New HIV infections in Thailand drop 50 per cent

[reader]

From The Nation

 

New HIV infections in Thailand have dropped 50 per cent in six years – the biggest decline in Asia and the Pacific, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

 

And UNAIDS has applauded Thailand’s Ministry of Public Health for its bold new national AIDS strategy, which provides a roadmap for ending the AIDS epidemic as a public health threat in Thailand by 2030.

 

Admiral Narong Pipatanasai, Deputy Prime Minister and Chair of the National AIDS Committee, launched the 2017-2030 National AIDS Strategy at the Government Complex in Bangkok on Wednesday.

 

The 13-year plan would ensure an effective, cost-efficient and high-impact HIV response, he said.

 

A recent UNAIDS report has found that annual new HIV infections have dropped 50 per cent in Thailand between 2010-2016, the steepest decline for any country in Asia and the Pacific.

 

“Thailand stands out in the Asia-Pacific region for its achievements in overcoming AIDS,” said Patchara Benjarattanaporn, UNAIDS country director for Thailand. “In just one generation the country has gone from having the fastest growing epidemic in Asia to the slowest.

 

The country’s epidemic is concentrated among key populations, including men who have sex with men, transgender people, people who inject drugs and sex workers.

 

http://www.nationmultimedia.com/detail/national/30326588

[PeterRS]

All the above sounds extremely welcoming. But it masks what are the real facts as they stand at present. These are horribly simple.

 

* Unsafe sex accounts for 90% of new infections

* 50% of new infections were between MSM

* In Bangkok it is estimated that 28.6% of Thai men who have sex with other men are infected with HIV 

* Prevention programs are geared to straight sex with little concentration on gay sex

* HIV prevalence is "far greater" amongst male sex workers than their female counterparts - 12% amongst males whereas only 2% amongst females

* Thais under the age of 25 have lower levels of HIV knowledge and HIV testing and counselling than those over age 25

* Homophobia still prevents Thais from accessing HIV services.

 

Although Thailand made enormous progress with HIV prevention in the 1990s, the decline in HIV prevalence has slowed down in recent years. Access to prevention services and behaviour-change communication hasn’t been enough to significantly reduce the rate of new infections, particularly among men who have sex with men

 

To be in with a real chance of ending AIDS by 2030, Thailand will need to give significant focus to new and innovative strategies to reach both young people and key affected populations, particularly men who have sex with men.

 

 

All the above facts are from the 5 September 2017 update of the Avert Report on HIV and AIDS in Thailand.

 

https://www.avert.org/professionals/hiv-around-world/asia-pacific/thailand

[Guest samebb]

28.6% in Bangkok! Thats terrifying!!!!!!

[Uranus]

 

* In Bangkok it is estimated that 28.6% of Thai men who have sex with other men are infected with HIV 

 

 

 

Be aware that this figure is taken from men who visit gay saunas in Bangkok. Even though this is a high rate, it does not imply that nearly one third of all gay men and msm in Thailand are HIV positive.

 

Always use a condom when having receptive anal sex in Bangkok, and you should also know that using PrEP is a good idea. Truvada or its equivalent is easily available in Thailand if you cannot bring it with you from home – and not expensive.

 

Have fun!

[PeterRS]

Be aware that this figure is taken from men who visit gay saunas in Bangkok. Even though this is a high rate, it does not imply that nearly one third of all gay men and msm in Thailand are HIV positive.

I gave the source of my comments. I can find absolutely nothing in that AVERT paper to suggest the figure for Bangkok is based on those visiting saunas. Look at the sources on which that AVERT paper is based. Where does your comment come from?

 

I have never heard of researchers visiting gay saunas to take HIV tests in Bangkok. Frankly I find it extremely hard to believe and really doubt your accuracy. The percentage of Thais in Bangkok who have sex with other men has been in the high 20s for quite a few years. There is nothing unusual in the figures.

[reader]

The link in post #2 deserves spending some time exploring and not just for the statistical data. It suggests that msm across the globe, many of whom are too young to have lived through the worst years of the AIDS crisis, are less likely to exercise caution that became common in the 80's and 90's. And there's evidence that older men are becoming less careful than they have been in the past.

 

Based on what I've observed over 15 years of visits, the number of men practicing safe sex is regressing in saunas. The reasons can include reduced availability of condoms and lubricants on premises and reduced inhibition due to anonymity and drug use.

