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March 3, 1998
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Condom Use In Thailand Dramatically Cuts HIV Infection

A five-year educational campaign to increase condom use in Thailand has led to a fivefold decrease in HIV infection among young army draftees in northern Thailand and a tenfold decrease in sexually transmitted diseases (STDs) overall, according to Johns Hopkins researchers.

The program, set up by the Thai government, would, if copied, lead to significant decreases in the rates of AIDS and STDs in other Asian countries, the researchers say.

Results of the study appear in the March 26 issue of the journal AIDS.

"This shows how important it is to educate sexually active people on the use of condoms," says David D. Celentano, Ph.D., professor of health policy management.

STDs, such as syphilis and chancroid, are the leading risk factor for HIV infections, says Celentano. They create breaks in the skin in the genital area, allowing HIV to invade the body more easily, and increase the number of immune system cells called macrophages and T cells, which are the preferred targets of HIV. T cells serve as "factories" that produce more of the virus.

The Hopkins study followed two groups of Thai army draftees from six northern provinces in 1991 (n= 2,417) and 1993 (1,669). The study began after the start in 1991 of the "100% Condom Program," a public health effort to reduce sex with prostitutes and promote condom use.

Within a few weeks of induction into the army and at each six-month follow-up visit, men were tested for HIV infection and interviewed about their backgrounds and sexual histories.

The Hopkins team found the HIV rate among 1991 draftees studied during 1991 to 1993 was five times higher than the rate among 1993 draftees studied during 1993 to 1995. The rate of STD among draftees decreased 10 times during the same two periods studied.

The Hopkins researchers also found that draftees were more at risk for HIV if they had a history of prior STD and sex with girlfriends and prostitutes.

The study was supported by the Rockefeller Foundation (New York), the Walter Reed Army Institute of Research, the Armed Forces Research Institute of Medical Sciences (Bangkok, Thailand), the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, and Family Health International (Research Triangle Park, N.C.).

Other authors of the study include Kenrad E. Nelson, Cynthia M. Lyles, Chris Beyrer and Vivian F.L. Go (Johns Hopkins); Sakol Eiumtrakul (Kawila Hospital, Royal Thai Army Medical Corps); Surinda Kuntolbutra and Chirasak Khamboonruang (Research Institute for Health Sciences, Chiang Mai University, Thailand).

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