Introduction

1.  By:
 Zeenat

 Supervisor:
 Asst .prof .Sukhontha Kongsin
 Co- Supervisor:
 Asst. Prof .Sukhum Jiamton







Research Proposal for the Fulfillment of requirement of MPH at
 Mahidol University Thailand.



2. Globally, 34.0 The burden of
It is estimated the epidemic
million [31.4
that nearly 0.8%
million–35.9
of adults aged different in
million] people
were living with
15-49 years between
worldwide are
HIV at the end of countries and
living with HIV.
2011 regions

3. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20
adults
(4.9%) living with HIV and accounting for 69% of the people
After sub-Saharan Africa, the regions most heavily affected are the Caribbean
and Eastern Europe and Central Asia, where 1.0% of adults were living with HIV
in 2011ple living with HIV worldwide

4. In 2011, 1.7 million [1.5 million–1.9 million] people
died from AIDS-related causes worldwide.
sub-Saharan Africa 70% of all the people dying from
AIDS in 2011

5.  The HIV prevalence among men who have sex with men
in capital cities is consistently higher than in the general
population . The prevalence of HIV infection among men
who have sex with men in surveys in capital cities is 13
times higher than that in the country’s general population

6. Country HIV Prevalence National HIV Criminalize MSM
among MSM prevalence
Kenya 43% 6.1 yes
Jamaica 25-30% 1.5% yes
Benin 25.5% 1.8% yes
Senegal 21.5% 0.9% yes
Gunny 21.3% 2.4% yes

7.  June 2001 the 26th session of United Nation assembly
convened according to pass resolution 55/3 of
November 2000 as a matter of urgency immediate
review to address the problem of HIV/AIDS
 and grave concern that all people, rich and poor ,
without distinction as to age ,gender or race ,
affected by the H I V/A I D epidemic.
 further it finds out that the people in developing
countries are the most affected and that women ,
young adults and children vulnerable group it was
recognized that access to medication in the
context of pandemics such as HIV/A I D S

8. 2001: UNGASS Declaration of Commitment
 Member countries have to measure their progress
periodically against a series of specific indicators
 Twenty three UNGASS indicators were identified, five of
which were relevant to MSM.
 Prevalence of HIV infection ,Knowledge of HIV.
 Condom use ,rate of HIV testing and access to prevention programme

9. 2001
2000 United Nations General
2006 2011
Millennium Declaration Assembly Special
Session on HIV/AIDS Political Declaration Political Declaration
MDG Target 6A:
Universal Access to HIV New impact targets and
Have halted by 2015 and ( UNGASS)
Prevention, Care and commitments towards
begun to reverse the Declaration of Treatment by 2015 “Getting to Zero”
spread of HIV/AIDS Commitment on
HIV/AIDS
Zero New HIV Infections; Zero Discrimination; Zero AIDS related Deaths

10. MSM MSM who MSM with MSM who MSM who
Infected test for correct had used reached HIV
with HIV last knowledge condom prevention
HIV year and about HIV last time programme
know Transmissi they sex
their on
result
Latin America 62% 57% 48% 57% 43%
Caribbean 58% 33% 25% 58% 25%
Eastern 50% 90% 70% 90% 70%
Europe
Africa 19% 19% 6% 21% 12%
Asia ,the 47% 57% 53% 63% 40%
pacific c of
middle east

11.  Most of the countries have no exist data about on
HIV/AIDS among MSM. Fewer than one-third reported
on more than three of the five UNGASS indicators
 Due to lack of appropriate data on HIV epidemic among
MSM in many countries governments cannot access the
need of prevention and treatment programme

12. HIV in Asia and the Pacific 2011
 4.9 million people living with HIV
 1.6 million women living with HIV
 370,000 new HIV infections
 310,000 deaths
 21,000 children newly infected

13. The HIV prevalence among MSM
increasing in low and middle
economic countries
At many countries such as
Cambodia, Thailand and Senegal
where the HIV prevalence is
declining among heterosexual
group
But high prevalence of among MSM and
the data shows HIV epidemic in this
group

14. 30%
25%
20%
15%
10%
5%
0%
Indonesia india Mynmaar Vitnaam

15. Strategic Testing and Treatment
100% Percentage of key populations (KP) who received an HIV test in
the last 12 months and know their results (selected countries)
90%
82
80%
70%
60%
50 50
50% 44 44
41
38
40% 35 34
29 30 29
30%
20%
10%
0%
Sex workers PWID MSM
Cambodia (2007 and 2010) China (2011)
Viet Nam (2011) Thailand (2010)
Data Source: UNAIDS Universal Access and GARPR

16. • Expand HIV testing in key populations wherever
prevalence is high.
• Treatment as Prevention with access to ARV
regardless of CD4 count for:
• Sex workers, people who use
drugs, men who have sex with men
• Sero-discordant couples
• Pregnant women
• Community led services to promote testing
uptake and treatment adherence

17. 100 % 50
HIV prevalence (%)
80 40
66
58 57
60 30
40 36 20
20 10
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Prevention coverage (Regional median) Condom use at last anal sex (Regional median)
China (Chengdu, Sichuan) India (Andhra Pradesh)
Indonesia (Jakarta) Philippines (Cebu)
Thailand (Bangkok) Vietnam (Hanoi)

