The DR Congo-Uganda corridor: One Health promised, not delivered.
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Letter↗
Biomedical subjects
Peter H Kilmarx
Publications and source records attributed to Peter H Kilmarx.
Rapid whole-blood finger-stick test for HIV antibody: performance and acceptability among women in northern Thailand.
Although use of rapid HIV antibody tests of finger-stick blood specimens could expand voluntary counseling and testing in areas where fear of venipuncture and delays in learning test results are barriers, there is little information on performance and acceptability of these tests in Asia. We used the Hema. Strip HIV-1/2 test (Saliva Diagnostic Systems, Vancouver, WA) in a prospective cohort study of HIV seroincidence among women in northern Thailand from 1998 to 1999. Nurses obtained whole-blood specimens by finger-stick testing and provided test results and counseling at each visit. Acceptability of the rapid test was assessed at the first 6-month follow-up visit. HIV-1 seroprevalence among the 804 women screened at enrollment was 3.1%. Positive rapid test results from 25 women were confirmed by enzyme immunoassay and Western blot analysis using serum obtained by venipuncture. Of the 741 women who returned for follow-up, 56% preferred specimen collection by finger-stick testing to venipuncture, 80% preferred immediate rather than delayed test results, 79% preferred the rapid test method to typical testing methods, and 97% were satisfied with the test method used. Results from this study demonstrate the utility and acceptability of the rapid finger-stick test for HIV antibody among women in northern Thailand.
AIDS Serodiagnosis↗
Need for a true placebo for vaginal microbicide efficacy trials.
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Acrylic Resins↗
Knowledge and perceptions of HIV among peripartum women and among men whose wives are of reproductive age, northern Thailand.
To investigate knowledge and perceptions of HIV transmission risk and interest in vaginal microbicides in northern Thailand, we conducted 14 focus group discussions and 80 interviews with men and women in Chiang Rai province. Women were recruited from antenatal or postpartum clinics, and men from various work sites. Participants evinced substantial knowledge about HIV, with two exceptions important for prevention campaigns: (a) confusion about the window period between a new infection and positive HIV-test result and (b) overestimation of the safety of extramarital sex with partners who are not sex workers. Most participants reported no personal HIV risk. Participants described Thai women as generally vulnerable to HIV infection because of the unlikelihood of condom use with their husbands and because women cannot control their husbands' extramarital behavior. Women apparently face particular risk after childbearing; peripartum abstinence averages 6-9 months, during which time some Thai men may have alternative sex partners. Women, and to a lesser degree, men were interested in potential microbicides, although they voiced many thoughtful questions about the products and about efficacy trials.
Adolescent↗
High rates of pregnancy among vocational school students: results of audio computer-assisted self-interview survey in Chiang Rai, Thailand.
Unplanned pregnancy among young people can lead to adverse social, psychological, and health outcomes, particularly when it results in abortion. In 1999, we examined the prevalence of and factors associated with pregnancy and abortion among 1725 consenting vocational school students in northern Thailand. Results from an audio computer-assisted self-interview showed that 48% of the male and 43% of the female students reported ever having had sexual intercourse. Among those who had had intercourse, 27% of the women and 17% of the men said they or their partner had ever been pregnant. Among the last reported pregnancies that resulted in delivery or abortion, 95% were aborted. Age, current contraceptive use, early initiation of sexual intercourse (</=16 years), alcohol and drug use, and sexual coercion were associated with self or partner pregnancy. The high rates of pregnancy and abortion in this population indicate the need for better sexual health education and access to effective contraceptive methods.
Abortion, Illegal↗
Risk factors for sexually transmitted diseases in northern Thai adolescents: an audio-computer-assisted self-interview with noninvasive specimen collection.
BACKGROUND: Previous studies of sexual behavior and sexually transmitted diseases (STDs) in Thai adolescents may have been limited by participation bias and underreporting of stigmatized behaviors. GOAL: The goal was to increase knowledge about risk behaviors and STDs among youths in Thailand. STUDY DESIGN: Students aged 15 to 21 years completed an audio-computer-assisted self-interview. Oral fluid was tested for HIV antibodies and urine was tested for Chlamydia trachomatis and Neisseria gonorrhoeae nucleic acids with polymerase chain reaction. RESULTS: Of 1736 invited students, 1725 (99.4%) agreed to participate. Overall, C trachomatis infection was detected in 49 (2.8%), and there were five cases (0.3%) each of infection with N gonorrhoeae and HIV. Among those who reported sexual intercourse, the prevalence of chlamydial infection was 3.7% among men and 6.1% among women. Logistic regression analysis showed age-adjusted factors associated with chlamydial infection among men to be parents' occupation in agriculture, having sold sex, having a sex partner who had been pregnant, and the number of casual sex partners during lifetime. Among women, age-adjusted factors were parents' occupation in agriculture, number of casual partners during lifetime, having an older sex partner, and perception of higher HIV infection risk. CONCLUSION: These adolescents had high rates of unprotected intercourse and are at risk for STDs. Prevention programs should emphasize use of effective contraceptive methods, including condom use; reducing the number of sex partners (stressing the risk a partner of older age may pose to female adolescents); and reducing engagement in commercial sex.
