Decline in HIV Infections in Thailand

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Abstract
Nelson et al. (Aug. 1 issue)1 report that seropositivity for the human immunodeficiency virus (HIV) declined among Thai military conscripts from a range of 10.4 to 12.5 percent in the period 1991 to 1993 to 6.7 percent in 1995, and they attribute the decline to the increased use of condoms. The authors rely on the post hoc ergo propter hoc fallacy, attributing causation on the basis of the temporal sequence (of a single pair of events). Among Ugandan men of comparable age, the prevalence of HIV declined from 11.8 percent in 1989 to 2.7 percent in 1994, in the absence of either a major program of condom distribution or a behavioral intervention.2 Thus, the decline in seroprevalence in Thailand might best be attributed to the natural course of epidemics rather than to the distribution of condoms.3 Table 3 of Nelson et al. shows that the use of condoms with prostitutes was not significantly related to protection from HIV in 1993 or 1995 and was associated with an increased risk in the 1991 cohort.