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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.
Pediatrics 2001;108(1):e13.
van Griensven F,
Supawitkul S, Kilmarx PH, Limpakarnjanarat K, Young NL, Manopaiboon C, Mock PA,
Korattana S, Mastro TD.
Abstract
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.