Stickman Readers' Submissions July 6th, 2006

Poppie Gets An “F”

I read with considerable disbelief the article by “Poppie” “On AIDS and Thailand”. The claim by Poppie that he/she had “searched the ends of the (English speaking) earth and found next to nothing.”
was frankly unbelievable. Thirty seconds on the most commonly used academic search engine, PubMed which is open access to anyone with a computer gave me over 1,700 published articles
using the search terms “HIV and Thailand”. A search of “HIV, Thailand and epidemiology” gave me 724 articles and an even more precise search using the terms “HIV, Thailand, CWS (commercial sex worker)”
gave me over 25 published articles detailing with the specific epidemiology of HIV/AIDS in commercial sex workers in Thailand. The last three terms (HIV, Thailand, CSW) gave me over 1,700 hits when using Altavista as a search engine, and staggering 38,000 articles using Google. Hardly “nothing” by anybody's criteria. Let me, for example give you a link to an excellent (although slightly out of date) article published in Science magazine,
which illustrates the type of report Poppie *could* have come up with:


mens clinic bangkok

Now, Dr Phoolcharoen *starts* his article with “Thailand's human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic is one of the most extensively documented of any developing country.”
Again, a bit difficult to reconcile with Poppie's assertion that he search to the ends of the earth and found nothing.

Or Poppie could have looked at the following papers:

Taketa K, et al., Differential seroprevalences of hepatitis C virus, hepatitis B virus and human immunodeficiency virus among intravenous drug users, commercial sex workers and patients with sexually transmitted diseases in Chiang Mai, Thailand.

Hepatol Res. 2003 Sep;27(1):6-12.

Kilmarx PH, et al., HIV-1 seroconversion in a prospective study of female sex workers in northern Thailand: continued high incidence among brothel-based women.

AIDS. 1998 Oct 1;12(14):1889-98.

Rugpao S, et al., Sexually transmitted disease prevalence in brothel-based commercial sex workers in Chiang Mai, Thailand: impact of the condom use campaign. J Med Assoc Thai. 1997 Jul;80(7):426-30.

wonderland clinic

Wawer MJ, et al., Origins and working conditions of female sex workers in urban Thailand: consequences of social context for HIV transmission.

Soc Sci Med. 1996 Feb;42(3):453-62.

Or Poppie could have gone to this site (World Health Organization):


Clicked on the “Link to Fact sheet” hyperlink, selected Thailand on the pop up and got a 21 page pdf file containing 16 years of data of HIV surveillance in Thailand by site as well as analysis of sex worker infection rates.

On the one study that Poppie *did* manage to find, he/she said “As an example, someone has done a study on infection rates of Burmese factory workers in the Northwest of Thailand. It’s not that they are unimportant, it’s just that maybe that energy could be refocused on more basic investigations. It’s all good though- that particular study was total and complete garbage with no meaningful conclusion or data- it’s amazing that it was published.”.

I am sure that migrant Burmese workers will be reassured that they are considered by Poppie as “not unimportant”, but the sentiment “that energy can be refocused on more basic investigations” is stunning.
What on earth is more basic than determining what is the magnitude of the problem? Now Poppie further states that the particular study was “complete garbage with no meaningful conclusion or data” Assuming Poppie was referring to
this article: “Srithanaviboonchai K, Choi KH, van Griensven F, Hudes ES, Visaruratana S, Mandel JS. HIV-1 in ethnic Shan migrant workers in northern Thailand.AIDS. 2002 Apr 12;16(6):929-31; we can find that the authors state: “Our 1999 survey of 429 Burmese migrant workers of Shan ethnic origin in Chiang Mai province found a 4.9% rate of HIV-1 prevalence (5.7% men, 3.8% women). This figure is almost double that of comparable population groups in Chiang Mai, e.g. pregnant women and military recruits. HIV prevention programmes are urgently needed for this vulnerable population”.
So this is a study of HIV rates in a particular population (and they used two separate methodologies to ascertain who was positive) The data shows that the rate is twice as high as other population groups, and the conclusion is that this neglected
group in Thailand needs more specific help. Hmmm. Poppie, I think you need help in learning to read papers. But perhaps we should re-focus the question. What, Poppie are *your* qualifications to assess the validity of the paper?. Doing an undergraduate
degree is not exactly a resounding recommendation for being able to fully comprehend a scientific paper. Can you for instance tell me how to calculate an Odds ratio? Or how to determine 95% confidence intervals? Both mathematical techniques used
in the paper to analyze the data. Perhaps Poppie, you need to bear in mind that just because you do not understand the methods and techniques, does not mean it is wrong. It just means you need more education.

For the sake of brevity we will ignore Poppie's little trite and tired side rant against scientists, the unconnected quick jaunt across to Africa and the ”big business conspiracy” waffle. Poppie's evaluation of the success of condom
usage programs in Thailand was a bit nearer the mark, but sadly Poppie missed the fact that HIV rates are actually *increasing* in certain segments of Thai society. Perhaps much of Poppie's failure is in having as a “Professor”
a feminist whose sole experience of Thailand was a quick package trip to Phuket. More help may have been obtained from an epidemiologist, computer expert or even, god forbid, a scientist working in the HIV/AIDS field. Overall, Poppie gets an F.
The only thing that saved Poppie from an “F-“ was he did not fall into the “virus-myth” trap. Lastly, Poppie, a piece of advice: Practice the phrase “Do you want fries with that order?”. You are going
to need it.

Stickman's thoughts:

Normally I do not allow articles of this type, but the HIV issue is an important one, and thus such a response was allowed.

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