Adolescent↗
Prevalence of lower genital tract infection among women attending maternal and child health and family planning clinics in Hanoi, Vietnam.
To determine the prevalence of lower genital tract infection (LGTI) with Candida spp, Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, and bacterial vaginosis among symptomatic and asymptomatic women attending maternal and child health and family planning (MCH/FP) clinics in Hanoi, Vietnam. A multi-centered, cross-sectional descriptive study stratified by reported symptoms of vaginal discharge was carried out in three MCH/FP clinics among 1,000 women aged 18-44 years in 1998. Of these, 89.1% lived in Hanoi, 97.6% were currently married, and 99.2% had only one sexual partner in the past 12 months. Regarding their contraceptive use, 28.2% did not use any contraception, 25.6% used an intrauterine device (IUD), 22.8% used condoms, and 23.4% used other methods. The overall prevalence of Candida spp was 11.1% (95% CI = 9.1-13.1%); T. vaginalis, 1.3% (95% CI = 0.6-2.0%); no gonococcal infection was found; the prevalence of C. trachomatis was 4.4% (95% CI = 3.1-5.7%); and of bacterial vaginosis, 3.5% (95% CI = 2.4-4.6%). The presence of LGTI was not associated with reported symptom of vaginal discharge. LGTI was common among married and monogamous women attending MCH/FP clinics in Hanoi, of whom many used IUDs and may have an increased risk of complications in the presence of LGTI. The lack of association between symptoms and laboratory-confirmed infection underscores the challenge of diagnosing LGTI when laboratory testing is not available.
Adult↗
Sexual coercion among adolescents in northern Thailand: prevalence and associated factors.
Sexual coercion was assessed in a cross-sectional survey of drug use and sexual behavior in vocational school students from Chiang Rai, Thailand (n = 1725; ages 15-21), using audio-computer assisted self-interview. Sexual coercion was reported by 6.5% of males and 21% of females. Mean age at first occurrence was 16 years (range 8-20) among males and 17 years (range 5-21) among females. Most perpetrators were male (52% among males; 98% among females) and known by the participants. Among females, associated factors were history of pregnancy, selling sex, marijuana use, perceived risk of STD, two or more lifetime sexual partners, and living away from family. Among males, associated factors were homo- or bisexual self-identification, parents living together, and ulcerative STD history.
Adolescent↗
Incidence of HIV-1 infection and effects of clinic-based counseling on HIV preventive behaviors among married women in northern Thailand.
To determine the incidence of and risk factors for HIV-1 infection among married women in northern Thailand, we enrolled 779 seronegative women from family planning clinics and a postpartum ward in Chiang Rai, Thailand, from 1998 through 1999. Women were tested for HIV antibodies at 6 and 12 months after enrollment. They received HIV prevention counseling at enrollment and at each follow-up visit. Counseling covered partner communication, partner HIV testing, and condom use by steady partners. Effects of counseling were measured using standardized questionnaires. Follow-up rates were 94% at 6 months and 92% at 12 months. Only 1 woman seroconverted during the follow-up period, yielding an overall HIV incidence of 0.14 per 100 person-years. After receiving counseling, women reported significantly increased communication with husbands concerning HIV risk, HIV testing, and condom use during the first 6 months after enrollment; communication remained high for 6 to 12 months. Women reported a modest increase in HIV testing and consistent condom use by husbands. The risk for HIV transmission to women in steady relationships is low in northern Thailand. Although HIV prevention counseling promoted partner communication, its effects on HIV preventive behaviors were limited.
Adolescent↗
Commentary: virus, host, or environment?
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Developing Countries↗
Prevalence of and risk factors for methamphetamine use in northern Thai youth: results of an audio-computer-assisted self-interviewing survey with urine testing.
