HIV Prevention Campaign in Thailand Leads to Dramatic Reduction in HIV Infections
Public health programs promoting safe sex practices have contributed to a significant decline in the rate of new HIV infections among young men in Thailand, according to a study funded by the National Institute of Allergy and Infectious Diseases (NIAID).
As reported in the Aug. 1, 1996 issue of the New England Journal of Medicine, researchers led by Kenrad E. Nelson, M.D., of the Johns Hopkins University School of Hygiene and Public Health, studied groups of men drafted into the Royal Thai Army in 1991, 1993 and 1995. Since Thai men are selected for military service by lottery, these groups comprise a representative cross section of young men in this country. Each new recruit was tested for HIV and interviewed extensively about his medical and sexual history.
HIV prevalence ranged from 10.4 percent to 12.5 percent among men recruited in 1991 and 1993, but dropped to 6.7 percent among 1995 recruits. The decline in HIV prevalence coincided with reductions in several types of behavior associated with a high risk for HIV infection. For example, the percentage of men who reported having sex with female sex workers -- 50 percent of whom are infected with HIV in Thailand -- during the year before their conscription decreased from 57 percent to 24 percent between 1991 and 1995. Condom use in these situations increased from 61 percent in 1991 to more than 92 percent in 1995.
"These findings show that behavioral interventions can be effective tools in the control of HIV transmission," says NIAID Director Anthony S. Fauci, M.D. Dr. Fauci adds that the findings underscore the importance of NIAID's HIV Vaccine Efficacy Trials Network (HIVNET), which provided funding for the study. NIAID established the HIVNET in 1993 to lay the groundwork for conducting large-scale clinical trials of HIV prevention strategies.
Dr. Nelson and his colleagues believe that a main reason for the reported behavioral changes and decline in HIV prevalence among Thai army recruits was the Thai government's 100 percent Condom Program -- a campaign begun in the early 1990s to promote safe sex practices in commercial sex establishments. The program included distributing condoms to these establishments, as well as campaigns to encourage and enforce condom use by sex workers and their customers.
"We hope that people making public health decisions elsewhere in the world will profit from the remarkable success of the condom-promotion campaign in Thailand," Dr. Nelson and his co-authors note in their report.
HIVNET investigators study the epidemiology of HIV transmission in high-risk populations, such as those in Thailand and other developing countries. They also collect information on the prevalence of sexually transmitted diseases and other potential cofactors involved in HIV transmission, and on the willingness of high-risk individuals to enroll in vaccine trials. Information gained in these studies serves as the basis for assessing the effectiveness of subsequent HIV prevention strategies in large-scale clinical trials.
NIAID is a component of the National Institutes of Health (NIH). NIAID conducts and supports research to prevent, diagnose and treat illnesses such as AIDS and other sexually transmitted diseases, tuberculosis, asthma and allergies. NIH is an agency of the U.S. Public Health Service, U.S. Department of Health and Human Services.
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