 

I also think that the role that bars and clubs once played in educating the community by distributing condoms and information has slackened off significantly. Likewise, there's fewer men looking for sex partners in the bars as apps proliferate.

 

This is understandably a less than pleasant topic of discussion but I believe most agree that it's one we need to have from time to time.

 

A cursory of on-line search about sexual behavior of msm in Asia did produce one study specific to men who visited saunas in Taiwan,

https://link.springer.com/article/10.1186/1471-2334-11-334

 

Other generalized msm studies of interest:

 

China study:

http://journals.lww.com/stdjournal/Fulltext/2008/04000/Concordance_Between_Sexual_Behavior_and_Sexual.19.aspx

 

Philippines study:

http://www.academia.edu/23848894/MSM_Sexuality_and_HIV_Risks_The_Case_of_MSM_Sexual_Identities_Behavior_and_Risks_in_Iloilo_City

 

 

[PeterRS]

Interesting statistical research. I am still waiting for Uranus to provide readers with the basis of his alleged findings. Sorry Uranus but I continue to believe they do not exist.

 

The link in post #2 deserves spending some time exploring and not just for the statistical data. It suggests that msm across the globe, many of whom are too young to have lived through the worst years of the AIDS crisis, are less likely to exercise caution that became common in the 80's and 90's. And there's evidence that older men are becoming less careful than they have been in the past.

I believe this trend has been continuing for some years if not longer. For those who lived through the early stage of the HIV-AIDS pandemic, we knew that infection meant certain death. Many of us were terrified. We took the best precautions we could by always wearing condoms. But there was always the fear - what if one broke?

 

With the advent of the antiretroviral drugs, the disease morphed in peoples minds into a chronic illness. Keep taking the tablets and you will be OK overtook the safe sex message. Older guys who had been used to bareback sex before the early 1980s found it too easy to revert back to what they believed was a more enjoyable form of anal sex. Funding for safe sex programmes in countries like Thailand were drastically reduced. Young guys were no longer bombarded with adverts on television with the Grim Reaper and other pretty gruesome images. For them, it was just another STD than can be treated with drugs. Now with PrEP there is an assumption that safe sex is not necessary. And that is so stupid because every doctor will tell you that PrEP is only about 90% safe. Does it protect you against the host of other STDs? No!

 

https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis

[reader]

The Australian Research Centre in Sex, Health and Society, La Trobe University, published a study of behavior in six Bangkok saunas in 2012. The report can be downloaded at the link below.

 

The saunas included Farose 2, Beach, Paradise, Torpedo, Cruising and 39 Underground.

 

Some random findings:

- The median age of the 728 participants was 31.5 years

- The median per visit time was 3 hours, about 45 minutes of which were spent having sex

- 56% of participants reported having sex with one partner while 28% reported having two partners per visit

 

Breakdown of socioeconomic demographics, sexual position preference, HIV status and testing and other pertinent data are included in the report.

 

http://arrow.latrobe.edu.au:8080/vital/access/manager/Repository/latrobe:35645;exact=sm_title%3A%22The+Bangkok+Sauna+Study+%3A+Findings+from+a+survey+of+gay+men+in+Thailand.%22

[PeterRS]

Fascinating study. It was clearly geared at saunas further from the centre of the city targeting almost exclusively younger Thais. No mention of Babylon, Sauna Mania, Heaven or Chakran. We must note that the survey was issued 5 years ago and so the findings are not up-to-date. I also have to add there is nothing in the study or the AVERT report to suggest that it was this study on which the latest AVERT findings were based.

 

However, several very interesting points arise from the 728 men who completed the study. (Presumably they gave correct answers - and there can be no guarantee that this was the case).

