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Abstinence in HIV Prevention: Science and Sophistry - Authors Reply. A Farewell to Abstinence and Fidelity? Epidemiology Bureau, Department of Health, Philippines. Practical Guidance for Collaborative Interventions. Epidemiology Bureau, Department of Health Philippines. International Sex Worker Rights Day. Yet fewer than 1, of these men started taking antiretroviral treatment despite it being available for free. A study of men who have sex with men in Bangkok found HIV incidence to be much higher in younger men 8. In Thailand, HIV prevalence is far greater among male sex workers than female.
This may be the result of a lack of information about HIV or a lack of access to services. Globally, transgender people are the most at-risk group of sex workers, with HIV prevalence estimated to be on average nine times higher than for female sex workers and three times higher than for male sex workers. There are more than 75, transgender people living in Thailand. A large proportion of transgender people also sell sex making them increasingly vulnerable to HIV. There are a number of reasons transgender men and women are being left behind in prevention and treatment work.
Discriminatory heath systems, transphobia, family rejection and a lack of access to education and employment all discourage transgender people from seeking HIV services. Although the need for harm reduction is increasingly accepted in Thailand, a largely punitive policy and legal environment focused on drug control continues to undermine access. Thailand still operates compulsory detention centres for people who use drugs, which deters many from seeking essential health services. Migration can put people in situations that heighten vulnerability to HIV, due to factors such as social exclusion and a lack of access to healthcare services or social protection.
In South-East Asia, HIV prevalence among migrants to Thailand from neighbouring countries is up to four times higher than among the general population. In a behavioural survey conducted in 24 provinces among migrant workers aged , Fishermen and those working in the sea-food processing industry were particularly likely to pay for sex. In Thailand, the vast majority of sex workers are migrants from villages, who use the income from sex work to support families in their home communities.
New Rise in HIV/AIDS Cases Among Young in Thailand
As of September 30, , the number of migrants who registered with the migrant health insurance stood at 1. HIV-related stigma and experiences of stigma and discrimination in healthcare are recurring barriers that prevent people from testing for HIV. Criminalisation is also an issue, especially for people who use drugs who fear arrest or detention.
Ethnicity or migrant nationality, sexual orientation, mental health issues or being co-infected with tuberculosis, are additional layers of stigma that prevent people from testing. Age has also been a barrier to HIV testing, although a ban on people aged 18 and under testing for HIV without parental consent was lifted in New approaches have been introduced to increase access to, and demand for, HIV testing among key affected populations, including the following:. This is a five-year project that started in and is being implemented in Thailand by FHI and local community-based organisations.
Those who test positive for HIV are then supported by their peers to access treatment and care. As of , HIV self-testing kits oral or blood-based have not been granted a clinical licence. However, a self-testing pilot study among men who have sex with men and transgender women was being conducted with a view to wider implementation if proven effective.
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In , 6, people in Thailand became infected with HIV. Roughly two-thirds of whom were identified as male 4, infections among those classified as men, compared to 2, infections among those classified as women. There were less than new infections among children years. Subsequent condom distribution and awareness campaigns have since run and often target young people. Despite this, condom use among this age group is low. For instance, Thailand has the second highest rates of teenage pregnancy in South East Asia. In addition to the individuals who seroconverted, 19 individuals seroreverted The relative risk of infection was increased almost fold if the recruit was born in the upper north.
This finding implies that the most important risk to the recruit is the location of birth rather than the location of the military base". The reason for the geographical concentration of the HIV-1 epidemic to the upper north of Thailand is fundamentally unknown". These conclusions can be questioned on several grounds.
From such studies, it is impossible to determine if one infectious agent is transmitted from men to women or vice versa. There was no laboratory confirmation of the STD history. In the Weniger et al. STD questions used well-known Thai terms for urethritis nong nai: One must question the validity of STD diagnosed retrospectively, without obtaining an isolate or other laboratory confirmation and employing self-diagnosis assisted by pictures and medical students.
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When the men had VDRL tests for syphilis, 4. The finding that "none of the 46 men who reported receptive anal sex was HIV-1 seropositive, compared with eight Thus, the only sexual act which leads to seropositivity is receptive anal intercourse, and perhaps receptive oral intercourse. The only reliable evidence from North America or anywhere else, regarding "female-to-male transmission of HIV", is found in Nancy Padian's prospective study of heterosexual couples where, from a cohort recruited from to March involving 72 male partners of HIV infected women, there was "one probable instance" of female-to-male transmission Padian et al.
