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The importance of military conscripts for surveillance of human immunodeficiency virus infection and risk behavior in Thailand.

Current HIV Research 2016 October 7
The human immunodeficiency virus (HIV) epidemic in Thailand was first recognized in 1988 among injection drug users (IDUs) in Bangkok. Soon thereafter, HIV infections were reported among female sex workers (FSWs) and men attending sexually transmitted disease (STD) clinics. Routine serological surveillance for HIV began in 1991 among young men who were conscripted annually into the Royal Thai Army (RTA). The data from these populations provided a national population-based sample to determine sexual behaviors and HIV prevalence among sexually active young men. The men were selected by a random process that conscripted about 10% of 21 year-old men from throughout Thailand each year. HIV seroprevalence data from these men provided data to evaluate the spread of the epidemic in the young male population throughout the country. In 1991, the Ministry of Public Health established the "100% Condom Program" to prevent sexual transmission of HIV. The data from cohorts of RTA conscripts showed a dramatic reduction in HIV seroprevalence among successive cohorts between 1991 and 1995.The reduced HIV prevalence among military conscripts was found to be associated with substantial temporal changes in sexual behavior, including increased condom use during sex with FSWs and less frequent commercial sex. In 1998, men with a history of injection drug use had a higher HIV prevalence than those with a history of sex with FSW. After 2005, men with a history of sex with men had the highest HIV prevalence. In conclusion, surveillance of HIV among military conscripts in Thailand has provided critically important data to monitor this evolving epidemic, which has been useful to evaluate prevention programs and modify their focus.

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