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

Abstract

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.

Risk-Taking Behaviors Among Vertically HIV-Infected Adolescents in Northern Thailand

“…In comparison, Thai adolescents in the general population in northern Thailand and Bangkok reported far higher rates of substance use, with alcohol use exceeding 80% and drug use, including methamphetamines and heroin, reported by up to 38% of adolescents. [12][13] Among youths in Bangkok with behaviorally acquired HIV, 70% had used alcohol within the past year. In regard to sexual risk behaviors, more participants (35.2%) reported having engaged in some form of presexual activity, while fewer reported sexual contact and intercourse (3.7%).…”

“…In comparison, teens in the general Thai population reported much higher rates of sexual intercourse, ranging from 7.9% to 50%. 12,13,24,25 In the United States, at least 30% of vertically HIV-infected teens were sexually active, [9][10] and in the Bangkok study among behaviorally HIV-infected youth, all reported sexual activity. 15 However, as presexual behavior typically precedes sexual contact and intercourse, it is possible that rates of sexual contact and intercourse will continue to rise in this cohort, raising concerns for possible future increases in unsafe sexual practices, STI, and unplanned pregnancies.…”

“…More than 40% have reported sexual intercourse, but only 16% and 11% of sexually active males and females, respectively, have reported consistent condom use. 12 Rates of alcohol, cigarette, and drug use have exceeded 80%, 15%, and 37%, respectively, and up to 37% have reported methamphetamine use, 12,13 which is associated with significant sexual risk behaviors. 14 Thai youths with behaviorally acquired HIV are also known to have extremely high rates of risk-taking behaviors.…”

Implementation of Audio Computer-Assisted Interviewing Software in HIV/AIDS Research

“…Kc were much higher in the HIV+ adolescents across all reports: 0.66 vs 0.42 (2-day), 0.92 vs 0.36 (5-day), and 0.92 vs 0.30 (7-day). Van Griensven et al (2001) noted that of all Thai youths with positive drug screens, 85% of adolescent males and 84% of adolescent females selfreported drug use via ACASI.…”

Young Thai women who use methamphetamine: Intersection of sexual partnerships, drug use, and social networks

“…Epidemiological studies show high levels of sexual experience among young Thais (Allen et al, 2003;Jenkins et al, 2002;van Griensven et al, 2001). Although visits to commercial sex workers (CSWs) have become more rare (VanLandingham et al, 2002) due largely to a history of focused HIV prevention efforts (Nelson et al, 1996;Rojanapithayakorn & Hanenberg, 1996), unprotected sex within non-commercial sexual relationships remains common (Mills et al, 1997;Jenkins et al, 2002;Lertpiriyasuwat, Plipat, & Jenkins, 2003).…”