Injection prevalence and risks among male ethnic minority drug users in northern Thailand

Legal status as a life course determinant of health: parent status, adjudication stages, and HIV knowledge among highlanders in Thailand

BACKGROUND

Rising nativism and political volatility worldwide threaten to undermine hard-won achievements in human rights and public health. Risks are particularly acute for hundreds of millions of migrants, minorities, and Indigenous peoples, who face disproportionately high health burdens, including HIV/AIDS, and precarious legal status (LS). While LS is receiving increasing attention as a social determinant of health and HIV, understandings are still limited to select immigrant communities. Its effects on health among stateless communities, particularly in the Global South, remain largely unknown. Moreover, widespread limitations in census measures of LS reduce its complexity to a simplistic citizen/non-citizen binary or insufficient proxies. Thailand's ethnolinguistically diverse highlander population experiences disproportionately high HIV prevalence and comprises one of the world's largest and most protracted cases of statelessness, an acute condition of precarious LS. As such, analysis of LS and health outcomes among highlanders is both critically warranted, and useful as a case study outside of the migration paradigm.

METHODS

Drawing on the UNESCO Highland Peoples Survey II (2010), an unprecedented and unique cross-sectional census of highlanders in Thailand, we mobilize complex measures of LS in adjusted ordinal logistic regression models to assess how parent citizenship and LS adjudication over the early life course condition adult HIV knowledge-a key protective factor against transmission (n = 8079).

RESULTS

Adjusted ordinal logistic regression on knowledge scores reveal that parent citizenship predicts odds of greater knowledge by 1.4- to 2.2-fold, depending on ethnic group. This is partially explained by divergent stages of LS adjudication between birth and adulthood, including successful birth registration and adult citizenship acquisition, along with secondary school completion. Precisely how these factors contribute to HIV knowledge varies by ethnic group.

CONCLUSIONS

This study advances knowledge of LS outside of the migration paradigm, reveals heretofore unexamined connections between LS and access to public health information, and elucidates how instabilities in LS adjudication stages underlie health inequalities over the life course. Findings indicate that securing success in public health and human rights agendas requires attention to how states adjudicate and deploy LS in multiple stages across the life course to structure access and exclusion among migrant and non-migrant communities alike.

Collaborative addiction research in the United States and Asia

Comparisons between Asian American and Pacific Islander (AAPI) and, when possible, similar populations from their ancestral land of origin may allow for unique insights into the development of substance use disorders. Drawn from research conducted within the Hmong residing in the United States and from ongoing collaborative work between the United States and Vietnam, this paper presents a few examples of the types of addiction research that may be possible in Asian populations, both in the United States and in Asia, with a focus on developing South East Asian countries and their AAPI counterparts in the United States. Approaches to research may include epidemiological surveys, evaluation of treatment need and outcome, and genetic contributors to the risk for substance use disorders (SUDs) as well as response to SUD treatment.

Prevalence and correlates of sexual behaviors among karen villagers in northern Thailand

A cross-sectional survey was conducted in two mountainous villages of the Karen, a major ethnic minority in Thailand. The participants were 566 villagers aged 15-54 years (371 in Village A, 195 in Village B; response rate=81.9%). Premarital/extramarital sex was experienced by 10-20% of the sexually active respondents and sex with a female sex worker (FSW) by 12.6% of males. Premarital sex was independently associated with being a Christian and occupational experience in town; extramarital sex was associated with Village A and drug use; sex with a FSW was associated with being unmarried, a nonfarmer, and occupational experience in town. Approximately 80% of the married participants never used a condom with their spouse, and nearly one-third never did so with a boy/girlfriend or a FSW. A history of sexually transmitted infections (STIs) was associated with sex with a FSW. These findings suggest that nontraditional sexual practices are prevalent and could potentially threaten Karen communities with the spread of HIV.

Predictors of mortality among injecting and non-injecting HIV-negative drug users in northern Thailand

AIMS

To estimate mortality rates among HIV-negative injecting drug users (IDUs) and non-injecting drug users (non-IDUs), and to assess predictors for mortality among the IDUs.

DESIGN

Prospective cohort study in northern Thailand with 2-year follow-up.

SETTING

IDUs and non-IDUs who were admitted for detoxification treatment for opiate or amphetamine dependence in a regional drug treatment center were screened. After discharge, HIV-negative individuals were followed-up in the community.

PARTICIPANTS

A total of 821 HIV-negative drug users [346 IDUs (42%) and 475 non-IDUs, median age = 32; 51% were ethnic minorities].

MEASUREMENTS

All-cause mortality.

FINDINGS

There were 33 deaths over 1360 person-years of follow-up. The all-cause mortality rate was 39 per 1000 person-years among IDUs [standardized mortality ratio (SMR) = 13.9], and was 14 per 1000 person-years among non-IDUs (SMR = 4.4). Among male IDUs, the hazards for all-cause deaths were ethnic minority status [adjusted hazard ratio (HR) = 2.9, 95% CI = 1.2-7.2], incident HIV infection (HR = 2.8, 95% CI = 1.1-7.7) and longer duration of drug injection (HR = 1.07, 95% CI = 1.01-1.14).

CONCLUSIONS

The mortality among IDUs is high. Being from an ethnic minority, recent HIV acquisition, and a greater number of years of drug injection are predictors of mortality among the IDUs in this region.

HIV prevalence and factors associated with HIV infection among male injection drug users under 30: a cross-sectional study in Long An, Vietnam

Background

Sufficient targeted HIV prevention activities aiming at reducing HIV transmission within and from an extremely marginalized population of injection drug users (IDUs) must urgently and efficiently be implemented in Vietnam. This study was conducted to facilitate the development of such activities by describing transmission risks of young IDUs and evaluating factors in association with HIV infection.

Methods

Thirty clusters were selected from 29 hotspot communes in Long An province by probability proportional to size (PPS) sampling method. The snowball technique was used for enrolling participants in each cluster. The cross-sectional association of factors obtained during direct structured interviews to 248 male IDUs aged 14 to 29 years old and with their HIV test results were examined.

Results

The HIV prevalence among the studied IDUs was 32%. Age range of 18–20 years old, low educational level, sharing injection equipment or injection drug use in the other cities were independently associated with HIV serostatus in the multivariate analysis. Sexual behaviors did not differ between HIV-positive and -negative IDUs. Among HIV seropositive IDUs who had sexual contact with primary (n = 37), casual (n = 6), and commercial (n = 15) partners, only 5.4% (n = 2), 33.3% (n = 2), and 46.7% (n = 7), respectively, responded that they had used condoms every time.

Conclusion

About one-third of young IDUs aged less than 30 identified in the hotspot communes in Long An, Vietnam was found to be infected with HIV, and socio-demographic and injection-related factors might account for the infection risk. Prevailing risky sexual behavior of this extremely marginalized population highlights the need to reduce their high transmission risks as a public health priority.