This means that either there is something fundamentally wrong with the serological data or its interpretation , or that not only HIV is unidirectionally transmitted but it is transmitted in one direction in one continent and the opposite in others. According to Nelson et al.
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However, both groups found a direct relationship between a positive WB and condom use, "increased condom use was associated with an increased risk for HIV-1", "indeed, those who reported ever having used a condom with a CSW had a higher HIV prevalence". This finding also means if as the authors of the two studies claim a positive WB is proof that the men have been infected with HIV by CSW , that unlike all sexually transmitted agents HIV is more efficiently transmitted with condoms than without them.
New Rise in HIV/AIDS Cases Among Young in Thailand
In all the studies from Thailand a positive WB is considered synonymous with HIV infection although such a claim is not supported by the presently available data. When the antibody tests were introduced to define HIV infection, Montagnier and his colleagues considered the presence of a p24 band as the only HIV specific band.
In contradistinction, Gallo and his colleagues considered only the presence of antibodies to the glycoprotein gp41 specific to HIV. When the Western blot was initially introduced for diagnostic purposes only the gp41 band could be detected. Later, when the test conditions were modified, the gp and gp bands could also be detected. Both Montagnier's and Gallo's interpretations are at odds with the knowledge available in the early s.
Moreover, the origin of the internal gs antigen of avian viruses, and consequently of murine viruses, may not be as obvious as stated. This is suggested by the finding of an apparently identical antigen in chicken cells free of visible virus-like particles" Vigier In , Gelderblom and his colleagues wrote: The major protein constituent of mammalian C-type oncornaviruses with a molecular weight in the range of 30, d was found to possess, besides gs spec. Thus, even if p24 and antibodies present in human sera which react with it are specific to a human retrovirus, they cannot be considered HIV specific.
In a paper published in Gallo and his colleagues acknowledged that antibodies which react with the retroviral glycoproteins are not directed against the virus coded polypeptide portion "but against the carbohydrate moieties on the molecule that are introduced by the host cell as a post-transcriptional event, and which are therefore cell-specific and not virus-specific" Kalyanaraman et al. However, by it was realised that antibodies which react with p24 are widespread in human sera.
The scores of all bands were summed However, to date, the specificity of the HIV antibody tests has not been verified by use of viral isolation, the only valid independent gold standard for the antibody tests. Furthermore, considering the many problems associated with HIV isolation this may not even be feasible Papadopulos-Eleopulos et al. The generally accepted "specificity of roughly An additional problem with the use of "virus isolation" as a gold standard is the fact that HIV cannot be "isolated" from all antibody positive patients.
While genetic techniques are employed for the diagnosis of HIV infection they are highly problematic. With the polymerase chain reaction PCR "only small regions may be amplified, a gene at best" Wain-Hobson and since the majority of HIV "isolates" studied to date are defective, that is, they lack one or several genes, finding a gene is not proof of the existence of the whole genome. Even if the whole genome were present this still is not proof of the presence of a retroviral particle because the genome may not be expressed.
Elsewhere, evidence has been presented that the Western blot is non-specific for HIV infection Papadopulos-Eleopulos et al. Here, some additional supporting evidence as well evidence directly related to Thailand is presented:. The presence of p24 bands was common" Belshe et al. Polyclonal antibodies to mannan from yeast also recognize the carbohydrate structure of gp of the AIDS virus" Muller et al.
Franchi ; iv sera from 29 patients with Sjorgen's syndrome SS and 25 with systemic lupus erythematosus SLE who were positive for antinuclear antibodies were also tested. Three of fourteen Immature particles are "highly labelled", but so is the rest of the cell from which they are budding. This, the authors conclude, "might be due to the fact that natural immune sera are indeed polyspecific" Hausman et al.
Even if there was evidence in other studies that the specificity of the HIV antibody tests was very high, such a finding may not be valid for the studies in Thailand. In Thailand "HIV-seropositivity" is apparently restricted to the northern provinces of the country and although all groups expressed the view that "The reason for the higher HIV infection rates in northern Thailand than in other parts of the country is unclear", Weniger and his associates added: Questionnaires were self-administered in a non-anonymous manner to men of generally low educational background.
It may be expected that stigmatised behaviour, such as illicit drug use and homosexuality would be under reported".