.


Van Griensven F et al. Three years of follow-up in the Bangkok MSM cohort : evidence of an explosive epidemic of HIV infection. Eighteenth International AIDS Conference, Vienna, abstract TUAC0301, 2010.

Kladsawas K et al. Trends in HIV prevalence and risk behaviour among men who have sex with men (MSM) in Bangkok, Thailand, 2003 to 2009. Eighteenth International AIDS Conference, Vienna, abstract TUAC0203, 2010.

This article was first published by NAM/Aidsmap.com and is republished with permission.


Reader's Comments

1. 2010-07-23 17:21  
Oh my, remind me not to have any relations when I'm back in Bangkok...
2. 2010-07-24 00:47  
More needs to be done to educate MSM about safe sex. There are some who are clueless about using the right lubricant. Oil and condoms don't mix well.
3. 2010-07-24 08:33  
scientist should invent a lubricant product that kill virus and sperm during anal sex. sure popularly wanted. make fortune
4. 2010-07-24 10:36  
The incidence of HIV is increasing among the younger age groups means that educational efforts should begin early like teens. The other message was HIV is associated with drug use and risk taking behavior.

The less society judges MSM the less emotional the issue, the more objective the interventions.
5. 2010-07-24 17:45  
Christ. This slammed me about the realness of HIV once again. =S
6. 2010-07-24 20:15  
On 15 July 2010 I launched a campaign with the Thai Red Cross AIDS Research Centre with the Thai-subtitled version of my music video ("The Power To Be Strong" HIV Testing/Safer Sex Awareness Anthem) as a cornerstone of the campaign. This video is embedded in my Fridae.com profile and it may also be shared from the fan page at Facebook.com/ThePowerToBeStrong.

Please share this version of the song to encourage HIV testing and safer sex among those who read Thai (and/or understand the English lyrics).


Nicholas Snow
7. 2010-07-25 19:27  
thats scary...aids is real aids kills people nobody should forget it
8. 2010-07-26 06:34  
no pad thai for me if I visit Thailand lolz
9. 2010-07-26 07:00  
I travel to Thailand several times a year for work and am often concerned by gay tourists canvassing the "Boy Bars" that are hiv+ and showing no concern for the well being of the Thai boys and i believe it is because the tourists simply dont care.. I know this is a generalisation but someone correct me if they done see and hear this kind of contempt towards a very obliging temperment in Thai people.
10. 2010-07-26 17:29  
what ever happened to just coffee, hand holding and a date?

romance and slow food and slow sex are back in vogue and its actually quite fun and far more interesting
11. 2010-07-27 21:38  
I can't agree more with lagunabro's comment.

Having read all these comments. Sure what what you say people have said is part of the picture. I have been here for more than 10 years and have many Thai friends who do not have sex with westerners only with Thai me . What you see in the around the bars is only a fraction of the gay life in Thailand. Among my friends , they all know the risks, but still bareback as they call it. One of the big problems is lack of real understanding about the problems associated with the medications available for treatment. There seems to be a prevalent attitude among young Thai gay men that it's treatable so the risk isn't life threatening. It's difficult trying to get the message across, but I try.
12. 2010-07-29 09:27  
I agree too with Lagunabro.

Thailand is a wake up to all of us. While the rate of contraction might be higher in Thailand, I have known people in Australia who have had HIV. One young kid committed suicide as a result. The whole attitude as a whole needs to change. This idea of random drunk hook ups which is promoted alot in 'the scene' is really quite stupid. Know someone who has been affected by HIV and you will know why.
13. 2010-07-31 01:17  
I have a 29 year old Thai male staying in my house who came to Los Angeles 3 1/2 years ago to study. He was a roommate of my ex. He came to me 13 weeks ago after hitting bottom with a meth addiction. I took him in got him to a clinic and of course he turn out HIV pos as well. By his own admission he was looking for love in all the wrong places, hookups on line, bath house and got involved in meth and used it almost daily for 2 years. If he really liked a guy he would let him bareback him thinking they would like him better. Of course he was also high most of the time. In Los Angeles the meth use at certain bathhouses is almost to epidemic proportions and a high percentage of those users are HIV pos because of their risky behavior while on the meth. Needless to say this party and play culture that exists now is creating problems. The young man now is clean of the meth for 13 weeks except for one slip up. When he got his CD4 count it was dangerously low and honestly he is lucky he came to me when he did. His numbers are coming up but he is of course at times deeply depressed about his HIV status and having to return to Thailand where many companies gives blood tests when hiring people (to avoid health care costs)(he is educated and has a masters degree). He was completely addicted to meth and sex for 3 years and it came close to killing him. He has a long tough road ahead of himself now. Lagunabro's comments are right on the mark. Too many guys are out hooking up for sex because they are lonely and starved for companionship rather than lusting after the sex. It seems the current thought now is that engaging in sex up front is see as the only way to obtain a boyfriend. Seems kind of backwards to me, but then maybe I am old fashioned as well as just being old. A word of advise particularly to you bottoms. If a guy wants to bareback you he does not give a damn about you or himself. He wants his gratification and that is all that counts. Don't be a fool!
14. 2010-07-31 19:28  
It’s always sad reading these type reports, hearing more beautiful young men in Asian countries are succumbing to fleeting unprotected sexual experiences and ending up HIV+ will many of them have the benefit of life saving medication? For the poor and rent boys in particular it’s probably not likely, I agree with statements made here about shady tourists trawling for sex on holidays looking to engage young guys into unprotected sex I agree with some that may be it’s time for homosexual males to pull back from rampant sexuality and go more for dating and temporary celibacy (abstinence) till they find some one that will respect and honour them, your sexual integrity is an important component to a good quality of life, I’m almost three years celibate it’s no big deal I know I’m not missing out on much especially the newer presently incurable strain of gonorrhea which is a relief in it self, when I was younger less wise and available to all comers (excuse the phrase) jeje I wasn’t happy just being a cheap fuck it lowered my self esteem and most sexual experiences were shabby and unsatisfying which is why so many men pump them selves up on alcohol or amphetamines to cloak the shallowness and lack of enjoy ability is this lesser kind of life style, there are many kinds of ‘gay life styles’ one can choose not just the promiscuous option this should be taught to younger men help them find more direction and time for some good old fashioned mentoring that’s not set up to lure them into sex.
15. 2012-12-07 15:06  
It is always sad to hear of people acquiring HIV and especially so of young people, whether it be out of stupudity, the heat of the moment or the many situations that they find themselves in.
But one thing I will completely fail to understand is how in Hong Kong on the chat sites so many people openly solicit for BB (Bareback) sex? From individual tops to btms to BB group sex, it seems these people have completely thrown caution to the wind....they might as well play russian roulette. Why is it in this age of information and knowledge are there this group of people determined to be infected with STD and HIV.? I beg the question, can anybody give me a guide line as to their pyschological well being and their state of mind towards this ' deliberate ' attempt to be infected.?
Comment edited on 2012-12-07 15:08:36

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