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.

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