AIMS: Data from drug treatment facilities, drug seizures and drug arrests suggest rapidly increasing methamphetamine use by adolescents in Thailand. However, limited quantitative data are available about the prevalence of its use or correlates of use. The purpose of our study was therefore to estimate the prevalence of methamphetamine use and to identify possible risk factors. DESIGN: Cross-sectional survey using anonymous audio-computer-assisted self-interview and urine specimen analysis. SETTING: Chiang Rai Province, Thailand. PARTICIPANTS: 1725 students, 15-21 years of age (893 male and 832 female) attending one of three vocational schools in Chiang Rai Province. FINDINGS: Three hundred and fifty male and 150 female students reported a history of having ever used methamphetamine. In addition, 128 male and 49 female students had positive urine test results, indicating recent methamphetamine use; 27 of these students denied having ever used methamphetamine. According to history, urine test, or both, 41.3% of male students and 19.0% of female students used methamphetamine. In multivariate analysis, methamphetamine use was highly correlated with the use of other substances, sexual activity, peer pressure, positive attitudes toward methamphetamine, and absence of a family confidant. CONCLUSIONS: Methamphetamine use is common among adolescent students in northern Thailand. Demographic, behavioral and psychosocial correlates of methamphetamine use identified in this study may be helpful for the design and implementation of preventive interventions.
Adolescent↗
Multiclonal increase in ciprofloxacin-resistant Neisseria gonorrhoeae, Thailand, 1998-1999.
BACKGROUND: isolates exhibiting clinically significant resistance to fluoroquinolones have been isolated most frequently in Asian and western Pacific countries, including Thailand. In Bangkok, Thailand, ciprofloxacin has been used to treat gonorrhea since 1987. GOAL: Our goal was to determine the prevalence of isolates of that exhibit resistance to ciprofloxacin in Bangkok and to characterize these strains with regard to ciprofloxacin MICs, auxotype/serovar (A/S) classification, A and C mutations responsible for ciprofloxacin resistance, and outer membrane lipoprotein (Lip) subtype analysis. STUDY DESIGN: MICs of gonococcal isolates from consecutive patients attending the Bangrak Hospital STD Clinic in Bangkok were determined by agar dilution. A/S class was determined by established procedures. Mutations within A and C were determined by DNA sequencing. Lip subtypes were determined by PCR and DNA sequencing. RESULTS: In 1998 and 1999, 115 of 168 isolated strains of exhibited decreased susceptibility or resistance to ciprofloxacin, and three cases of possible ciprofloxacin treatment failure were identified. Ciprofloxacin-resistant (CipR) strains increased from 13.8% (8/58) in 1998 to 25.4% (28/110) in 1999 ( = 0.08). Ciprofloxacin MICs of CipR isolates ranged from 1.0 microg/ml to 32.0 microg/ml. CipR strains belonged to a number of A/S classes and Lip subtypes. Different CipR strains contained alterations at both amino acid 91 and amino acid 95 of A and also contained an amino acid alteration in C. These alterations are known to be involved in gonococcal resistance to ciprofloxacin. CONCLUSIONS: The prevalence of CipR strains of isolated in Bangkok increased substantially in the 1990s. Characterization of the CipR isolates revealed a number of different strain subtypes, indicating that CipR isolates in Bangkok are not from a single clonal source and therefore result from multiple cases of importation or local emergence. Because of the high level of CipR isolates at Bangrak Hospital, in 2000 the Thai Ministry of Public Health issued recommendations against the use of fluoroquinolones for the treatment of gonococcal infection in Thailand.
Anti-Infective Agents↗
Condom use among vocational school students in Chiang Rai, Thailand.
Condom use and its psychosocial correlates were investigated in a sample of 1,725 male and female vocational students (aged 15-21 years) in northern Thailand. Consistent condom use was relatively infrequent with all partner types (8.0% with recent steady partners, 28.5% with casual partners, and 30.7% with commercial sex partners), and only 24.3% reported condom use at first sex. These findings suggest that condom use, even with commercial partners, is not becoming widely established in the younger generation of Thai youths. Condom use with commercial partners was far below goals established by Thailand's 100% Condom Campaign, which was particularly significant for a population in Thailand's HIV epicenter. Consistent condom use with a steady partner was significantly related to condom use during first sex, which suggests the importance of establishing a "condom habit." Consistent condom use with casual partners was related to never having been pregnant (self or partner). Having used condoms at first sex also was associated with never having been pregnant (self or partner), as well as with a number of background social and psychological factors. Intentions to use condom were highly related to peer norms. Results suggest the importance of addressing peer norms concerning condom use, as well as the role of condoms in effective birth control.
Adolescent↗