Thailand has been much (and rightly) praised for its pragmatic approach to cutting HIV in its illegal but vast heterosexual sex trade. Of course when the tide of brothel-caught infections goes out, the rocks of ongoing infection in jails, among drug injectors and between men who have sex with one another are left exposed. And gay men have stormed into the lead in China, too.
Thailand’s relative neglect of HIV prevention among gay men has been confirmed yet again by a new paper to be published in the upcoming edition of JAIDS — the abstract is on line now. (JAIDS is one of those dinosaur journals which still makes you pay for access to the full text.) Using blood samples taken between 2006 and 2007, researchers in Bangkok used a relatively new technology to find out which infections were recent at the time people came in for their voluntary test.
Nine of the 11 incident infections were in men, and 60% were in gay men. Overall, the rate of new infections was equivalent to 2.7% a year. This sort of testing is imprecise at best, not least because it depends on who walks in the door asking for a test. But still, it’s worrying that such an overwhelmingly high proportion of the newly infected are among gay men. To make matters worse, the data probably exclude many of the highest-risk gay men in Bangkok, who go to gay and sex-worker friendly clinics, one improbably based in Bangkok Christian Hospital, just a sound-system’s reach from the flesh-pots of the Patpong red light district and Silom Soi 4, it’s gay equivalent.
The concentration of new infections among gay men led the researchers to conclude that these boys would be a good study population for new HIV infections in Thailand. So at least the junkies — who have long been study-population of choice for Bangkok’s talented pool of AIDS epidemiologists — may get a break for a while.
Meanwhile, over in Beijing, colleagues of mine from China CDC used a slightly different but also relatively new method to look at new HIV infections among gay men. Because the Chinese Medical Journal is not a dinosaur, you can read the full text online. They actively recruited gay men to the study; many people signed up through internet sites or because they were contacted in bars and clubs; you’d expect these guys to be at the higher end of the risk spectrum. And they are. My mates estimated new infections at 2.9% in 2005 and 3.6% in 2006. About the same as among gay men in London, in fact.
A McDonald’s in every airport, a Starbucks on every block, and a hear-no-evil, see-no-evil, speak-no evil HIV crisis in the gay community. Thailand and China look more like the US and Britain every day.