Sexual behaviors and human immunodeficiency virus infection among Thai Army conscipts between 1992 and 1998

Military Medicine, Apr 2002 by Saengdidtha, Boonterm

This study examined changes in sexual behavior among Thai army conscripts from 1992 to 1998 in association with human immunodeficiency virus (HIV) seroprevalence. The sexual behavior survey was started in 1992 during the epidemic of HIV infection in Thailand, when sexual transmission was the most common route and young men were at high risk, and it has continued yearly since 1995. The self-reported questionnaires were administered to randomly selected conscripts (N = 294 in 1992, N > 4,000 in 1995-1998), and trends in sexual behaviors were studied. The results showed that risky sexual behaviors generally decreased in relation to the decline in HIV seroprevalence, but the conscripts still engage in risky sexual behaviors. Appropriate interventions should be implemented to change these behaviors. The periodic sexual behavior surveys will be useful in evaluating program outcomes and planning for future interventions.

Introduction

Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are important health problems in Thailand. The first AIDS case in Thailand was diagnosed in 1984. Then the epidemic was reported in homosexual men, intravenous drug users, and female commercial sex workers (CSWs) and their clients. In less than a decade since HIV/AIDS emerged and spread in Thailand, there were more than 2,000 AIDS cases reported in 1992, and the estimated number of HIV-infected individuals was more than 400,000, and these numbers increased rapidly.1 Thai young men ages 21 years had an HIV infection rate of 0.5% in 1989, and the rate increased to 3% in 1991. The prevalence rates of HIV infection in other risk groups were also increased.2

The major route of HIV transmission in Thailand changed during the early 1990s.3,4 In the early years of the epidemic, injection drug users played a principal role in the increase, but during the course of the epidemic, sexual behavior patterns in Thai society have been the most important contributing factors to disease transmission.4-8

Thai army conscripts are young Thai men, usually 21 to 22 years old, who may come from families of low socioeconomic status. They are selected by a lottery system according to Thai laws to work in the military service, mostly in the army. There are approximately 60,000 new conscripts every year who must serve for 2 years in the army. They are divided into two groups: the first group enters the army in May, and the second group enters in November. After 2 years of service, some of them will be enrolled as army students and army volunteers, but most will be army reserves, which can be called up in case of war.

The Royal Thai Army (RTA) Medical Department started to respond to the HIV/AIDS situation in the army in 1987 by means of health education. The AIDS Control Committee of the RTA Medical Department was established in 1989 after the first HIV-infected army personnel were reported in 1988.9 The committee started HIV testing in 1989 for all army conscripts in the first month of their service using a program similar to that used in the U.S. Army. 10 The infection rate among army conscripts reflected the infection rate of Thai male youth, which was derived from HIV testing in a cohort of Thai men 21 to 22 years old.11 In 1991, the Thai government established the National AIDS Control Committee, in which every ministry takes part, with the Prime Minister as chairman. The government started to allocate funds for the prevention and control of HIV/AIDS to every ministry in 1992. There has been cooperation between governmental and nongovernmental organizations in the fight against HIV/AIDS.9

Thai army conscripts are at high risk for HIV infection because of their risky behavior, such as having sexual intercourse with CSWs without condom use, having multiple sexual partners, intravenous drug use and drinking alcohol, and risky sexual practices.12-14 Thus, the sexual behavior survey of army conscripts was started by the Preventive Medicine Division of the RTA Medical Department in 1992. The surveys have been given annually since 1995. The objective of this study is to track the changing trends of sexual behaviors between 1992 and 1998 to provide useful information for the prevention and control of sexually transmitted diseases (STDs) and HIV infection in this particular high-risk group.

Materials and Methods

The voluntary, self-reported questionnaires were administered by the systematic random sampling method in 1992 to new army conscripts ages 21 to 22 years who entered the army in May to obtain demographic information, data on risky sexual practices, and history of STDs (N = 294). Thirty-seven of 75 provinces in Thailand contain army hospitals, and conscripts from army camps near the 19 army hospitals from all 4 regions of the country were selected for this study. Almost all of the conscripts who received the questionnaire actually completed it. The initial questionnaire was approved by the research committee of the RTA Medical Department. Then it was developed in cooperation with the Division of Epidemiology of the Ministry of Public Health and approved by the same committee for annual sexual behavior surveillance, starting in 1995 with the sampling of more than 4,000 persons and 300 to 350 samples for each selected province.

The new questionnaire consisted of 20 items and included items concerning the use of condoms in initial sex, sexual intercourse with and without condom use in the previous year, having more than five female sexual partners, having STDs, and proper treatment of STDs (i.e., treatment by a physician) in the previous year. Condom use here means using a condom every time when having sex. There were two or more response options for each item in the sexual behavior questionnaire. The item regarding having more than five female sexual partners was not included in the questionnaire in 1998.