Changes in risk behaviors among Thai men who have sex with men and transgender women enrolled in the test and treat cohort

ABSTRACT

The test-and-treat approach has the potential to reduce high-risk sexual behaviors by linking high-risk individuals to health education, although this has not been proven yet. We used longitudinal data from the Test and Treat Demonstration Project among Thai men who have sex with men (MSM) and transgender women (TGW) who were not known to be HIV-positive to analyze changes in risk behaviors during the 24-month study period categorized by three groups: HIV-negative without seroconversion, seroconverters, and HIV-positive at enrollment. Five binary risk behavior outcomes – laboratory-diagnosed sexually transmitted infections (STIs); multiple sexual partners, unprotected anal intercourse, self-perceived HIV risk, and amphetamine-type stimulants use in the past month – were assessed. Among 689 participants, with a mean (SD) age of 23.1 (6.2) years, 165 participants were diagnosed with HIV: 115 at enrollment and 50 with seroconversions. HIV-positive participants at enrollment showed significant reductions in all five behavioral risk outcomes. Seroconverters demonstrated higher risks at enrollment than HIV-negative participants, and continued to practice high-risk behaviors even after seroconversion despite a significant reduction in self-perceived moderate-to-high HIV risk. Continuation of risk behaviors among seroconverters could negatively affect the ending AIDS goal, thus the integration of other effective preventive measures into HIV/STIs management programs are needed.

KEYWORDS:

• Behavior
• test and treat
• HIV
• men who have sex with men
• transgender women

Acknowledgements

Our study team is grateful to the individuals who participated in this study and for the staff at the Thai Red Cross AIDS Research Centre, Sanpasitthiprasong Hospital, Lampang Hospital, and Mahasarakham hospital. AH interpreted the data, drafted the manuscript, and performed statistical analysis. DT collected the data, gave advice on statistical analysis, and performed statistical analysis. DT, SN, CL, PP and NP designed and developed the study. SP, NT, PC, PP, ST, SP, SN and NP conducted the study. All authors approved the final draft of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding for this project The project was supported through grants from the National Research Council of Thailand, National Health Security Office program [grant number NHSO3.18.7/00172], Government Pharmaceutical Organization [grant number ST.5109/040], Department of Disease Control, Ministry of Public Health, World Health Organization [Project Number 120077], Aids Fonds [File Number 2012112], and amfAR, The Foundation for AIDS Research [TREAT Asia Award #108896-95-IATA]. The content of this presentation is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above.