Abstract
Although HIV prevalence remains high among Bangkok’s MSM early HIV testing as an entry point to ART has not been successfully implemented among in this population. Men who present late for initial HIV testing are a particular concern in the context of the Bangkok HIV epidemic, in that if long-term positives have had condomless sex during the time that they remained untreated they are likely to have been efficient transmitters of infection, to say nothing of the implications for their own health. A sequential sample of MSM who tested HIV positive, and CD4 counts, was taken at the Thai Red Cross Anonymous Clinic and two drop-in centers in Bangkok. Inclusion criteria were MSM aged >18 years, having not tested HIV positive earlier, who reported ≥1 of the following in the previous 6 months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection (STI) diagnosis. Analysis was conducted by distinguishing between three groups of CD4 counts: <200, 200–500, >500 cells/μ to identify the social and behavioral characteristics of the men who presented late for HIV testing. Median CD4 was 325 cells/μ(n = 95). MSM with initial CD4< 200 cells/μ were significantly more likely to report problematic alcohol use. They were also more likely to report receptive anal sex and more likely to be engaged in sex work. MSM with CD4< 200 cells/μ were less likely to report recent HIV testing. Main barriers to HIV testing included being afraid of finding out that they were HIV positive and concerns about efficacy and side effects of HIV treatment. HIV stigma and concerns about treatment are still widespread and are potential barriers to HIV care among MSM in Bangkok. These barriers may work to keep men from finding out their positive HIV status in a timely manner. Thai MSM need to be made aware of the current availability of friendly HIV testing and ART services, and public health programs need to work to change their perceptions regarding ART itself. These same types of strategies might also work to destigmatize HIV and MSM within Thai society as a whole.
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Acknowldgements
This study was funded by amfAR, The Foundation for AIDS under two awards. The first amfAR award# 108,805 “A training program for HIV research among MSM/TG in developing world settings” (Pittsburgh) and 109,049 “Factors that contribute to unknown HIV seropositivity and influence HIV testing patterns among high risk MSM” (Thailand). The protocol was developed with help from colleagues at the Center for LGBT Health Research at the University of Pittsburgh’s Graduate School of Public Health. The study team also wants to thank all helpful staffs at all 3 research sites, including Thai Red Cross Anonymous Clinic (TRCAC), Rainbow Sky Association of Thailand (RSAT), and The Service Workers in Group Foundation (SWING). Finally, this study could not have been conducted without the participation of the men who presented for HIV testing and agreed to contribute to this study.
Funding
This study was funded by amfAR, The Foundation for AIDS under two awards. The first amfAR award# 108,805 “A training program for HIV research among MSM/TG in developing world settings” (Pittsburgh) and 109,049 “Factors that contribute to unknown HIV seropositivity and influence HIV testing patterns among high risk MSM” (Thailand).
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Authors Sapsirisavat, Phanuphak, Egan, Pussadee, Klaytong, Friedman, van Griensven, and Stall declares that they have no conflict of interest.
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This study involve human participants (MSM). All procedures were approved by both University of Pittsburgh IRB and Faculty of Medicine Chulalongkorn University IRB along with those ethical standards (already stated in the method section). Therefore, all procedures were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments orcomparable ethical standards.
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Informed consent was obtained from all participants in the study using an electronic informed consent procedure.
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Sapsirisavat, V., Phanuphak, N., Sophonphan, J. et al. Differences Between Men Who Have Sex with Men (MSM) with Low CD4 Cell Counts at Their First HIV Test and MSM with Higher CD4 Counts in Bangkok, Thailand. AIDS Behav 20 (Suppl 3), 398–407 (2016). https://doi.org/10.1007/s10461-016-1456-0
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DOI: https://doi.org/10.1007/s10461-016-1456-0