Celentano D D, Nelson K E, Suprasert S, Eiumtrakul S, Tulvatana S, Kuntolbutra S, Akarasewi P, Matanasarawoot A, Wright N H, Sirisopana N
Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md 21205, USA.
JAMA. 1996 Jan 10;275(2):122-7.
To identify behavioral and sociodemographic risk factors for incident human immunodeficiency virus-1 (HIV-1) infection among healthy young men in northern Thailand.
Men inducted into military service in northern Thailand in May and November 1991 were followed at 6-month intervals until discharge 2 years later. Trained nonmilitary interviewers identified risk factors for HIV-1 infection through interviews with the men.
Thirteen military bases in northern Thailand.
A total of 1932 seronegative men, aged 19 to 23 years (average age, 21 years) at enrollment, conscripted into the Royal Thai Army and Air Force from six upper-northern Thai provinces.
Human immunodeficiency virus-1 seroincidence as determined through enzyme-linked immunosorbent assay and verified by Western blot, and univariate and multivariate analyses of risk factors related to HIV-1 incidence.
A total of 85 men seroconverted to HIV-1 over the period of observation, giving an incidence rate of 2.43 per 100 person-years. Factors strongly associated with HIV-1 seroconversion were frequency of visits to female commercial sex workers (CSWs), sex with men, and incident sexually transmitted diseases (STDs). High frequency of condom use showed a significant (P < .001) protective effect for HIV-1 incidence among men with a history of recent sex with female CSWs in univariate analysis, but a multivariate model demonstrated no difference in HIV-1 seroconversion rates by consistency of condom use. Multivariate analysis incorporating condom use showed that having sex with men (adjusted relative risk [RR], 2.59; 95% confidence interval [CI], 1.08 to 6.25), having sex with CSWs (adjusted RR ranged from 2.54 [95% CI, 1.81 to 3.58] to 2.74 [95% CI, 1.56 to 4.81]), and incident STDs (adjusted RR, 2.38 [95%, CI, 1.31 to 4.32]) to be predictors of incident HIV-1 infection. Substance use was not associated with HIV-1 seroconversion rates in multivariate analysis.
The HIV-1 incidence in this cohort of young men appears to be primarily attributable to having sex with female CSWs. Condom use provided some protection, although not in multivariate analysis; however, condom use has previously been shown likely to be useful in preventing HIV-1 transmission. Thus, programs to increase effective condom use in brothels are essential. Efforts to extend condom use to non-CSW partners are especially needed. More effective prevention and treatment of STDs may also be necessary to decrease HIV-1 infection in this population.
确定泰国北部健康年轻男性感染人类免疫缺陷病毒1型（HIV-1）的行为和社会人口学风险因素。
1991年5月和11月在泰国北部应征入伍的男性，每6个月随访一次，直至2年后退伍。经过培训的非军事访谈员通过与这些男性访谈来确定HIV-1感染的风险因素。
泰国北部的13个军事基地。
共有1932名血清阴性男性，入伍时年龄为19至23岁（平均年龄21岁），从泰国北部六个省份应征加入泰国皇家陆军和空军。
通过酶联免疫吸附测定确定并经免疫印迹法验证的HIV-1血清阳转率，以及与HIV-1感染率相关的风险因素的单变量和多变量分析。
在观察期内共有85名男性血清转化为HIV-1，发病率为每100人年2.43例。与HIV-1血清转化密切相关的因素包括拜访女性商业性工作者（CSW）的频率、与男性发生性行为以及新发性传播疾病（STD）。在单变量分析中，高频率使用避孕套对近期有与女性CSW发生性行为史的男性的HIV-1感染率显示出显著（P <.001）的保护作用，但多变量模型显示避孕套使用的一致性对HIV-1血清转化率没有差异。纳入避孕套使用情况的多变量分析表明，与男性发生性行为（调整后的相对风险[RR]，2.59；95%置信区间[CI]，1.08至6.25）、与CSW发生性行为（调整后的RR范围从2.54[95%CI，1.81至3.58]至2.74[95%CI，1.56至4.81]）以及新发STD（调整后的RR，2.38[95%，CI，1.31至4.32]）是HIV-1感染的预测因素。在多变量分析中，物质使用与HIV-1血清转化率无关。
这一队列年轻男性中的HIV-1感染率似乎主要归因于与女性CSW发生性行为。使用避孕套提供了一定的保护，尽管在多变量分析中并非如此；然而，此前已表明使用避孕套可能有助于预防HIV-1传播。因此，在妓院增加有效使用避孕套的项目至关重要。尤其需要努力将避孕套的使用推广到非CSW性伴侣。为减少该人群中的HIV-1感染，可能还需要更有效的性传播疾病预防和治疗措施。
