Characterization of persons highly exposed to human immunodeficiency virus (HIV)-1 who remain uninfected may help define protective immunity. Seventeen HIV-1-seronegative Thai female sex workers (CSWs) with epidemiologic evidence of exposure to HIV-1 were studied for humoral immune responses and phenotypic and genotypic analyses of HLA class I and CCR5 allelic profiles. Infected CSWs and low-risk HIV-1-seronegative Thai women were controls. Highly exposed, persistently seronegative (HEPS) CSWs did not differ from HIV-infected CSWs in HIV risks, condom use, or sexually transmitted diseases. Significant differences were seen in humoral immune responses: gp160-specific IgA responses were detected in cervicovaginal lavage fluids in 6 of 13 HEPS CSWs but 0 of 21 seronegative subjects. All women had wild-type CCR5. HEPS CSWs were more likely to have the HLA-B18 phenotype and genotype than were matched controls (corrected P=.018). Epidemiologic exposure to HIV-1 without apparent infection, an unusual distribution of HLA class I alleles, and HIV-1 gp160-specific IgA responses suggest a biologic basis for this phenomenon.

A multiplex polymerase chain reaction (M-PCR) assay that simultaneously detects the three major causes of genital ulcer disease (GUD), Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus, was used to evaluate swab specimens for 38 sequential patients with GUD at a Thai sexually transmitted disease clinic. Subjects received clinical diagnoses and syndromic treatment. Genital ulcer disease (GUD) is an important health problem cultured with methods available to the clinician and is typically diagnosed either serologically or with darkfield microscopy [3]. in many developing country settings. GUD has been implicated in several studies as an important factor in the sexual spread However, the latter is also unavailable in many developing country settings, and the sensitivity of serologic assays in acute of human immunodeficiency virus type 1 (HIV-1) in numerous developing countries, including Thailand [1]. Clinical diagnoinfection can be as low as 30% [4]. ses of 3 of the most common etiologic agents of GUD (HaemoRecently, a multiplex polymerase chain reaction (M-PCR) philus ducreyi, Treponema pallidum, and herpes simplex virus) assay with colorimetric detection has been developed for the in sexually transmitted disease (STD) clinic settings are probsimultaneous amplification of DNA targets of these three lematic, however [2]. H. ducreyi is a fastidious organism; while pathogens using a single swab from genital ulcer secretions culture is the reference standard for diagnosis, sensitivity of [5]. This assay has been used in several studies, including one culture varies considerably [3], and culture is not routinely in Lesotho, where its sensitivity compared with culture for H. done in Thai Ministry of Public Health (MOPH) clinics. Herpes ducreyi and HSV was 95% and 93%, respectively [2]. In a simplex virus (HSV) can be definitively diagnosed by culture, large GUD patient series in New Orleans, the sensitivities of but cost has limited the utility of this assay in most developing M-PCR for HSV, H. ducreyi, and T. pallidum were 100%, country settings, including Thailand, where viral culture is not 98.4%, and 91%, respectively, versus 71.8% for HSV culture, used in government STD clinics. HSV ELISAs are also not 74.2% for H. ducreyi culture, and 81% for darkfield microscopy currently used in Thai MOPH clinics. T. pallidum cannot be for T. pallidum [5]. Chiang Mai City has been one of the epicenters of the Thai HIV epidemic, with HIV prevalence rates among sex workers reaching 40% by 1990 [6]. HIV prevalence among male STD

These preliminary studies have shown the Thai version of the MOS-HIV to have psychometric properties comparable with those reported in previous surveys. Further testing and modification should make it useful as an HIV-specific QOL measure in Thailand.

The Thai government began HIV voluntary counselling and testing (VCT) in all provinces in 1992. We evaluated HIV incidence after participants utilized VCT and its effect on risk behaviours among northern Thai adults aged 19-35 years. A total of 924 men and 1,327 women volunteered to participate in the study. Subjects were counseled, interviewed (socio-demographic, HIV risk behaviour, and HIV testing history), and tested for HIV infection at baseline and at 6 months follow-up. All participants were provided group pre-test counselling; HIV test results were provided in individual confidential post-test counselling. Overall, 329 of 391 men and 621 of 669 women who reported a prior HIV test before participating in our study reported negative results at the previous test. Of these, nine men and 13 women tested positive at baseline, giving incidence rates of 1.04 and 0.69 per 100 person years (PY), respectively. Recent risk behaviour was rare; as a result, the effects of VCT on risk behaviours among the study participants could not be determined. The HIV incidence after VCT among this study population is substantial. Studies to investigate factors associated with HIV incidence among VCT clients could provide insights for more effective HIV prevention.

Voluntary HIV counseling and testing (VCT) is a central component of comprehensive HIV prevention strategies targeting individual risk reduction. VCT data are essential for planning and improving HIV/AIDS intervention strategies. The objective of this study is to describe demographic profiles, reasons for seeking HIV counseling and testing, rate of declining HIV testing after pretest counseling, rate of failure to return for HIV test results, and HIV prevalence and associations among 3570 clients who sought VCT at Sansai Hospital in northern Thailand from 1995 to 1999. Data were abstracted retrospectively from client-level data recorded by the hospital counselors on a standard form. HIV prevalence was 29% and remained high throughout the study period. Reasons for seeking VCT for men and women were markedly different and highly correlated with rates of declining the test, failure to return for test results, and HIV prevalence. Declining VCT and failing to return were high among uneducated clients (p <.001). Failure to return among men was associated with HIV prevalence (OR = 1.72, p =.003), particularly for those who had risk behaviors (OR = 5.92, p <.001) and those who wanted to know their HIV serostatus (OR = 4.44, p =.002). Overall, VCT acceptance and returning for test results were high. VCT services at the community level can reach high-risk individuals, especially male partners of women tested as part of routine prenatal care.