18.  In Thailand AIDS is the major problem for
males and the death rate is two times more in
them than females and AIDS is the 3rd
leading cause of death mostly at the age
group of 15- 49 yrs
 .HIV/AIDS is stand the first leading cause of
DALYS(Disability Adjusted Life Years lost)for
males

19.  in Thailand HIV epidemic originate in
homosexual males during 1986-1987
then it spread to injection drug user, female
sex workers after 1991 though IDU cases
declining but the HIV infection among MSM is
high and show no significance decreasing

20.  In adults HIV prevalence is 1.4% and
prevalence in most risk population 5.0%(
 In Thailand HIV epidemic originate in
FSW,30-40% IDU
 In Thailand, the HIV epidemic among MSM
has been considered severe
 Most of MSM continue to have high-risk
behaviour.

21. 35
30
25 2003
2005
20
2007
15
2008
10 2009
5 2011
0
BANGKOK PHUKET Changmai urdon Patalung

22. Year Bangkok Chinghai Phucket
17.3
2003 - -
2005 - 15.3 5.5
2007 - 16.9 20.5
2012 31 17.5 5

23. In provinces not considered to be
popular tourist sites, it was found that
In Bangkok during 2003 to 2009, it HIV prevalence in the MSM population
was found that reports of consistent is also high, despite being lower than
condom use in the previous three in the primary tourist locations. For
months showed no signs of increase. example, surveys in Patalung and
Udorn in 2008 found levels of HIV
among MSM as high as 5.5% and 4.7%

24.  In 2007 at Bangkok, Phuket and Chiang Mai in 2007 that
proportion of MSM who reported having “always used”
condoms in the three months prior to the survey was
66%, 44%, and 36%
 In 2008, the survey in the rather small provinces of
Udorn and Patalung found that “always used” condoms
by MSM in the prior three months were also rather low at
56.3% and 57.0%

25.  In 2009, a survey of condom use found that MSM
condom use during last episode of anal sex was only
21.7%, which represented a sharp decrease from the
level found in the previous year’s survey.
 The decline in condom use may be due to some
modification in questionnaire about use of condom with
last partner and not distinguished about type of partner

26.  At 2009, the proportion using condoms with casual
partner when compared to data from 2008 increased
in some provinces: from 56% to64% in Khon Kaen;
and from 71% to 82% in Phuket, but , in Udorn the
proportion declined from 68% to 64%

27. Core Indicator 2004 2006 2008 2010 2011 Remarks
Percentage of NA MSM MSM used IBBS,
most-at-risk 24.6 20.0 data from 3
populations who tourist
are HIV provinces;
infected Bangkok,
Chiang Mai
and
Phuket
Percentage of 28.5 24.8 20.0
men who have
sex with men who
are living with HIV
Percentage of 29.2%
men who have
sex with men that
have received an

28.  At 2010‐11, the government had expanded
HIV prevention interventions targeting that
population utilizing multiple channels.
 There have simultaneously been measure
Implemented supporting treatment, care and
support through collaboration with civil society
and the private sector.
 The CHAMPION Project (HIV prevention among
KAPs), with support from the Global Fund, has
been implemented in 30 provinces, which has
started in late 2010.

29.  There are many literatures available, which shows
that the MSM group is the vulnerable for HIV/STIS
so by this research we have to find out that
unidentified risk factors associated with HIV
transmission
 Especially the risky behavior among in MSM that is
responsible for more transmission of HIV in this
group in Thailand

30.  Research Title
The factors related to the sexual risk behavior
among MSM living in Thailand
 Research Question
What are the factors related to the sexual risk
behavior among MSM living in Thailand

31. General Objective
1) To determine the knowledge and attitude factors and
their association to the risk sexual behavior among
MSM
2) To determine the association between the Socio-
demographic and socioeconomic and social support
factors with sexual risk behavior among MSM

32. Hypothesis
 1) There is an association of knowledge and
attitude with sexual risk behavior among MSM
 2) There is an association between socio-
demographic factor with sexual risk behavior
among MSM
 3) There is an association of socioeconomic and
social support factors with sexual risk behavior
among MSM

34.  Men who have sex with men (MSM)
 Denoted all men who have sex with men (oral-
genital) regardless of their sexual identity, sexual
orientation and wither or not they sex with
female


35.  Socio-Demographic Factors
a) Age
 refers to complete years of respondent’s age at the
time of study
 b) Age at first homosexual intercourse
It refers the age of respondent at which he had first
homosexual intercourse including oral sex and anal sex.

36.  Habit of Alcohol drinking Number of Partners
 referred the number of both homosexual and heterosexual
partners during last week of study

 Type of partners
 It referred partners of respondent including both male and
female during last week, each type including regular,
commercial and casual
 Role during sex with men or gays
 Referred the role of respondent during sexual intercourse with
men or gay
 Habit of Alcohol drinking
It refer alcohol drinking behavior of respondent during last week


37.  a) Education level it refers the highest attain
education level of respondent
 b) Monthly income refers the monthly average
income of respondent in Thai baths at the
time of study

38.  Knowledge of HIV/AIDS
 It refer to understanding of respondent on
mode of transmission and prevention of
HIV/AIDS and condom use
 Peer Support,
 Referred to positive moral and information
support from peer of the respondent on
consistent condom use