 

- the average annual wage of participants was Bt. 300,000. Even today, thats quite high. In 2012 it was a lot higher

 

* almost 60% had completed secondary school and/or university

 

* those under 30 get most of their info about HIV from the internet and family members

 

* 72.6% had had an HIV test but only 57% in the previous 12 months

 

* only 7% stated they tested positive

 

* 12% said they would prefer not to say (which rather implies they could be positive)

 

* those over 30 were more likely to have been tested than those under 30

 

* 23.8% had never been tested

 

* gay kings (tops) were much more likely to have been tested than gay queens (bottoms)

 

Other interesting factors -

 

* 59% went to the sauna primarily to find sex

 

* 31% went primarily to spend time with friends

 

* 86.1% had anal sex

 

* of these, 41% were tops, 18% were bottoms and 39% said they were versatile

 

* 96.8% used condoms and 92% water-based lube

 

* less than 3% had sex with a non-Thai

 

A few conclusions at the end of the Report -

 

In 2011 the International Labour Organisation (ILO) conducted an assessment of HIV prevention initiatives at eleven saunas across Bangkok. The assessment revealed a lack of information on sexual safely and health, lack of water-based lubricant and condoms, with limited condom access points throughout sauna spaces and specifically where sexual activities occur, and lack of staff training on HIV, sexual health or hygiene.

 

Most of the men who go to these saunas are Thai men in their twenties. These saunas attract few foreigners and even fewer westerners. These six saunas, as is the case for nearly all gay saunas in Bangkok, are for locals. These men tend not to live in the surrounding area or neighbourhood.

 

Middle class and professional men make up the majority of patrons, with nearly all men in full time employment and mostly highly educated. Students make up a distinct group for most of these saunas

 

While these saunas are sexualised spaces, the act of sex is not why all men go and certainly not the only reason why men go. One third of these men did not have sex on their most recent visit although they may well have arrived with the intention to have sex.

 

Most, but far from all, of the 728 men who visited the sauna did have (anal) sex with one or more men. For those who did have sex while at the sauna, just over half (56%) had sex with only one man, with the remainder having sex with at least two men.

 

Saunas are settings where there is potentially high risk for the transmission of HIV and other sexually transmitted infections. The potential for risk comes from both the structural characteristics of the setting (high partner change rates, reciprocity, versatility and sexual concurrency) and population characteristics (young, highly sexual active, multi partnered men) and these are well recognised within epidemiological representations of saunas. What can be seen from this simple study, however, is that the social processes and social mediators may be far more important when it comes to the development and enhancement of prevention work with this population.

 

As stated this study found the patrons were mostly highly educated. Counting those who preferred not to respond to the HIV question, the assumption could be that up to 19% had positive HIV test results. That is still way below the AVERT findings. IMO a further assumption could be that those saunas catering for less well educated Thais would probably find a lesser knowledge of HIV and therefore a higher proportion of  positive clients.

[reader]

Fascinating study. It was clearly geared at saunas further from the centre of the city targeting almost exclusively younger Thais. No mention of Babylon, Sauna Mania, Heaven or Chakran.

 

The authors said at the outset they deliberately avoided saunas that foreigners visit to keep results focused on behavior of Thais.

 

If Babylon and Heaven had been included, mean age would probably have been in the 50's.

 

 

 

(Presumably they gave correct answers - and there can be no guarantee that this was the case).

 

Unless they're hooked up to a polygraph, that's always the situation in studies of this sort where participants agree to cooperate on basis on anonymity. That's why they spread their net wide (728 participants in six different locations).

[PeterRS]

Unless they're hooked up to a polygraph, that's always the situation in studies of this sort where participants agree to cooperate on basis on anonymity. That's why they spread their net wide (728 participants in six different locations).

 

By concentrating on the non-foreigner saunas the researchers were obviously able to get a far better picture of the situation as it affects Thais who prefer not to associate sexually with westerners. That is very valuable. But I really do not think the findings of just 728 participants over six days who may or may not have answered a written questionnaire correctly is a very good sample. That is an average of just over 20 per sauna per day. 

 

On the other hand the Reports primary focus is on how best to reach these mostly young Thais the better to communicate the safe sex and other STD message. The problem for the country is that the sample covers mostly better educated Thais living in the capital city with good salaries and good access to info about HIV. 

 

There is one further issue made at the start of that Report which is particularly useful in relation to the figures in the AVERT findings. 

