Widely varying HIV prevalence and risk behaviours among the ethnic minority peoples of northern Thailand

Abstract

We compared HIV prevalence, risk behaviours, and social and sexual norms among nine ethnic minority (Hilltribe) groups in northern Thailand. Communities were selected on the basis of size, ethnicity, development level and geography. Subjects (15-45 years) were stratified by gender and selected by household using two-stage randomization. Forty volunteers were identified in each of 27 villages. Participation was voluntary and informed consent was obtained. HIV infection status was determined using ELISA and Western Blot on saliva samples. Risks for HIV were measured with structured interviews using local languages. Overall HIV prevalence was 23/1080 (2.13%) with an equal male-female ratio. HIV prevalence rates were: Shan 8.75%, Akha 5.0%, Yao 5.0%, Thin 1.25%, Hmong 0.63%, Lahu 0.63%, Lisu 0.63%, Karen 0, and Pa-Long 0. Sex worker use was an HIV risk for men (p = 0.0001), but injecting drug use was not; for women, having been a sex worker was a significant HIV risk (p < 0.0001). HIV rates, social norms and sexual behaviour varied considerably among ethnic groups, as did attitudes toward commercial sex work and use. HIV prevention needs to target the Shan, Akha, and Yao communities, and to focus on reduction of brothel work and use.

Personal History of Voluntary HIV Counseling and Testing (VCT) Among Adults Aged 19–35 Years Living in Peri-urban Communities, Chiang Mai, Northern Thailand

“…Data are also needed on the effectiveness of VCT in reducing risk behaviors and HIV incidence in those who seek testing and the effectiveness of the referral system in caring for and supporting those who test positive. Whether rapid tests, such as ORA-QUICK, or noninvasive methods, such as those using urine or saliva testing, would increase the acceptability of HIV testing or improve notification is worth evaluating (Hilton et al, 2002;Beyrer et al, 1997;Kassler, 1997;Nookhai et al, 2001). This research agenda is crucial for improving the effectiveness of the national HIV prevention program in Thailand.…”

Hepatitis B Virus and Hepatitis C Virus Infections in United States-Bound Refugees from Asia and Africa

“…The Hmong refugees born in Thailand were on average 20-30 years younger than those born in Laos, so risk factors for acquiring HCV infection may be different between these two Hmong groups. It has been reported that injection drug use has increased among the Hmong, 39 thereby potentially contributing to the higher rate of HCV-RNA-positivity observed for the Thai Hmong. Currently, no specific policy exists for hepatitis C screening of immigrants or refugees, although CDC has recently included in its recommendations one-time screening for hepatitis C of all individuals born between 1945 and 1965.…”

Prevalence and Correlates of Sexual Behaviors Among Karen Villagers in Northern Thailand

“…Although the conservative nature of the Karen sexual culture might contribute to the extremely low HIV prevalence rate (Beyrer et al, 1997), despite living close to the infection epicenter in Thailand, our findings suggest that this trend will not persist. As HIV spread readily and widely among FSWs and male clients in the Thai population within a short time in the early 1990s, especially in northern Thailand, emerging unprotected sexual contact with a FSW, and other nontraditional sexual behaviors, will allow the HIV to infiltrate these mountain-dwelling ethnic minority communities if no timely, effective preventive measures are taken.…”

“…Studies in the late 1990s compared the HIV prevalence, sexual attitudes, and behaviors of the villagers among several ethnic minorities (Beyrer et al, 1997;Omori, 1999). These studies demonstrated the presence of a major risk factor for HIV infection: contact with Thai society.…”