From June 1992 to May 1993, 39,939 Thai men attended the clinic for laborers going abroad at Siriraj Hospital in Bangkok for a pre-assignment physical exam and mandatory blood screen for HIV and syphylis. Of this total, 438 tested positive for HIV antibody (1.1%). Of these, 215 men returned for post test interview and physical exam and were compared with 1,348 men randomly selected HIV-1 seronegative men. None of the HIV-1 seropositive had a history of injecting drug use or had received blood transfusion in the past seven years. HIV-1 seropositivity was associated with the TPHA serological marker for syphylis > 1.160 (p = 0.015, odd ratio 1.8), history of urethritis (p = 0.009, odd ratio 1.92) (Table 4). This study found that HIV-1 seropositive men were mostly single, were likely to be from the rural northern provinces of Thailand or Bangkok. History of purchase of low-fee commercial sex and less condom use were significantly associated with HIV-1 seropositivity as was a history of STD in the year prior to interview. Information on HIV disease and pre-test/post test counselling is needed for Thai laborers who are applying for work abroad to countries which require HIV and syphylis screening. In this effort, the Ministry of Labor and Social Welfare, the Ministry of Public Health and the clinic for laborers going abroad should join forces to provide this service. This will serve to increase awareness and self-determination among an increasingly vulnerable segment of the population who also have the potential to spread HIV infection to their spouse and other sex partners.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: According to data from the Siriraj Hospital Medical School, where mandatory human immunodeficiency virus (HIV) screening is provided for Thais who travel abroad as contract laborers, the incidence of HIV infection in this population group increased from 0.25% in 1989 to 1.16% in 1992. To assess the risk factors associated with this trend, interviews were conducted with every 25th laborer out of the 39,939 men who presented to the clinic from June 1992 to May 1993. This yielded a sample of 1786 men, 438 of whom were HIV-positive. However, only 215 HIV-positive men returned to the clinic, resulting in a sample of 1563 men (average age, 31.4 years). None of the seropositive subjects had a history of intravenous drug use or blood transfusion. HIV-infected laborers were significantly more likely than their noninfected counterparts to be single, from the Northern and Central provinces, and to be less educated and unskilled. 75.3% of HIV-positive men, compared to 19.5% of seronegative men, had engaged in commercial sex in the past year and were more likely than their counterparts to have visited a low fee (under 100 baht) brothel-based prostitute. The rate of condom use during commercial sex encounters was 59.3% among seropositive men compared to 68.9% among seronegative men. 53.7% of seropositive men, compared to 33.1% of their seronegative counterparts, reported having a sexually transmitted disease (especially urethritis) in the preceding year. Given the threat that HIV-infected itinerant laborers will transmit the virus to others in their home provinces, it is recommended that HIV prevention education become a part of labor recruitment; also urged are continued efforts to promote the goal of 100% condom use in Thailand's commercial sex industry.