 

The alarmingly high number of MSM who tested positive for HIV at Bangkok’s Silom Clinic in 2010 was 35%. Sadly, reports of infection rates of this magnitude among MSM are becoming more common (UNDP 2011). Van Griensven and colleagues’ biennial cross-sectional HIV prevalence study conducted in 2003, 2005 and 2007 alerted us to the disturbingly high rates of infection among these marginalised and forgotten men. Their study, repeated over three years, recruited men from saunas, entertainment venues and parks. HIV prevalence rates were recorded at 17.3 % in 2003 28.3% in 2005 reaching 30.7 % in 2007 (van Griensven et al. 2009 and 2010). Of particular note is that younger men are more vulnerable to acquiring HIV. The HIV prevalence rate among MSM 15-22 years old was 29.9% in 2003, 22.3% in 2005, and 22.2% in 2007 (van Griensven et al. 2010)

 

The figure of 35% at the Silom Clinic in 2010 is especially alarming. More encouraging is that the numbers in the 15-22 year age bracket were falling. Yet all these men remain HIV+. I therefore assume that they help to make up the AVERT figure of 28.6% of MSM in Bangkok who are currently HIV+

 

Another factor on which little data seems to be published is of those infected by extended family members up country. I have one good friend from a northern family who was infected after being raped repeatedly by an uncle starting at age 14. Bright, intelligent, with a good degree and now in his mid-20s, he has been unable to obtain a job in his ideal profession. Companies require medical tests and will not employ anyone who is HIV+. He has a well-paid job in another field and an understanding western bf. But he is saving everything he possibly to move to the west as he sees no future for him in Thailand.

[reader]

I took a second look at the AVERT link about Thailand and found that it relies on the UNAIDS website for its data.  Went to the UN site and located the Thailand information:

 

http://www.unaids.org/en/regionscountries/countries/thailand/

 

At that site you will see Thailand country report - 2015, a pdf that can be downloaded. (The 2015 report cites data collected through 2009-2014 which appears to be the most recent available).

 

In some categories, Information for some years is partially or completely missing. In other years, the figures are unchanged across the years as is the case of the estimate of MSM (550,000) and total number of female and male sex workers (141,769).

 

The percentage of male sex workers living with HIV in 2014 was 11.66%. Condom use among that group with their most recent client was 95.52%. Workers who knew their HIV status within the past 12 months was 54.37%.

 

In the MSM category, condom use was reported to be 82.08%. Men living with HIV was 9.15%.

 

In the category of young men ages 15-22 who have sex with men (YMSM), anal sex declined from 99% to 82% but receptive anal sex increased 55-74%. Condom use among the group remained stable at about 50%. This was for the period 2003-2014.

 

Although not reflected in any table, the report contains a statement that the HIV status of MSM in Bangkok remained in the 20-30% range throughout the period. (This may be influenced by the Silom clinic experience cited elsewhere in this thread).

 

For most of us, this isn't our first rodeo when we deplane at Swampy. The take-aways seem evident.

[GWMinUS]

I hope that younger Thai men are watching the TV Series "Gay OK Bangkok" (Season 1 and 2).

It is realistic treatment of Gays in Thailand and of HIV.

Encouraging Thai men to get tested, use condoms, and take PrEP.

If you have not watched it go to YouTube for Episodes with English Subtitles.

[PeterRS]

I took a second look at the AVERT link about Thailand and found that it relies on the UNAIDS website for its data.  Went to the UN site and located the Thailand information:

 

As you can see from the Appendix, that AVERT conclusion takes into account not just one but over 60 Reports from a variety of individual organisations. Any Report prepared exclusively by Thailand is bound to play down certain unwelcome statistics and play up others. That Thai Report inevitably plays up what is being done and what the government plans to do. It pays scant attention to the present.

 

The later UNAIDS 2015 Report has very specific information on Thailand. Look at page 129 (yes it is LONG) and the statistics show HIV infection amongst MSM as a percentage of total infections rose from roughly 30% of the total in 2005 to well over 50% in 2015. The rising trend is obvious. Then look at page 130. This is clearly where the AVERT figure comes from. 

 

HIV prevalence among gay men and other men who have sex with men in 2015 was higher than 5% in nine of the 19 countries that reported data. HIV prevalence was particularly high in many cities and urban areas: it was 28.6% in Bangkok (Thailand), 26.6% in Yangon (Myanmar) and 20.3% in Yogyakarta (Indonesia) 

 

 

The Report generally makes clear that Thailand is a mature HIV destination compared to many of its neighbouring countries. The percentages should therefore start to fall earlier. However, as most posts in this thread have pointed out and as this UNAIDS Report makes clear, it is young people around the Asia Pacific Region who are both most at risk and showing the greatest annual increases in infection -

 

young people aged 15 to 24 years accounting for 37% of all new HIV infections...a study in Bangkok showed an overall high HIV incidence among younger cohorts of men who have sex with men compared to their older peers: HIV incidence was 8.8 per100 person years among those aged 18 to 21 years  and 3.7 per 100 person years among men over 30 years of age.

