Dynamics of risk behavior for HIV infection among young Thai men

The objective of this investigation was to analyze the dynamics of risk for HIV-1 infection among young men in Thailand. We conducted a prospective study in a cohort (n = 1,236) of young men, aged 19-23 years at conscription into the Royal Thai Army and Air Force from six provinces in northern Thailand in May 1991 who were followed until their discharge in April 1993. The outcome measure was change since conscription in the frequency of self-reported sex with female commercial sex workers (CSW) during military service. Although 42% of conscripts reported no visit to a female CSW in the year prior to conscription, most had a visit during military service. Men who visited female CSWs infrequently at baseline increased their visits somewhat over time, whereas those with high initial rates of CSW visits decreased. Based on an assumed stable distribution over time, change from baseline was not statistically significant. Only marital status and high baseline CSW visit rates were associated with diminished visit frequency in multivariate analysis. No differences were seen in patterns of change in CSW visits by HIV-1 serostatus. More aggressive preventive interventions are needed to reduce the frequency of CSW visits in northern Thailand, a setting where 40-80% of all female CSWs working in brothels are now HIV seropositive.