|Connecting Lower HIV Infection Rates with Changes in Sexual Behaviour in Thailand - Data collection and comparison (UNAIDS, 1998, 18 p.)|
Thailand has done an exceptional job both of tracking the epidemic and of attacking its roots. As the evidence gathered in this case study clearly shows, the biggest risk behaviour for HIV infection in Thailand - unprotected sex with a sex worker or the clients of sex workers - is on the decline. As a result, rates of new HIV infections and other STDs are also declining.
But the epidemiology of HIV is dynamic; closing off one avenue of transmission by changes in behaviour has the effect of driving the virus in different directions, to other routes of transmission. As unprotected commercial sex recedes, other risky behaviours will contribute an increasing proportion of new infections. Behavioural surveillance is beginning to point towards some possible routes of continued transmission. They include:
· a shift to indirect commercial sex, where condom use is lower and harder to promote than in brothels;
· casual sex, with continuing very low levels of condom use;
· inconsistent condom use by sex workers with regular clients and partners;
· continued unprotected sex between men and their male partners;
· continued risk behaviour among drug injectors, including possible risk behaviour in prison.
These behaviours, and the individuals who engage in them, are far harder to identify than was the case with the brothel-based commercial sex that fuelled the epidemic in its early years. To understand shifts in risk behaviour and to identify appropriate responses, Thailand will need to expand monitoring and surveillance in these areas.