A large, randomised sample of 21-year-old Thai men, presented at the 19th International AIDS Conference in Washington recently, has found that by far the largest risk factor for HIV infection is gay identity. Contrary to the oft-quoted saying “it’s not who you are, but what you do,” actual male/male sexual behaviour, while still an important risk factor, was not as strongly associated with being HIV positive as gay identity.
The survey was conducted among over 35,000 army conscripts from all parts of Thailand. All 21-year old Thai men enter a lottery at the age of 21 for conscription into the Thai army and of these half a million young men, 60,00 to 100,000, in any year, are conscripted, twice a year in May and October..
This survey thus constituted a truly randomised, cross-sectional survey of the 21-year-old men who were inducted into the Thai army in May 2011. It was conducted no more than two weeks after induction and therefore serving in the army had no influence on the results. Men from all provinces in Thailand were included and from both urban and rural areas.
The survey found that 7% of respondents had had sex with another man (MSM) but that only 1.1% only had sex with men.
In all MSM, 83% identified as heterosexual, i.e. desiring women only. Even in exclusive MSM, only 21% said they desired men exclusively and 31% both men and women, meaning that nearly half (48%) of men who’d in fact only ever had male partners said they actually preferred women.
Only 0.5% of all respondents had HIV, and only 2.6% of the MSM. However HIV prevalence increased to 9.4% in men who exclusively had sex with men, and to 16% in men who said they preferred sex with men, i.e. who identified as gay or transgender. Gay identity was in fact quite uncommon, at 180 individuals out of 35,359, or 0.5% of respondents.
Having sex with both men and women was associated with a 4.5-fold higher risk of having HIV, and solely having sex with men with a 35-fold raised risk; but defining oneself as wanting sex with men and women was associated with a 26-fold raised risk, and as wanting sex only with men with an over sixtyfold raised risk.
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