Human immunodeficiency virus infection and self-treatment for sexually transmitted diseases among northern Thai men.

ABSTRACT

PIP: In May 1993, at 11 military camps in the upper northern region of Thailand, civilians interviewed 869 men aged 21-29 years (most of whom were 21 years old) so researchers could determine the frequency and variety of self-treatment and self-prophylaxis behaviors for sexually transmitted disease (STD) and the relationship of these behaviors with the prevalence of HIV infection. 12.3% of the men at conscription into the military tested positive for HIV infection. 32.5% had ever had an STD. The leading STDs and syndromes were gonorrhea (16.1%), penile discharge with pus (15.5%), and pain while urinating (11.4%). HIV-positive men were more likely to have had sex with commercial sex workers (CSWs) (odds ratio [OR] = 9.14), to have had an STD (OR = 5.96), and not to use condoms consistently when having sexual intercourse with CSWs (OR = 3.13). 65.2% of men who had ever had an STD self-treated with antibiotics. 8.5% of men who had ever had an STD used antibiotics, particularly chloramphenicol, before having intercourse with a CSW. Among all the men who had sexual intercourse with CSWs, almost all (98.7%) had adopted steps to prevent STDs: increasing urine output (69.2%), washing the genitals with soap and water (28.9%), and using antibiotics (0.9%). Men who self-treated with antibiotics after having intercourse with CSWs were less likely to have HIV infection (OR = 0.53). Antibiotic use before intercourse with CSWs did not have as strong a protective effect as it did after intercourse (OR = 0.74). The protective effect of self-treatment was significant, even when controlling for syphilis, gonorrhea, lymphadenopathy, penile discharge with pus, and condom use with a CSW. These findings show that some sexually active men in northern Thailand are trying to prevent HIV and other STDs and that self-treatment with antibiotics may reduce the HIV risk associated with bacterial STDs in a high prevalence population.