Sapsirisavat Vorapot, Phanuphak Nittaya, Sophonphan Jiratchaya, Egan James E, Langevattana Kamonthip, Avihingsanon Anchalee, Friedman M Reuel, Stall Ron
HIV-NAT, Thai Red Cross AIDS Research Center, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand.
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
AIDS Behav. 2016 Dec;20(Suppl 3):398-407. doi: 10.1007/s10461-016-1456-0.
Although HIV prevalence remains high among Bangkok's MSM early HIV testing as an entry point to ART has not been successfully implemented among in this population. Men who present late for initial HIV testing are a particular concern in the context of the Bangkok HIV epidemic, in that if long-term positives have had condomless sex during the time that they remained untreated they are likely to have been efficient transmitters of infection, to say nothing of the implications for their own health. A sequential sample of MSM who tested HIV positive, and CD4 counts, was taken at the Thai Red Cross Anonymous Clinic and two drop-in centers in Bangkok. Inclusion criteria were MSM aged >18 years, having not tested HIV positive earlier, who reported ≥1 of the following in the previous 6 months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection (STI) diagnosis. Analysis was conducted by distinguishing between three groups of CD4 counts: <200, 200-500, >500 cells/μ to identify the social and behavioral characteristics of the men who presented late for HIV testing. Median CD4 was 325 cells/μ(n = 95). MSM with initial CD4< 200 cells/μ were significantly more likely to report problematic alcohol use. They were also more likely to report receptive anal sex and more likely to be engaged in sex work. MSM with CD4< 200 cells/μ were less likely to report recent HIV testing. Main barriers to HIV testing included being afraid of finding out that they were HIV positive and concerns about efficacy and side effects of HIV treatment. HIV stigma and concerns about treatment are still widespread and are potential barriers to HIV care among MSM in Bangkok. These barriers may work to keep men from finding out their positive HIV status in a timely manner. Thai MSM need to be made aware of the current availability of friendly HIV testing and ART services, and public health programs need to work to change their perceptions regarding ART itself. These same types of strategies might also work to destigmatize HIV and MSM within Thai society as a whole.
尽管在曼谷的男男性行为者中，艾滋病毒感染率仍然很高，但将早期艾滋病毒检测作为抗逆转录病毒治疗的切入点，在这一人群中尚未成功实施。在曼谷艾滋病毒流行的背景下，那些很晚才进行初次艾滋病毒检测的男性尤其令人担忧，因为如果长期呈阳性的人在未接受治疗期间有无保护性行为，他们很可能是高效的传染源，更不用说对他们自身健康的影响了。在泰国红十字会匿名诊所和曼谷的两个救助中心，对检测出艾滋病毒呈阳性的男男性行为者及其CD4细胞计数进行了连续抽样。纳入标准为年龄大于18岁、此前未检测出艾滋病毒呈阳性、在过去6个月内报告有以下情况之一的男男性行为者：与男性有无保护性行为、是性工作者或有性传播感染（STI）诊断。通过区分三组CD4细胞计数进行分析：<200、200 - 500、>500个细胞/微升，以确定很晚才进行艾滋病毒检测的男性的社会和行为特征。CD4细胞计数中位数为325个细胞/微升（n = 95）。初次CD4细胞计数<200个细胞/微升的男男性行为者更有可能报告有问题的饮酒行为。他们也更有可能报告接受肛交，并且更有可能从事性工作。CD4细胞计数<200个细胞/微升的男男性行为者报告最近进行艾滋病毒检测的可能性较小。艾滋病毒检测的主要障碍包括害怕发现自己艾滋病毒呈阳性以及对艾滋病毒治疗效果和副作用的担忧。艾滋病毒污名化和对治疗的担忧仍然普遍存在，是曼谷男男性行为者获得艾滋病毒护理的潜在障碍。这些障碍可能会使男性无法及时发现自己艾滋病毒呈阳性的状况。需要让泰国男男性行为者了解目前可获得的友好艾滋病毒检测和抗逆转录病毒治疗服务，公共卫生项目需要努力改变他们对抗逆转录病毒治疗本身的看法。这些相同类型的策略也可能有助于消除泰国社会整体对艾滋病毒和男男性行为者的污名化。
