Vorapot Sapsirisavat, MD
Nominated From: University of Hawai’i
Research Site: Thailand
Research Area: HIV/AIDS; STIs; Syphilis
Primary Mentor: Dr. Alan Katz
Co-occurrence of HIV, HCV and syphilis: Association and Risk of emerging STD syndemic among Thai Men who have Sex with Men (CHARM, MSM)
Previously perceived to occur mainly among people who inject drugs (PWID), hepatitis C viral infection (HCV) has recently emerged among MSM in different regions, including Asia. HIV positive MSM, following a similar pattern as syphilis, have a higher incidence of HCV compared to HIV negative MSM. The syndemic of syphilis and HCV infection among methamphetamine users has been reported but there is limited information on the syndemic effects of HIV, HCV and syphilis among the MSM population. Co-occurrence of HIV, HCV and syphilis may potentially complicate one another by not only burdening treatment and care, but also facilitating disease sexual transmission. The effectiveness of behavioral and biomedical interventions targeting each sole disease might be diminished unless addressing them altogether.
In order to design effective interventions to manage this STD syndemic, we need a clear epidemiological understanding of MSM infected with HIV and/or HCV and/or syphilis and the potential interaction among these diseases. This application proposes to address this situation by collecting data from MSM who come for HIV testing in Thailand to:
1. Describe risk factors and clinical characteristics of HCV and Syphilis among MSM participating in HIV Test and Treat study. To accomplish this we will implement a survey for MSM, using convenience sampling, at Test and Treat site.
2. Examine the potential interaction and consequences of Syphilis, HIV and HCV infection. This will be accomplished using laboratory data from Test and Treat study (with additional tests if applicable) to examine the interaction among STD syndemics.
During the past decade an explosive epidemic of HIV infection has been described among Thai MSM, especially in large cities like Bangkok (BKK) and Pattaya. HIV prevalence among MSM in BKK increased from 17.3% in 2003 to 30.6% in 2007, and has remained constant at 30.0% since then. This high prevalence has been confirmed in clinic-based convenience samples of MSM, notably, from the Thai Red Cross Anonymous Clinic, 29.1%, during 2006-2009, and the ECHO Clinic in Pattaya, 17.6%, during 2009-2010.
Co-occurrence of poor physical and mental health, which together termed syndemics, has been proposed to increase unprotected sex, HIV prevalence and incidence among BKK MSM. While psychosocial syndemics focused primarily on HIV infection, high risk behaviors also bring forth other STDs. As did the incidence of HIV, The incidence of syphilis also increased significantly among BKK MSM from 0.0 per 100 PY to 7.1 per 100 PY during 2005-2006 to 2011. Studies demonstrated that STD, including syphilis, are magnifying HIV through common sexual risk behaviors, and genital ulcerations and inflammation. Data from Test and Treat study showed that HIV-positive Thai MSM had higher rates of asymptomatic STD comparing to HIV-negative, thus illustrating the importance of syphilis as an STD conductance.