March 5, 1996
Media Contact: Marc Kusintz
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"If the prostitute is HIV positive, the brothel is notified, but generally the women remain working until they develop symptoms."

Because the majority of Thai men still have sex with prostitutes, marriage is the number one risk factor among Thai women for becoming infected with HIV, according to a study by researchers at Johns Hopkins and other institutions.

Despite the AIDS epidemic in Thailand and a huge government condom campaign, men of all ages and marital and socioeconomic status still visit prostitutes and have unprotected sex with their wives, the study found. "The AIDS epidemic has made prostitution less popular, but business is still thriving," says David Celentano Sc.D., professor of health policy and management at the Johns Hopkins School of Public Health. "Eighty-five percent of all men over the age of 16 have visited prostitutes, down from ninety-six percent in 1993." Because men rarely use condoms with their wives, the next wave of the epidemic is going to be heterosexual monogamous women.

Thailand's AIDS epidemic is the second fastest-growing epidemic in the world, overshadowed only by India, with an expected 2 million cases by the year 2000, according to Celentano. Celentano is the lead author of the study published in a recent issue of the Journal of the American Medical Association.

"Programs that increase effective condom use in brothels are essential to slow the epidemic," says Celentano. In 1989, the ministry of Public Health in Thailand instituted a "100% Condom Campaign" that supplied condoms to brothels and persuaded brothel owners to enforce their use according to Celentano.

The government tests women for sexually transmitted diseases every two weeks and HIV every three months, says Celentano. "If the prostitute is HIV positive, the brothel is notified but generally the women remain working until they develop symptoms."

The Hopkins team studied 1,932 healthy men, ages 19 to 23, who were drafted into the Royal Thai Army and Air Force from northern Thailand. During the 22-month study, the researchers examined their social and economic background, lifetime and recent sexual history, use of condoms, medical history, and drug use. During the study, 85 men became infected with HIV. "Because Thai men are randomly chosen for the draft, they represent a cross-section of the male population," Celentano says.

Other authors of the study include Kenrad Nelson and Surinda Kuntolbutra (Johns Hopkins School of Public Health), Anuchart Matanasarawoot, Somboon Suprasert, and Choti Theetranont (Chiang Mai University), Sakol Eiumtrakul (Royal Thai Army), Supachai Tulvatana (Royal Thai Air Force), Pasakorn Akarasewi (Ministry of Public Health, Chiang Mai), Nicholas H. Wright (Robert Wood Johnson Medical School) and Narongrid Sirisopana (Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand).

The study was supported by grants from the Rockefeller Foundation and the Walter Reed Army Institute of Research-Armed Forces Institute of Medical Sciences, Bangkok, Thailand.

-- JHMI --
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