 

No matter how accurate, statistics can be manipulated to suit different purposes. For this forum, surely the key points are just these two - 

 

1) The rate of HIV infection amongst MSM in large cities like Bangkok is much higher than elsewhere.

2) It is the 18-21 age group which is showing the greatest rise in infection.

 

The message is therefore extremely clear. Stay safe! Dont take any risks to your own health - and since many guys come to Thailand specifically for sex with several partners and may not be aware of their own most recent HIV status, please dont put  the health of your Thai companions at risk.

[reader]

Any Report prepared exclusively by Thailand is bound to play down certain unwelcome statistics and play up others. That Thai Report inevitably plays up what is being done and what the government plans to do. It pays scant attention to the present.

 

 

Thanks for your lesson in statistical analysis.  But I think most readers here are pretty smart guys and can make prudent judgements based on the numbers. That's what I tried to do: present the information and allow people to decide for themselves.

 

First, you mock the UNAIDS agency for citing Thailand's new national AIDS strategy, which provides a roadmap for ending the AIDS epidemic as a public health threat in Thailand by 2030.

 

Second, you refused to believe that a study of saunas in Bangkok had ever been done.

 

Third, when one was found, you did your best to discredit it.

 

Fourth, when the major source of AVERT's data is found to be that same UN agency, you cherry pick numbers and use a combination of bold face and red ink to pound home what you think people must believe.

 

Give the rest of us some credit for being able to interpret the impact of the reports. Informing folks is one thing; trying to scare them into what you want them to do is something else altogether.

[PeterRS]

Hold it a moment! You are putting lots of words in my mouth that i have never uttered. 

 

1. I have never berated Thailands new strategy to fight the epidemic. Please tell me where I said that. You certainly posted the Nation article. I added to it because it dealt in vague generalities about where the country presently stands and looked to the future. I doubt if any country wants it known that nearly 30% of MSM in its capital city are HIV+. I believe visitors and residents should know the facts as they presently stand, not just the overall rate of reduction and plans for the future.

 

2. I have never berated the UNAIDS Agency.. Again, where have I said that? After all that is Where the statistic about the percentage MSM being HIV+ has come from. I quoted that statistic.

 

3. Yes, I was wrong about there having been a sauna study. But you absolutely can not say I was wrong in my conclusion. Uranus stated the figure of 28.6% came from a sauna study. He stated it as fact. But the fact is that unless there is another study which neither you nor I can find, it didn't! That Australian sauna study, very useful though it was, was made 6 or 7 years ago. The UNAIDS figure is much more recent. Please note also I did not discredit that sauna study for what it was. In fact I analysed it dispassionately. However it was perfectly obvious that this was not where the figure of 28.6% of MSM being HIV+ came from. I was correct.

 

4. Yes, i cherry pick. You yourself have stated in one post that when you post articles (often interesting ones, I might add) you also cherry pick for length. What do you expect me to do? I cherry picked actual facts! Not thoughts, not conjecture, not suggestions, not supposition. Facts!

 

5. Of course readers can interpret the facts for themselves, but I do wonder how many actually have the time or can be bothered to read through all the pages that are linked to threads. That UNAIDS Report I quote from had many pages relating to Thailand! The long AVERT article had 68 Reference Papers, Who is going to read through all that?

 

But lets not have a beef at each other. We all enjoy Thailand and want the country to get its HIV infection rates down. Being aware of the facts is one way of doing it. It is right that visitors are aware that the actual infection rates are very high in Bangkok as they are in certain other major Asian cities. Then they can be even more aware of the need to take precautions.

[reader]

 

But lets not have a beef at each other. We all want Thailand to get its HIV infection rates down. Being aware of the facts is one way of doing it. It is right that visitors are aware that the infection rates are very high in Bangkok as they are in certain other major Asian cities. Then they can be even more aware of the need to take precautions.

 

This I have no argument with.  But lets keep in mind that providing information without preaching about conduct is the best way to do it.