title: Differences Between Men Who Have Sex with Men (MSM) with Low CD4 Cell Counts at Their First HIV Test and MSM with Higher CD4 Counts in Bangkok, Thailand.
abstract: Although HIV prevalence remains high among Bangkok's MSM early HIV testing as an entry point to ART has not been successfully implemented among in this population. Men who present late for initial HIV testing are a particular concern in the context of the Bangkok HIV epidemic, in that if long-term positives have had condomless sex during the time that they remained untreated they are likely to have been efficient transmitters of infection, to say nothing of the implications for their own health. A sequential sample of MSM who tested HIV positive, and CD4 counts, was taken at the Thai Red Cross Anonymous Clinic and two drop-in centers in Bangkok. Inclusion criteria were MSM aged >18 years, having not tested HIV positive earlier, who reported ≥1 of the following in the previous 6 months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection (STI) diagnosis. Analysis was conducted by distinguishing between three groups of CD4 counts: <200, 200-500, >500 cells/μ to identify the social and behavioral characteristics of the men who presented late for HIV testing. Median CD4 was 325 cells/μ(n = 95). MSM with initial CD4< 200 cells/μ were significantly more likely to report problematic alcohol use. They were also more likely to report receptive anal sex and more likely to be engaged in sex work. MSM with CD4< 200 cells/μ were less likely to report recent HIV testing. Main barriers to HIV testing included being afraid of finding out that they were HIV positive and concerns about efficacy and side effects of HIV treatment. HIV stigma and concerns about treatment are still widespread and are potential barriers to HIV care among MSM in Bangkok. These barriers may work to keep men from finding out their positive HIV status in a timely manner. Thai MSM need to be made aware of the current availability of friendly HIV testing and ART services, and public health programs need to work to change their perceptions regarding ART itself. These same types of strategies might also work to destigmatize HIV and MSM within Thai society as a whole.
authors.affiliation: HIV-NAT, Thai Red Cross AIDS Research Center, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand. cvsapsirisavat@gmail.com.
authors.forename: Vorapot
authors.initials: V
authors.lastname: Sapsirisavat
authors.affiliation: HIV-NAT, Thai Red Cross AIDS Research Center, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.affiliation: HIV-NAT, Thai Red Cross AIDS Research Center, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand.
authors.forename: Jiratchaya
authors.initials: J
authors.lastname: Sophonphan
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.|Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Egan
authors.affiliation: HIV-NAT, Thai Red Cross AIDS Research Center, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand.
authors.forename: Kamonthip
authors.initials: K
authors.lastname: Langevattana
authors.affiliation: HIV-NAT, Thai Red Cross AIDS Research Center, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand.|Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Anchalee
authors.initials: A
authors.lastname: Avihingsanon
authors.affiliation: Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.|Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: M Reuel
authors.initials: MR
authors.lastname: Friedman
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.|Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Stall
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D023241:Antiretroviral Therapy, Highly Active; D001294:Attitude to Health; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003863:Depression / Q000453:epidemiology; D058872:Epidemics; D015658:HIV Infections / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D015438:Health Behavior; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior; D000072339:Sexual and Gender Minorities; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D063508:Social Discrimination; D057545:Social Stigma; D013785:Thailand / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014754:Violence; D055815:Young Adult
keywords: Bangkok; CD4; Diagnoses; HIV; Late HIV testing; Men who have sex with men; Testing behaviors; Thailand; Unknown HIV positive serostats