Nitiya Chomchey, MSc
Nominated From: University of Hawaii
Research Site: Thailand
Research Area: The Thai Red Cross AIDS Research Centre (Bangkok, Thailand)
Primary Mentor: Jintanat Ananworanich
Factors Affecting the Intention to Take Non-Occupational HIV Post Exposure Prophylaxis Among Thai Men who Have Sex with Men
HIV/AIDS is an important sexual transmission disease which greatly impacts health, family, social structures of the country. Although HIV infection rates in new cases are declining, the HIV infection rate among men who have sex with men (MSM) is increasing worldwide and here in Thailand. Similar to treatment, HIV prevention relies on combination measures. Giving antiretroviral drugs either pre or post HIV exposure prophylaxis as part of combination prevention could help reduce HIV transmission. Post exposure prophylaxis is provided as soon as possible, but within 72 hours, to people who have had contact with blood, genital secretion or body fluid from a source with known or unknown HIV infection. It is generally recommended to continue antiretroviral drugs for 28 days. The decision to prescribe antiretroviral therapy and to select certain regimens depends on source’s HIV-RNA level, channel of exposure and duration of exposure. New cases of HIV in MSM are likely to rise throughout the world, which results in global collaborative efforts to study combination preventive approaches to reduce the spread of infection to others. These include condoms and lubricants, risk reduction counseling, education using innovative social media and antiretrovirals pre or post exposure. There is limited information about non-occupational Post-Exposure Prophylaxis (nPEP) to prevent HIV infection among the MSM population. Important issues pertaining to nPEP in MSM is the need, especially the acceptability and adherence to nPEP in this group. Issues of discrimination and stigma affecting access to HIV prevention and nPEP are also important. We have the unique opportunity to study the need for nPEP, factors affecting intention to use nPEP, acceptability and adherence to nPEP, and risk behavior disinhibition in MSM clients at the Thai Red Cross Anonymous Clinic, the largest voluntary counseling and testing center in Thailand. The Thai Red Cross Anonymous Clinic sees approximately 15,000 clients for HIV testing yearly, and of these, around 5000 are MSMs. Data from 2010 showed an HIV prevalence of 25.3% among MSM clients of this clinic. Moreover, 83% of subjects from this clinic diagnosed with acute HIV infection (antibody negative/nucleic acid positive) in an ongoing study are MSM. These data highlight the need for additional HIV prevention interventions for MSM.
In Thailand, post-exposure prophylaxis is mainly recommended for occupational exposure. nPEP is currently recommended and paid for by the government for rape victims only. It is important that we gain more knowledge on the local use of nPEP in the MSM population to guide practices in Thailand.
Advice for Future Applicants
It is important to know the local research gaps and design studies that would be beneficial in guiding treatment and prevention practices in the country. The Global Health Fellows Program is a unique opportunity that fosters research training and development for young investigators who are interested in international public health. There is opportunity for learning research principles online, conducting research studies in the international settings and exchanging experience and knowledge with other fellows.
- Prof. Cecilia Shikuma, MD
- Assoc Prof. Jintanat Ananworanich, MD, PhD